Coffee and biscuits in the atrium then the delegates move into the large lecure theatre.Professor McEwan welcomes them, expresses her pleasure that so many experts are assembled in the same venue. She is delighted to introduce the world famous Emeritus Professor Nathan Bronowski, acknowledged as one of the world’s leading authority on addiction. Fulsome applause accompanies his walk to the podium. Then follows an avuncular talk interspersed with good humour which brings ripples of appreciate chuckling from the audience. Beautiful slides on the big screen bring images of complex neural activity, statistics and the chemical structures of the latest pharmaceutical medications which evidence has shown to be efficacious. He is humble enough in his lecture to acknowledge the work of others in the field, but he deftly dismisses their theories almost with sadness.
The day proceeds with further lectures and workshops in which various experts gather by speciality. A delicious banquet is provided in the university’s great hall in the evening, then delegates retire to the several bars. Somewhat ironically, some of them fail to hide their hopeless addiction to alcohol and make fools of themselves. Others, more fortunate, bond in pairs that find their way to the bedroom.
The second day, a little less enjoyable for those nursing hangovers or guilt, ends with Professor McEwan’s rapturous celebration of how successful her conference has been. The delegates disperse. Journalists from the BBC and the world’s leading media send their stories through the ether to sub-editors who will headline them with claims that huge advances in the treatment of addiction have been discovered. Within a week, everybody will have forgotten the conference and the media stories – except for Professor McEwan who will already be thinking about her next big event as she continues her ruthless climb towards the top of the academic tree. So it goes.
The proceedings of the conference are made available in a publication which, like most academic publications, costs a great deal of money to compensate for the fact that there will be very few buyers and even less readers. Perhaps a PhD student will discover it in a few years’ time and refer copiously to it safe in the knowledge that neither his supervisors nor the world at large will have the slightest inclination to examine the primary material. The said student may with equal safety discover and refer to perhaps a hundred or two such dusty tomes in a university library, and go on to produce a thesis which does indeed add ‘an original contribution’ to the field of research, a remarkable tapestry of totally random material made whole and coherent through the application of academic discourse. Such tapestries – and there are very many of them – reveal great skills of weaving and stitching If the successful PhD candidate is lucky and possesses rudimentary knowledge of self-promotion the thesis may be the basis of a reputation such that other academics and journalists will regard him or her as an authority. So it goes.
Those of us who are not academics and who lack the humility to look up to them, are not lacking in access to experts on addiction. Since most people are addicted to something or other these days, not surprisingly there is money to be made. Anybody can set themselves up as a private therapist, for instance. With some capital you can establish a recovery retreat centred around holistic principles and involving a diet almost totally of watercress: you could charge, say, £2000 a week. In publishing, there are so many magazine and newspaper articles, so many books that will cure you in a week, so much drivel on social media (a place people go to when they have lost the capacity to live in the world), so much of it all that I lack the will to say more (although doubtless a different kind of person may find it a rich area for PhD enhancement). Suffice it to say you could end your life still addicted having spent it reading about how to beat addiction or paying a fortune to people to beat addiction for you. Or eating watercress.
But addiction isn’t funny. And though it’s fine to be lighthearted about academia, we acknowledge too that getting a PhD, doing research are not easy. Most are doing their best to add a drop to the ocean of knowledge, most are passionate about their work, many are deeply motivated by wanting to make the world a better place. Like addicts, academics, are human beings first. An addict or an academic may be a murderer or a saint. Anyway, addiction isn’t something to be treated lightly. It’s certainly unlikely too that all the academic research in the world has made or is likely to make any immediate difference to an actual addict, a unique human addict. ‘Expert’ theorists of addiction argue wih other, often vehemently, defending their position and attacking their ‘opponents’. The situation is as bad or worse for us ordinary mortals who equally support this idea and strongly oppose that idea. 12 steps enthusiasts can be unshakeable in their belief of the power of the programme; others have a strong aversion to it. ‘Born again’ ex-addicts can be evangelistic: for them it’s not enough to have recovered, they have a mission to convert those left behind with ‘the indusputable truth of the way’.
