How can we support—yet not enable—a loved one with an addiction?
What is the definition of addiction? What constitutes healing?
Q&A with an Intimacy & Addiction Expert.
Dr. Robert Weiss is an expert in the treatment of adult intimacy disorders and related addictions. A clinical sexologist and practicing psychotherapist, Dr. Rob has served as a subject matter expert for major media outlets such as The New York Times, The Los Angeles Times, CNN, MSNBC, and NPR. He is also the author of several books, including Prodependence: Moving Beyond Codependency.
How did you become interested in studying addiction?
My own personal story is one of having been hyper-sexual and having a lot of compulsive and addictive behavior and a lot of drug use when I was a teenager and young adult. Unfortunately, when you live that way life doesn’t go so well. Dating, intimacy, relationships — forget about it. And when my life in my 20s wasn’t really happening, I started realizing what it was about. It was this compulsive and addictive behavior that ruled my life. For me, that meant finding a 12-step program, which is where I first went just to be around people who had the same problem. I was like, “Oh my god, I’m not alone.” But the times are very important here — if you ever talk to a gay man my age, in their late 50s, they will all probably say this in one way or another, “And then along came HIV/AIDS in the late ‘80s.” And all of a sudden, other people who had sexual problems, or who were sexually acting out, were dying or sick.
For me, that was kind of what you might call a spiritual awakening. It motivated me to understand that there are people who act in certain ways that are harmful to themselves and others, and they really don’t have control over it. I realized that I was looking at a leading issue around sexuality — compulsive and addictive sex — that is directly intersecting with HIV transmission. And I knew that there weren’t any nice heterosexual therapists from the Midwest who were going to be able to talk about gay sex, because nobody wanted to hear it. So I got out there, went back to school, got a degree, started writing and speaking, and really discovered the whole field of problematic behavior as an addiction — gambling, spending, eating, etc. I’ve spent the last 25 years working with impulsivity, compulsivity, and addiction around behaviors or behaviors tied to drug use.
How would you define addiction?
I work with things like sex and drugs, etc., and people will say, “Is having too much sex or partying too much an addiction?” Maybe, maybe not, it depends on how it’s affecting the person’s life. We don’t determine addiction by how often you use or how much — we don’t look at it by numbers. The definition of addiction is not determined by the quantity of anything, it’s about the quality of something. It’s the quality of the person’s life. That’s when we begin to look at addiction; when the person’s ability to function in multiple areas of their life is either failing or beginning to go downhill. One of the requirements for something to be an addiction is that it has to cause pleasure and escape. Addicts are using a pleasurable activity to escape and disappear.
What are the signs or symptoms of an addiction?
There are really three signs of addiction, traditionally. One is a loss of control, which means I say I’m not going to do that anymore, yet I can’t not do it. Another sign is having consequences — trouble is brewing and it’s directly related to my behavior. The third real sign is that I’m not paying any attention to that. I continue [the addictive behavior] and I know that it’s causing problems, and I do it anyway.
Is “addict” a life-long label/identity?
This is a very cultural question. I will speak to it from an addiction culture perspective. For me and the people I work with, to say “I am an addict” is a relief. Now I can finally understand what has been wrong with my life. It’s not that I’m a bad person, it’s just that I have had this huge monkey on my back. I think just in the beginning, the idea that “I have an addiction” for many people means “I have a problem that can be identified, and there is a solution for it, and that gives me hope.”
The problem is not the word addiction, it’s the stigma we have around it. To me, claiming that I am an addict is simply saying, “I have a problem, and I know that I am responsible for that problem.” To me, that is no different than someone who is depressed and realizes that they have to deal with depression throughout their lives. Addiction is a mental health problem, but we have these two silos of addiction and mental health. If we were able to see addiction where it belongs, which is under mental health, then it wouldn’t be a problem to acknowledge it. It’s only if you see addiction as something to do with your personality or your morality that it’s a bad word. If you see it simply as a word for your disorder, then it’s good to know what you’ve got so that you can fix it.
Somebody I know who is a recovering addict told me, “Once an addict, always an addict,” in the sense that people can find other things they are “dependent on” or “addicted to” that might not necessarily be damaging. In fact, they might have even played an important role in their recovery from substance abuse. For example, one might find themself training for Ironmans.
It’s the neurobiological changes that I can bring about by an activity or a fantasy. Addiction can be whack-a-mole. When we do addiction work, it is important to be aware of the multi-dimensional fact that, yes, the person is addicted to alcohol, but even more than that, they’re looking for escape. It’s not unusual for someone who is an intensity or pleasure-seeker or an escapist to continue to find forms through which they can disappear. But by the way, I want to remind you that we all disappear. We all escape, and we all disassociate. What addicts do is not inherently unhealthy, it’s the degree to which they deny, they escape, and they disappear.
