-By Gerhard Scholz
A Historical Review:
Drug abuse has become a widespread international problem, although the substances abused and the abuse pattern may differ from country to country.
The multiplicity of phenomena generally known collectively as addictive behaviour have a long and rich social history. The field that has developed as a result of the study of these phenomena is of more recent vintage.
There is no single agreed definition of drug addiction in modern scientific or medical literature. A fairly widespread statement was the following definition by the World Health Organisation's 1957 Expert Committee on Addiction-Producing Drugs1. "Drug addiction is a state of periodic or chronic intoxication produced by repeated consumption of a drug (natural or synthetic).
Its characteristics include:
- an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means.
- a tendency to increase the dose.
- a psychic (psychological) and generally a physical dependence on the effects of the drugs.
- detrimental effect on the individual and society."
This is a definition allowing for both psychological and physiological addiction, with the increasingly compulsive character of the irresistible urge as its central characteristic.
The question of whether the term "addiction" should be reserved for cases of physiological dependence, or if it should also include psychological addiction, was always very problematic. Another historically controversial issue is the use of the word "craving." According to the understanding of Alcoholics Anonymous: "Addicts are not drinking to escape, they are drinking to overcome a craving beyond their mental control." They cannot start drinking without developing the phenomenon of craving2. Others rejected the use of the term "craving" because of its vagueness3.
A similar source of disagreement was the question of what addiction does to the addict. Some argued that opiate addiction at least has little or no effect on the personality4. Others suggested that addiction of any variety brings about a total transformation of the personality5. What is missing in such dualistic addiction concepts is the dynamic between these two fields of mind and matter. Unless we know about this driving force, the underlying mechanism, how one becomes an addict, one cannot really come out of addiction. If we are not careful in the field of addiction research and rehabilitation we just exchange one prison for another and the wonder of freedom gets lost.
Nowadays, in the world of science and medicine, theories about the nature of addiction, and what should be done about it, have changed dramatically. Many researchers now agree that addiction, whether to narcotics, alcohol, heroin, amphetamines or any other chemical substance, is one single disease. According to typical life stories of drug addicts gathered during my research work, addicts switch drugs when the drug of their choice is not available, and display addictive behaviour even with drugs thought to be non-addictive (marijuana, diet pills etc.). Clearly this means that for the understanding of addiction, the chemical is not the entire problem, it is the individuals reaction to it, and this dynamic between the two fields that causes the difficulty.
Case-Study Related Methodological Remarks
During the last 20 years, the analysis of life histories, formerly used in the famous Chicago School, has again become acceptable to modern social scientists, emphasising what can be learned from individual life stories. In general, historical life case studies reveal the causes and treatment of a social problem. This information cannot be arrived at by more formal techniques, which must depend heavily upon external data. Establishing a relationship in which the experience of a drug addiction is described from the point of view of the subject, the analyst attempts to enter the life experience of the subject and then, by engaging the subject in a critical dialogue concerning these experiences, to penetrate the empirical data and end up with a "grounded theory"6.
To illustrate, here is a short unedited extract from a life story interview with an ex-addict from Australia.
Joe: "...addiction, basically means escapism, escape from reality...you use insanity...the human insanity, escapism. With a drug addict....has used the vehicle of drugs to escape. And it is a very, very powerful vehicle...much more powerful than just the unaided fantasy...for the human being they get into dreams, workaholism, or TV. The drug motivation, the drug use, is much more powerful than anything else...when I use it, and that's what...because it's so powerful, it takes the escapism to a life-threatening degree. Whereas other motivators of living for money, power, prestige or...doesn't reach a life-threatening...doesn't threaten life."
This story shows the power of people to articulate their own problems, using the voice of the world in which they live. The scientist's task is essentially one of reconstructing the inherent structuring logic, which is sometimes no more than formalising and commenting on the wisdom that is already there. Joe's story indicates to the scientist the basic topics which have to be explained and penetrated (bearing in mind that this is only a small part of a long interview).
It would be beyond the scope of this article to do the reconstruction in a controlled text-analytical way. We will just look at certain essential points which are raised by the short excerpt. The first is that addiction is itself addictive. People who are predisposed to addictive behaviour are inexorably drawn into that downward spiral of irrational behaviour. (In the life story of Joe it wasn't important which drug he had taken. The addiction was progressive and fatal). The second point is that there are differences as regards content in substance abuse. Ordinary substance abuse is an escape from reality, while drug abuse has a life-threatening element. There is a wide range of abuse, the main difference being that the more powerful the drug, the faster the deeper trouble occurs.
