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By: Rick Fannin
How Addiction Is Just a Symptom: Learning to Identify and Deal with The Core Causes and Conditions
Ok, let me go on the record in saying, "Addiction is not the problem." Yep, that is right. Your drinking or your drug use is not the problem. Our addiction is just a symptom of the problem. The chapter How it Works from the AA Big Blook states, "Our liquor was but a symptom. So, we had to get down to causes and condition" [1, p. 64]. After working on my recovery from alcohol, cocaine, sex, and pornography and working towards my Master of Science in mental health counseling, I'm convinced that this claim made in 1939 by Bill W and Dr. Bob is indeed a fact.
We often make the mistake of working on the perfect solution for the wrong problem. That is the mistake that many of us make in our attempts to recover from addiction. We may have been in denial for a long time regarding the damage that our alcohol and drug use has caused in our life, and in the lives of those around us. When the fog of denial clears, we gain visibility to this damage; we become convinced that our drug or alcohol use is the problem. We enter rehab confident that if we could just overcome our substance use, life would be good. However, this illusion baffles and frustrates us in early recovery. When the pain of addressing the wrong problem becomes great enough, we feel hopeless and return to the only solution to our problems and begin drinking or using drugs again.
How is addiction a symptom? How to identify and deal with the core causes and conditions? We will attempt to answer these questions and more so that you gain clarity as to the real problem and begin to fix the things in your life so that you can experience true joy and happiness in recovery.
If Addiction is a Disease, then How Can Addiction Be a Symptom?
The debate over the causes of addiction has raged on for years. There are over 200 theories and models regarding the causes of addiction, including choice theory, moral model, temperance model, characterological motel, educational model, and the medical model of addiction.
As viewed by the medical model, addiction is a disease with biological, neurological, genetic, and environmental causes. The traditional medical model of disease requires only an abnormal condition that causes discomfort, dysfunction, or distress to the individual afflicted. The contemporary medical model attributes addiction, in part, to changes in the brain's mesolimbic pathway. The biological changes in the brain are the reason why we continue to crave and use substances despite their overwhelmingly negative effects.
There is overwhelming evidence that supports the biological alterations within the brain, which are part of the disease model, or medical model, of addiction. So if addiction is truly a disease, how can AA's claim that addiction is a symptom of underlying core causes and conditions be valid?
Before we directly address that question, let's look at a similar set of symptomatic diseases that are caused by underlying core causes and conditions. I doubt that there would be any debate that heart disease, diabetes, gallbladder disease, asthma, and cancer are all forms of diseases. However, what might be the underlying core causes and conditions behind these diseases? Obesity is from the chronic consumption of food where the caloric intake of food far surpasses the body's energy needs, resulting in excessive weight gain. As we continue to put on pounds, our "Body Mass Index" increases, and once BMI is above 30, then we are at risk of developing a number of health problems, including the above diseases.
So then is overeating, the underlying core cause, any condition resulting in the symptoms of high blood pressure, heart disease, diabetes, and other diseases. It certainly is a cause that contributes to these diseases, but it is likely the symptomatic cause and not a core or primary cause. What is essential is to examine then why someone would overeat. For example, someone might overeat when they are depressed, bored, due to low self-esteem, or because they grew up in a home where food was the primary with that love and affection were shown. For each of these causes that contribute to the symptom of overeating, we must then determine if it is the primary cause or if it is yet another symptom of another underlying core cause and condition. However, the root of many of these core causes and conditions is often found because we, or others, did not adhere to Biblical instructions. In the cause of overeating, we are breaking the commandment, include but are not limited to the verse below:
- failing to present our body as a living sacrifice that is holy and acceptable to God (Romans 12:1)
- the discipline of our body and keep it under control (1 Corinthians 9:27)
- failing to glorify God with our body (1 Corinthians 6:20)
- failing to give God glory in everything that we eat or drink.