Can you clarify the differences between certain addictions — substance addictions versus behavioral addictions?
When I think about being addicted to heroin, or alcohol, or nicotine, I understand that the body is addicted — that if I don’t continue taking the heroine, I’m going to go into withdrawal. There is a physical addiction to certain chemicals, and there is a thought that you can’t be addicted to something that doesn’t physically addict you in that way. But there is this question — how can you be addicted to a behavior? What I try to explain to people is that when a drug addict makes a decision to use, they don’t necessarily have the drug in their hand, but when they start thinking about getting the drugs, their heart is pounding, their pupils are dilating, they are excited.
So your brain is literally already releasing those chemicals…
That is correct. I am already releasing dopamine, serotonin, oxytocin. Can a fantasy change your thinking? Of course. That excitement and arousal around using means the person is high before they get to the drugs. That arousal process is what compulsive gamblers struggle with, what compulsive sex addicts struggle with — they get caught up in the emotional arousal, the fantasy, the intensity, and the excitement about what they’re going to do. We call these process addictions because it isn’t just getting the drugs that’s the high—it’s the whole process of organizing the situation.
How would you define healing?
I think there are various levels of healing for an addict. The first one really has to do with becoming conscious that what I thought was okay, isn’t. And then the next step is, “Well I guess I better do something about it.” And then everything sort of flows from there. Once you have worked on these issues for long enough, you begin to realize that there are other people who have them and that you can help them. One of the tenants of addiction work is that you pass on what you’ve gotten.
I think that for me addiction is a badge of courage because it means that I did a lot of shitty things, I hurt a lot of people, I ruined parts of my life, I ruined other people’s lives, but I don’t regret any of that now because I understand where it came from. I understand that I was doing the best that I could, and now I have a whole opportunity to live a different life and treat people differently if I’m able to see that that was really a stage in my emotional progression.
Can you talk about the success rates of recovery? What does it mean to recover and how can we reiterate the fact that recovery is an ongoing process versus a concrete end-goal?
What you find if you look into the research around addiction recidivism is that if someone has been through a treatment center, it is most likely that if they return to drugs and alcohol, they will drink or use less, they will drink or use in less dangerous situations, and they will have more awareness of the problem. They’re not done with the problem, but they have so much awareness that they’re unable to act the way they did without at least some conscious knowledge about how it’s affecting them. People tend to be more tapered in their experiences.
Some people need to go to treatment a few times before they’re able to stop altogether, other people can stop simply because they have the support of a 12-step group. It’s specific to the individual. If you gauge recovery on “Is it fixed? Is it never going to be a problem again?” then I don’t think that’s a realistic or very well understood concept. We should look at it like a chronic medical condition that you’re always going to have to pay attention to and that might flare up at times.
I think there’s a couple of disconnects. One is that the treatment world is out of control — it’s overpriced, it’s poorly managed. I think that because of the corporatization of my field, we’ve lost a lot of the value we had. I’m glad to be an expert in this field, because I think that’s what’s needed now — those of us who understand the work to guide it and to help promote the understanding that we don’t cure people, but we really do help them figure out how to live a healthier life and they can choose to live that life one day at a time.
I loved how you often mention that it all starts with yourself and that you can’t make amends elsewhere until you make amends within.
You have to stop drinking and using before anyone’s going to believe anything you have to say — or until you can trust yourself. It’s a journey, the recovery process, for any addict. It’s a journey from selfishness and narcissism into connection. Because if you think about the person who’s using, they don’t care about anything except getting to the drug. That’s their primary relationship, the drug. That’s the most important thing to them.
I worked with a guy who was a heroin addict who would spend his kid’s college fund buying drugs, but four years later when he was sober, he went and worked three jobs to pay those college funds back. So that’s not a sociopath, that’s not a bad or uncaring person, that’s someone who is very broken and unconscious. Through their brokenness, we’re able to help them become conscious, and then they take responsibility for their life.
How much are these addictive or compulsive behaviors related to the people around them versus just the person themselves?
So, I had a mentally ill mother who was in and out of psychiatric hospitals for much of my childhood. I grew up in the 1960s when nobody talked about that, and I never really grew up with any kind of ability to trust or rely on my caregivers. I had to learn to rely on myself, and I think this is very frequently the experience of those of us who become addicts. In our most important developmental stage — when what we’re supposed to be learning about is to trust, to rely on, to depend — what people who grow up in extremely troubled backgrounds learn about is to protect themselves.
