The Insidious, Elusive Becoming: Addiction in Four Steps
Posted by dlende on March 10, 2009
Trying to describe the process of becoming an alcoholic is like trying to describe air. It’s too big and mysterious and pervasive to be defined… [T]here is no simple reason it happens, no single moment, no physiological event that pushes a heavy drinker across a concrete line into alcoholism. It’s a slow, gradual, insidious, elusive becoming.
Caroline Knapp wrote those lines near the beginning of her powerful memoir Drinking: A Love Story. Every year I use this book in my class on addiction. Students get drawn into Knapp’s clear and close account of how she began to drink so much, what it is like to be an alcoholic, and how she managed to get to recovery. Every year the book challenges my own thinking as well.
I used that last line—alcoholism as a slow, gradual, insidious, elusive becoming—to end my earlier post on Subjectivity and Addiction: Moving Beyond Just the Disease Model. There I argued that our two views of addiction, a popular one of getting hooked on things and a serious one about tolerance and destructive use, are crucial to understanding what addiction is.
For each category my class stuck up exemplars on the blackboard, from Facebook to hard-core drugs. Then I drew a ↔ between the two categories, using a thick two-headed arrow to indicate that the subjective and biological views interact. Both sides matter.
But I’ve realized that is not enough. That double-sided arrow remains woefully inadequate, a place marker that can end being two-faced, saying nothing of consequence, or double-edged, used simply to cut into the other side. That one symbol tells us little about the interactions themselves, about how people and disease mesh. It lends no insight into what Knapp shows us with her book—that addiction is an elusive and terrible becoming.
So how do you become an alcoholic or addict? How do you go from something fun to something all-encompassing? This question matters deeply. One fact, often overlooked in all the moral angst about addiction, is that most people who try alcohol or drugs do not end up addicted to them. They remain on the popular side. But some cross over. In the same passage as the opening quote, Knapp describes the end point: “Alcohol is everywhere in your life, omnipresent, and you’re both aware and unaware of it almost all the time; all you know is you’d die without it, and there is no simple reason why this happens… (8)”
There is no simple reason. Knapp is right about that. But we do know much more about the process of becoming than we used to. Here I will outline four important factors that shape the terrible becoming – vulnerability, training, intention, and meaning. My focus will be on understanding the subjective transformations, and I will use Knapp’s own words and experiences to help us grasp how this happens. In a forthcoming post, I will address a core biological process—competitive plasticity—that acts as the complement to this description, a process that has also helped me see the interactions in new light.
Some people come to their encounter with alcohol and drugs already vulnerable to what these substances can do, both physiologically and subjectively. Genetics is the typical answer that students give for why some people get hooked and others do not. Genetics is complicated – you can see a traditional take in a post by my students last year on genetics and environment, and my more interactive coverage of addiction and our faultlines. But in the end it’s not genetics or societal faultlines. That nature/nurture dichotomy is a lousy one, and doesn’t set up Knapp at all well.
Put differently, what I want to say that vulnerability is more than just genetics and/or environment. Saying that misses how to understand vulnerability to substance use and abuse. Here I outline some of the reasons Knapp describes – family, behavior, and first experiences – that find resonance in the scientific literature and my own work on adolescent addiction.
Caroline Knapp’s father was an alcoholic, a nature/nurture mix if there ever was one. Her father certainly shaped Knapp’s own understanding of how to relate to alcohol. She writes, “You could tell, watching him sip those martinis year after year after year, that there was something central about the ritual, something deeply soothing and needful about it. I liked that ritual long before I started to drink myself… He’d drink his martini, perhaps pour the second one. He’d begin to loosen up, and within a few minutes it would feel as though all the molecules in the room had risen up and then rearranged themselves, settling down into a more comfortable pattern (38-39).”
