Developmental Disturbances within Addiction Populations

What to expect in this episode:

1. Understanding areas of identity, emotion regulation, emotional awareness, cognitive ability
2. Jean Piaget was interested in was how human beings transform, that’s what growth is: growth is transformation.
3. There are developmental disturbances in every single person coming into treatment.

Developmental Disturbances in Addiction Populations

We have got these areas of identity, emotion regulation, emotional awareness, cognitive ability (my ability to think in more complex ways) that’s actually worth understanding.

There was a guy named Jean Piaget, who was one of the founders of Developmental Psychology, he was also a revolutionary biologist, a mathematician… a deep brilliant man, study Jean Piaget.

Jean Piaget spent huge parts of his life watching kids play. What he was interested in was how human beings transform, that’s what growth is: growth is transformation.

He was particularly interested in the uniform, universal ways that human beings grow, learn, change and transform in predictable periods under predictable circumstances. What he discovered was that human beings cross-culturally, and cross-gender, grow in particular ways.

For example, if you ask a 3-year-old to do multiplication, it’s not going to happen. Around 4-5 years old kids can start to add up oranges.  One orange plus two oranges makes 3, 2+2 is 4, they can do addition. If you ask them to do mathematics, they actually do not have the structure of the mind, the capacity in that moment, manifested to be able to do abstract math. It doesn’t operate as easily in things that you can grab and do, in more complex abstract, mathematical terms.

That’s in every area of our life, so development is having more complex and nuanced ways of interacting and thinking about the world as we grow older. That’s cognitive development, and we have all these areas of cognitive development, emotional awareness, emotion regulation, identity… and then one that’s very rarely talked about by psychologists because it’s very controversial.

It’s at the core of being human, which is moral development. How I think about issues of right and wrong and my understanding and ability to articulate to myself why I think something is right, and why I think something is wrong. In all of these areas, we can develop uniformly, and in all of these areas, we can become disordered.   

What you’ll find if you do some psychometric testing on people in the addiction population, or you do developmental testing in all of these areas, you’ll find that there are disturbances in every single person coming into treatment. My parents actually who are developmental psychologists did a longitudinal study of 700 people coming into treatment, and all 700 people had an identifiable developmental disturbance outside of the norm of the population. It’s the same kind of developmental disturbances that you see in a mentally ill population, and also the criminal population, and as we know there is a great overlap between those populations.

Part of recovery, if that’s part and parcel of addiction and developmental disorders, then part and parcel of recovery is treating those developmental disorders. First, we have to be able to identify them, people will say when somebody comes in (to recovery), clearly you’re stuck and you can almost feel people when they’re having issues and coming into treatment beyond addiction. But understanding what areas they’re stuck in is much more complex and it’s one of the areas that’s going to have massive development in treatment.

Guess what, you’re not stuck cognitively, you’re stuck emotionally, ok how do we deal with that? Guess what, you aren’t stuck cognitively or emotionally, you’re stuck in your identity and your vision of seeing yourself. These areas are well researched in the field of psychology and we even have therapeutic approaches to deal with them. What we haven’t developed well is a method to identify and then treat that in the addiction population. That’s what’s happening right now and one of the things we do in our treatment program.

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Treatment for co-occurring disorders is vital to successful addiction recovery

Developmental Splits & Boundaries

What to expect in this episode:

1. A major developmental split we see is the split between self and other.
2. Really Good Boundaries equate to really good mental health. Psychosis is an extreme example of this imbalance
3. If you ever stumble upon a person on the street of LA experiencing psychosis, you notice they might cuss

Developmental Splits in the Psyche

One of the things that we work with in recovery are called splits, and splits are part of the psyche, part of the self that split off from each other and are not communicating well with each other. A common example would be my cognitive capacity, my ability to think and reason, and my emotional capacity. Those two capacities should grow together relatively close.

A split is where one area of the self or structure of the mind continues to grow, and the other one gets stuck. So let’s say I continue to grow cognitively; I go to college, I am able to reason and think well. But for some reason, usually some kind of trauma or traumatic dynamic or drug use, I don’t grow in the area of emotion regulation. There you have somebody who is very reasonable and under stress is 7 years old. Throws tantrums, we all know people like that who we can say the tail wags the dog. They are very reasonable, they’re smart, sophisticated, and mature when it comes to their thoughts, but emotionally they’re tyrants. That is a split, between emotion regulation and cognitive capacity.

One of the major splits we deal with is the split between self and other. I have to negotiate and navigate the interpersonal sphere and I have to constantly understand where I stop and start, both in my field of existence and in my boundaries. In fact, you can equate mental health directly to how good my boundaries are. Really good boundaries basically equal really good mental health.