There was an old term for drug addiction called chemical dependency. And the reason I really like that term is because people become dependent on drugs, alcohol, sex, gambling, gaming because they do not feel safe depending on people. And the person who is an alcoholic is a person who says, “Oh my god, I had a really shitty day, I’m going to go have a drink.” The person who is not an alcoholic is going to say, “Wow, I had a really crappy day, I’m going to go talk to some friends, go for a run.” In other words, healthy people understand that connection and relationships soothes us.
People who are addicts, almost universally, learn very early in life to not share what’s going on with them and not to reach out for help, because the outcome of that in childhood has not been very positive. So they take that into adult life as, “I have to handle my problems by myself, I have to figure it all out on my own, I shouldn’t rely on other people for help.” The problem is that you can’t go through life like that. People are meant to depend on people, we’re meant to be connected. We are at our healthiest when we are pair-bonded and deeply embedded in a meaningful community. That’s what makes us the happiest.
When you mentioned chemical dependency, it reminded me of the fact that some people are physiologically predisposed to addiction because of their brain chemistry.
I think drug addicts almost universally — and we will come to see that in the coming days — have brain damage. We are acting in ways that are dysfunctional. They don’t make sense, but we do them anyway. Why is that? Because my brain is wired not to trust people.
But connection isn’t the sole healing of addiction. By the time people seek help, they’re often so beaten down and troubled, that they need more than just a group of people. But I’ll tell you what — what is every AA meeting? A group of people coming together, sharing their own experience, trying to be in a community together without shame or judgment, to try to grow. That is the basic building block.
You mention the role that selfish thoughts and narcissism play into addiction. And oftentimes we hear the mentality that “something isn’t an issue if it only affects me — it’s only an issue once it starts affecting others.” Is it even possible for it not to affect other people? And how does that belief, or false belief, relate to those selfish thoughts and narcissistic thinking?
Addicts live in bubbles. If I’m an active addict, I’m living in a bubble of my own making where I think I can “have my cake and eat it, too” and as long as nobody really knows about my problem then I’m going to be fine.
Addiction is the result of early childhood trauma—before most people can even remember — the kinds of things that happen when you’re 1, 2, 3, and 4. Oftentimes we don’t have any memory of those kinds of things, but they will affect how we act for the rest of our lives. Addicts are often times people who have raised themselves. If my brain did not develop toward connection, relationships, intimacy, and safety as a 2-year-old, that’s not going to change when I’m 40.
For most addicts that I work with, when you really reflect back on their experiences growing up, they didn’t learn the most basic thing that people need to learn, which is: when you are in trouble, reach out your hand and find someone to help you.
You frequently say that you don’t recover alone.
No one recovers alone, because in a disease of isolation it requires others to have hope.
But to say you don’t recover alone doesn’t necessarily mean that your partner bears the burden. How is that shared responsibility determined between partners or loved ones of recovering addicts?
Families and partners are essential, but they also require boundaries. Because when you’ve been living with someone who is troubled for a long time, you can get a little troubled too. Spouses and partners are not meant to be treatment providers. You need recovering people, you need meetings, you need groups, and you need people who are not as deeply invested in you emotionally to help you.
If I’m your wife or husband, I’m so deeply involved, and it’s so acutely painful and real for me that I have a hard time detaching and just being real. And that’s what addicts need — a kind of no-bullshit, speak-truth-to-power person who will say, “I love you, I care about you, but I’m not putting up with any of that and you need to take a look at it.” The idea that you as a partner alone should be able to help your partner learn how to heal addiction is not really reasonable, and it’s an unreasonable burden to put on a partner. It’s not a partner’s responsibility to get somebody well, it’s a partner’s responsibility to love someone the best that they can and hope that they’ll get love back in return.
Could you give some actionable advice for those with a loved one who is an addict?
The number one most important thing for partners and spouses — and this is so hard for them because they’re so ashamed and embarrassed and uncomfortable — is to get help for themselves. Partners will say, “Well, I didn’t do anything wrong. I’m not an addict, why do I need help?” You need support and nurturing to be able to show up for this very troubled partner with better boundaries and more structure. I don’t believe in detachment from relationships — either you’re in or you’re out — but I do believe that you can set really clear boundaries and structures so you don’t end up getting hurt or chronically abused if someone is unable to get well.
This Q&A with Dr. Robert Weiss was edited from his interview on the BBXX Podcast.
Check out episodes 28 & 29 for the full interview.
Listen on iTunes, Spotify, or wherever else you podcast!
