Addiction in Human Development

Developmental Perspectives on Addiction and Recovery

Bruce Carruth, Jacqueline Wallen

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317822974
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Find fresh perspectives on the treatment of addictions and effective methods for helping recovering alcohol and drug abusers in this valuable book! Addiction in Human Development provides practical strategies based on theories of human development for working with clients recovering from alcoholism and drug addiction. An understanding of these theories will help therapists and addictions counselors recognize stages of recovery and better select appropriate interventions for every phase of treatment of addicted clients. Addiction in Human Development shows how a developmental perspective is particularly appropriate to the treatment of alcohol and substance abusers and the patterns involved in their addiction. Disruptions in clients'childhood or adolescent development, stemming from their own or a parent's drug abuse, can influence their present recovery process. This informative book also describes the developmental course of addiction and provides tools designed to interrupt addictive patterns. In addition, stages in the developmental process of recovery are identified to help therapists select appropriate interventions. Some of the topics related to human development and addiction covered in this insightful volume include developmental deficits and developmental arrest in recovering clients, delayed reactions to sexual abuse and other childhood trauma, stages in recovery from alcoholism or drug addiction, developmental issues in the professional's own life, and multi-problem families with a multigenerational history of substance abuse. Applying these developmental strategies to work with addicted individuals will significantly improve communication and rapport between helping professionals and recovering addicts and lead to more success in alcohol and drug addiction therapy.

Chapter 1
Developmental Issues in Recovery

A colleague of mine recently told me a story that illustrates how important a sensitivity to developmental issues can be when working with individuals who have alcohol or drug problems:

Irma had been referred for an assessment to determine whether she should continue receiving disability payments. A victim of severe childhood physical and sexual abuse, she was receiving disability payments because of an anxiety disorder which prevented her from working. She had been placed on an anti-anxiety medication by her physician.

Irma was a few months away from her sixtieth birthday, but she looked at least ten years older. The information she gave in response to questions about her drinking indicated that she also suffered from longstanding alcoholism. My colleague, reluctant to "enable" Irma's alcoholism by signing the disability form without addressing her drinking problem, suggested that she continue in therapy to resolve some of the issues underlying her anxiety problems and that she attend an open Alcoholics Anonymous meeting to explore the possibility of working on her drinking problem. While Irma indicated that she was willing to continue in therapy for her anxiety disorder, she made it clear that she would terminate therapy if she were pressed further on the issue of her drinking. The therapist agreed to continue to see Irma for therapy but, after several more weeks, did press Irma further on the question of attending an AA meeting, at which point Irma terminated therapy.

Shortly after Irma terminated therapy, my colleague received a pamphlet from the Johnson Institute in the mail. The Johnson Institute is known for its pioneering work in developing techniques for intervention and confrontation with alcoholics. An intervention is a technique for persuading an alcoholic to accept treatment. In an intervention, individuals who play an important role in the alcoholic's life (family members, employers, friends), after much planning and with the guidance of a trained professional, confront the alcoholic with their perceptions of her behavior and insist that she seek treatment. The pamphlet stressed that interventions with older individuals must proceed differently from interventions with younger people. In particular, they must be conducted much more slowly. This therapist said that if she had been aware of the special needs of older alcoholics, she would not have expected to address her client's alcohol problem so quickly.

An Individual's current developmental stage affects how she experiences interventions for her alcoholism or drug abuse. Problems in recovery are also influenced by developmental stage. For this reason, it is necessaty to be aware of the developmental issues that are currently most salient for the individual being treated for substance abuse. Because unresolved developmental Issues from the past also affect recovery, it is also important to assess the extent to which conflicts or deficits originating in earlier development stages are still active in influencing feelings and behavior.

Psychodynamic approaches, including psychoanalytic theory, and neo-Freudian perspectives such as the object-relations school, ego psychology, and self theory, provide a comprehensive framework for understanding developmental stages.