But Knapp first encountered alcohol with her own susceptibilities. Her non-identical twin sister never developed a drinking problem. What was one thing that marked the sisters as different? Caroline had an obsessive side, marked in her incredible dedication to her work, her anorexia, and her own way of soothing herself. “As soon as I could sit up in my mother’s lap, I started rocking, rocking myself back and forth, and I did this for years… [Later] I’d get on my knees and elbows and curl up in a ball on the bed, facedown like a turtle in its shell, and rock away, for hours sometimes… I can see the rocking now as a first addiction of sorts. It calmed me, took me out of myself, gave me a sense of relief (62).”
Beyond family and individual patterns, first experiences with alcohol and drugs matter. At the most basic level the earlier an adolescent uses alcohol socially or tries drugs, the higher the risk of abusing alcohol and drugs. But beyond that starting point, how young people learn to use shapes subsequent interactions with alcohol and drugs. Knapp illustrates both these problems:
The summer after my senior year in high school, [my father] took me to dinner at a Greek restaurant in downtown Boston. It was the first time we’d ever gone out to dinner alone and he ordered a martini for himself and wine for me… I saw on my hands. I remember feeling that particularly acute brand of teenage awkwardness, unable to think of a word to say, and I remember a thick, interminable silence… But then the wine came, one glass and then a second glass. And somewhere during that second drink, the switch was flipped. The wine gave me a melting feeling, a warm light sensation in my head, and I felt like safety itself had arrived in that glass, poured out from the bottle and allowed to spill out between us (39-40).
I told her about the very first time I got drunk in secret. I was sixteen, a senior in high school, and I’d realized over the course of a phone call that the boy I’d been dating was losing interest in me. I forget the phone call, but I remember the feeling: pending rejection, the sense I’d done something wrong. I didn’t kiss well; was that it? I wasn’t pretty enough.
I was in my bedroom, on the second floor of our house, and I stole downstairs and snuck a bottle of wine out of an open case in my parents’ kitchen. Then I took a corkscrew from the kitchen drawer and went upstairs and drank the whole thing, straight from the bottle. This was not the first time I’d ever gotten smashed… Nor was this an alcoholic frenzy, a question of physical craving, the way it would be later on. The drinking felt more like an experiment, an act based on some vague hypothesis I’d begun to form about the connection between liquor and anxiety, liquor and sadness, how one corrected the other (32).
A Training Regime
It would be an easy explanation if vulnerability alone—family and early behavior and first experiences—made some people into addicts and others not. But it would be wrong. For example, we never use this sort of “vulnerability” approach to understand what makes someone a great athlete. It takes hard work and quite often a special training environment for someone to excel in a sport.
Turning someone from a potentially good athlete into a successful performer offers a useful way to think about addiction. Take running. Long, slow walking doesn’t turn someone into a great runner. Doing a sprint once in a while is also inadequate. One of the most accepted ways to build performance, from elite athletes to weekend warriors, is interval training. Intermittent, intense use is a very effective way to build muscle.
It’s also a very effective way to get too involved with alcohol and drugs. A drink or two a day, say at a meal, keeps a person at the same level. A binge at that one holiday party leaves a nasty hangover and not much more. But regular, intense use – that does the trick, just as with interval training. To expand on this concept, I would go further and say that regular training can produce adaptations – a habit – over several weeks or months. Periods of more intense use then provides one main way to ratchet up the level of engagement with alcohol and drugs. And Knapp describes just such a process in different moments in time:
David [her boyfriend during college] and I drank that summer, a lot. We took to buying vodka by the gallon jug, and large bottles of tequila, and we’d have a drink before dinner, then wine while we ate, then more after dinner: vodka-and-tonics, or tequila sunrises (95).
Conveniently enough, my twenties coincided with the 1980s, the decade of excess: if the line of my drinking graph began to creep upward, intake and frequency rising, it did so culturally as well: I had plenty of company. I moved to Boston in the mid-eighties, when I was twenty-five, right around the time fancy restaurants with elaborate wine lists began cropping up all over the city. Everyone drank, or so it seemed (18).
It was late in the evening, and I’d probably had seven or eight glasses of wine by then, maybe more, and I reeled across the [hotel] lobby, bumping into the wall at the top of the staircase. Downstairs, I shut myself in the stall, then leaned over and put my head down on my knees. I was dizzy and drunk and I knew it (153).
