Addiction reinforces addictive behavior. A substance is consumed; feel-good chemicals are released or enhanced, motivating repeated, and later compulsive, use of that substance. At its basic level, addiction is a relationship between physiology and impulse. However, isolating the brain’s function as catalyst, it is the mind that actually determines the course of addiction. This isn’t to say that they are mutually exclusive, but drawing a distinction between the two is helpful to understand addiction.

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Addiction is regulated by the same parts of the brain that control basic survival instincts such as hunger and sex. When addictive impulses are not satiated, an addicted person experiences anxiety, depression, restlessness, irritability, and difficulty feeling pleasure. This is the brain functioning as catalyst. Prolonged use of an addictive substance generates corresponding neural pathways, which are reinforced by physical dependency. But it is the mind not the brain that forms an emotional attachment to the substance and believes that only that substance can reverse such negative emotional states, bring pleasure, and satiate. Because the mind isn’t “autonomic” like the physical brain and nervous system, but is subjectively, and thus voluntarily governed; cause and effect reasoning is also subjective. Even though negative states, like withdrawal, are a result of the substance interacting with the physical brain, the mind of an addicted person may be deliberately avoid recognizing the problematic role the substance plays.

According to Jack Trimpey, the founder and author of Rational Recovery, continued addictive behavior is due, in large part, to ambivalence. He believes that the addicted person truly desires abstinence, but at the same time wants to continue using. Trimpey doesn’t believe there’s any magic to it. A person drinks, for example, because they like to. The problem is that their addiction convinces them that their drinking isn’t the cause of their problems. If anything, their problems entitle them to their drinking. While Trimpey believes the addicted person is actually capable of stopping, they will remain addicted until they learn to recognize and manage their ambivalence.

Yet, even if an addicted person is able to comprehend the consequences of their addiction, this doesn’t necessarily mean they’re willing to discontinue living with those consequences. For example, I was working with an individual who was concerned at one point with his marijuana use. Although he gave significant reasons to stop, he painstakingly kept circling back to plausible reasons to continue his use. Although acknowledging this when I brought this to his attention, his acceptance was short lived, and soon gave way to a less pressing topic. This occurred several times throughout the session. The following week I casually told him I wanted to share something from another’s session earlier that week. I basically repeated our previous session, substituting “peanut butter” for Marijuana, and sited “health concerns” for addiction. When asked if the other person should stop eating peanut butter, he said, “Yes,” without much consideration.

Telling someone they drink or use too much and need to stop, may not only be something they already know, but has the potential risk of shutting them down and making them wary of further discussion. Sometimes all one can really do is provide an open, non-judging space, and either let the person talk it out to their own conclusion, or wait for something so egregious to happen that person is convinced it’s time to cut bait.

Yet it isn’t the substance that’s going to do something egregious, but the person under the influence of that substance. This isn’t to suggest the addicted person shouldn’t take responsibility for their actions—under the influence or not. It would be nice if the substance could bear some of the responsibility. But in reality, if a person crashes their car, the substance can’t pay for half the damages. When a person admits their responsibility due the substance, carrying out this responsibility means recognizing the influence that substance has over them.

Confronting addiction is best understood by a variation of an old joke:

Question: How many therapists does it take to change a light bulb?

Answer: The light bulb has to want to change.

Thinking one can get another to give up an addiction is pure hubris—as much hubris as denial takes in the person addicted. Years ago I worked with an individual who got sober after having a dream in which he woke up in a flop house, with others, presumably down and out, sitting around him. In the dream he immediately began explaining how he’d unintentionally drank too much the night before, and wound up there—recognizing he was using excuses he’d used many times before. After offering a few of these, an older, bearded man, who the individual described as having that particular wisdom that comes as a consequence of experience, replied, “That’s just the disease talking.” These exchanges continued a little longer, when the individual began feeling a calm conviction, and accepted the man was right. The next morning he sat for a long time, considering the truth of the dream. It was a disease, an influential one, with a mind and agenda of its own. He didn’t choose to have it, however he realized he had it all the same, and there wasn’t a cure. Until then, the only cure he could imagine would be one in which he could suddenly drink—not with moderation, but without problem. Seeing this, he found himself saying, “That’s just the disease talking.”

People attending A.A. for the first time are sometimes advised, “Look for the similarities, not the differences.” Alcoholics are good at looking for differences. This is poignantly exemplified in A.A.’s much quoted definition of insanity, “… doing the same thing over and over and expecting different results.” But far better than looking for differences, Alcoholics are gifted at ignoring doing differently. For example, testing out whether being sober for a period of time, or even an occasion, is actually unbearable, or impossible. Objectively they may know, “That’s just the disease talking,” but subjectivity their disease continues looking for, finding, and convincing the addicted person that it makes far more immediate sense to drink or use. This is where looking for the differences, the exceptions and, unfortunately, the susceptibility to addiction’s insanity comes into play. Addressing this, A.A., has the slogan (and, “slogans are wisdom written in shorthand”), “Pick up the telephone before you pick up a drink.” A sound suggestion, however, it relies on an external force. This isn’t intended to criticize A.A.’s philosophy: part of facing addiction is “not having to do it alone.” But a central characteristic of addicted individuals is their lack of definitive internal regulation. In other words, they have difficulty standing by their convictions while faced with the compromising draw of their addiction. They are ambivalent. Again, when a person is presented compelling reasons to quit something as inconsequential as peanut butter, doing so is barely a blip. But with an addiction, doubt follows shortly behind the intention, tempering it so as to leave room for exception and negation – in short: ambivalence. The person knows they should quit, but rather than acknowledge this, they diminish what, to someone who isn’t addicted, are compelling reasons to quit. They do this not so much to rationalize their use, but to leave a possibility to continue their use—even at some point in the future. Yet if an addicted individual we’re presented a mechanism with two buttons, one to continue the course of their addiction, and another to remove it, they’d most likely press the one that removes their addiction. Clearly, they recognize their better choice. But in the absence of such a mechanism, while the choice remains clear, the choosing is still left to chance. The difference perhaps isn’t the absence of the mechanism, but again, a lack of definitive internal conviction. In its absence however, the dilemma remains the same.

Addiction has been called “a disease of loneliness,” despite addiction’s promises to the contrary. What makes this loneliness so insidious is the secrecy within which addiction exists, and that the addicted person guards it instinctually. That is perhaps why therapists are trained to double the amount an individual reports using. Four drinks a night certainly sounds more acceptable than the eight they may actually be having. Were the individual to disclose the true amount, they risk recognizing the true degree of their use. But, more to the point, it would mean exposing this to another outside the relationship with their addiction. Being fully forthcoming goes against the dictates of the “disease’s talking,” because it potentially establishes accountability, and thus threatens the addiction. Hence the motto, We’re only as sick as our secrets. As long as the addicted person has no outside attachments their addiction retains its place, though the addicted individual continues to suffer and struggle with their ambivalence. However, much more depends on this ambivalence than is perhaps realized. If, as Jack Trimpy believes, people drink because they are ambivalent, then addiction needs this ambivalence to obscure threat. The irony though, is that addicted people often seek help because they are ambivalent. This is where the scales perhaps tip. If the addicted person could recognize addiction as separate from them, and form outside attachments, their desire to cease addictive behavior has a better chance. By allowing for initial objectivity, they can begin to form a fundamental stance–conviction, to counter their ambivalence and, with time and experience, develop definitive internal regulation.