This example provides you with a framework to view addiction as:
- A disease due to the biological and neurological changes that occur within the brain; AND
- The disease of addiction is a symptomatic disease caused by underlying causes and conditions; AND
- The root, primary, core cause is often the breaking of Biblical instructions
Common Model of Addiction
Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions, including etiology, course, and neurobiology. While there is a high co-occurrence rate with substance abuse and mental health issues, there is also a high co-occurrence rate with substance addiction and other behavioral addictions, including gambling, internet 38%, compulsive buying 46%, and sex addiction 64% (Kim & Hodgins, 2018). Common to all forms of addiction is the "failure to resist an impulse or urge, leading to persistent engagement in the behavior," "despite recurring harms" 
Common to all addictions are six core components of salience, mood modification, tolerance, withdrawal, source of conflict, and relapse  . Each form of addiction shares common risk factors such as adverse childhood experience or childhood trauma, dysregulation in neurobiology systems such as the dopamine reward system, impulsivity or delayed gratification control, emotional dysregulation, lack of social support, dysfunctional relationships, or interpersonal conflict within the individual's life . Regardless of component addiction, each shares a common set of variables, including lack of motivation, disposition of acting rashly in response to strong emotions, lack of self-control, expectancies, motivation for engagement in addiction, support system deficits, executive functioning deficits, and compulsivity .
Relationship conflict has been a common factor in the addict's life . The addict may develop an attachment to the source of addiction in place of attachment to meaningful or healthy interpersonal relationships . Our relationship with our drug of choice, while toxic and abusive, becomes the most significant ad important relationship in our life.
What Are The Core Causes and Conditions Behind Addiction
While it is still not simple, getting sober turns out to be the easy part of recovery. Anyone can stop drinking or using drugs, but it is staying stopped that we struggle with the most. The other part of the recovery process, and the far less glamourous part, is accepting that your substance abuse, or behavioral addiction, was actually a symptom of something more profound. This realization will inform and complicate how you relate to yourself, your life, and everything in it for as long as you live. So, what are the core causes and conditions behind addiction?
Jacobs (1986), as cited in Kim & Hodgins (2018), proposed two common risk factors for developing any addiction: chronic hypo-arousal or hyper-arousal and maladaptive schemas as inferior-self. This means that we are either overly sensitive or lack emotional sensitivity, and we tend to have poor self-esteem and self-worth. These factors can contribute to various mental health disorders such as anxiety, depression, substance abuse, or behavioral addiction.
Many of our problems are rooted in the experiences from our early childhood years, neglect, abandonment, or from the experiences of trauma. We tend to have trouble trusting others or trusting ourselves and, as a result, may have attachment insecurities. We either are overly attached and preoccupied with our relationships, or we fearfully stiff-arm others and avoid close intimate relationships. These experiences were painful, and often we held deep-seated resentments against others, ourselves, and God for allowing these things to happen in our life.
We lived our life attempting to minimize the pain and maximize the pleasure. Our attempts to avoid our underlying fears and negative emotions were often the driving factors behind our relentless pursuit of pleasure-induced addictive behaviors. We simply wanted an escape, and a reprieve from the reality of life as the reality of life often did not align with our expectations of what life should be like. This realization often left us lashing out in anger, further damaging our ever-shrinking social support, often leaving us feeling totally isolated and alone.
While addiction may be a disease, those who suffer from the horrific grip of substance use disorder also suffer from numerous underlying causes and conditions of addiction that either create, advance or exacerbate the addiction. Here are some of the chief causes and conditions of addiction.
Mental Health Issues.
While many people like to talk about terms such as co-occurring disorders or dual diagnosis, addiction experts for years have known there is very little separation between addiction and mental illness. While certainly, a person can suffer from just addiction or just mental illness, they typically go hand-in-hand. Many people who have a substance use disorder also develop other mental illnesses. Likewise, many people who are diagnosed with mental illness are often diagnosed with a substance use disorder. An estimated 40-75% of those who struggle with addiction also have Co-Occurring Disorders (COD) of trauma-related disorders or Post Traumatic Stress Disorder (PTSD) [5, 6, 7, 8], have more significant substance use , and have poorer mental health and SUD outcomes . This is one of the reasons that it is vital to get treatment not only for the addiction but also for the underlying co-occurring mental health disorders.
