By Janene Heldman
Unlike many of the helping professionals in the substance addiction field, I am not a
recovering addict. I have, however, lived in the realm of addiction for the last 11 years. I am a
psychotherapist who has treated many clients with addictions. More important, my son, Justin, was a methamphetamine addict. Justin became addicted upon first experimenting with meth at the age of 18. I supported him in every way I could during the five years he struggled with his addiction. I helped pay for his treatment, and I accompanied him, when invited,
as he went through addiction treatment programs. I attended Narcotics Anonymous (NA) meetings with him several times a week and occasionally attended sessions with his psychotherapist and psychiatrist.
As he moved from inpatient to outpatient treatment, Justin worked diligently to create a drug-free life for himself. Our hope and optimism, however, were short-lived; he never stopped
craving the high that he experienced under the influence of methamphetamine. Time and again he failed to maintain sobriety — until he finally broke the pattern of relapse at age 23 by killing
himself. Seen through the eyes of a psychotherapist as well as a mother, my son’s treatment always seemed to miss the mark. I felt sure there was an underlying issue that conventional treatment failed to address. After Justin died, I was determined to identify this underlying issue so I could understand why he viewed suicide as his only respite from relapse.
Through reflection, research, and personal and professional experience, I believe I have identified the principal reason why our attempts to help clients or loved ones — or to help ourselves – — overcome addictions so often fail. And I believe the missing ingredient in our efforts has lessons about healthy living for all of us, whether or nor we have ever suffered the scourge of addiction.
We typically associate addiction with dependence on a substance of some type, especially drugs. But it is a common experience to become dependent on or addicted to something, whether it is a
drug, a person, a relationship, a situation, a belief, an attitude, or a pattern of behaviors. Think of the things in your life that you feel you couldn’t possibly live without, and you will see what I mean. Many of our dependencies may be relatively harmless, but some have crippling and even lethal effects on our lives. Those who practice a spiritual approach to addiction treatment believe these toxic addiction disorders are caused by trauma, whether physical, emotional, or both. More precisely, addiction is rooted in the interaction between some traumatic circumstance and our
biological and psychological makeup.
We all are born with physiological and emotional weaknesses that come from our genetic makeup, including, for some of us, the tendency to become addicted to a substance. Our
predisposed weaknesses are more likely to show themselves when we experience severe stress or trauma. Just as severe stress weakens our immune system and makes us more
vulnerable to colds and flu, it also weakens our willpower and leaves us more vulnerable to poor decisions. This view of addiction is much more than theory to me. I have lived
it. For about six weeks after my son’s suicide, I stared into the face of my own of addiction. I certainly knew of my genetic predisposition to addiction — my grandmother and
grandfather both were alcoholics, to say nothing of my son’s addiction. Following my son’s suicide was the first time in my life when I wanted, with all my heart, to get plastered — so
drunk that I didn’t have to experience the pain of such intense loss. I needed to feel numb, a state in which I would engage, alone, earlier and earlier each day following his death. I knew
that getting drunk would not soothe or take away the pain; it would only mask it. But for a time, that was good enough.
I don’t know what exactly made me stop drinking, but it was probably a combination of factors. I noticed my tolerance to the alcohol was building, so that it took more and more alcohol to
reach the desired state of numbness. I realized that the alcohol complicated the sober part of my day by adding unnecessary physical discomfort and disorientation. I imagined my son,
Justin, looking at me from his grave, shaking his head in sorrow. So, I stopped drinking.
However, my compulsive behaviors did not stop there. After that I became addicted to shopping — for clothes, shoes, furniture, and accessories for the house — until I literally ran
out of space and money.
So, I know intimately the connection between trauma and addictive behavior. It was as if there was a tear in my heart that needed to be mended, an emptiness that needed to be filled. I
imagine that this type of emptiness is experienced by many with addiction disorders.
The insight that trauma is an essential trigger for addiction disorders leads to a simple but powerful conclusion: full recovery from an addiction disorder requires a healing of the core trauma. Treatments that fail to respond to the trauma — or actually make it worse by causing even more trauma — are consequently bound to fail.
Professionals in the field of addiction know that treatment failure is frustratingly common, so much so that relapse is considered part of the disorder. An estimated 70 percent of patients undergoing treatment for drug addiction will relapse after their first time in
treatment. Similar numbers have been cited for programs such as Alcoholics Anonymous. For the 5 million people aged 12 or older who attend self-help programs for drug addiction each year, each relapse is torture, destroying health, families, and careers.