Thus this small extract shows that the problem of drug addiction is always dialectical: constituting the interaction between a general (addiction) and a specific (the addiction to drugs).
Summary of Results
Certainly, a drug is a chemical compound which, taken into the body, changes the body's metabolism. But obviously not everyone who takes drugs is an addict. The so called classical model of addiction is certainly insufficient. This model emphasised the inherent overpowering nature of the drug per se, stating that no person could resist the pull of the drugs: the one-shot-and-you-are-gone-syndrome. After the 1940's (especially in the USA) this biological disease concept was revised. The new disease model differed in the location of the source of the addiction. The old addiction-in-the-drug model considered the source of addiction as being in the drug itself. The new model considered the source of addiction as being inherent in a minority of people who were susceptible to addiction to drugs because of (unknown) factors in their personality.
A third position, developed following the explosive drug use in the 1960's, is a proposed revision synthesising the available evidence of the two disease concepts. There, it is stated that addiction is not an inherent characteristic of drugs or people, but of a person's response to a particular type of experience. The main problem with most past and continuing research on addiction, is that it locates the source of addiction in the wrong place. Addiction does not come from a drug; it begins with the person, his or her situation and that person's search for a given experience7.
This is a much broader and more unified understanding of addiction: addiction as a very personal, subjective response to a given experience; a result of behaviour, not necessarily inherent in any person or substance. But the main question we still have to solve is this: what exactly is the mechanism causing the tendency to increase the dose, resulting in repeated consumption of drugs? Initially, taking the drug is a pleasant experience, giving one the feeling of being relieved from anxiety, when in actual fact those things in life which cause anxiety grow more severe. Drugs lessen the person's ability to cope with life's difficulties. It is here that the vicious circle of drug addiction starts, with the dialectic of relief and slavery as its driving force. This is certainly more complex than mere physical dependence.
The key to diagnosis of addictive disease is in the observation that the patient persists in using drugs in spite of the consequences. It also means that taking away the drug would not solve the problem of drug addiction.
Typical Progression in the Drug Life of an Addict
The reconstruction of drug addicts' life stories gives the following picture:
- Addiction starts as a pleasant experience, chasing pleasant feelings and running away from the unpleasant. It becomes an addiction when the experience is no longer pleasant, but the person continues to risk everything by compulsively attempting to repeat and even intensify the pleasant experience previously produced by drugs.
- Addiction becomes a life style: predictable, habitual, and repetitive. Drug-addicted people doubt both their ability to set themselves realistic goals and their ability to bring about the results they want. Because they do not believe their efforts will be rewarded, they give up trying. For the addict, the reward becomes the drug of his or her choice.
- Because of the life-style maintained by a drug addict (using mostly illegal and very expensive drugs) his or her behaviour starts to infringe on the rest of society (criminal activities, prostitution, etc.).
- These kinds of activities go against the set of values with which the addict has been raised. This produces strong feelings of guilt and self-hate associated with the addiction which cause the addict to rely more heavily on his or her drug. The vicious circle keeps rolling.
To sum up, addiction means an over-dependency which has become habitual, obsessive and compulsive, governing in its totality all the different dimensions of an individual's life-physical, emotional, social and mental. This means that one-dimensional treatment strategies are not adequate, whether they are individually oriented or based on social psychological/socialisation theories.
The recovery from addiction has to be based on this multi-dimensional system. Hence, one has to solve three problems:
- As a result of the almost complete destruction of personality, a fundamental motivation is needed. Counselling can create a base so that drug addicts know there is something worthwhile to go back to. The drug addict is given the chance to become motivated to stop his or her over-dependency on drugs.
- The need to treat drug addiction at its deepest level: to eradicate the indicators of addiction compulsion, loss of control and continued use in spite of adverse consequences. In other words, to take out the deeply rooted mental cause.
- The provision of a support system for the drug addict after initial intensive residential treatment, providing vitally important after-care during the process of adjustment back into society.
To gain freedom from addiction, one has to eliminate its deeply rooted cause. This work of removing the cause has to proceed in a very methodical way: it cannot be accomplished simply by changing outer circumstances or by an act of will; by simply wanting the addiction to go away. The work must be guided by investigation; one has to find out what the defilements (inner drives) depend upon and then see if it lies within one's power to remove the cause. This is done by Vipassana meditation.
