Quite clearly, the treatment of alcoholism and substance abuse is a serious and urgent issue, and clinicians should ideally utilize the most thorough and effective methods of treatment. For this reason, one should look with a skeptical eye at any alcohol treatment model that does not equally address the “bio”, “psycho” and “social” aspects of addiction. All facets of the person need to be treated for the best possible outcome, and this is only possible from a BioPsychoSocial perspective.

Part II of this blog will address the “bio” and “social” understanding of the disease as well as how it is treated from a BioPsychoSocial perspective. For the purposes of Part I, we are only interested in some of the psychodynamic understandings of chemical dependency, i.e. the “psychological” element. This is not to underplay the “bio” and “social” aspects of addiction and alcoholism, or the treatment of the disease, but to do justice to these matters I have saved them for Part II.

Understanding the Ego Deficits

Poor Emotional Regulation

Addicts exhibit ego deficits that predate the addictive behavior, interact with it, and re-emerge in full force in abstinence. One such ego deficit is the inability to experience and process his or her emotional experiences, with the individual often experiencing emotional numbing or flooding. There can be an internal sense of emptiness along side a fear of the outside world. Overwhelmed by both, the user seeks solace in a drug-induced state. Drugs are selected by the differing abilities to sedate, excite, numb or energize, making one’s drug of choice neither random or accidental.

Emotional Dependency

Alcoholics have profound dependency needs that are usually acted out through familial or relationship psychodrama.  Addicts often do not have the psychological structures to self-soothe, and as such induce a short respite from this emotional pain through drugging and drinking. Without being conscious of it, they recreate their family dramas by trying to get the love that they never received as children, manipulating others around them to take care of them. They are often masters at half-truths, manipulation, and lying, selfishly fostering a false sense of responsibility in others for their personal good. Family members and loved ones often pay rent, bail money, lawyer fees, and credit card debt in a misguided attempt to protect the user from the terrifying consequences of their behavior. Since the addict cannot experience the needs and wants of their loved ones as real, they exhibit tremendous narcissism and grandiosity. As such, the alcoholic is unable to experience his or her own failures and successes as an adult, making it difficult to have authentic and meaningful connections with others.

Magical Thinking

By avoiding personal responsibility for their actions, addicts and alcoholics demonstrate a fundamental fantasy- The Fantasy of Life Without Consequences. In general, alcoholics do a very poor job of taking care of themselves, and instead manipulate others to do it for them. It is believed that childhood rejection, overprotection, or conversely premature responsibility leads to the unconscious desire for nurturance that cannot be met in an adult reality. In turn, this leads to feelings of abandonment and anxiety that get washed away with more alcohol.

Low Self-Worth and Self-Concept

Alcoholics have serious deficits in self-worth and self-concept. Feelings of low self-worth that were probably present from as far back as early childhood are reinforced by social, educational, and vocational failures in adult life, and often compensated for with narcissistic entitlement and pompous grandiosity. Their repeated failures and social rejections leave them feeling profoundly alienated from mainstream society, creating a vicious cycle that leads to greater despair, and more self-hatred. The addict must acknowledge and challenge their dependency by taking on the adult task of sobriety. Then the pride of genuine accomplishment can improve their self-worth and lead to a more positive self-concept.

Common Defense Mechanisms Use by Addicts and Alcoholics

For the alcoholic, primitive defensive structures keep the individual trapped inside of his or her own developmental deficits. Addiction can become an autonomous process that takes on a life of its own. Despite the good intentions of family, friends, and rehab facility staff, at some point each addict must work through their defense structures if growth is to occur. Addicts and Alcoholics have the same defense mechanisms as everyone else, but these appear to be the preferred defenses of addicted people.

•Denial: Denial is considered the most primitive of all of the defenses. The addict actually believes his or her distortions are essentially correct and that it is the rest of the world that is experiencing the faulty perception, especially regarding their drinking or destructive behaviors. Sometimes direct assertions are needed to break through this defense, as facts do not seem to affect the alcoholic’s psychic structures.

•Projection: The addict often attributes unwanted and/or unacceptable parts of themselves to others. One example would be feeling incredible discomfort in an AA meeting because they feel that they are not like the rest of the people in the meeting, and that they are superior and above them.

•Rationalization: Addiction can be defined as indulging immediate gratification followed by delayed negative consequences. Addicts are able to rationalize just about anything to avoid contemplating the many negative consequences as a result of addictive behavior.

The following are maladaptive behaviors often seen in addicts and alcoholics

• Isolation from others: Addicts tend to retreat from socialization when they are in the addictive phase of their disease as feelings of shame, self-loathing, and guilt well up.
• Lying and Manipulation: Addicts often live from hand to mouth, and their coping skills involve stealing, cheating, and lying from both strangers and loved ones.
• Obsessiveness: Alcoholics and drug addicts not only become obsessed with their drug of choice, but also narcissistically focused on money, success, and sex. In fact, newly sober people often shift their obsessive thinking into becoming sober.
• Self-Centered Thinking: Addicts and alcoholics have difficulty empathizing with others, are self-referential in their thinking, and are obsessed with how the information at hand relates to them. They can be rigid and resistant to feedback that feels at all critical, and ignore information that does not conform to his or her distorted self-concept. Another way to describe this phenomenon is that they are very sensitive to “narcissistic injury”, while at the same time devaluing the self-worth of others.
• Placing Blame on Others: No matter how self-destructively they have behaved, there is always someone else, or some other circumstance, to blame.
• Dangerous Risk Taking: Addicts and alcoholics are far more likely to engage in risky behavior such as committing crimes and engaging in unsafe sex.

