A question of why

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Existentialism can give us a fresh angle on addressing the debilitating void that follows addiction, suggests Lana Durjava.

Read the full article in May 2019 DDN magazine

Lana Durjava picture. Who has a background in forensic psychology and works in the probation service
Lana Durjava has a background in forensic psychology and works in the probation service

Through years of interactions with compulsive drug users in a variety of different settings, I have noticed the recurring pattern of lack of direction and meaning. This has appeared to be a significant factor in both predisposing and perpetuating addictive behaviour, and is something that is not automatically eliminated when a person stops using drugs.

Purpose deficit, so to speak, frequently persists through time, and it sometimes becomes even more pronounced once drug-free life is achieved. To help people attain long-term and personally fulfilling recovery, it is advisable for practitioners to be mindful of this shortfall, to understand how it relates to excessive drug use and to possess enough practical knowledge to be able to confidently deliver effective interventions. In order to do that, useful insights can be drawn from a field that is not necessarily the first go-to within substance use treatment – that of existential philosophy.

Existentialism is a philosophy that is concerned with finding self and the meaning of life through free will, choice, and personal accountability. Its basic premise is that there is no inherent purpose in life and that each individual is responsible for finding their own meaning, making autonomous choices and aspiring towards freedom and authenticity. The topics that it focuses on are directly relevant to the symptomatology of addiction, and because of its emphasis on understanding people as free agents who are fully accountable for their lives, it can offer a fresh angle that complements biopsychosocial theories and treatment of substance use.

Bus stop with the message: You are nothing else but what you make yourself

Clients with substance use problems often present under the illusion that they are working against their will when they are using drugs. The existential perspective suggests otherwise. It argues that drug use is not random but serves a specific purpose; underlying drug use is a particular need and people are acting in accordance with their will, which aims for this need to be met. As a part of effective addiction treatment, this need has to be identified, fully explored and addressed in an alternative way.

However, that is not enough. We shouldn’t just focus on why the drugs, we must also inquire into why anything else. What motivates a person at a specific time to change their behaviour? What could carry more significance than drugs? What can provide solid ground and a sense of direction? What has the potential to offer some value to life?

Drug use is essentially a needs-driven behaviour, and underlying every addiction there is a certain lack, an emptiness, a gap that needs to be filled. This gap might have been, to varying degrees of success, replete when the person was using drugs. However, when drug use stops and once the initial post-detox honeymoon phase comes to an end, the person is faced with the original void that played a material role in setting off compulsive drug use in the first place.

Jean Cocteau once wrote down reflections on his opium using days and treatment, and I have encountered the same message, expressed with different words, on multiple occasions during my work with people with substance use problems: ‘After the cure. The worst moment, the worst danger. Health with this void and immense sadness. The doctors honestly hand you over to suicide.’

Every person is unique, and people use drugs for a variety of different reasons, but among those who progress from recreational to dependent drug use, certain patterns keep emerging. There is a recurring motif of disconnection from the world; an acute sense of feeling out of place. Reality is experienced as unsafe and unreliable to lean on, relationships are perceived as overwhelming and bewildering, and self is interpreted as overly sensitive and ill-equipped to navigate through life on its own resources.

Among other things, drugs bring relief, freedom, joy, relaxation, company, safety, focus, comfort and solace. Because they serve to compensate for the deficits in other areas in life, the relationship with them develops the structure and dynamic of a volatile love story, and practitioners need to be aware of the meaning clients attribute to drugs and the amount of hope they invest into this relationship. Meaning and hope, in combination with extreme attachment to the drug, is what makes the transition away from compulsive drug use a complicated process.

Change can, of course, be initiated by applying pressure or removing an obstacle, and recovery often begins in the context of a crisis of sufficient magnitude that it temporarily overwhelms the person’s deep-rooted aversion to stopping using drugs. However, what triggers the commencement of recovery is not necessarily sufficient for its maintenance. To keep drugs out of the equation on a consistent and long-term basis, something else will need to start to matter more than them because a satisfying life can simply not be built around emptiness.

But just as there is no one-size-fits-all in addiction treatment, the new meaning is not universal. Every person needs to find what gives their life a direction, fulfilment and purpose, and the practitioner’s role is to support this journey of discovery, not endorse a particular model of living. Clients primarily need to be encouraged to consider their life experience in light of their implications, purpose and consequences, and leading the way in the process of reflection and change must be the client’s own narrative, not the practitioner’s theoretical model or personal biases.

Addiction tends to be accompanied by a dissatisfied world view and thrives in an atmosphere of unhappiness, mistrust and isolation. It is also closely associated with a general feeling of disorientation and discomfort with existing in the world. However, while it is overall a rather unsatisfying condition, it does come hand in hand with the longing for something more, with an itch to live a different life – a life that matters.

This is a natural human condition that addiction doesn’t eradicate. It might temporarily mask it, but it doesn’t put an end to it because people have an intrinsic orientation towards a personally meaningful life. After all, human beings are just meaning-making animals. This inclination towards purpose is important to be acknowledged and utilised as a solid foundation for the process of change, self-discovery and development of a value-driven life.

Friedrich Nietzsche picture with the quote: ‘If we have our own why in life, we shall get along with almost any how.’
Friedrich Nietzsche: ‘If we have our own why in life, we shall get along with almost any how.’

Once people feel safe within their own psychological resources, once they have a better understanding of their authentic self, and once they discover things that are of personal significance to them, they will find it substantially easier to move on from drugs and invest their time and energy in activities and relationships that are purposeful, fulfilling and sustainable on a long-term basis. And while an important part of recovery consists of learning new skills and adopting alternative patterns of thinking, feeling and relating to the world, people also need a rationale for making these changes, direction as to where they want to go, and the belief that a drug-free life is worth the effort.

Essentially, when the going gets tough, people need a reason not to give up. Or to put it in words of Friedrich Nietzsche, a philosopher whose work has been fundamental to the existentialist movement: ‘If we have our own why in life, we shall get along with almost any how.’