At the same time conditioning takes a central part of the increasing specificity of associations and actions that a heavy drinker goes through:
I suppose that [first beer in a restaurant] marked the start of what would become a cumulative process, a Pavlovian phenomenon of persistent reinforcement: this feels good, the way this glass of white wine flows from bottle to glass to throat to brain, the way it tingles and warms and lightens. This feels good, the way a group of us gather around a table, elbow to elbow, united in the camaraderie of drink and laughter and reward. Later, the sensations would grow more specific: this feels good, this snifter of Cognac warming in the palm, and this flute of Champagne, cool and delicate to the touch as mother of pearly, and this tumbler of gin, clear and icy and laced with lime: it feels like me; it feels right (66-67).
Training and conditioning don’t capture the relationships and the searching that facilitate these same processes. Having friends who drink heavily or who use drugs is a major risk factor for excessive involvement (or to take the athlete example, people to train with). Knapp captures this joint process well in the following passage:
For a long time you drink because the drink just seems to be available, and then, at some point down the line, you drunk because you make it available. Without being completely aware of it you organize your life in such a way that alcohol is always there: at the table over dinner, in your cupboard or refrigerator, in the cupboards and refrigerators of your closest friends. You hang out with other drinkers, people who find it perfectly desirable and perfectly normal to down six bottles of wine in a single sitting, people who support for the effort and the denial of its consequences (159).
But to make that happen, to make it a personal achievement, requires pushing yourself – making it your own. In the process of becoming an alcoholic, drinking moves from something social to something personal, something done alone, even surrounded by people but often not.
That fall, after David moved away to Chicago and my parents nearly broke up and I said good-bye to Roger, I learned to drink alone. That’s the year my sister started worrying about my drinking—more than a decade before I finally quit. She came to my apartment one day, opened the refrigerator, and saw a large jug of white wine, nearly empty. “Did you drink all thus by yourself?” she asked. I looked at her quizzically, not sure what the big deal was. “Sure,” I said. “Why not?” (102)
Alcoholic drinking is by nature solitary drinking, drinking whose true nature is concealed from the outside world and, in some respects, from the drinker as well. You think you’re drinking to have fun, to be sociable or more relaxed. But you’re also drinking to shut down, to retreat (103).
Pushed ever higher, with a turn from social to individual use, the use of alcohol becomes a central part of that person’s life. And often after that comes the end of training.
A naturally inhibited person, someone who grew up feeling mystified and insecure about what it means to feel sexual, I turned to liquor the way a dancer turns toward music: it felt central to the process, central to my ability to shut down the voices of self-criticism in my own head and simply let go, move to a different kind of music (87).
And then, tragically, the protection stops working. The mathematics of transformation change. This is inevitable. You drink long and hard enough and your life gets messy. Your relationships (with nondrinkers, with yourself) become strained. Your work suffers. You run into financial trouble, or legal trouble, or trouble with the police. Rack up enough pain and the old math—Discomfort + Drink = No Discomfort—ceases to suffice; “comfortable” isn’t good enough anymore. You’re after something deeper than a respite from shyness, or a break from private fears and anger. So after a while you alter the equation, make it stronger and more complete. Pain + Drink = Self-Obliteration (75-76).
Even being vulnerable and engaging in heavy drug use is not enough to turn a person into an addict. One of the main tricks is getting them to turn themselves into an addict. Crucial to this process is linking a subjective experience with a subjective action, tying together wanting something and engaging in doing it. They need to have reasons to use – and just as we knit together that sentence so easily, so drug users must engage in each part of that sentence. Specific individuals, the development of compulsive involvement, motivations and expectations and desired outcomes, and the act of using—those things come together through the elusive becoming.
Quite different than older theories which too often relied on “pleasure” as some primal cause. Incentives matter in seeking and wanting alcohol and drugs. Using alcohol and drugs to cope with negative emotions marks a major transition towards problem use. Functional drug use, not simply self medication, provides reasons to keep using.