There is a distinct and robust link between trauma and addiction behaviors. This trauma may have occurred in adulthood, but childhood trauma often leaves the most profound emotional wounds that are self-medicated with drugs or alcohol.
A person's childhood plays a vital role in mental and emotional development. Traumatic experiences often profoundly affect underlying core beliefs and how people cope with their emotions and react to situations.
Over the last two decades, it has become clear that many of us with addiction to alcohol or drugs have a history that includes traumatic events. Research suggests a substantial overlap of trauma to addiction:
- 4% of individuals with lifetime PTSD also met the criteria for SUD
- 9% of women with lifetime PTSD also had SUD
- 9% of men with lifetime PTSD also had SUD
- Women with PTSD were 2.48 times more likely to meet the criteria for alcohol abuse or dependence and 4.46 times more likely to meet criteria for drug abuse or dependence than women without PTSD
As a result of trauma and its aftermath, drugs and alcohol become our addictive higher power, allowing us to self-medicate the pain away. In this way, drugs or alcohol becomes a coping mechanism for emotional survival. However, obsessive-compulsiveness of drugs or alcohol use impairs our judgment and decision-making, leading to risk-taking behaviors and putting us in situations that significantly increase our likelihood of additional trauma.
Without professional help, trauma, trauma-related disorders, and PTSD can be devastating and have a lifelong impact on the individual and their family. After all, trauma and PTSD can make day-to-day tasks and relationships extremely difficult.
When the emotional pain becomes too much, people may turn to drugs or alcohol to hope. While the relief from substance abuse may work temporarily, this is an unhealthy way to cope with emotions. Sometimes, this substance abuse becomes compulsive and habitual. As a result, a person who abuses drugs or alcohol to cope with trauma can quickly become addicted.
Individuals with COD of SUD and PTSD report higher levels of cravings in response to trauma-related cues resulting in a higher frequency of SUD relapse . The Substance Abuse and Mental Health Services Administration SAMHSA) National Survey of Substance Abuse Treatment Services reports that only 38% of addiction treatment centers consistently offer trauma-related counseling. Oy 50% of substance abuse treatment centers routinely conduct a comprehensive mental health assessment .
Years of self-medicating to dull out trauma can create unique obstacles in the path to recovery. Consequently, people suffering from trauma and addiction benefit immensely from professional addiction treatment and trauma therapy.
If trauma is left untreated, a person may work endlessly to stay sober only to find themselves replacing substance abuse with other addictive, dangerous coping habits. As a result, before one can recover from addiction, one must begin healing from past trauma.
Addiction is about isolation. Addiction isolates us from those who love and care about us. Addiction separates us from God and disconnects us from the genuine and authentic version of ourselves. Recovery is about reestablishing these connections. However, these authentic and secure connections with others are complicated for many recovering from drug or alcohol addiction. Recovery from addiction is more than just stopping drinking or using drugs. Full recovery includes repairing attachment insecurity, thus allowing the person to connect with God and others securely. In doing so, they discover and connect with the authentic version of themselves.
The way we connect with others, referred to as our attachment style, is formed in childhood. The interactions between the child and the primary caregivers create an internal working model representing the child's beliefs about self, others, and the future . Our attachment style influences our perceptions of emotional intimacy, communication style, response to conflict, and relationship expectations. Research has shown that the degree to which people can regulate emotions is determined by the strength of their earliest attachment experiences . This attachment style formed in our early years can impact the quality and structure of relationships formed in adulthood.
Research has shown that the majority with addiction, be it drugs, alcohol, sex, gambling, food, video gaming, or other behavioral addiction, do not have secure attachments   . Alcoholics and addicts are particularly counter-dependent individuals, living their lives in the extremes of overly preoccupied relationships to the other extreme of isolating and pushing all supportive support away . A recent study of individuals in addiction treatment observed 86% of these patients had insecure attachments instead of the non-substance abusing group, where 42% had insecure attachments .
