Articles by David H Jacobs Ph.D

What Stands Out about Addicts

First the usual caveat about ‘addiction’: It does not lend itself to precise definition. It is really is a term indicating use (substance or activity) on the part of someone that has come to stand out to others or the user him/herself as damaging well-being and which resists efforts to eliminate or modulate. It is consequential for treatment if the person using does not really (as opposed to lip service) see his/her use as ‘over the line’ in terms of self-harm.

The following features stand out about the person using drugs or activities in an addictive manner (in my experience, of course):

The person using (whatever) addictively of does not regard other people as effective and reliable sources of comfort, soothing, reassurance, and so on. In short, the person using addictively does not deeply trust anyone. This is the frequently overlooked other side to the common observation that the person using addictively regards the substance as his/her friend, is having a love affair with the bottle, and so on. There is a reason based on life experience growing up that the person using addictively is disinclined to deeply trust and rely on a person as opposed to a substance (or activity).

The person using addictively is driven from within to alter his/her ‘background feeling state.’ I use the foregoing term to bring to attention how a person feels in the absence of strong distraction or absorption in a task. I have heard clients say that boredom is a predictable precursor to using so often that I began to ask if it was not more accurate to say ’empty.’ Virtually no one seems inclined to deny that empty is a more accurate descriptor. The idea of ‘background feeling state’ is not very esoteric once it is stated and explained, but it does not seem to be a routine feature of professional discourse concerning addiction. I think it is quite revealing. If a person’s background feeling state is unbearable, some remedy must be sought . Remember that reliance on others is not an option.
It more or less goes without saying that lying, disguise, subterfuge, cover-up, and the like are functional imperatives of addictive use. The person using addictively is well aware that other people will regard the extent of his/her use with dismay, horror, disapproval, etc. Eventually the person using addictively tends to use alone/privately (as much as this is possible given the substance or activity; if the addictive activity requires other people, e.g., gambling, sex with a living person, etc., there is simultaneously effort to seclude as much information as possible from people who matter). The feelings of shame and guilt that accompany hiding and lying add to the person’s dysphoric background feeling state, and serve (paradoxically it might seem) to augment the need to seek excitement and soothing via the addictive substance or activity. Using addictively locks the person into using addictively.

It is obvious that self-harming use is incompatible with self-care/love. The point to emphasize here is that there must be a prior injury to self-care/love for sustained self-harming use to develop. In the absence of a prior injury to self-care/love a person will not persist in a self-damaging course of action. Self-care/love is not to be confused with narcissism (usually meant to indicate selfishness and over-inflated, unrealistic but quite fragile self-esteem) and is not a pejorative term. Self-care/love is meant to convey the idea that the individual values him/herself and his/her life. It is the opposite of self-hatred or self-contempt. Self-care/love develops as a derivative of receiving genuine care and love growing up; it goes along with being able to care for and love others. Self-care/love is self- preservative, that is it is incompatible with sustained self-harming activity. The person using addictively acts like a person who does not care about his/her own welfare.

It is apparent that the person using addictively is not just getting high (intoxicated) because use continues long past the point of getting high. As implied above, use continues beyond intoxication into danger and harm. People who do not use addictively find themselves wondering why the person using addictively uses so aggressively, that is so much. Why three bottles of wine a night, why not a couple of glasses to get pleasantly intoxicated? I think part of the answer is that the person using addictively is trying to get as far away from his/her background feelings as possible, therefore just getting high will not do the trick (remember I am referring to a person who engages in high volume use over and over again). Caution or concern for well-being is not an inhibiting influence because self-care/love is damaged. Seeking comfort from others is not a viable option because basic trust is damaged.

How Does Change Occur in Psychotherapy?

I think it will be helpful to me and to prospective and beginning clients to try to provide an overview of how I think about …

Make-Believe in the Addiction Treatment Industry

Therapists shouldn’t be in the business of make-believe. There is a great deal of make-believe in the addiction treatment …

Magical Thinking About Drinking

Most of the people I see who have serious drinking problems express the hope that they can over time acquire the ability …