Psychodynamic Views of Development

Psychodynamic theories focus not just on behavior, but also on the emotional processes underlying behavior, especially motives for behavior. Many of these underlying processes are unconscious. They originate in the interaction between developmental and environmental influences.

While there are a number of different psychodynamic approaches to development, most have been influenced in some way by the psychoanalytic approach originating in the work of Sigmund Freud. Freud based his theory on the existence of inborn drives that underlie human behavior. These drives can be seen as a kind of energy in the sense that when they are unsatisfied, they build up and lead to a kind of tension, or uncomfortable excitation in the organism. Because humans, like all other organisms, are motivated to maximize pleasure and to minimize pain, we respond to this tension with activities aimed at reducing it. The most straightforward way to reduce tension is simply to meet the need. For example, a hungry infant can reduce tension resulting from her hunger by nursing. Whatever we focus on as having the potential to meet the drive we are currently experiencing is, in Freudian terms, the object of that drive. For the very young infant, the object of her hunger is the bottle or the breast, whichever is the usual vehicle for her nourishment. Freud actually pictured the drive, or energy, attaching itself to the object, or "cathecting" the object. He believed there were two basic drives: Eros (sexual or erotic energy, or libido) and Thanatos (aggressive or destructive energy), but his developmental theory focuses more on libido than on aggression.

While individuals are motivated to gratify their inborn drives, society is based on the individual's ability to control them. In this sense, human nature and civilization are at odds. Social organization would be destroyed if individuals indulged all of their sexual and aggressive urges. Because human beings require the care and protection that societies offer in order to survive, we must learn to reconcile our instinctual drives with the limitations society places on meeting them. Individuals with alcohol and drug problems, in many ways, dramatize this conflict. They have become accustomed to gratifying needs in a way that often puts them at odds with society.

The internalized representation of the inevitable conflict between the individual and society has been described by Freud in terms of a three-part model of the psyche. The id, for Freud, consists of the instinctual drives, mostly unconscious, that motivate human behavior. The superego is made up of the restrictions placed by society, particularly through parental influence, on gratifying these unconscious drives. These restrictions are internalized by the individual and produce an uncomfortable or perhaps painful feeling of guilt when the individual violates them or even thinks about violating them. The ego is the part of personality that enables the individual to meet instinctual needs within the constraints imposed by the superego and by the external environment. The ego, for example, may postpone gratifying a physical desire until an appropriate time, may substitute a socially acceptable pleasure for an unacceptable one, or may repress an unacceptable urge. These are all called ego defenses because they are mechanisms employed by the ego to defend the individual against pain while still meeting instinctual needs. While the ego has a defensive function, it also has a survival function. It is responsible for coping with reality—both inner and outer. The more primitive the ego defense used by the ego (that is, the earlier in development it originates), the more it obscures reality and interferes with coping. A strong, healthy ego is one that can accommodate to reality. In Freud's terms, it functions according to the "reality principle." Individuals with alcohol and drug problems often have problems in this area. Ego strength is achieved through coping with the challenges that life inevitably presents. To the extent that an individual has turned to alcohol or drugs to allay painful feelings instead of learning to cope with stressful experiences, that individual has been deprived of opportunities to build ego strength. In addition, by relying on alcohol, they have avoided the need to develop more differentiated, sophisticated ego defenses.

Most defenses are based, at least to some extent, on the mechanism of repression, which involves keeping forbidden urges unconscious. Repression facilitates a number of different kinds of defenses. Different psychodynamic theorists tend to stress different defenses, but all agree that defenses that dominate early in development are more primitive (more global and undifferentiated) than those developing later on. This has to do primarily with cognitive factors. The infant cannot perform complex mental operations. As a result, the psychological defenses employed by an infant must be very simple and rudimentary. The most primitive defense discussed by Freud is one he terms denial. Denial involves denying an unpleasant fact or aspect of external reality that interferes with instinctual gratification through fantasy or in behavior. One way that an infant can deny reality is to go to sleep. Harry Stack Sullivan calls this "somnolent detachment" (1953).

