Four Vital Principles for Addiction Therapy

As the addict slowly but bitterly falls out of love with the addiction, with the dawning realization of how it's been playing them, they become ripe for real help.

“I have had dreams and I have had nightmares, but I have conquered my nightmares because of my dreams.”

– Joanas Salk

What can a monkey and a Simpson teach us about addiction?

Consider this 13th-century Sufi tale from Tales of the Dervishes, by Idries Shah:¹

Once upon a time there was a monkey who was very fond of cherries. One day he saw a delicious-looking cherry, and came down from his tree to get it. But the fruit turned out to be in a clear glass bottle.

After some experimentation, the monkey found that he could get hold of the cherry by putting his hand into the bottle by way of the neck. As soon as he had done so, he closed his hand over the cherry, but then he found that he could not withdraw his fist holding the cherry, because it was larger than the internal dimension of the neck.

Now all this was deliberate, because the cherry in the bottle was a trap laid by a monkey-hunter who knew how monkeys think.

The hunter, hearing the monkey’s whimperings, came along and the monkey tried to run away. But, because his hand was, as he thought, stuck in the bottle, because he refused to let go of the cherry, he could not move fast enough to escape.

But, as he thought, he still had hold of the cherry. The hunter picked him up. A moment later he tapped the monkey sharply on the elbow, making him suddenly relax his hold on the fruit.

The monkey was free [of the bottle], but he was captured. The hunter had used the cherry and the bottle, but he still had them in hand.

Okay, so you may still be wondering what on earth this has got to do with addiction… or Homer Simpson?

Homer Simpson and ancient wisdom

In this tale, the greed is built upon need. The monkey needs to eat. But if we don’t organize the completion of our vital emotional and physical needs adequately, those needs can run riot. Our lives can end up in ruin as we blindly try to meet the need in ways that harm us and others.

This is exactly what happens in addiction. If the need for, say, meaning, or excitement, or even social connection isn’t met adequately, then addiction may seem to meet that need – or at least offer a seductive promise.

Interestingly, I saw a version of the Sufi tale of the monkey and the cherry depicted in the TV series The Simpsons (you can see a clip of this here).

Like our monkey, Homer is ‘trapped’ because he won’t withdraw his hand from the vending machine by letting go. He even risks amputation rather than simply withdraw. And who can blame him? Withdrawal can be painful.

Both primates were deeply focused, to the extent that wider reality disappeared. This, too, is a central feature of addiction.

The trance of addiction

All addictions, whether substance abuse or behavioural, can be understood in relation to this ancient monkey tale.

Homer’s (and his monkey prototype’s) perception of context narrowed to a kind of trance-like focus so that he inevitably missed the bigger context that this is a trap.

For an addict, this wider context may include the effect the addiction has on their children, finances, life, and longevity. All this disappears in the moment of addictive enthralment.

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Now this isn’t to say there aren’t many and varied reasons why someone became addicted. But the reasons always come back to missing needs or peer pressure, which does, after all, play on the need to belong as well as to have status and a sense of safety in numbers.

It’s easy to see one thing as many things, but all addictions share a common root or set of principles.

Loss of autonomy, habituation, and withdrawal

True addiction always involves loss of autonomy. How in control are we? If I feel I have to drink, or smoke, or gamble, then I am addicted, because I feel I am being led by the behaviour. If I sometimes choose to engage in these behaviours but can take or leave them, I am not addicted.

The boundary between autonomy and compulsion can get blurred though. Cognitive dissonance, or ‘denial’, is rife among addicts: “I can stop any time!” or “I haven’t got a problem with it!”

Along with habituation (needing more and more to get less and less effect), addiction also produces a ‘comedown’, an uncomfortable or even painful withdrawal effect.

Before we get into some of the shared principles of addiction, I want to take a quick look at one way of looking at addiction that can cause more problems than it solves.

The disease model

Some have tried to convince us that addiction is a ‘disease’ but there is very little evidence for that theory, and much more evidence that when people meet their psychological needs in balance addiction drops away.²

Branding addiction as a medical disease is, I think, often a well-meaning but wonky way of trying to reduce judgement or stigma. After all, if it’s a disease then it’s no one’s fault. But this is problematic in that it creates the expectation that there can be no cure, only management. It also flies in the face of what we know about how stigma and empathy actually work.³ Less charitably, it may also be a way of selling more drug products.

If the addicted client gets past denial, they often fall into disenchantment and desperation at the helpless realization that the ‘hand’ now seems to be stuck fast – and the hunter is approaching.

The approach of the hunter

People can and do throw their lives away through addiction.⁴

One alcoholic I worked with told me, “Booze has taken my kids, my wife, my job, and my self-respect. And now I’ve been told I have liver cirrhosis!”

The ‘hunter’ had caught him in his trap – but he was still able to escape as the shock diagnosis of cirrhosis helped him learn to live without excessive drinking. But for those who can’t get out of the trap quickly, the hunter will soon have his way.