Some of Knapp’s best writing centers on this area. Here she describes one of her early experiences drinking with her father, an adolescent girl out alone with her father: “Then the wine came, one glass and then a second glass. And somewhere during the second drink, the switch was flipped. The wine gave me a melting feeling, a warm light sensation in my head, and I felt like safety itself had arrived in that glass, poured out from the bottle and allowed to spill out between us (40).”
The use of alcohol to subjective effect continues to develop – it is, indeed, part and parcel of the training regimen. It takes conditioning that next step into the realm of subjectivity.
I liked being able to laugh with them [her friends], to sit on barstools and let my own emotions spill out the very same way, the sense of disinhibited high amusement. And I liked the way the drink helped turn me into that kind of person, someone more hardened and rebellious and cynical than the person I was raised to be, someone who could scoff and tell stories and make other people laugh. It was something I’d been looking for all my life… Drinking released me from the compulsion to hold back, gave freer rein to appetites… I wanted that feeling, and I couldn’t seem to generate it on my own, and the amazing thing—the truly amazing and seductive thing—was that the drink could generate some version of it for me, a most convincing replica of ease and connection and relief, at least for a little while.
And there it was again, the connection: Repression + Drink = Openness. At heart alcoholism feels like the accumulation of dozens of such connections, dozens of tiny fears and hungers and rages, dozens of experiences and memories that collect in the bottom of your soul, coalescing over many many drinks into a single liquid solution (73-74).
In many ways alcoholism has the feel of a psychological safety net, something a drinker constructs over a period of many years by making connections between feelings, like an emotional game of connect-the-dots. Take a difficult, sober feeling—shyness, fear—and connect it to its easier, drunken counterpart—disinhibition, courage. The net gets woven beneath you, a tight set of strings that promises to cushion you when you fall against a hard emotion. That’s exactly what happened when I drank with Sam: dot A, tension; dot B, relief. In my head, out of my head. Disconnected, connected.
There were so many transformations like that, so many strings in the net: self-consciousness to less self-consciousness; inhibition to ease… When the feeling of shyness washed away my voice, there it was, the liquid solution, and there I was beside it, ready to reach for another one. Connect the dots: shy to les shy (69).
Connecting the dots becomes more than simple functional use. It worsens, changes, reaches into other domains of life.
I think my relationship with alcohol began to deepen and shift around that time, my college years, moving from a simple tool of self-transformation—a way to relax and feel less inhibited, a way to be more sexual and open and light—into something more complicated, a more deeply ingrained way of coping with the world. Looking back I can see how certain patterns were beginning to develop, certain classically alcoholic ways of managing feelings and conflicts in relationships that would grow more entrenched and complicated over time.
Almost by definition alcoholics are lousy at relationships. We melt into them in that muddied, liquid way, rather than marching into them with any real sense of strength or self-awareness. We become so accustomed to transforming ourselves into new and improved versions of ourselves that we lose the core version, the version we were born with, the version that might learn to connect with others in a meaningful way (88-89).
Even at the end, in the midst of drinking prodigious quantities due to high tolerance and the gnawing compulsion to keep having more, the intention doesn’t simply vanish from the equation. It doesn’t work that way. It is one of the clearest things from Knapp’s writing, her real strength as a memoir writer. And so she writes:
There is never enough, no such thing. You’re always after that insurance, always mindful of it, always so relieved to drink that first drink and feel the warming buzz in the back of your head, always so intent on maintaining the feeling, reinforcing the buzz, adding to it, not losing it (57).
Humans are meaning-making animals. Just become someone becomes more involved with drugs doesn’t mean our sense of self, our use of language, our interpretations of the world suddenly disappeared during that process. Au contraire, they become deeply entwined in that developing involvement. Alcohol itself, the organization it provides, the act of drinking, the experience of drinking – all these are shot through with meaning.