Initially, one may start using drugs for a number of reasons, but eventually drug use becomes a reaction to the uncomfortable body sensations which result from the constant interconnection between mind and body, and the thoughts which accompany these interactions. One does not get addicted to anything outside, or to some kind of inherent quality of the drug itself; it just looks like this. People get addicted to their own vibrations of the body. By taking a drug, a certain kind of bio-chemical process starts in the body and one feels a type of vibration, which one starts liking. One develops a craving for it, then a habit, and finally gets addicted to the vibration. Addiction is therefore a continuum: one wants to enjoy that vibration again and again. This is what happens in all types of addiction. People get addicted to so many things, not only to drugs and alcohol. There, the type of created vibration is considered by one's own judgement to be pleasant. But all addictions are addictions to vibrations, to the sensations.
The world of physics has already begun to recognise that the objective and subjective cannot be separated. Recent scientific works8 support this important point; that any experience that arises in our consciousness is a subjective experience, not part of an independent external world. Although we experience the outside world as a series of sensory objects, what actually comes to our senses is energy in the form of vibrations of different frequencies. The unconscious mind, which is still beyond the understanding of modern sciences, is in constant contact with these energy schemes, often simply described in modern physics as heaps of statistical probabilities. These vibrations carry no subjective information, they just carry objective value. They trigger neural codes, which are transformed by the brain and its judgments into a model of an external world. This model is given a subjective value and projected outwards to form the subjective world. Unfortunately, we call this mixture of subjective and objective components the objective world. From the fact that many of us see a similar external world, we can only deduce that we have similar models. The similarity of models does not necessarily imply the uniformity of the world that gives rise to those models.
Addiction means addiction to a certain type of vibration that has been created by the drug use and the subsequent chemical processes in the body. The addiction has gone to the deepest level of the mind, and there is every likelihood of it becoming rooted in the deep unconscious. As Vipassana reaches the unconscious level of the mind by working with the sensations, it can remove the roots of addiction.
The deepest level of the mind is constantly in contact with the bodily sensations. As we develop awareness of the sensations and observe them with equanimity, the addiction at the subconscious level is automatically removed.
This interrelation of mind and matter is the key to Vipassana meditation, and it was of crucial significance in the teaching of the Buddha. "Whatever arises in the mind is accompanied by sensation" (Anguttara Nikaya 8, Mulaka Sutta). Therefore observation of sensations offers a means to examine the totality of one's being, physical as well as mental. In the Satipatthana Sutta, the Discourse on the Establishing of Awareness, the Buddha presented the practical method of Vipassana meditation, for purifying the mind. Here, the importance of sensation (Pāli: vedana) is stressed. Other references about the key role of sensations are found in: Brahmajala Sutta, Pathama Akasa Sutta, Pathama Gelanna Sutta, Indriya Bhavana Sutta, Dighanakha Sutta, Pahana Sutta, Maha-Salayatanika Sutta, Apana Sutta9.
When an addict understands that observing oneself at the level of sensation is the key to coming out of addiction, and works on sensation with Vipassana meditation, he or she will begin to recover. But Vipassana meditation is not some kind of magic or miracle. Progress requires a strong will to come out of addiction, and also a strong will to work towards this goal by observing oneself at the level of sensations. This is the point at which professional counselling will play an important role, as has been observed in one of the most successful drug rehabilitation centres in Australia. Cyrenian House operates with counselling, crisis intervention, the integrated philosophy of Narcotics Anonymous, and the first part of a ten day Vipassana meditation course called Anapana meditation, which means observing incoming and outgoing breath.
The role of counselling is: to stabilise the addict, to give intellectual understanding, and to motivate the person to try to stay clean after the residential programme. They are then encouraged to join a Vipassana course in order to work hard on the technique. However, if there is no motivation to come out of addiction and to work properly according to the instructions, Vipassana will not give proper results. This motivation enables the addict to work to eradicate the mental defilements of addiction and to face the difficulties which are bound to crop up during a Vipassana course.
When a person abstains from taking drugs, he or she very soon feels uncomfortable. Unpleasant feelings/sensations come to the surface, and the mind begins to react to them.
Using Vipassana meditation to eradicate the sources of compulsive behaviour, one passes through different stages with these sensations:
- The sensations are kept completely in the unconscious. This means that as soon as there is the slightest hint that some of the poison and pain will reach the conscious mind, the addict immediately gives in to his addiction, assuming that this will prevent the pain.
