Addiction and Will Power

A person posted the following after one of my youtube videos about Suboxone:

While SuboxDoc knows what he’s talking about in his videos, not everything he says is always true. Not everyone needs permanent blocker therapy. Everyones willpower varies. The simple fact is, the worse withdrawal is, the more likely that person is to not want to go through it again, meaning abstinance. The easier withdrawals are, the more likely that persons mindset will be “one more can’t hurt”. Pain builds you, it builds character, personality, and maturity.

My thoughts:

I have had my share of bad withdrawals.  So have most opiate addicts who have live with their illness for a few years.  Unfortunately, there is much more to staying sober than remembering the pain of withdrawal.  There is also much more to staying clean than ‘character, personality, and maturity.’

I’m not sure the best way to approach this discussion, but the first thing to do is to dismiss the comment about ‘will power’.  The collective experiences of hundreds of thousands of addicts over the past 75 years have taught most of us that there is one thing we know about addiction: Will power does not work.

I learned this simple fact during a ‘spiritual conversion’ that removed my desire to use, back in 1993. Since then I have tried to approach the issue more scientifically. The first thing I come up with is the realization that if I had will power, I would have no reason NOT to use. I would just go ahead and use today, and stop tomorrow! But I can’t do that—I can’t use today– because I KNOW that I do not have will power over opiates. I KNOW that if I used today, I would never regain control again. I have mentioned my ‘7-year relapse’ before—after 7 or 8 years of sobriety, all the time working in the OR with potent opiates in my hands, I relapsed on some codeine tablets that I found for sale ‘over the counter’ in a little market in the Bahamas. I came back to the US terrified, but didn’t use after getting back to work. But six months later I had a cold, I was tired, and I was stressed…. and I had the sudden thought that I was able to stop when I came back from the Bahamas… so I must have Will Power!! And so I used that day, planning to stop the next day using that wonderful will power that I now had. But the next day I decided to wait, and use the will power the next day. And a month later, I started to wonder just how much will power I really had. Finally after about 5 months, I lost my job, my medical license, my friends, my vacation cottage, 30 pounds of my body weight, my self respect… and I went into treatment, planning on a quick ‘tune-up’, since I had done it all before, and thinking that I had that ‘will power’ to help me out. It ended up taking over three months to stamp out that thought of having ‘will power’. So as far as I am concerned, you are welcome to all the ‘will power’ you want. Take my share too, while you are at it!

From a psychological perspective, I wonder if ‘will power’ keeps us from experiencing the appropriate fear about addiction that is needed to stay clean. Addiction lives in the ‘limbic system’ of the brain—in the primitive part of the brain that controls basic drives. Too often we try to control our addictive behaviors with our higher-order brains, and with reason—but we end up just talking in circles and rationalizing further use! I think the way to take on addiction is to meet it where it lives—in the limbic system. That is a place where animals fight over territory, where mates are chosen, and where we fight to the death—or run like heck to get to safer ground. Will Power involves the higher order brain, and our ‘super-ego’ making the ‘right choices’; powerlessness and fear live in our id, in the lower structures of the brain, and they work to keep us safe—while the higher order parts ponder away. So from my way of thinking, BE AFRAID. Drop the will power. Addiction has killed friends of mine—wouldn’t I be a fool, not to fear it?

Then there is the question… does more severe withdrawal help keep one safer from relapse? The question reminds me of my anesthesia residency in Philadelphia, doing labor epidurals. The nurses wouldn’t let me put a labor epidural in a 14-y-o girl until she suffered for awhile— until she had a bit of what they called ‘punitive labor’. They assumed that the pain would help keep the girl’s legs together for the next few years. But I always wondered about that philosophy. Instead, what if the girl was hooking up too young because she had a rough life, and was always beaten down by one person or another… and getting pregnant was a consequence of a desperate desire to stop the emotional pain? If that was the case, maybe more ‘punitive labor’ would just make her burden a bit heavier, and make another pregnancy MORE likely!

That is where I am with the withdrawal experiences (note– since writing this post I have received a couple e-mails from people who don’t understand the analogy.  Hopefully most people reading this understand what I am saying!)   Beyond this apparently-confusing analogy, I don’t buy the argument that worse withdrawal provides protection from relapse for another reason as well.  People don’t remember ‘pain’ very well.  If you try to remember something painful, you will see my point.  I don’t really remember the pain of my worst withdrawal episodes; I know that the last one, the final detox before treatment in 2001, was pretty horrible… but I don’t ‘feel’ it anymore. And even if I did, would it make me avoid using? Or would it make me think that I was safer, for example make me think that ‘the pain built me up.. . gave me character, personality , and maturity… so I probably am a stronger person now.  In fact I am so strong and full of character that I don’t really need to go to meetings— I can handle it on my own.  In fact, I am such a strong person… that I could probably take some codeine for this darn cough that has been keeping me up… I’m probably strong enough now to take it just once, and then stop… ‘

Tricky business, addiction. See the problem with thinking too much? That is why I choose to stick with fear– when it comes to addiction, fear will keep you safer than will character, in my opinion.  Don’t get me wrong– build your character too!  But don’t think that good character alone will keep you from using.

SD