Jennifer De Francisco, MPA, MSW, LCSW is a psychotherapist in the Newport Beach, Irvine, and Orange County areas. She specializes in relationships and depression. Jennifer also has significant experience in the treatment of alcoholism and substance abuse disorders.

If you are interested in making an appointment, please call her at (949) 251-8797.

Normal Grief and Bereavement

Much like an earthquake, grief shakes the foundations of a person’s life, triggering a full-blown separation response in adults. Acute grief is a cocktail of trauma and separation response; it is present most of the day, every single day, for approximately six months although it can last longer.

There is often a sense of anger or protest at having to accept the loved one’s death, and an intense yearning to be with the deceased. Episodes of crying, sobbing, and feelings of sadness and remorse are typical, and should be thought of as a healthy grieving. Most experience a constant stream of images of the deceased  which are incredibly vivid, and for some there are hallucinatory experiences in which the bereaved hears or sees the loved one for a few moments.  There can be a very strong desire to relive and reminisce about their life with the loved one, spending long periods of time with important objects and photos at the expense of engagement in current life activities.

Other symptoms can include a loss of appetite, feelings of emptiness, fatigue, poor concentration, feeling disconnected from the world, and restlessness.

Normal Grief Changes over Time

Normal grief changes over time, evolving as the individual processes the death. The grieving person is able, over time, to accept the finality of the death, and begins to understand that their relationship to the deceased is forever altered. The bereaved starts to be able to take pleasure in life, even if it forever different. There is a renewed interest in other people, with a capacity for joy even while the mourning process takes place.

This is not to say that feelings of sadness and loneliness do not persist. These feelings, as time goes on, tend to shift to the background, and memories of the deceased person are bittersweet but not overwhelming. Surges of grief often occur on anniversary dates that bring up memories of the deceased.

Complicated Grief Leaves the Person “Stuck” in Mourning

For about 10 percent of the population, the normal progression of grief can become derailed with prolonged and intense symptoms of grief.

Complicated grief differs from normal grief due to complicating thoughts, feelings, and behaviors that derail the normal and healthy progress of adjustment. Some of these feelings include avoiding activities or places that illicit intense emotions related to the loss. Other symptoms include an intense preoccupation with the deceased, anger and bitterness toward the world in general, emotional isolation from others, rumination about how the person died, and how the death could have been prevented. The person may also feel that they have no idea how to manage how they feel; they may be emotionally out of control or perhaps overly controlled.

Most importantly, the bereaved person, over time, feels no sense of progress or a
working through of the grief, and cannot adjust to the finality of the death. There can be a sense of morbid hopelessness that they will never feel better.  It is important to take pause and note that any bereaved person may experience the above symptoms going through a normal grieving process. If, however, these symptoms show no improvement over time, the grief may be more complicated than normal.

Why Do Some People Develop Complicated Grief?

There are several risk factors for complicated grief. First, the risk of developing the syndrome sometimes depends on circumstances of the loved one’s death. PTSD is more likely to follow after a traumatic death, such as a car accident, especially if the person regards his or her grief reactions with shame or as a sign of weakness. Individuals who have lost a loved one to suicide appear to be at a much higher risk for complicated grief. There are almost always persistent themes of guilt, blame, and shame emotionally as well as the task of trying to make meaning out of such a tragic and unnecessary death.

Complicated grief  also develops if someone has difficulty dealing with loss. Those that have suffered from emotional loss, trauma or neglect in early life are more likely to experience grief as persistently traumatic. Those with accumulated trauma over their lifespan are also at a higher risk, as well as those with a history of depression, anxiety or personality disorders.

Complicated grief is more likely to occur if the person had an ambivalent or conflicted relationship with the deceased. Most of us tend to remember the good in those that pass away, but if an individual is racked with guilt due to negative feelings or interactions that they had with the deceased, the grieving process can take on a morbid, obsessive form.

Treatment

Treatment of complicated grief, through bereavement counseling or psychotherapy, allows the person in mourning to work through feelings of being “stuck” or preoccupied with the loss. Often, issues regarding emotional instability, previous losses, or difficulties in the relationship with the person who has died must be addressed for an individual to work through the grieving process. The mourning person is often concerned that they are upsetting others by talking about the deceased and feels uncomfortable acknowledging how much of their time and energy is spent in painful preoccupation. A patient, understanding clinician may be exactly what this person needs.

Jennifer De Francisco, MPA, MSW, LCSW is a psychotherapist in the Irvine, Newport Beach, and Orange County area. She specializes in relationships and depression.