- With the practice of Vipassana the operation starts. The suppressed feelings, along with the unpleasant sensations, start to rise out of the unconscious mind. This is the most difficult part for drug addicts, as the habit of not facing the unpleasant, deeper unconscious reality is their weakest point.
- Gradually the mind becomes more equanimous. By observing the reality within, one first discovers that these sensations can be accepted and second, that the conditioning that distorts the perception of these sensations can be eliminated step by step, with pure awareness and wisdom becoming established.
As ignorance disappears, the addict looks at reality as it is. The underlying tendencies of craving and aversion get eradicated, and the drug addict slowly emerges from addiction.
Outlook: What Can be Offered?
It was found during my stay at the Vipassana International Academy, that many addicts who try to pass through ten day Vipassana courses are not able to overcome the problems in step two; facing the suppressed feelings and unpleasant sensations that arise out of the unconscious mind. As a result of this, many leave the camp soon after the start of the course, unable to grasp the depth of the technique. This demonstrates that drug rehabilitation activities such as counselling, group therapies, role modelling, after-care etc. cannot be replaced by Vipassana meditation nor Vipassana replaced by drug rehabilitation activities.
Elsewhere, different groups follow a variety of different concepts (Fair Oaks and Daytop, just to name the most successful ones in the U.S.A.). Some use brainwashing, others try to divert the mind; but what most of them seek to trigger is a huge emotional displacement. All these concepts try to accomplish some kind of spiritual transformation to help the addict recover10.
A major problem with drug addiction is that even with one episode of drug use, a Pandora's box of dormant memories can get unlocked. The various drugs are just like pressure points. Touch one and you will set the entire continuum of latent drug memories vibrating like a great spider's web. It is this process of recapturing and reliving that makes people say: "Once you are an addict you are always an addict." Now, with the impact of Vipassana meditation we no longer have to agree with this statement; relapse need no longer be considered as a biological imperative. Yet we have to be aware that: "Once you are an addict you are still at risk of relapse." It is at this point that ordinary therapies and stabilising methods in the field of drug rehabilitation have their natural limitations and Vipassana meditation starts playing its unique role; eradicating the defilements of the deep unconscious mind. It is this scientific, methodically controlled process of Vipassana meditation, purifying the unconscious mind, and demystifying any kind of mysterious spiritual transformation, that fuels the drive away from relapse, fighting and breaking the addiction pattern at the root level.
And it works. The only thing that has to be done is: to prepare the motivational ground for passing through the Vipassana operation by counselling and by teaching Anapana meditation to addicts already in rehabilitation clinics. After the Vipassana course, the power of the peer group, family treatment, the outpatient programme and general social integration have to be combined with the depth of the meditation experience and its applied practice in daily life. Those who really want to come out of drug addiction can succeed, for their own emancipation and for the benefit of others.
- World Health Organisation, Expert Committee on Addiction Producing Drugs.(WHO Tech. Rep. Ser., 116) Geneva, 1957.
- See: Silkworth W.D. The doctor's opinion, page 28. In: Alcoholics Anonymous; 2nd rev. ed. New York; Alcoholics Anonymous; 1955.
- See: Jellinek E.M. The disease concept of alcoholism. Highland Park, N.J.Hillhouse; 1960.
- See: Duster T. the legalization of morality; laws, drugs and moral judgement. New York; Free Press. Lindesmith. A.R. Addiction and opiates. Chicago; Aldine, 1968.
- Wexberg L.E. Alcoholism as sickness. Quart. J Stud. Alc. 12: 217-230. 1951.
- Life history method, see: Shaw, Clifford the Jack-Roller: a delinquent boy's own story, page 18-19, Chicago 1969. Bertaux, Daniel, A very different picture-From the life practice. History approach to the transformation of social science. Paper presented to the ninth World Congress of Sociology, Ad Hoc group on the Life History Approach, Uppsala, Sweden, 1978.
- Pele S. Redefining Addiction. The meaning of addiction in our Lives. J Psychedelic Drugs, Vol.2, 1979, p.289-297.
- Like: Peter Fenwick and David Lorimer in: New Scientist, August 1989.
- See: The Art of Living, William Hart, 1987, Appendix.
- See: Proceedings of 11th World Conference of Therapeutic Communities, February 21-26,1988. Bangkok, Thailand.
The Cyrenian House Programme
Richard Hammersley & John Cregan
Cyrenian House is one of the leading drug rehabilitation centres in Western Australia and is the only one that is drug free. It was founded in 1981 by Richard Hammersley and has treated over 600 addicts on an inpatient basis and over 400 on an outpatient basis.