Does your client seem to need more and more of whatever it is they are addicted to get less and less reward? Or do they engage with the addiction simply to function, to ‘feel normal’?

It’s been found that cocaine addicts blast their neural ‘reward centres’ to the point where they can no longer feel pleasure from anything subtle.⁵ Rewards need to be gross just to register. A beautiful sunset or smile just won’t do it anymore.

As the addict slowly but bitterly falls out of love with the addiction, with the dawning realization of how it’s been playing them, they become ripe for real help.

I hope you will find the following general principles useful in helping your addicted clients. They are not intended to cover all eventualities. Some addicted people may need hospitalization, medication, or other forms of support. But even for extremely addicted people, these principles will always apply.

Principle one: Ascertain where your client is at

Are they still in self-deception mode? Do they perhaps feel that it “might be a good idea” to quit smoking but keep doing it, even as they sit there with a portable oxygen tank like it’s no big deal? That might seem like an extreme example, but one of my smoking clients (who claimed they didn’t need to quit for health reasons!) did just that.

I’ll sometimes say a variation of the following to a client as a way of presenting the pattern of their relationship to the addictive behaviour or substance.

You know, sometimes someone can seem wonderful at first. Abusers or con artists can be awfully good fun in the beginning, and we get sucked in. But eventually we start to see through them and realize they are in fact stealing from us. They’re stealing our self-esteem as they put us down and belittle us. They’re stealing our independence and our peace of mind. They may even start to physically abuse us.

We feel trapped and want to walk away from them – but they convince us we can’t possibly live without them. Still, the more we see through them, the more out of love we become. The more we want to break away…

So where are you at? Are you still taken in by that smoking/drinking/gambling, or do you see through its lies and empty promises now? Are you out of love with it fully? Are you ready to break away?

If your client is still taken in by the promises of the addiction, it’s your job to help them see through it more clearly. So find out where your client is in the cycle of their relationship to addiction, and take it from there.

Notice that applying this first principle also enacts the next one.

Principle two: Help remove it from them

A central principle of all therapy is to remove the client’s sense of core identity from their condition. Unfortunately, the trend in psychology is to do just the opposite. Labelling people is just one potentially harmful consequence of our current mania for diagnosis.

When you feel that the problem is with your central identity – who you are – it can feel like an immutable and permanent problem.

It’s a cliché to say, “You are not your addiction!” And the problem with clichés is that, despite containing vital truths, they just bounce off the mind precisely because they’re clichés – there’s nothing new or interesting about them to hold our attention.

Truths need to be conveyed in fresh and unexpected ways in order to actually change people’s relationship to their problems.

So how can we do this?

Linguistic and metaphorical methods

“I’m a smoker. It’s who I am!”

I’ve had clients say this to me. Yet no one is born a smoker or drinker or crack addict. The more our sense of identity is entwined with a habit, the scarier it can be to imagine letting it go.

If someone feels they are a smoker, it is wrapped up with who they fundamentally are, then how can they stop the habit without in some way annihilating themselves? We need to disentangle the person from the addiction. And there is an art to this.

We can gently help remove addiction from a person’s core identity through our use of language and metaphor. Stories, such as that of the mythical Greek heroes withstanding the deathly allure of the sirens, can be used to help separate the addiction from the identity of the client.

On the How to Stop Anyone Smoking Online Course we teach a myriad of different metaphors to use with smokers in order to defamilarize the habit to the extent that it no longer feels tenable for the person to continue.

I frame ‘withdrawal’ as ‘sensations of healing’ and ask the client to watch with amusement at the cigarette’s pathetic and weak attempts to con its way back into their life. This metaphor places the withdrawal pattern well and truly outside of the client.

We should always refer to the problem pattern as ‘it’, not ‘you’.

“How does that alcohol lie to you?”may seem like a strange thing to ask someone who feels they are their drinking. But notice how it strongly separates who they are as an individual from it, the drinking.

But during the throes of addiction, when the mist grows thick and all they can see is the cherry in the bottle… what then?

Principle three: Break the trance

Addiction is a kind of hijacking of the natural reward pathways in the brain.

If I learn a new guitar piece, I feel an emotional reward. I get something of a ‘high’. With time, though, playing this piece becomes routine. I’ve become habituated to it. I need to learn more and more musical pieces to get the same satisfaction. It’s the same with learning anything. This is what the reward centres of the brain are really for: to help us enjoy life and develop skills. Once a skill has been developed, the rewards start to subside.

But even more fundamentally, the reward pathways operate in order to motivate us to stay alive: to eat when we’re hungry, drink when we’re thirsty, rest when we’re tired, feel relieved when we’re safe, feel accomplished when we learn a new skill, seek out and enjoy the company of others, and of course have sex – all vital behaviours for human survival.

Survival is one side of the reward pathways coin. The self-sabotage of addiction is the other. But make no mistake, it’s the same coin.