Another way that the infant can deny reality, according to Freud, is to engage in "primary process" thinking. In primary process thinking, the infant gratifies a need in fantasy that it cannot gratify in reality. The existence of primary process thinking has never actually been proven to exist in infants, but the concept remains a useful metaphor for thought processes that clearly occur in adults. Many drug-induced states, for example, reflect primary process thinking rather than an attempt to cope with reality.

While defenses based on denial can relieve tension, denial, by definition, involves ignoring reality. Reliance on denial, therefore, can interfere with ego development because it deprives the ego of information that would enable it to accommodate to and cope with inner and outer reality. As a rule, the more developmentally primitive the defense, the more it is based on repressing or denying reality. Projection, in which an individual attributes a forbidden wish or impulse of her own to someone else, is another defense that develops relatively early in development. In projection, reality is not completely denied. The drive and the obstacles to its fulfillment are acknowledged, but the locus of the drive is misperceived.

Defenses that evolve later in development are more sophisticated and differentiated. These defenses allow more aspects of reality to be taken into account. In contrast to denial and projection, sublimation is a highly sophisticated defense mechanism. It involves substituting a similar, but socially acceptable, activity for a forbidden one. The impulse is acknowledged and transformed into a socially useful or culturally valued behavior. The more developmentally advanced the defense, the more likely it is to produce socially valued, or "civilized" behavior in the individual. For example, an individual might sublimate aggression by participating in a competitive sport. Or he might sublimate sexual urges by creating sculptures of the human body. In sublimating their sexual and aggressive urges, humans have produced great art, literature, and music, and have created highly evolved civilizations.

Rationalization is another fairly sophisticated defense that the individual does not become capable of until fairly late in development. Rationalization consists of providing a reasonable intellectual justification for an unacceptable urge or behavior. It is advanced because it is reality-based and because it uses thought and reasoning. It is more primitive than sublimation, however, because the individual still acts on the forbidden impulse rather than transforming it into a more acceptable behavior.

Two defenses that develop in early childhood, but after infancy, are identification and reaction-formation. They are more advanced than such infantile defenses as denial and projection because they involve accommodation to reality. They also may produce socially valued behaviors, although this is not always the case. Identification involves gratifying a need symbolically or vicariously by identifying with another whom one considers successful in this regard. Reaction-formation occurs when one overemphasizes a feeling opposite to the forbidden one. Both defenses provide an impetus to growth and development when they motivate an individual to adopt prosocial, rather than antisocial, attitudes and behaviors.

Freud argued that the primacy of the genital zone in sexuality was only a relatively late feature in human development. He introduced the notion of infantile sexuality, calling the infant "polymorphously perverse." By this he meant that the infant can derive libidinal satisfaction from many different kinds of stimulation. In fact, the story of human development is the story of the sequential emergence of a series of erogenous zones, each posing a developmental conflict that the individual must resolve. Freud believed that mental disorders arise in the course of the development of an individual's sexual instincts and reflect fixation, or developmental arrest, at certain stages in development during which the individual could not fully resolve the developmental tasks posed. Under stress, an individual predisposed to mental disorder may regress to that point in development where fixation occurred, manifesting behavior that bears the hallmark of that period.

While Freud's theory focused rather narrowly on this aspect of the infant's experience, many modern psychodynamic theorists have broadened the classical perspective on infancy to include a wide range of experiences. Comparing traditional Freudian theory to neo-Freudian ego psychology, Stephen Johnson discusses the distinction between "conflict models" and "deficit models" of ego development or developmental arrest (1987). Freud's is a conflict model. It holds that development is shaped by how an individual resolves conflicting impulses, drives, or feelings at each stage of life. Developmental arrest occurs at points in development where these conflicts cannot be resolved and can be remediated only through uncovering and resolving these conflicts. A deficit model, more characteristic of ego psychology, or self theory, emphasizes developmental deficits rather than conflicts. In this view, developmental problems may often be resolved by strengthening the ego functions that were not initially adequate.