The therapeutic programme consists of:
- Individual counselling
- Group therapy
- Promotion of physical and mental well being through yoga, relaxation, meditation, sport and drama
- Attendance at Narcotics Anonymous meetings
- Participation in arts and crafts projects and household work programmes.
Cyrenian House helps addicts not only to free themselves of drug use but also to reintegrate into society by finding employment, education opportunities, accommodation, etc. It is one of an umbrella group of organisations operating under the aegis of the Western Australia Council on Addictions. The Council itself is directed by Vipassana meditators, and for three years it has made time available for addicts undergoing treatment, and for staff to attend Vipassana courses. At present 80% of the staff have taken at least one ten-day course. The results are encouraging among the addicts who have taken Vipassana courses in the final part of their rehabilitation programme.
Vipassana benefits recovering addicts both directly through their participation in meditation courses, and indirectly as well. Nearly all the counsellors at Cyrenian House are ex-addicts who have passed through its programme themselves. Once they are firmly established in the Dhamma, they provide excellent role models for recovering addicts, inspiring them through such virtues as honesty and compassion, acquired and cultivated by the practice of Vipassana.
Cyrenian House treats addiction as a family illness and provides support for members of the addict's family, particularly through the Narcotics Anonymous programme.
Using drugs is a way of suppressing reality, whatever the reality may be; a difficult financial situation, an unhappy relationship, or simply uncomfortable bodily sensations. This suppression leaves a mark on the mind. Vipassana meditation is the only technique we know that removes these deep mental impressions totally. Of course over a long period of time other methods may be helpful, such as giving positive reinforcement to the conscious mind; in fact, to a large extent the Cyrenian House programme works in this way. But the speed with which Vipassana works means that addicts can virtually clear their minds and start again free of the conditioning of this terrible period of their lives.
Drug addiction is an addiction to bodily sensations. Someone may start taking drugs for any number of reasons, but eventually it is the dreadful sensations and their accompanying thoughts that drive a true addict to continue using drugs. The addict becomes caught in the web of craving and aversion. By fostering equanimity toward sensations and thoughts, Vipassana opens a way out of this web.
An important part of the rehabilitation process at Cyrenian House is the Narcotics Anonymous programme, based on the tried and tested methods of Alcoholics Anonymous. This programme encourages self-evolvement through self-awareness and understanding. Addicts learn to accept themselves and others as they are, to bring honesty into their everyday lives. As with Vipassana, the understanding of impermanence is of central importance to the Narcotics Anonymous programme. Addicts base their recovery on the understanding that things are changing and that life is manageable by taking it one day at a time. Vipassana reinforces this approach by showing how to take life one moment at a time.
During their stay at Cyrenian House, addicts realise that they and no one else are responsible for their recovery. This realisation plus the observation of successful role models (former addicts who have learned Vipassana) provide the impetus to undertake a ten-day course.
Confidence building is an essential part of the programme, from detoxification through sharing household duties and the halfway house experience.
Simply having completed a Vipassana course is itself a great boost to the confidence and self-esteem of an addict. Still more importantly, the technique fosters self-dependence and inner strength. By continuing the practice, the addict develops these qualities to achieve positive results.
Vipassana shows the addict that there are alternatives to using drugs, by providing the example of the peace and tranquillity that is attainable within oneself through meditation. A course thus gives an understanding of harmony that is experiential rather than merely intellectual.
When people have used drugs for long periods of time, they become numb to feelings. When they stop using drugs, it is important for them to have time to experience and identify feelings, and to accept the feeling of isolation and low self-esteem that is common among addicts. To attend a Vipassana course when one has just stopped using drugs is to do a course as an addict, with the values and outlook of an addict. To do a course after a period of sobriety, having learned to accept oneself, is to do a course honestly as a human being. For this reason we believe that a Vipassana course is a perfect conclusion to the Cyrenian House programme.
The continuing practice of Vipassana assists in times of stress which could have led to a relapse in the past.
Addiction goes to the deepest level of the mind, and if it is not to recur it must be removed by the roots. The deepest level of the mind is constantly in touch with bodily sensations. Through Vipassana one can learn to observe these sensations with equanimity, and by doing so eradicate addiction from the depths of the mind.
From numerous examples it appears to us that after undergoing a Vipassana course, an addict shows dramatic behavioural improvement, far more so than an average person with no dependencies. Recovered addicts who have passed through the Cyrenian House programme and a Vipassana course show exceptional willingness to help other addicts.