Those with insecure attachments were unable to connect and attach to people securely . Instead, they found an alternate substitute in which to connect securely  . For substance abusers, they found that drugs or alcohol provided those same qualities as what should have been provided by the caregiver . Drugs and alcohol had a direct effect; it was consistent, it supported the addict or alcoholic's emotional needs, and while drunk or high, they felt ten feet tall and bulletproof. Much like a child's love for a parent, the addict or alcoholics' love for booze or drugs was unwavering.
While attachment insecurity may have contributed to addiction, this attachment insecurity creates stressors and barriers while in recovery. Research has also shown that insecure attachment styles may influence attachment security to God or a Higher Power, a foundation of the 12-steps . Consider how the characteristics of each of the insecure attachment styles can create significant obstacles in recovery.
Assessment of attachment style while in treatment from addiction can add valuable insight to possible stressors and barriers in recovery. The counselor can work with you on intervention strategies to improve emotional and interpersonal functioning .
A person who has spent years struggling with addiction has robbed themselves of their self-awareness. They often wander in a space where their emotions are out of control, core values are lost, beliefs and thoughts are twisted and distorted, unaware of their strengths, and frequently tripping over their weaknesses. Dysfunctional behaviors continue to disrupt life, relationships, and hope for a better tomorrow.
Self-awareness is the ability to see yourself clearly and objectively through reflection and introspection. Self-awareness involves being aware of different aspects of the self-including traits, behaviors, values, beliefs, and feelings. Self-awareness plays a critical role in understanding ourselves and how we relate to others and the world.
Abusing drugs or alcohol creates significant changes within the brain. Research has found that individuals who have abused drugs or alcohol experience alterations in the area of the brain called the prefrontal and anterior cortexes, and these changes reduce their self-awareness.
A lack of self-awareness causes negative impacts on the addict's life and dramatically reduces their ability to live in the present and effectively plan for what is ahead. Emotions are often out of control for these individuals, and they cannot call upon any inner strength or insight to regulate these emotions. With self-awareness, we are uncertain about our beliefs, core values, and motivations, and we struggle to control our emotions. Without self-awareness, an addict experiences a severe downward spiral, with their life wildly out of control.
Self-awareness is vital to recognizing your strengths, setting goals, redefining your beliefs and values, identifying thinking errors, communicating effectively, and identifying and responding to triggers and relapse warning signs. Without self-awareness in recovery, it is like you are walking through a minefield with a blindfold on, and utterly unaware that you have a metal detector strapped to your back and a radio on your side that you could use to call for help.
Becoming more self-aware is a challenging process. Your success depends on your willingness and receptiveness to change and the time and commitment necessary to hone your self-awareness skills.
People who are in recovery work on their self-awareness in a variety of ways. Talking about their feelings and thoughts in one-on-one or group therapy sessions can help them make positive changes in their lives. They may also keep a journal, practice "self-talk" conditioning, or engage in art or music therapy to better put them in touch with their feelings and thoughts. This is referred to as comparing against our standards of correctness. We do this daily, using these standards to judge the accuracy of our thoughts and the appropriateness of our behaviors. Using these standards is a significant component of practicing self-control as we evaluate and determine whether we are making the right choices to achieve our goals.
At its most basic, shame is an emotion, but it has more significant physiological ties than many other emotions. In fact, shame triggers the same sympathetic nervous response as fear, putting the individual into a state of flight, fight, or freeze. When shame becomes internalized and pervasive in our lives, we live in a constant state of fight, flight, or freeze. Often this starts from early childhood, where parents are always negative and emotionally harmful to the child by making statements that the child is unloved or unwanted, is a failure, cannot do things right, is terrible, or is unattractive unintelligent. Some people consider this "core shame," and it is not the same as shame over a given event in how we responded.
Over time, and with these types of negative messages, the individual begins to have very deep and extensive feelings of inadequacy. Still, they see themselves as the reason they are unloved and unlovable. Suppose this is not corrected and a positive message instilled in the child. In that case, this shame continues to grow and fester, creating low self-esteem, anxiety, depression, perfectionism, and increased codependency risk.
Toxic shame is a feeling that you're worthless. It happens when other people treat you poorly, and you turn that treatment into a belief about yourself. You're most vulnerable to this type of poor treatment during childhood or as a teen. When you feel toxic shame, you see yourself as useless or, at best, not as good as others.
