Source: Engeström, Y., Miettinen, R., & Punamäki, R. (Eds.) Perspectives on activity theory. New York: Cambridge University Press, 1999, pp. 435-443.
It is well known that human beings may become addicted to just about anything, ranging from chemical substances such as caffeine, nicotine, alcohol, and other drugs to commodities such as clothes, shoes, and fancy cars, as well as to various behaviors such as gambling, jogging, working, and even criminal activities. The consequences of these fatal involvements are, however, different. Some may lead to fame and riches, others to illness, despair, or even suicide depending on the societys but also on the individuals biopsychosocial responses to the behavior in question.
Originally, the Latin verb addico, from which addiction is derived, referred to devoting or giving oneself up to someone or something either good or bad. The meaning of the word was value free. From the 19th century on, with the rise of the temperance and anti-opium movements, it became used in place of intemperance and inebriety, thereby gaining a mainly negative connotation. It referred to the heavy consumption of intoxicating substances and, in the narrow sense, to drug abuse alone (Alexander & Schweighofer, 1988).
Today, however, the scope of the term addiction has widened again. It now refers to all kinds of more or less harmful dependencies. It is my aim here to look at this issue from this wider perspective, even though the focus of this chapter is mainly on the addiction to alcohol.
How should we characterize these harmful dependencies? Typical features of addictive behaviors are a strong desire or sense of compulsion, impaired capacity to control the behavior, discomfort and distress when the behavior is prevented or stops, and the tendency to persist with the behavior despite clear evidence that it is leading to problems. Addictive behaviors can thus be characterized as fixed, compulsive, and highly repetitive action patterns that limit the perception of and involvement in alternative behaviors. Generally they bring immediate gratification but long-term harm to the individual and often to surrounding others as well.
As specific kinds of action patterns, addictions could be approached from the activity-theoretical frame of reference. This was done, for instance, by Bratus, who described excessive drinking as a form of activity that tends to suppress all the other motives and respective forms of activity of the person in question.
How does this tendency develop? Bratus describes the initial attraction of alcohol as follows. In most cultures alcohol is a common accompaniment of various festivities. These social events awaken, even by themselves, happy expectations. This mental preparation usually goes unnoticed. Hence the resulting euphoria is attributed to the beverage consumed. The link between the drink and the unconsciously prepared frame of mind is the seed from which the special attraction of alcohol is to grow.
That people also drink for other purposes to relax, to forget, to medicate themselves, to get courage and inspiration further illustrates that the psychophysiological effects of alcohol are relatively diffuse. Through the projection of drinking-related expectancies, alcohol may, however, turn into a magic elixir, a universal means for reaching desired states of mind.
In addition to various social and psychological factors that push an individual toward a drinking career, the development of excessive drinking is therefore, according to Bratus, a consequence of growing reliance on alcohol as a means of need satisfaction and conflict resolution.
The chances of satisfying ones needs and solving ones problems are generally improved through social object-related activity. While drunk, these ends are, however, reached on an illusory level and with much less effort or they are pushed away from consciousness. The motivation for excessive use thus stems from the conflict between what is and what is wanted, between the instrumental and motivational aspects of personality, and from the illusory-compensatory solution of this contradiction.
Other addictions could be described in a similar fashion. A point to note is, however, that the psychological object of addiction in all these cases is not a substance, a commodity, or an activity. The object of addiction is an experience, a particular state of body and mind. An addiction could therefore be regarded as an attempt to manipulate the internal state with the help of chemicals, commodities, or activities. And the faster the effect occurs, the better it serves its purpose. In the short run, this kind of activity may provide remarkable relief, but when driven to excess, the detrimental effects usually override. From the point of view of personality development, drug and alcohol addictions are particularly harmful because they interfere with the persons cognitive functioning and do not allow the individual to develop his or her capacity to meet the shifting demands of everyday life. On the contrary, they tend to narrow this capacity and to destroy the ability to reach ones goals in life.
Why is it so difficult to break the habit?
Addictive behaviors are known to be resistant to change; relapses are common. The concept of trap suggested by Anthony Ryle provides a way to understand this difficulty and thereby to extend the theoretical frame presented so far.
A trap is defined as a circular kind of self-perpetuating disturbance in goal-directed activity. Its typical sequence consists of an inappropriate belief, which leads to a form of action intended to correct it, but in fact serving to maintain or reinforce it. Traps are typical in neurotic behavior, but they are also common in the area of character pathology. Usually the person perceives the situation in a distorted way and/or chooses a wrong means to the goal he or she is striving for.
