Articles by David H Jacobs Ph.D

Why do people keep on drinking after the first few?

Why do people keep on drinking after the first few? The answer shouldn’t be circular or tautological, as in ‘That’s what alcoholics do.’ The answer should actually shed some light on the matter. I’ve asked myself this question many times in the course of doing therapy with problem drinkers. I’ve asked them, too. This seems to be one of those questions that the person doing the activity in question has a hard time answering. I might even opine that it’s a micro scenario for illustrating why it’s frequently pointless to ask questions as a therapist. Let me put this another way: You can’t just ask a question and hope to get an answer or a clue that only emerges during or at the end of a lot of discussion. It’s putting the cart before the horse. A lot of insights or tentative conclusions can only be reached after a great deal of discussion. Why? Because in the main we just do things in the course of living without an extensive inner rationale and analysis preceding or accompanying the action (or habit).

So I’ve come to the conclusion that for the most part the person who is doing the problem drinking or binge drinking can’t readily say why he drinks a lot after the first few drinks. I’ve had to infer a reason based on what the person has told me about his life, background, and so on. My formulation is as follows: The first few drinks provide emotional relief from the stress of life. Not just the stress of recent events, but the stress and persistent background feelings that are part of the legacy of growing up under adverse circumstances. Once the person experiences becoming distant from his customary emotional background state via the effects of alcohol, he is motivated to continue drinking in order to get even further away from his customary background state. The further away the better. This may not happen every time, but if it doesn’t happen persistently over time the person is not going to wind up in my office. It’s a paradox to hope that resolutions arrived at in a regretful sober state will remain unaltered when seriously intoxicated.

There has to be a reason why a person will drink very excessively again and again despite consequences. It’s not about enjoying getting very drunk any more than cutting is about enjoying cutting or excessive eating and throwing up is about enjoying getting painfully full and bloated and sick and throwing up. It’s about altering one’s usual psychological state because one’s usual psychological state is good to get away from. This is not something a person in therapy may come right out and say, especially in the beginning of therapy. Actually many problem drug users are neither willing nor able to say much about the emotional impact and legacy of their pre-adult life in the beginning of therapy. The inference on my part is based on what the person says about her history over the course of numerous sessions. If I have given the impression that a person would have to be quite desperate to do the things I mentioned above, that would be the right impression. Why not go to a movie or chat with a friend or jog around the block instead? Because stronger medicine is needed.

Addiction can be thought of as a trap because it provides relief along with mounting harm and problems over time (an expression from Vincent Filetti, creator of the Adverse Childhood Events study conducted at Kaiser in San Diego: ‘It’s hard to give up something that almost works’). The trap is not the addictive substance or activity itself. There would be no trap if the person was able to find relief and satisfaction in relationships with other people. Whenever we see a mature addiction (I am not talking about a phase in high school or college that is strongly context and stage of life dependent), we see deep distrust of and discomfort with others. Virtually all the adult addicts I see have spouses. Indeed without a pressuring significant other I doubt I would see the people I do see in my office. None the less, it is the substance or activity that is turned to and relied on to manage the pain of living, eventually including the spouses’ anger and disappointment.

Therapy is an opportunity to directly talk about the pain of living and its roots in past maltreatment on the part of the most important people in the addict’s life growing up. It is an opportunity that is hard to grasp because it does entail trust and vulnerability, precisely what the substance or activity enabled the addict to mainly avoid. It would not ordinarily be attractive but by the time I see a person his options have about run out. The therapist must be able to endure contradictions. Naturally the therapist wishes the client would stop harming himself and feel more at ease in living, but at the same time the therapist cannot become just another angry, disappointed, confrontive, nagging person in the client’s life. The therapist cannot demand ‘progress.’ The therapy session must be a safe harbor. The role of therapist is filled with contradictions and antinomies (antinomy is a good word to know because life is filled with them. Google it.). The chief antinomy for the therapist is that he is dedicated to helping the client get better but he can only go about it by being accepting of the client’s ambivalence and difficulty committing himself to change. Accepting does not mean approving or not recognizing the desirability and importance of change.

I was once struck by a distinction drawn by the psychologist-therapist David Shapiro: ‘The therapist can try to help the client with his problem or he can try to help the client.’ The client’s problem is continuing to drink and drinking a lot once he gets started drinking. This can be seen as a sort of solution to psychological injuries sustained in the chronological past that are still active in the present. A person’s ‘present’ from a psychological-emotional-existential perspective is not a straightforward matter. Someone says something to you in conversation that you grasp in a certain way. This goes beyond the present moment in real (clock and calendar) time. Apprehending the meaning and implication of a remark draws upon your linguistic and social experience as a whole. Your ‘now’ is filled with your life experience. I believe this is why William Faulkner had a character in one of his plays say: ‘The past is never dead. It isn’t even past.’ Trying to help a person who drinks excessively with his problem (drinking excessively) is something like bailing water from a sinking row boat while ignoring the leak. The real problem is the leak, not the rising level of water in the boat. You might have to bail frantically for awhile but if you ignore the leak you aren’t going to get anywhere. That’s what Shapiro was saying: you have to address the leak to really get anywhere. Or: you have to help the client address his injuries and desperation, not just concentrate on (probably doomed to fail) strategies to avoid drinking or replacing drinking with more benign activities. The therapist is interested in helping the client feel less desperate and therefore less invested in the addiction as the primary means to cope with the pain and frustration of living. The therapist can afford to pursue the long term goal and be patient when others are not because the therapist’s personal fate is not intertwined with the client’s in the manner of the spouse and so on. This is the upside of a therapy profession. Professions also have down sides, but that is another story.

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 …