In working with individuals recovering from alcohol or drug problems, it is important to be able to apply both models. Virtually all individuals who have used alcohol or drugs to such an extent that one or both have become a problem in their lives have some developmental deficits. These deficits may be contributing factors in their continuing reliance on alcohol or drugs, a result of this dependence, or, more likely, both. Many of these deficits can be remedied through providing information or opportunities to learn new skills. Individuals who have never learned to deal with anxiety without alcohol or drugs, for example, can benefit from learning techniques for relaxation and stress reduction. Individuals who learned to "stuff" their anger by getting drunk instead of trying to change problem situations may profit from assertiveness training. Other areas in which recovering individuals may need information or skills include parenting, financial management, social relationships. communication, and sexuality.

Sometimes what has been missed is experiential and cannot be taught in this manner: the experience of cooperating in a group, for example; the experience of trusting another with one's feelings; or the experience of coping successfully with a set of structured requirements. Some opportunities for overcoming these experiential deficits can be provided in substance abuse treatment, some in therapy, and others in Alcoholics Anonymous or other self-help groups.

When neither education nor experiential opportunities seem to help remedy a deficit, then the existence of an underlying conflict can be suspected. In these cases, psychotherapeutic techniques for dealing with unconscious conflict are appropriate.

Types of Developmental Issues in Recovery

1. Issues Connected to Current Life Stage
2. Deficits or Vulnerabilities that Originate in Earlier Life Stages

• Information or skills deficits
• Experiential deficits
• Unconscious conflicts/fixation

Erikson’s Stages of Development

Erik Erikson, an ego psychologist, focuses on ego strengths and deficits in development. He also emphasizes the importance of the child's social environment in shaping development. Like Freud, he identifies stages in development, but for Erikson, developmental themes are primarily "psychosocial," rather than "psychosexual," meaning that social rather than sexual issues are of key importance in shaping personality. Erikson characterizes each developmental stage in terms of the primary task or psychosocial issue that must be resolved in that stage. He also draws on the work of object-relations theorists who emphasize the critical importance of the child's relationship to the parenting figure in the first few years of life. His eight stages of development are helpful tools for the clinician. They are easy to remember and describe the key issues of each developmental stage.

Erikson’s Developmental Stages

Trust vs. Mistrust
Autonomy vs. Shame and Doubt
Initiative vs. Guilt
Industry vs. Inferiority
Identity vs. Role Diffusion
Intimacy vs. Isolation
Generativity vs. Self-Absorption
Integrity vs. Despair

Trust vs. Mistrust

Freud called this period the "oral stage" because he considered the oral region (involving sucking and biting) to be a focal point for libidinal energy in the infant. This stage is characterized by Erikson in terms of what he considers to be the basic task of this period: the development of "basic trust." The alternative is a failure of trust, or "basic mistrust."

According to object-relations theorists, the ability to sustain intimate relationships—ones in which the other is loved for himself or herself rather than being seen simply as an object one uses to meet one's own needs—depends on a series of developments that begin in infancy. This process begins with the infant becoming attached to the parenting figure because the parent represents a source of need gratification. This relationship is initially completely narcissistic, or self-centered. Narcissistic attachme...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• About the Author
• Preface
• Introduction
• Chapter 1: Developmental Issues in Recovery
• Chapter 2: Recovery As a Developmental Process
• Chapter 3: Developmental Trauma and Recovery
• Chapter 4: Family Recovery As a Developmental Process
• Chapter 5: The Intergenerational Transmission of Addiction and Recovery
• Chapter 6: Developmental Issues for the Professional
• Appendix A: Short Michigan Alcoholism Screening Test
• Appendix B: Piaget's Cognitive-Developmental Stages
• Appendix C: Moral Development
• Index