Let us start with the object– the alcohol. See how it becomes part of one’s life:
It’s not at all unusual in AA to hear people refer to alcohol as a best friend, and to mean that on the most visceral level: when you’re drinking, liquor occupies the role of a lover or a constant companion. It sits there on its refrigerator shelves or on the counter or in the cabinet like a real person, as present and reliable as a best friend. At the end, when I started hiding bottles of Scotch around the house, and tucking nips of brandy into my bathrobe pockets, I did so in the manner of a child who’s afraid to be without a favorite blanket or a teddy bear. Protect me. Shield me from being alone in my own head (104).”
But the meaning isn’t just in the object but also in how drinking helps to organize a life, to define it and provide shape to what to do when.
As soon as I got home, I’d crack open the first beer and drink it with a deep relief… I’d understand that the beer, and the one after it and the one after that and the bottle of wine after that, served a very specific purpose: it kept me from that piercing consciousness of self, kept me from the task of learning to tolerate my own company.
Without liquor I’d feel like a trapped animal, which is why I always had it. Without liquor I didn’t know what to do with myself, and I mean that in the most literal sense, as though my thoughts and my limbs were foreign to me and I’d missed some key set of instructions about how to use them. I used to feel that way on Sunday mornings, when I’d wake up alone in the apartment with nothing before me but unstructured time. Here I am, in my apartment. Here I am, puttering through the kitchen. Here I am, washing a dish and setting it on the rack. Here I am… conscious of being alone, conscious of my own breath and my own skin and my own thoughts; here I am, waiting waiting waiting and if I keep doing this, if I don’t find some way out of my own head, I’ll die of boredom or go insane or explode at any moment (114).
Meaning also gets enmeshed into the drinking. Knapp’s words to herself, about deserving it, are literally marked in the next passage through italics. She entered a more vulnerable situation. She drank more. She had reasons. And she deserved it – that too marked the transition into her worst drinking.
I also had a long list of reasons to drink, a growing list. No one would have begrudged me that. Two major losses in the space of two years. A stressful job: deadlines and responsibilities. A messy romantic life: ambivalent and confused. So I drank a little too much; it’s situational. I deserve it. I said that to myself, too, with increasing conviction. Stress. Depression. An exceptionally bad day, or week, or month. Too much going on. Need a little relief. I deserve it (19).
The experience of using itself has meaning. Knapp came to understand this:
That line stuck [from Nan Robertson] with me for many years… She goes off into some little room in her mind and pulls down the shade. Without stating so explicitly, the image has to do with the places alcohol can take you. It has to do with transportation, with the very real—and, to alcoholics, enormously seductive—phenomenon of taking psychic flight, ingesting a simple substance and leaving yourself behind… Many of us drink in order to take flight, in order to pour ourselves, literally, into new personalities: uncap the bottle, pop the cork, slide into someone else’s skin. A liquid makeover, from the inside out (64-65).
Meaning of course exists within a cultural framework. Here is one relevant quote:
You hear echoes of [this yearning for something] all the time in AA meetings, that sense that there’s a well of emptiness inside and that the trick in sobriety is to find new ways to fill it, spiritual ways instead of physical ones. People talk about their fixations with things—a new house they’re looking to buy, or a job they’re desperate for, or a relationship—as though these things have genuinely transformative powers, powers to heal and save and change lives. Searching, searching: the need cuts across all backgrounds, all socioeconomic lines, all ages and sexes and races.
Part of this, of course, is culturally determined or, at least, culturally reinforced. The search for a fix, for a ready solution for what ails, has become a uniquely American undertaking, an ingrained part of consumer culture, as prevalent as the nearest diet workshop or plastic surgeon. In some ways alcoholism is the perfect late twentieth-century expression of that particular brand of searching, an extreme expression of the way so many of us are taught to confront deep yearnings. Fill it up, fill it up, fill it up. Fill up the emptiness; fill up what feels like a pit of loneliness and terror and rage; please, just take it away, now. Our society has become marvelously adept at presenting easy—or seemingly easy—solutions to that impulse (60-61).
But meaning is not simply constant, without tension. In the following quote all I can think is that all three versions of Knapp are the real one. That’s the point of meaning. As a process, it doesn’t discriminate.
