Latest LACT articles and publications

1 - Addiction vs dependence

The term dependence is commonly used to refer to the use of a psychoactive substance , the absence of which leads to psychological or even physical discomfort, encouraging the consumer to resume his consumption and to perpetuate it.

This is the case with heroin. The heroine gives a lot of pleasure the first time. Then the day when the consumer will stop because there is an addiction, there is less desire, he will have difficulties. Because he is already a prisoner of it and the fact of not being able to use it will bring suffering. In this case he will become dependent on his consumption, not to have pleasure, but not to suffer.

The term addiction is rather retained to group drug addictions and dependencies without products . In the 1970s in Anglo-Saxon countries, it was shown that the notion of dependence also encompasses “drug-free addictions”. Addiction is a relationship of dependence that is more or less alienating for the individual, and more or less accepted or even sometimes totally rejected by the latter's social environment.

You can be addicted to:

• a product : drugs, tobacco, alcohol, medicines, etc.
• a practice : game, purchase, sex, Internet…
• more recently, the possibility of an addiction to almost everything has been mentioned: work (workaholism), sport (bigomania), etc.

What is an addiction? To define a dependency, we retain three elements:

• The use . It is repeated use with impaired functioning and disarray. That is to say that there is suffering in relation to this use. Suffering that is personal but also environmental (family, friends, work). And the suffering could be for oneself or for others. We are in a domain where there are three types of interaction: interaction between me and me, interaction between me and others and interaction between me and the world. If one of these categories is damaged there will be consequences for the others, because all these interactions are dependent on each other.
• Tolerance.  (Mithridate effect). With all types of addiction, at some point through use, the body gets used to it. It will either be necessary to use another product, another activity to have the same sensation, or to increase the quantity to obtain the same effect. There will be a significantly less effect despite using the same amount. The problem with tolerance is that you get used to it.
• Weaning . Then we have the withdrawal phenomenon which corresponds to the suffering when we stop a substance/a practice. This can be physical as in the case of heroin, but also psychological with mood disorders, anger, suffering, depression because we no longer have the activity, or we don't you no longer carry out an activity or you no longer have the product you want to absorb.

In addition to all this, there are other phenomena:

• Excessive or longer than expected intake or activity. For example an active person can work 60 hours per week for one or two weeks because of imperatives. The problem arises when this activity continues for a long time (3 months, 6 months, 1 year) and we cannot get out of this imprisonment.
• The person may make efforts to try to reduce, control this drug intake or this activity without succeeding. That's a warning sign that shows that there may be a problem.
• As far as the substance is concerned, the person will take a long time to obtain it or to recover from its effects.
• She will give up social, professional or relational activities because of the substance or because of the activity. That is to say that the person will have an imbalance between himself and his life. Family and friends will be neglected. What made his life in the past will be neglected.
• And the person will also continue this addictive activity despite the problems that he will encounter in other areas of his life. She will encounter problems between herself and herself, she will start to be depressed, to worry, to become aggressive but she will continue. Or she will have problems with her family, but she will continue anyway.  

It's like when the boat sinks, the person attaches himself to the only thing that remains stable in front of him, namely the mast. The problem is that the mast sinks with the boat, so it will also sink with the boat.

To end this first presentation on dependence and addictions, we can quote Ivan ILLICH:

“In a consumer society there are two types of slaves: prisoners of addiction and prisoners of envy” 

Let us understand by this that what we are talking about today is very much linked to our society as well as to its functioning. We will recall that in nature, there are no animals that are dependent apart from a few elephants in Africa or India that consume fermented fruits that make them stagger. But an elephant is not in danger. In the wild, animals that are intoxicated do not survive.

It is society that creates this zone where the person can manage to put these behaviors in place. So it is intimately linked to our society.

2 - Pleasure

There are four basic sensations that must be understood as a system of perception and reaction to the world. "I perceive the world in a certain way and I react to it, so I have fear, pain, anger and pleasure"

Some general points about pleasure

You can have fun with:

• Work
• Internet
• sex
• Games
• purchases
• Substances
• The food
• vomiting

Any activity repeated for a certain time can lead to pleasure, this is called perversion. We can therefore define perversion as the diversion of an activity towards obtaining pleasure.

“If I allow myself, I can resist it; if I forbid myself, it will become irresistible” Giorgio Nardone

The problem with pleasure is that there are two things that interpenetrate, ie “I have an activity that brings me pleasure so I continue to do it. And if I try to decrease it, reduce it, or control it, what I'm going to increase by decreasing is my desire for that activity. »

There will then be two things that will counterbalance each other in a negative way: pleasure and the control of pleasure. One of the ways to get around this control of pleasure is to authorize pleasure in certain areas in order to make it less desirable.

What alcohol addicts say is:

You have to accept having lost control, because by accepting this you let yourself go and you have less desire.

What is done with pleasure? What are the attempted solutions?

• Control
• Resist
• Avoid thinking about it
• Have fun
• The self-delusion "I do it because it's good for me and I like it"

3 - Strategies for taming addiction 

"Addiction is not within everyone's reach, you have to insist heavily and neglect many signals to get there" Jacques Barsoni

That is to say that at the beginning there is a certain confinement in my relationship with me and me to arrive at an addiction: it is me folded up on me.

• “Pleasure is to the soul what rest is to the body” Saint Thomas Aquinas. Let us understand by this that a strategy in relation to addiction to products or to an activity is to vary the products, to vary the pleasure. Pleasure is not the enemy. Nothing in life is too good or too bad, too little or not enough is the problem, being in the middle is never the problem.
• "The most common thing, as soon as it is hidden from us becomes a delight" Oscar WILDE
• "The only way to get rid of a temptation is to give in to it" Oscar Wilde
• The strategy is to “do it even better”, that is to say organize yourself to have more pleasure and therefore reduce the frequency to increase the pleasure. It is also to focus on a particular moment with a particular activity to get the most out of it. By decreasing the frequency we will increase the desire for this pleasure and its obtaining.
• Make the search for pleasure even more ritualized. Interrupt the sequence that brings pleasure to distort it. This is what we do in particular with addictions to vomiting. The person is asked to consume as usual and to wait 30 minutes (initially) between the moment when she swallows this food and the moment when she will vomit. Introducing a period of interruption between these two activities will destroy the pleasure.
• Add or vary the pleasures
• Putting a bit of reality into the virtual for everything related to internet addictions

Christian Moretto is a psychotherapist and trainer in New York. He was trained by Giorgio Nardone and is an associate researcher at the Center for Strategic Therapy (Arezzo). In the United States he worked in the field of product addiction (cocaine, heroin, alcohol, etc.) but also in other activities (addiction to online shopping, the Internet, work).