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by Timothy Sudrovich, MA, LCSW, Clinical Director, JLAP, Introduction by by Terry Harrell, J.D., MSW, LCSW, Executive Director, JLAP
Volume 25, No. 1. Indiana Trial Lawyers Association quarterly journal, The Verdict. Reprinted with permission.
"When asked that most complex question-Why do people drink? - he would place the tips of his fingers together, glance around at his bulging files and bookshelves sagging under the weight of brilliant scientific minds, and finally answer: 'BECAUSE IT MAKES THEM FEEL GOOD.'"
- A COUPLE OF DRINKS never hurt anyone, but.
by John Robert (1967)
The first time Susan Eisenhauer and I spoke at the ITLA Annual Institute in 2000 we brought with us a volunteer who spoke about substance abuse issues. Because of that we chose not to write about those issues in our first several articles. We were eager to get the word out that JLAP is "broad brush" and involved in much more than just substance abuse. Today, however, I think it is time that we focus on this issue. I had someone e-mail me last month wanting to know if we would help an attorney with a substance abuse problem or if there was another organization for assistance with substance abuse. That e-mail leads me to think that we have been successful in letting people know that we deal with other issues. We do assist individuals with a wide range of problems but substance abuse problems are still the largest percentage of our calls and we need to give those issues the attention they deserve. In turning our focus to substance abuse, I decided that it was a good time for me to introduce Timothy J. Sudrovech, JLAP's new Clinical Director, and have him write the article.
Tim has been working in the mental health field since he left teaching and obtained his M.A. in Social Psychology in 1986. While Tim's background is in community mental health, which involved assessing and treating a wide range of mental health issues, his primary focus has been in the area of substance abuse. He has worked with substance abuse clients in almost every treatment area from crisis intervention and assessment to group and individual treatment focusing on everything from early recovery to relapse prevention in later recovery. I actually met Tim when we were both involved in an intervention a few years ago. Last fall, we were lucky enough to entice him to join us here at JLAP.
I think Tim's background qualifies him to write our first article on substance abuse. I also think that you will enjoy the article and I hope that it will make you think. Please do not hesitate to contact us at any time if you have comments or questions about this or any of our articles. In addition, if there is a topic you are curious about and would like to see us address please let us know. Enjoy Tim's article.
We all live under the same emotional rules and function along the same emotional spectrum. On one end of this spectrum is "Pain" or utter despair and on the other end is "Euphoria" or absolute joy. We generally tend to function in a middle area which we will call "Normal". Envision a Teeter/Totter. "Pain" would sit on one end, "Euphoria" would sit on the other end, and "Normal" would be the middle area around the point on which the Teeter/Totter balances (the balance point). Over the course of our lives we will move up and down on this emotional spectrum, never very far towards "Pain" or "Euphoria" but only far enough to feel sad or happy ("cost" or "gain") depending on the specific life circumstance. For instance a birthday celebration might cause a move one direction on the spectrum (towards "Euphoria--"gain") whereas a poor round of golf might cause a move in the other direction (towards "Pain"--"cost"). As the specific life circumstances become more significant the movement along the spectrum would be greater in terms of a "gain" or "cost". When there is movement on the spectrum a person FEELS something. The KEY IDEA is once a person has experienced whatever feeling the specific life circumstance has caused they will return to the "Normal" area and the balance point of the emotional spectrum. The cycle continues as life goes on.
Now that life on the emotional spectrum has been described let us look at how The Process Of Addiction occurs from an emotional standpoint. This will not look at biochemical or environmental aspects but will focus exclusively on the emotional perspective.
Remembering this emotional spectrum, now introduce a substance, such as alcohol or any other mood altering substance, into the equation. From an emotional standpoint there will be movement from this starting point along the spectrum in the direction of "Euphoria". The movement will be slight but will generally be positive. (It feels good and possibly better for some than for others. One theory holds that those with a genetic predisposition for substance abuse may experience a greater increase in this positive feeling.) This positive movement is evidenced by how a person feels or acts when the substance is introduced. They may feel happy or lively, or their mood will be upbeat and their behavior may be more outgoing. They will generally be enjoying themselves and will consider the event being experienced to be a positive one. However, given the KEY IDEA introduced earlier, they must return to the balance point of the spectrum. How far a person moves up on the spectrum (say a "gain" of 3 emotional spaces) determines how far they must move back (or a "cost" of 3 emotional spaces) to the balance point. This moving back ("cost") constitutes what may happen after the substance-using episode. A person may have gotten sick, or may have gotten into some amount of trouble with a parent or a significant other for missing a curfew or forgetting a promise or commitment. Whatever "cost" is not significant at this point, it only allows the individual to recognize that there is in fact some "cost" involved in using a substance. It also balances the "gain" -- to return the individual to the balance point of the emotional spectrum within the "Normal" area. The person has learned how to create a mood swing. They now know how to introduce a substance to affect their mood in a positive way with minimal "cost".