One night after work, on my way to a bar to meet a friend for drinks, a sentence popped into my head. I thought: This is the real me, this person driving in the car. I was anxious. My teeth were clenched, partly from spending a long day hunched over the computer and partly from the physical sensation of wanting a drink badly, and I was aware of an undercurrent of fear deep in my gut, a barely definable sensation that the ground beneath my feet wasn’t solid or real. I think I understood in that instant that I’d created two versions of myself: the working version, who sat at the desk and pounded away at the keyboard, and the restaurant version, who sat at a table and pounded away at white wine. In between, for five or ten minutes at a stretch, the real version would emerge: the fearful version, tense and dishonest and uncertain. I rarely allowed her to emerge for long. Work—all the productive, effective, focused work—kept her distracted and submerged during the day. And drink—anesthetizing and constant—kept her too numb to feel at night (17).
So why did Knapp favor this real version, the one she thought could come out but didn’t? Here alcohol itself plays a central role, both contributing to and immediately solving the difficult questions of life.
[In the end] the drinking merely complicated the sense of fragmentation, contributed to the gradual loss of control. And that’s precisely how drinking works. Your life gets ugly and you drink more. You drink more and your life gets uglier still. The cycle goes on and on, and in the process you become increasingly isolated and lost, stuck in your own circle of duplicity and rationalization and confusion, the gap between your facades and your inner world growing wider and wider and more complete (207).
These were tough questions, complicated feelings, but I never addressed them with David, not once. I drank instead and the questions running through the back of my mind faded away, just faded out of consciousness (96).
The end point is even more ambivalent. Alcohol at once helps the person feel more like their self as it continues to deliver the terrible consequences of its own becoming.
At the end I didn’t even feel like myself until I had a drink or two, and I remember that scared me a little: alcohol had become something I felt I needed in order to return to a sense of normalcy, in order to think straight. After one or two drinks I’d feel like I’d come back into my own skin—more clearheaded, more relaxed—but the feeling would last for only half an hour or so. Another few drinks and I’d be gone again, headed toward oblivion (231).
Almost everyone I know who’s quit drinking describes that feeling, the sense that life has turned stale and colorless and slowly ground to a halt. You’re someplace you don’t want to be—in a bad job, a bad relationship—and you can’t fathom a way out of it, simply can’t see what steps you could take to change things.
The pain becomes acute. With each day you spend in the bad situation, your dignity erodes just a little bit more, keeping your feet glued more firmly to the floor. You cast around for explanations—whose fault is this? Is it your lover? Your boss? Your family? Are you simply doomed, destined to live an unhappy life? Reality clouds. You wake up after another night of heavy drinking and you can’t put the pieces back together, can’t figure out what the fight was about or why you ended up in the bed you’re in or what happened the night before, and you don’t understand—you simply do not understand—why you’re so miserable, so fucking depressed and full of hate. And so you drink again; of course you drink again. You can’t stand this—it’s too much—and drinking is the one sure way, the only way, to kill the feeling.
The circle closes in on itself; the cycle is repeated. You are smack in the middle of the dance of addiction and you can’t find your way off the floor (186-187).
My title is, in the end, misleading. It is about the becoming but not quite about addiction. The four steps—vulnerability, training, intentions, and meaning—do not get us all the way there. The core process of compulsion and craving is not addressed. The lack of control, though certainly related to trained intentional doing, is not really answered by the steps. The rationalizations and the denials that Knapp describes well have been left to one side.
Nor do these four steps capture how individuals often move through a radically changing social landscape as they get deeper and deeper into substance abuse. These individuals often become the worst cases, not just because of the destructive consequences for the person, but also because these marginalized, often predatory landscapes are traumatic and heighten the focus on short-term fixes.
Craving, control, destructive consequences, and difficult situations lead us beyond the insidious becoming to a dangerous and often deadly endgame. But the becoming matters. It is different from the hallmarks of addiction, and has remained obscure because of that, hidden by two-faced arrows and assumptions of disease and moral failure. It takes an entire book to describe such a process, and Caroline Knapp did so with the starkest of honesty. And most certainly with a becoming and elusive elegance.