An example of bad mental health, meaning mental health that has really gone chaotic or awry is psychosis, someone who is clinically detached from reality, someone who is psychotic. If you have ever walked the streets of San Francisco or downtown LA and you see a psychotic person, one of the things you’ll see is they have terrible boundaries. They will cuss you out right in your face and you’re like wait a minute here.

Mental health and boundaries are pretty much equated and one of the areas where people need a lot of work when they come into recovery is figuring out how to navigate and negotiate Self and Other. It’s easy to pull back into myself, it’s easy to accommodate into the other, figuring out how to navigate that in the complexity of our lives. For some people that’s really easy with friends and family, well I don’t think for anyone it’s easy, but they’ve adapted to it and know how to do it, but they don’t know how to do it in multiple roles. It’s a certain level of development. How can I be a husband, a father, a worker, an employer, an employee, a friend?

These are different roles with different boundaries and different demands and different competing claims.  Part of mental health and maturity, and part of recovery is becoming attuned to those fields and figuring out my general boundaries and my specific boundaries in each moment and each role. It’s a tremendous amount of work, and it’s why recovery is so hard. You’re not just treating your drug addiction, you’re also figuring out how to live well. Living well means figuring out how to navigate what it means to be a self, and what it means to care about the other.

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We can help you begin to heal the splits in the psyche

The Relationship Between Development and Addiction

What to expect in this episode:

1. The relationship between development and addiction
2. The Unbroken Brain Looks at addiction as a developmental disorder
3. You’d be shocked if you actually sat with someone who was in some sort of distress and said, “what do you feel right now”? And they could not answer.

The Relationship Between Development & Addiction

One of the ways to understand addiction, that recently became popular, that I’ve been engaged in, in this blog or this conversation for 8-10 years, is the relationship between development and addiction.

There was actually a popular book called “The Unbroken Brain” which was looking at addiction as a kind of learning disorder. That’s complicated and there are parts of it that I like, parts of it that I don’t. Putting that aside, I think to look at addiction as a part of the developmental process and when addiction becomes full-blown addiction as somebody being stuck in their development is a really insightful way to understand what’s happening with people in their addiction.

I have never met somebody who is coming into recovery from addiction that is not stunted in some particular areas of the self. That is not stuck or split in a particular area of growth in a statistically identifiable way.

So the most common example, that makes a lot of sense to people, is when people stop growing in the realm of emotional awareness and emotional regulation but grow in other areas. That makes sense, right?

Addiction could be categorized as an impulse disorder, in some ways. I can’t stop myself from impulsively engaging in this behavior over and over again.

What is an impulse disorder? It is the inability to regulate my cravings and emotions. On top of that, there is another area, which is around emotional awareness; actually not being aware of what’s happening inside of me.

You’d be shocked if you actually sat with someone who was in some sort of distress and said, “what do you feel right now”?

To have them label their feeling, and for huge parts of the population both in the recovery population and otherwise actually aren’t very good at identifying and being aware of their feelings. Being aware of your feelings is somewhat of a prerequisite to being able to work with them or regulate them.

If you don’t know you’re having them in any real way, cognitively, it’s hard to step back from them and do something about them. And just telling someone to relax usually isn’t helpful.

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We can help you find a way to bridge the gap between belonging and autonomy

The Battle Between Autonomy & Belonging

What to expect in this episode:

1. one of the most complex realms to navigate when were in recovery is the social, is the  interpersonal, is the areas that we get connected and disconnected
2. One of the things we are working on within recovery, and it’s deeper work, is we’re working on these internal developmental splits
3. How do you bridge these two conflicting desires? How do we stop leaning too hard into one or the other? Strength through compassion. Compassionate strength. A place where people feel the most whole. 

The tension between autonomy and belonging

There is a common meme that was floating around in recovery, I think it was in a ted talk based on this study, It said the opposite of addiction is not sobriety, the opposite of addiction is connection

And people love that, they love it because it holds truth. It holds a lot of truth.

Probably one of the most complex realms to navigate when were in recovery is the social, is the  interpersonal, is the areas that we get connected and disconnected, intrapersonally inside of ourselves, and interpersonally with each other.

What you see with people coming into recovery is you’ll see what I call splits. And splits are…. Dis-Integrated. They are areas of the self in the way that we interact that are not in communication with each other.

It’s often why when were talking about human beings we talked about our different parts. Our yin and our yang, our shadow, those kinds of things – the little devil on my shoulder, the angel on my shoulder,

You think about the start of these different… subpersonalities, these archetypal characters that exists inside of us often though subpersonalities are split

So, the person who is really mature and articulate – I can be very mature and articulate – and then one of my children spills the milk, then suddenly I’m my nine-year-old self. It kind of comes out. Or I have a trickster part of me. Different parts of myself.