In fact, addiction is a messy concept. We can get rid of the cases where it’s used metaphorically such that people say they are addicted to Game of Thrones or chocolate. We can be left with a clear idea of devestating addiction where life is slowly destroyed at many levels, but it’s still a pretty tangled concept. A jingle-jangle as Bob Dylan refers to in Hey, Mr Tambourine Man. The experience, the being, of addiction can’t be categorised neatly, objectively. Like severe depression (which often precedes, accompanies or follows addiction) the experience is different for every person. Even a gifted writer has trouble explaining what it is or was like for her or him, but there are some excellent addiction memoirs which demonstrate the uniqueness of the experience for each unique person. (There are also many more dreadful memoirs. Not everybody has the gift of writing well).
Nevertheless, there are some commonalities which most addicts would recognise. Some of these factors are overlooked, ignored or counted as unimportant in therapy and research. It is much more straightforward to categorise addiction as ‘impuse control disorder’ or to concentrate on the neural pathways involved in orbitofrontal cortical mediation: such precise ‘scientific’ approaches are neat and can be investigated, and do add something to understanding addiction. But they’re not the complete picture by any means. Many of the factors overlooked are subjective feelings which cannot be seen by the scientific gaze.
We could call these factors ‘the human factors’ since they appear in everybody, not only people suffering with addiction (and incidentally, ‘addict’ is a word loaded with negative connotations which is when used here is simply for brevity. The language of mental health is a serious topic in its own right).
In everyday language we are familiar with the word ‘shame’ which refers to a fear of what other people think of our wrong actions The word ‘guilt’ refers to our conscience, it’s a negative feeling brought on by judging ourselves. In addiction, both of these factors are greatly amplified, partly because of the damage caused to self and others, partly because the addicted person’s mind will be hyper-vigilant, in extreme anxiety which over-arouses negative feelings. And partly because of stigma – related to shame, the shame that society stigmatises, ‘casts out’ the class of people with addictions, and related to guilt because of self-stigmatisation. The addicted person as a member of society has internalised the norms and values of the culture, and is then in the terrible situation of ‘casting out’ themselves as worthless, not fit to be in public. It is not unusual to hear of people in such extreme states talk of hating themselves. Yet how can one ‘recover’ if one feels deeply that one is worthless? And, unsurprisingly, it is to be expected that people then feel ashamed of being ashamed like this, ashamed of feeling worthless – so they have to put on some sort of front, a mask just to survive in the family, in public, in the doctor’s office.
In many cases, especially in connection with gambling addiction, it will not be only the guilt, the shame, the loss of dignity and self-respect that goes with addiction. The person may well have done things that anybody would feel ashamed or guilty about. especially theft, conning people, perhaps violence.
Clinically the person will suffer to varying degrees from depression and anxiety. There may be complex underlying mental health issues that have never been diagnosed. Mental distress such as chronic depression may have been what led a person into addiction in the first place, a means of relieving pain through self-medication. Adverse childhood experiences are known to be particularly strongly correlated with not only addiction but other adult problems, and often the person may suffer from addiction as well as developmental problems. In the case of gambling addiction there is an extremely high correlation with alcohol dependence and/or other drug dependence.
People with addictions often present with what are called ‘multiple and complex problems’. Some are mentioned above. Others include imprisonment, homelessness, severe debt and long term unemployment.
We’re a long way from the lecture theatre and the academic research. In each individual any or all of the above factors may ‘cross cut’ through the central problem of addiction. It’s a reasonable supposition to claim that there are many who face a much harder road to ‘recovery’ than others. Reasonable but not always the case. Experience demonstrates that some facing the most severe obstacles not only beat addiction but turn their lives around. On the other hand, some who seem to ‘have everything going for them’ find it impossible to overcome their addiction. Sadly, not everybody does recover. But the majority do, and of that majority most do it ‘on their own’ with little or no help from doctors, support groups, books or social media gurus.
To label somebody an ‘addict’ is wrong not only because it carries a lot of negative stigma but because it misses the point that somebody suffering with an addiction is a unique person first and foremost, with a complex and singular individuality. There are therapists, doctors, psychologists, psychiatrists and others who can relate to the human factors, and through their art (as opposed to their science) provide some help. Help but not a magic wand. Maybe medication is a necessary help. Maybe being housed or helped with money worries. Maybe just being treated with respect and loved.