The evil amnesia of addiction

A group of researchers asked a subsection of alcoholics living rough what they hoped to gain from drinking ‘meths’ (methylated spirits) before they did so.⁶ They all said they hoped to feel better. When the researchers asked them how they felt after drinking it, they all said (not surprisingly!) they felt worse.

The addictive trance makes us forget the downsides in the moment. When we expect something we feel we must have, we get a surge of dopamine in our brain, which makes our expectations about what we hope is about to happen positive and exciting.

Dopamine is known as the ‘motivating’ chemical, and unless it’s hijacked by addiction it tends to motivate us towards doing what is good for us. Once we have completed what we set out to do (learn that guitar piece, drink that water on a hot day), we then get a sense of satisfaction and completion. This is mediated by the opiate reward systems, which work together with dopamine to help us survive and thrive.

But the heady throes of desire make us forget the bad times and just recall the good feelings associated with the addiction. We forget that, actually, the addictive behaviour doesn’t really fulfil us. In fact, it often makes us feel much worse.

Dopamine-laced memories block out realistic memories of the consequences of the behaviour. We forget that the bingeing will make us feel ill and disgusted with ourselves, that the drinking will make us feel lousy, that the gambling will leave us with an empty feeling in our gut when we inevitably lose. These memories are blocked out when the addictive trance descends because of the distorting effects of dopamine on recall.⁷

But what if they weren’t?

Total recall

No chronic gambler is truly in touch with the shame of losing his house just as he’s about to place another bet. In this moment, the memory of that has vanished.

Addiction shuts down awareness of wider context. But what if we could help our clients access wider contexts so as to ‘spoil’ the addictive trance? What if we could give them a visceral sense of the consequences as they enter the addictive trance? Then we could help them escape the trap before they enter it.

Well, we can do this – both hypnotically and cognitively.

I talk to my clients about the comedown after smoking or drinking or doing drugs all night, or the shame of facing loved ones secretly knowing you’ve lost thousands gambling. I have them access the actual feelings hypnotically, with eyes closed.

Next, I encourage them to hypnotically evoke the high of addiction. Then I take them straight from that feeling to the consequent comedown by simply asking them to open their eyes again, then close them and access the downside feelings. In this way we can start to merge the feelings of (a) motivation to engage in the addictive substance/activity, and (b) the comedown after having done so. Doing this repeatedly can sometimes merge the desire and the comedown to the point that the addiction immediately feels repellent.

I did this with a chronic slot-machine gambler. By having him evoke all the negative experiences of losing money, we polluted his addictive desire with the reality of what he was doing. Last I heard, his parade had truly been rained on and he had never gambled since.

Note that this isn’t the same as trying to use willpower. Rather, we’re changing the very nature of the blinkered, amnesiac addictive trance itself.

Principle four: Outwit the addiction by getting needs met healthily

Most people who go through a period of excessive drug or alcohol usage will mature out of the behaviour as they acquire new interests and responsibilities.⁸ They begin to meet their needs in healthy ways, which enables them to lead a healthier, more balanced life.

But continuing to try to meet an emotional need though a ‘quick fix’ can get you in a fix quick – and keep you there.

Within the addictive trance is a sense of promise. Promise that fundamental needs will be satisfied. This sense of promise may be implicit, embedded within an unconscious expectation that all will be well when I get my fix.

But addiction never delivers what it seems to promise. It’s a con played on those who don’t, for whatever reason, meet their primal needs in balance.

Loneliness, boredom, anxiety, meaninglessness, and so forth all make us vulnerable to addiction. They are not excuses; they are emotional signals that the client is in need of something. Just not the something they’ve been seeking.

Engine oil is a liquid just like water, but trying over and over to quench your thirst with it will never work. You need to find a source of genuine water.

When we help clients become free of addiction and begin to both understand their real needs and meet them healthily, the raison d’être of addiction falls away.

What’s more, we can help our clients in ways that mean they don’t have to exchange one dependency for another, for example by joining a permanent support group as the ‘price’ they have to pay for overcoming the original dependency.

Work hard to help your client both understand and meet their needs sustainably.

So to sum up:

• Ascertain where your client is at. Are they well and truly out of love with the addiction, or do they still view it through a distorted lens of affection?
• Help remove your client’s sense of who they are, their core identity, from it, the addiction, so that when they separate from it the freedom feels natural.
• Help break the trance of addiction by helping your client access all their memories, both positive and negative, as the addictive trance descends upon them.
• Teach your client about their primal needs and help them develop a life that intrinsically meets those needs – for real.

The monkey was trapped – and maybe the hunter was, too, if he couldn’t help but hunt monkeys.

If humanity is to avoid the trap of addiction and be truly free, we need to understand that trap inside out.

Getting round the trance of addiction

Using trance to treat the addictive trance state may sound strange at first, but once you understand the psychological principles at work, it makes perfect sense. If you don’t yet incorporate hypnosis into your work, take a look at Mark’s online course Uncommon Hypnotherapy.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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