So one of the things we are working on within recovery, and it’s deeper work, is we’re working on these internal developmental splits. These areas that are unintegrated because we’re shooting for some kind of Integrity.

One area were people are split, they are unintegrated that’s a really common and people struggle with it deeply, they’re in deep conflict when they come into recovery is…

The tension between autonomy and belonging

What that means is, as I’m growing and developing in my adolescence I’m trying to figure out how to become more autonomous.

More self-contained, more in myself. Especially as I’m moving away from my family system and then eventually I’m figuring out how to navigate the relationships in my friendship system in a way that doesn’t take too much for me.

So I can still have some sense of autonomy and self. So there is this tension that exists in being human between the pull of autonomy – living life as an embodied creature on my own – and belonging. We’re tribal familial creatures that crave deep connection.

But if I’m too much on either end I’m lost, right? If I belong too much I get swallowed up and lose my autonomy in my sense of self. We’ve seen that historically with great tragedy.

And if I’m too isolated, I’m disconnected from my environment, my Wi-Fi is not working – I don’t know what the hell is happening around me.

so what we see people coming into recovery is a split they’re usually afraid of connection because I don’t want to get swallowed up by belonging and they kind of lean heavy towards autonomy.

What does that look like?

Well, what it looks like psychologically is on the belonging end is over-accommodation. Which we commonly referred to as a people-pleasing, or co-dependence. I’m giving more and more to the people around me at a great cost to myself. I’m over accommodating.

It’s one of the most common traits you see addictive personalities. They over-accommodate more and more and more to their family system, to their work, socially. They’re social they’re smiley. They say,

“no problem, I love to do that all of this stuff, oh you want a cigarette – oh take two!”

They’re not connected with a part of them that gets resentful and frustrated at the cost to themselves when they choose to belong, so they get high. Getting high almost gives them the courage, so to say, to move in the other direction.

NO! They get drunk and say, “no – I’m not doing that! How dare you disrespect me”

So you see that very often, and then sometimes, I think it’s more rare honestly, maybe 10% of people, are so afraid of belonging that they’ve weighted deep on this other end of autonomy.

They’ve completely disconnected from everybody around them their self contained systems all on their own and you can feel that when it walks in the room.

And so one of the splits you are trying to navigate is becoming whole in that area. Recognizing the necessity to belong and the necessity to have some sense of autonomy while belonging

How that manifest inside the self, often, I think in the psyche is… the sort of… the strength and compassion poles

and so often in a conflict and I’m not sure how to be – where something has rubbed up against my ego defenses, I’ll my immediate reaction is “I need to be strong here” if I’m not a very deferential person

If I push back too hard and then feeling guilty and ashamed at having like pushed back too hard so I have this other mode

Which is compassion and understanding.

Which is: people are having their feelings and emotions and I’m compassionate understanding

If I’m too compassionate and understanding I end up feeling weak and deferential. Like I accommodated too much of this person’s being, thoughts, ideas, whatever it was. Behaviors.

So what’s the solution for that internally?

This is high-level work, this isn’t day-one work, this is 10 year 20 year work. And this is for everybody not just addicts. But for addicts, I think it’s crucial point.

Strength through compassion, I call it.

That there’s actually a space that exists inside human beings that is incredibly compassionate and incredibly strong at the same time.

Meaning, I go all it in compassion but not in a differential way.

I fight for compassion, reasonably inside of myself inside the world.

It’s really high-level work but when you find that space of strength through compassion. Strength AND compassion, all in one let’s call it frequency,  that’s when humans feel the most whole.

Strength through compassion.

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We can help you find a way to bridge the gap between belonging and autonomy

Therapy and the Subconscious

What to expect in this episode:

1. Therapy is built on a particular premise: I don’t understand myself
2. A lot of times, people don’t know how to do therapy, I think there are certain modalities of therapy where of instructing the client is helpful
3. Approaching what’s happening in the background (unconsciously), a little more actively than people often do, you see much more profound effects.

Therapy can be aided by identifying unconscious thoughts

Therapy is built on a particular premise which is:

“I don’t understand myself”

and there are forces and drives inside of me that manifest in my feelings, my emotions, my behaviors, the thoughts and images inside of my mind that I’m not aware of.

That there is a hidden realm to the consciousness and Freud and Jung and the founders of analysis came along and that was a discovery.

Now everybody gets that and knows that, it’s seeped into modern culture and nomenclature. I think often people don’t give, this is a tricky thing to say – it’s actually not accurate, but worth thinking about

A lot of times, people don’t know how to do therapy right. Now sometimes that’s good, because the therapist wants to work with whatever is in the room, they don’t want to instruct the client.