An alcoholic trap could be described as follows (see Figure 26.1). A negative emotion due to, for instance, unsolved life problems leads one first to look for a way out. Low frustration tolerance directs the person to look for a fast solution. Alcohol is a substance that is believed to provide fast relief from emotional pain. This expectancy leads one to think about taking a drink. Rationalizations and the denial of possible negative consequences are drawn in to justify the indulgence. The combination of positive outcome expectancies and these cognitive manipulations then leads to drinking, which is followed by short-term relief and a long-term increase in negative emotion. After piling up for a while, negative emotions trigger the alcoholic trap again.
A further example is provided by an attempt to cure sleep disturbances by drinking. Alcohol may, in fact, help a person to fall asleep, but the quality of the sleep is inferior and too early awakening is common due to the metabolism of alcohol in the body. In this way, sleep disturbances continue and increase instead of disappearing, but getting out of the trap is improbable as long as the person adheres to faulty beliefs about the beneficial effects of alcohol.
Similar positive feedback loops that increase the initial disturbance instead of diminishing it often appear in other spheres of life, too. Divorce, loss of a job, or loss of a place to live are processes that more often increase the initial disturbance than help the person out of the trouble.
The self-perpetuating nature of traps makes them difficult to change. In the treatment of addictions, it is therefore essential to identify these self-serving patterns of thinking and acting and then to push a wedge into the vicious circle so that the person gets a chance to stop for a while and start to reconstruct his or her thoughts and behavior in regard to the necessity of indulgence in addictive practices. With the term wedge I refer to the use of signs as psychological tools of change in the Vygotskian sense. Therapeutic change and healing could thus be approached in the same way as any other developmental transformation of human behavior. The tools of change in this area may, however, have some peculiarities that are less pronounced in other areas of personality development.
All human behavior is regulated by signs. According to Peirce, the founder of semiotics, signs come in the form of icons, indices, and symbols. Icons represent their objects by resemblance. Pictures, images, maps, and models are examples of icons. Indices are used to point to or identify specific objects. Symbols are arbitrary signs used to generalize over a class of objects.
Alcohol research provides ample evidence that the urge to drink is triggered by all these different types of signs. For example, heavy drinking models (iconic sign) increase the level of consumption in their peers, particularly if the model is liked. The smell of alcohol (indexical sign) increases salivation and craving in alcoholic subjects compared to nonalcoholics. Celebrations symbolize the time to drink for most of us.
In contemporary alcohol research, these different antecedents of drinking are usually called just cues. They may be perceptual cues, contextual cues, internal cues, and so on. There are, however, some advantages in looking at them from the previously described semiotic perspective. Here I elaborate on just one point.
To overcome the addiction to alcohol, a person has to learn to control the urge to drink connected to the signs that usually trigger the drinking response. This is possible with the help of other, more powerful signs that are used to master the temptation and to direct ones attention to alternative behaviors. But what makes some signs more powerful than others? To clarify the issue, let us look at some examples of signs used in the process of recovery.
First, it should be pointed out that there are several paths to recovery. For some people, it is enough just to write down what they drink. For others, the route to recovery may be paved by a new challenge, which is incompatible with excessive drinking. Yet, in the case of many heavy drinkers, the change seems to require decisive experiences that function as turning points in their lives.
For instance, Alcoholics Anonymous (AA) literature abounds in stories of drunkards who, after a devastating drinking bout, finally end up in an AA meeting. There they suddenly feel that they have finally come home. This experience is often so strong that the ties to the group are established on the first encounter.
Similarly, stories of spontaneous recovery often credit special life events, such as getting sick, getting divorced, or being fired as the reason for change. These events possess no intrinsic or fixed meaning. They may even appear trivial to others, but they gain their crucial significance from the perceptions and interpretations of the individual in question.
A case description by Ludwig may be used here as an illustration. An engineer had drinking-related problems with his family and difficulties at work. Because of his diabetes and kidney trouble, he was warned by his physician that he would die if he continued to drink. Ignoring this threat he got out of his bed in the middle of one night to get some liquor when he saw his wife crying. He felt so guilty and awful over what he was doing to her that he decided to quit drinking.