There are several reasons why drug addiction recovery is so prone to relapse. First, prolonged drug use changes the brain, which makes many talk-based treatments ineffective. Much has
been written recently on how meditation, for example, changes the brain to increase happiness. Addictive substances, however, can have the opposite effect on the brain, making happiness
essentially impossible without the substance. Second, most drug addicts also show other psychological disorders besides their addiction, and these disorders can make treatment even more difficult. The third reason why drug addiction recovery is prone to relapse is less well known, yet it is pervasive: it is the presence of what researchers call nocebos. Nocebos are the opposite of
placebos; they are influences that worsen a person’s chances of improving. An example that demonstrates both the placebo and the nocebo effects is the view from a hospital room for those
recuperating from surgery. In one study, patients who were put in rooms with a view of nature experienced less pain and were released from hospital care seven to nine days earlier than
patients whose recovery took place in a room that looked out at a the parking lot. The first group of patients showed a placebo response to their pleasant view. The second group showed a
nocebo response to the parking lot.
There are many nocebos present in the lives of people who deal with addiction disorders that delay, alter, or sabotage healing, including some that are built in to conventional drug
rehabilitation programs. These nocebos include — among many others — encouragement from peers to experiment with drugs or alcohol, the stigma that keeps many people with drug
problems from seeking treatment in the first place, and the disapproving attitudes of friends and family that keep them from offering adequate support.
Such worthy programs as the 12-step approach used by Alcoholics Anonymous clearly recognize the positive role of spiritual factors in healing. Yet even this form of treatment can
contain hidden nocebos. For example, the first of the 12 steps is to acknowledge that we are “powerless over” the substance to which we are addicted. This acknowledgment may, in essence,
blind us to our innate healing power to overcome the addiction. In fact, six of the 12 steps emphasize how wrong the addict is for becoming addicted. While it is important and empowering
to take responsibility for inappropriate choices, self-blame is a nocebo that may only reinforce the stigma that society already associates with addiction problems. If we want to improve
people’s chances of recovering from addiction, we need to pay attention, both to their positive placebo responses and to their negative nocebo responses.
Once again I can testify to the power of nocebos from my own experience. The biggest challenge that sabotaged my healing from my son’s death involved my guilt. After all, I was a therapist
with over 3,000 hours of clinical experience. I should have been able to see his depression. I should have been competent enough to relieve his suffering. I should have saved him. These “shoulds” tormented me for years.
Reflecting on this stage of my grief, I realize now that I truly did not believe that I deserved to be healed, much less be entitled to it. My Christian upbringing greatly influenced
how I viewed my suffering. Because I fell short of my own expectations, I rationalized that I deserved to suffer. I stewed in this misery, holding on to a distorted sense of virtue in the
acknowledgment of my sins and shortcomings. Perhaps I could pay for my sins with my own suffering.
It was only after challenging the beliefs that supported my guilt that I found a way out of my depression. In my attempts to understand Justin’s experience leading up to and after his
suicide, I researched philosophies that offered a glimpse into the dying process. From my reading I became more and more convinced that the death of the human body is not the end of
life, because the spirit lives on.
In hope of further soothing my grief, I set upon the task of creating a belief system that integrated core spiritual concepts and practical psychological practices that would
soothe and support me in my grief. I explored the beliefs of the major religions as well as writings on spirituality by clinicians, doctors, psychologists, and other scholars. I studied and sampled nontraditional interventions, such as EMDR (Eye Movement Desensitization and Reprocessing),
shamanic healing techniques, and hypnotherapy. Then I compared what I had learned with material from people who were not scholars or professional therapists. With every belief
I entertained, including the beliefs of my childhood, I asked the question: Does this belief system support healthy or unhealthy coping systems? I rejected, categorically, the beliefs
that caused me more suffering or those that clearly displayed a “self-endorsed agenda.” For example, the Christian belief that we are all sinners is a constant reminder of our need
for redemption by external interventions (provided by the church). This belief sets people up to believe they need the church, thus supporting the continuation of the church’s
existence. I replaced this focus on my sinful nature with the belief that we are all created in God’s image, which speaks to our divine and powerful nature to heal.
This research eventually led me to entertain new perspectives of life and its purpose. From this vantage point, I was finally able to see my proclivity to hold on to negative,
fear-based, defensive postures toward life. With a new, more compassionate belief structure in place, I was finally able to letgo of my guilt and depression.
Janene Heldman, MA, MFT, is the president and founder of Counseling Works
Services, Inc., a nonprofit organization dedicated to empowering individuals to
heal and experience their potential. For the past eight years, Ms. Heldman has
studied spirituality and shamanism and their value in treating contemporary
disorders. For more information, go to counselingworks.org.