But I think there are certain modalities of therapy where of instructing the client on the most helpful way to approach the therapeutic process is actually helpful. But I had to discover that on my own.

I never had a therapist say, “Hey it might be more helpful if you do this” – ever! Which is kind of incredible considering the variety of therapeutic approaches that exist

I’ve found that in therapy, for me at this phase of my life, that being conscious of the things that aren’t in the front of my mind but in the back of my mind and speaking them out loud is helpful.

I’ll give an example.

I’m sitting in the room with the therapist picks up on some hesitation or some resistance that I have and then says “what’s going on” and I say “I’m feeling frustrated right now”

• “okay what’s that about”

and I say “I’m feeling helpless in this process of therapy.”

And she goes “oh. Are you concerned that I can’t help you? Is that what’s coming up in the room right now?”

I say something but actually, in the back of my mind, I have an image of myself picking up the chair this to the right of us and breaking it in front of her and just raging 🔥

So instead of just saying what I say, in the midst of therapy, I’ll say – “wait a minute, I just had an image flash in my mind of me breaking a chair right in front of you and raging” – and then we work with that

If one of the points of certain types of therapy is to gain access to the parts of ourselves that we’re not really conscious of then I think approaching what’s happening in the background, maybe a little more actively than people often do, you see much more profound effects. In terms of your own understanding, biases, belief systems that are buried real deep in the bottom of the mind.

There are plenty of therapists that will disagree with that and they are 100% correct and I’m just putting that out there for the one person who goes, “oh wow you know I have those images in my mind that I don’t share that with my therapist and I’ve had them for months or years”

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The Role of Psychology in Recovery

What to expect in this episode:

1.  Psychology has taken a central role lately, but traditionally, it is not ideal for treating addiction. 
2.  Commonly, after weeks, months, or years, therapists recommend AA or treatment because no progress can be made while in active addiction
3.  People have to immerse themselves in a culture of recovery and integrate recovery as part of their identity as the primary task of recovery

The Role of Psychology in Recovery

Its a newer phenomenon that therapy has taken a central role in the world of recovery. Part of me is rubbed a little wrong by that. It’s not that I am anti-therapy, both my parents are psychologists I actually love psychology. I’m fascinated by it.

But traditionally, we have an understanding that individual Psychotherapy is not a very effective way to treat addiction.

What you’ll find most commonly is somebody’s afraid to enter into the world of recovery for a variety of reasons, so they go see a therapist – may be an addiction specialist or maybe just a therapist – and I think the most common story is somebody will see a therapist for months or even years while still continuing to engage in their addiction maybe with some improvement maybe with no improvement.

Eventually, that therapist will say – maybe in months maybe in years, “hey, I can’t continue in this therapeutic process until you do something about your addiction problem and I can’t help you with your addiction problem. You need to go to treatment or Alcoholics Anonymous.”

It’s kind of a shame to me that somebody might be in therapy for five, six, seven, eight years I would hope that therapists out there recommend that early, and I also understand that if the clients not willing to go into treatment or to seek out some recovery that the therapist is stuck.

Understanding the role of therapy and Recovery is a fascinating conversation.

In general, my belief (and this is complex in nuanced) is that people have to immerse themselves in a culture of recovery and integrate recovery as part of their identity as the primary task of recovery. And that’s up front.

Upfront I have to challenge myself to admit that I have an addiction problem that I’ve not been able to solve. Then I have to take on the task of saying “okay, I’m a person who suffers from Addiction” and in order to treat this condition, I need to be a person in recovery.

I need to be a person who identifies myself as someone in recovery from this condition just like I would if I diabetes. If I had a horrible case of diabetes then my recovery from that, or even a cancer survivor, I would identify as a cancer survivor. It almost killed me!

I have to know that deeply about myself and it is the first and primary core task of recovery

Then therapy comes along in order to help me to better understand myself and treat the underlying emotional conditions that existed, maybe prior to my addiction. In all different dramas in different ways of being different blocks that I had etc on that caused me to suffer that I then use drugs and alcohol to treat so I think of therapy as by and large the later stages of recovery.

At first, I have to be a person in recovery then I can work on this other stuff because if I’m not a person to recover, continue to use I’m not going to get any therapeutic work done.

There are exceptions. The exceptions to that are if I have trauma and it’s so severe it’s getting in the way of me being able to identify as somebody in recovery. So if the psychological problem or even psychiatric problem is so severe that I can’t engage.

An easy example is if I have a really hard time regulating my emotions. Incredibly impulsive. It will be impossible for me to engage in recovery because I can’t sit still, I can’t stop talking, I can’t take it in, take information and reality in, so a specialist, a therapeutic specialist would have to come in and treat my Emotion Regulation Impulse Disorder in order for me to engage in recovery.

But in general, I think that’s the exception

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