Many people who struggle with substance abuse problems and addiction have experienced trauma or long-term patterns of dysfunction in their lives. While growing up, trauma and difficulties in the environment can cause some people to use drugs and alcohol to cope with their emotions. These two things can also cause toxic shame, which feeds an addiction.
Individuals with a deep and ongoing shame of themselves are, by nature, isolated with deep and closely held feelings of being unworthy and unlovable. This, in turn, is linked to depression, and the use of alcohol and drugs is often initially a form of self-medication.
Additionally, the use of alcohol and drugs creates different feelings of shame. They also lower self-esteem and contribute to the constant cycle of seeing yourself as inferior or unable to cope. Significant and influential intervention can only stop this downward spiral.
People who feel unworthy of being helped or even asking for help rarely seek professional services on their own, but they will often seek help for addiction when prompted by family and friends.
Toxic shame contributes to addiction because it causes people to develop skewed images that further motivate them to seek comfort in substances. Toxic shame leads to lower self-esteem, hiding of emotions and aspects of personality, negative self-talk, increased risk of anxiety and depression. These things can cause someone to turn to drugs and alcohol or make an already-existing addiction worse.
Finding a safe and supportive environment to be able to talk about your shame openly does wonders in helping to overcome toxic shame. In addition, working with a counselor can help to identify and correct any underlying negative core beliefs and negative thinking patterns that contribute to toxic shame and addiction.
Automatic Negative Thoughts (ANTS)
For many with addiction, drugs or alcohol were used to cope with strong negative emotions. But then, the damage caused by our addiction created even more unpleasant thoughts and emotions and, we use them again to numb out this pain. The cycle of addictive destruction spirals out of control.
Our thoughts, feelings, and emotions, and our behaviors are all interconnected. The way we think impacts how we feel, and how we feel impacts how we behave. It works the other way too, our behaviors (like a relapse) impact the way that we feel (guilt, shame, hopelessness), and this impacts our thoughts (I am a horrible person, It is never going to get better").
In the rooms of AA, you may hear the phrase, "We didn't have a drinking problem; we had a thinking problem." Distorted thinking is a common cause of many problems, such as anxiety, depression, and addiction. We hate it when someone lies to us, but often, we don't even notice when we lie to ourselves with our twisted and distorted thinking. We may minimize, rationalize, or justify our drinking or drug use, which keeps us trapped in denial and digging away for our next rock bottom. We may blame others as the source of our problem, keeping us trapped in the cycle of addiction. Our twisted thinking may convince us that things are not as bad as they really are or that we have the power to stop on our own, but we finally realize that we are powerless to do so.
Negative and distorted thinking can manifest in a number of ways. It can be internalized or projected, and it can occur on a large or small scale. Fixating on negative thoughts can be a de-motivator, affecting the person's ability to function normally and have healthy relationships. Research has shown that people develop these distortions in thoughts to cope with painful life events. It's a kind of emotional evolution in that our beliefs and thoughts evolve to survive the emotions associated with pain in our life. And, the more prolonged and severe these painful life events are, then the more likely it is that our belief and thought system gets more and more twisted or distorted.
Cognitive-Behavioral Therapy (CBT) is an evidence-based practice that is used widely in addiction treatment. CBT teaches recovering addicts to find connections between their thoughts, feelings, and actions and increase awareness of how they impact recovery. CBT also teaches the skills to identify and correct negative thinking patterns which contribute to negative emotions and dysfunctional behaviors.
A God-Shaped Hole
People in the room of 12 Step fellowships such as Alcoholics Anonymous and Narcotics Anonymous will recognize these underlying causes and conditions with little problem. 12 Step fellowships define addiction or alcoholism as a physical allergy, mental obsession, and spiritual malady. The spiritual malady is often described as a "hole in the soul," or a "God-Shaped Hole" type of disconnection between the addict or alcoholic and the world around them, or just feelings of difference and not ever feeling comfortable or fitting in quite right.