Yet, events like this had probably occurred several times before. Why did this specific incident suddenly have such a profound effect on this man? Ludwig speaks about subconscious ripening of motives. A semiotic perspective on this event, however, provides another hint to what could have been going on in this situation. According to Peirce, the most powerful or perfect signs are those in which the iconic, indicative and symbolic characters are blended equally. It may be assumed, therefore, that similar events that before had only iconic and indicative functions for this person now somehow also conveyed a more generalized symbolic meaning for him. He was forced to ask himself what he was doing to his wife in a more global sense than just with regard to this specific situation. A whole new life perspective may have been opened up for him through this decisive insight into his wifes suffering.
The story shows the role of strategic, emotionally laden images in the change process. A similar experience is involved in the feeling of coming home described earlier. This experience is a particularly powerful iconic, indicative, and symbolic sign for a person who has been adrift for a long time.
Therapeutic case stories provide further illustration of this point. The next one is taken from my own experience. A couple of years ago, I had a young client with features of borderline character pathology in an in-patient clinic where I worked. He was an impulsive, difficult, but also amiable person who, despite his youth, had already completely messed up his life with drinking and drug taking. He stayed in the clinic twice for several weeks, but both treatments ended prematurely due to his return to drinking and drug use.
Because he lived in another city, I could not maintain regular contact with him after his discharge. He nevertheless phoned me every now and then, and we met four times during the following 2 years. And eventually, something began to happen. First, he dropped the drugs. He still drank, but much less than before. Consequently, he did not need to be hospitalized because of pancreatitis, whereas before this had occurred several times a year. After some trials, he met an understanding woman whom he married. He even began to keep some jobs for more than a couple of weeks at a time.
Some time ago, we discussed this change. To him the crucial message was mediated on a single occasion after the treatment when he suddenly realized that if Anja can really care about me, perhaps I am not such a total failure. perhaps there is also somebody else who can care about me. Shortly after that, he met the woman he married. In his opinion, he would not have been able to maintain the relationship without this basic change in his self-image and his perception of self-worth.
This is, of course, only one aspect of the whole story. But it says something interesting about psychological healing. This process often involves certain momentary revelations that are believed to push the person onto another track. In AA literature these experiences are described as hitting a personal low or bottom, but the lever of change may just as well be an uplifting experience. Religious conversions are described in the latter way.
The core of these significant events seems to be basically identical. The old, highly over-learned self-schemata are somehow challenged by a deeply personal new perspective, idea, or image, which simultaneously bears a generalized meaning for the person in question. These powerful events often serve as incentives for change, but they may also be used to maintain the change. In the latter case, they serve as an intrinsic contract with oneself taking the form: Because I had this important experience, I'll stick to this choice rather than do something else.
In his early work The Psychology of Art, Vygotsky pointed out that some signs wake up emotions, and by analysing them we can approach the emotional regulation of behavior. It is obvious that in the recovery stories described earlier this is just what is going on people learn to regulate their behavior with the memories of these crucial events.
Summing up, addictive behavior represents a trapped form of goal-directed activity. To break the vicious circle, one has to push a lever or wedge into this pattern of self-serving consummatory behavior. Many things can be used as tools of change, but a decisive incentive for change is often provided by some emotionally significant event. The memory of this event may later be used as means of maintaining the change. It serves as a special kind of mediating sign, as an inner contract with oneself concerning the decision once made.
It is important to note, however, that these changes seldom happen in a vacuum. The persons immediate social network also plays a role. In a sample of Finnish in-patient alcoholics, it appeared that subjects who had children at home, who identified with AA, and who had spouses who seldom or never drank with them had a much better prognosis than subjects without these supporting and obliging social relationships. Group therapy also significantly improved the outcome. In other words, people need other people to internalize the necessity to cut down their drinking. This is why the term self-governance was chosen here as the opposite to addiction, instead of more commonly used terms such as self-control or life control.
The problem with set-control is that it is usually conceived as solitary behavior. It is equal to saying no to ones desires, which in itself does not provide a worthwhile goal to strive for. Life control, preferred by some researchers, sounds somewhat unrealistic, implying control over ones entire life. In contrast to these concepts, the term set-governance, introduced by Mack, acknowledges the essential interdependence of the self and others. Mack uses it in the context of AA, arguing for the role of surrounding social structures in aiding a person to govern the impulse to drink. Self-governance as a psychosocial term thereby refers to the sense of being and the power to be in charge of oneself together and with the help of others. In this sense, it comes closest to the Vygotskian idea of internalizing socially created external means of governing ones thought and behavior with regard to the object of addiction.