Assuming the individual has decided to continue to pursue seeking a mood swing ("gain") through their substance use, they will enter into this stage. They will cross that fine line. They will continue the same behavior as they did in Stage Two, increasing the quantity or frequency of their use in attempts to achieve a greater level of emotional "gain". However in this stage they cross a line, which alters the KEY IDEA. They now experience the "gain" in a positive direction on the emotional spectrum towards "Euphoria", as they have in Stage One and Stage Two, however rather than returning to the balance point within the "Normal" area they return to a point below there. In essence what occurs is that the "cost" will outweigh the "gain". For example, they may have achieved an emotional "gain" of 6 spaces but then experience an emotional "cost" of 9 spaces. They have NOT returned to where they started, but to a point below that, further towards the "Pain" end of the spectrum. The "gain" may be greater but the "cost" is even greater than the "gain". They do not return to a balanced emotional state; they have eliminated the KEY IDEA. The "cost" is significant. The "cost" is evidenced by taking more and more substance to achieve the desired effect, or even a decreased effect with the same amount; they may experience withdrawal from the substance or take the substance to relieve the withdrawal; they may experience unsuccessful efforts to cut down or control their use (because they may recognize some of the "cost" involved with their substance use); they may spend more time obtaining or attempting to obtain the substance and then recovering from it's effects; they may give up or reduce important hobbies or social activities that do not include substance use; they may continue substance use despite the knowledge that it has caused the already listed problems; or they may experience significant legal, financial, work and/or relationship costs. Once that imaginary line is crossed between Stage Two and Stage Three the NEW KEY IDEA will be not returning to the balance point as before but returning to a point below that which becomes their new balance point. They have now arrived at Stage Four: Addiction.
If a person keeps in the mind the emotional spectrum and its description as a Teeter/Totter, they will realize that at this point the individual is now sitting in a place on the "Pain" end of the spectrum. This is not a comfortable place to be for very long. Using their past experience in inducing mood change, this individual will introduce a substance in an attempt to move them in that direction, towards the "Normal" area in the direction of "Euphoria", to get them away from the "Pain" end of the spectrum where they are. They will move towards the balance point, in a positive direction, and in essence will then be USING TO FEEL "NORMAL". THIS IS ADDICTION. This is the cycle that the individual falls into once they arrive at this fourth stage. They may remain in this cycle for some unknown period of time. They move up on the spectrum with substance use but then return to a place just below where they started (the NEW KEY IDEA). They continue this cycle trying to reach "Normal", however with the "cost" continuing to outweigh the "gain" it becomes an emotional spiral downward until the person is no longer able to move beyond the very limits of the "Pain" end of the emotional spectrum. They can no longer return to the "Normal" area or above. They are now living in emotional pain. What has worked for them for a period of time in terms of giving them a positive reward or "gain" -- the substance -- is now dragging them downward into a place of utter despair. They are experiencing feelings of hopelessness and worthlessness, and are "dying" emotionally if not physically. The only way out of this cycle downward is to eradicate the cause -- the substance. Once the substance is taken out of the equation they can begin the process of reversing the cycle. This is known as Recovery.
Recovery is the process of returning to a healthy emotional state. It is the process outward from within the emotional abyss caused by The Process Of Addiction. With abstinence and support a person will eventually return to the "Normal" area, and will re-establish their position on the Teeter/Totter. Individuals vary in terms of describing their "success" with this process and how they achieved it, but all would say if asked that it involved significant effort on their part to re-establish this emotional homeostasis.
How does your experience with substances compare to what is described in this article? Ask yourself these questions (in no particular order):
If you think that you might be in one of the stages described in this article, or if any of these questions have raised concerns about your substance use, or even if you are not sure about your substance use and would like to look into the issue further please Call JLAP. JLAP deals with all of these issues confidentially. Our phone numbers are (317) 833-0370 or Toll-Free (866) 428-5527. Our email addresses are firstname.lastname@example.org or email@example.com
(References for this article are available by request.)