The Big Book describes it as feelings of being "restless, irritable and content" while sober. Much of this stems from a self-centered perception that addicts and alcoholics have of themselves, only seeing things as they relate to themselves and their circumstances. Another common trait is feeling "less than" and constant negative self-talk resulting in feelings of "I'm not good enough," "I'm a piece of crap," or "I don't deserve happiness." Underlying fear, doubt, insecurity, and self-esteem issues are common amongst most people who suffer from substance use disorders.
For many of us with addiction, we have felt like something was missing for most of our life. There has been a general emptiness or void that we have tried hard to fill. We may have felt like we never fit it, so we tried to blend in. We may have felt like we just never really connected with others. We may have felt like we would never find someone that we could really trust. We may have always been searching for that next thing that would finally fill the emptiness within us.
We may have tried just about everything: Gambling, sex, alcohol, drugs. Each of these would fill the void for a moment, allowing us to escape, allowing us to feel "normal." But, when that high rush was gone, we were left feeling even worse than before. With each use or from each new consequence, we were flooded with emotions of guilt, shame, resentments, anger, doubt, and an overall sense of hopelessness. Our self-worth plummeted along with our hope of finding a solution to what was missing from our life.
Famed psychologist, and understudy of Freud, Carl Jung proposed the idea of a "God-Shaped Hole" that exists within each of us. Jung proposed that until this hole is filled with its intended source, an emptiness plagues the individual and an unquenching thirst to fill this void. As the individual struggles to quench this thirst, they may discover many things that appear to do so. However, this euphoric exhilaration is short-lived and a cheap substitute for an authentic spiritual experience. Once the short-lived euphoria starts to fade, the desperate, thirsty individual must either consume more and more to chase the euphoria, or they must find an alternative, more powerful way, way of achieving a state of satisfaction.
Pain from the longing for something "more" pushes the addict to seek relief in alcohol or drugs . When a connection to the transcendent or Spirit cannot be found, intoxication provides a cheap substitute for an authentic spiritual encounter. When allowed to have a truly transcendent experience, research shows that alcohols and drug addicts decrease their substance use . This spiritual experience, as described with the AA Big Book and as researched and validated by scientific research, is a profound phenomenon that propels us away from drugs and alcohol and in search of a closer relationship with God. For the alcoholic or addict who had discontinued substance use but has not yet had this spiritual encounter, they may be described as a "dry drunk." They are irritable and angry that they gave up substance use, but they still feel a deep emptiness inside of them.
From this theoretical model, we see the phenomenon of addiction as spiritual sickness and a misguided attempt to fill the "God-shaped hole." Combining this with the theoretical models of addiction as a disease, we can see how the chronic attempts to fill this God-shaped hole with drugs or alcohol result in brain alterations which become the basis of the disease of addiction. Finding a Spiritual connection and filling the God-shaped hole is vital to recovery.
Addiction is often described as a selfish disease. Addiction is a disease, but chronic abuse of drugs or alcohol is a selfish act. The difference is a significant distinction to make. Whether it takes the form of having a few too many beers, sneaking an extra pain pill, or shooting up with fentanyl, no one engages in substance abuse as a way to make someone else's life better. We do it for ourselves, we like the way it makes us feel, and we do not like how we feel without it. There is nothing about abusing drugs or alcohol done out of care, love, concern, or consideration of others. We merely do it for ourselves.
Part of recovery involves recognizing the human tendency toward selfishness, taking responsibility for the consequences of selfish behavior, forgiving others and the ridding of resentments, making amends when we have harmed others, and relinquishing control over oneself and others. Selfishness can be a lot like fire: When controlled, it can make life better. When uncontrolled, self-will, selfishness, and self-centeredness can destroy everything in its path.
The remedy for selfishness and self-centeredness is found in Step 3 and our decision to turn our will and our life over to the care of God. In doing so, we trade our life ran on self-will for God's will. We change conflict for harmony, pain for peace, and fear for faith. With the help of God, we rid ourselves of these character defects we become closer aligned to the way that God has intended each of us to live our lives. We discover peace and serenity like nothing that we could have ever imagined.