Please call her at (949) 251-8797 to schedule an appointment.

If nagging is so harmful to relationships, then why do we keep doing it? Some people nag because what they consider important does not get taken care of by their spouse, and their method of addressing it is to repeat what they want, over and over again, and more urgently over time. Unfortunately, their spouse reacts in the exact opposite way that they had hoped; instead of wanting to take care of the issue they become resentful and withholding, and are less likely to complete the task at hand. What happens then? More nagging-creating a cycle of negativity and anger.

Who tends to nag? Those with obsessive, anxious personalities are the most likely to nag, since they are planners, notice small defects, and want to fix things as quickly as possible. Women also tend to nag more often than men, as they are more often in charge domestically and may want more help from their spouse. Unfortunately, nagging is not the answer.

Nagging can be a prime contributor in divorce, as couples that have this type of negative communication in their marriage have a higher probability of ending the marriage. Couples who report being unhappy in their marriage five years into marriage have a 20% increase in negative communication patterns consistent with nagging, and a 12% decrease in positive communication.

Fortunately, couples can learn to communicate effectively without nagging. The following tips can help:

•Try to stay calm

Your marriage and relationship is more important than whatever you are asking your partner to do. It is important to work as a team and change negative communication patterns. As such, stay calm, and ask nicely. Also, you can respond calmly and maturely when asked or nagged.

•Explain why the request is important

Explaining why you need something done can help. Saying, ‘It is important for me that the garden looks nice when your family comes over,’ works far better than, ‘You never mow the lawn.’

•Set a reasonable timeframe

You may think is it reasonable to ask for something to be done and have your spouse attack the task immediately. Your spouse may not see things the same way. Let your partner know when you would like the task done by, and give them enough time to do it without feeling rushed.

•Please remember-you are asking for a favor!

It is always easier to get someone to do something for you when you remember that you are asking them to do something that they do not have to do, even if you feel that they should offer to help without being asked. Adjusting your tone and perspective can help.

•Try to look at it from the other person’s point of view

Try to remember that no one likes feeling nagged, unappreciated and controlled. On the other hand, for the naggee, try to remember that your spouse wants to work as a team and may just want a little bit of extra help from you.

•Make Sure Your Expectations are Realistic

Does this task really need to be done now? Does your spouse have to be the one to do it?

•If your spouse is not responding to your requests, you may have to stop asking for a while

As unfair as it might sound, it is important to know when to stop. If a negative pattern of communication is escalating, it is far more important to break it than to continue an ugly power struggle that threatens the marriage. Whatever the task is, it is ultimately less important than your marriage.

•Consider other options

Sometimes it is just easier to get a handyman, plumber or maid to do the extra work. The fight may not worth it.

Jennifer De Francisco, MPA, MSW, LCSW is a psychotherapist in the Newport Beach, Irvine, and Orange County area. She specializes in relationships, anxiety and depression.

Please call her at (949) 251-8797 to schedule an appointment.

For most of us, anxiety can hardly be imagined to be a positive thing- we often are overloaded with work, family, financial, social and relationship obligations  to the point that we never feel relaxed. Many of us walk around with a fearful sense of dread that cannot be shaken, with a pounding heart and a clenched jaw.

But for many poets, comedians, actors, athletes and philosophers, anxiety can been experienced advantageously, and has been labeled the “handmaiden of creativity.” Before a performance, actors find it a helpful hormonal springboard to achieve emotional heights they never could hope to achieve during rehearsal.

In fact, in just the right handful, the hormones that drive anxiety can be a powerful, arousing stimulant that allows our senses to function at their best. There is a point when tension and performance rise in lockstep with the quality of that performance. In just the right amount, we can remember with almost perfect clarity everything we need to know for our performance or test, and this is when those that know how to really use anxiety for their own benefit can shine and blossom.

Not all Anxieties are Equal

This ability to turn anxiety back onto itself is something that some of us are more adept at doing than others. For many of us, anxiety is just crippling. Our nervous systems are not quite as adept at distinguishing between mortal terror and non-mortal circumstances. For many, there are constant subtler worries that grind at us every day, and make it impossible to relax. It is this constant feeling that creates a kind of chronic anxiety condition that leads to overload and paralysis. Sometimes a chronic anxiety condition is the consequence of having lived through a threatening experience, and then having to live in dread of its reoccurrence, such as with Post Traumatic Stress Disorder (PTSD).

Running from the Tiger

For all the suffering that anxiety causes, it is important to remember that we need it. Ultimately, anxiety is a reaction, an arousal to stimulus that we perceive as dangerous and threatening. If, evolutionarily speaking, we did not react within nanoseconds to the perceived threat of the tiger in the jungle as our progenitors did, we might not be here at all. When we perceive a biological threat, our brains short-circuit away from the thinking parts of our brain and the neural pathways head straight to the hypothalamus, in a sort of biological red-alert. This releases hormones that increase heart rate, perspiration, and blood flow. This is what the human body needs to move as quickly as possible away from danger.

Why Can Some Harass Anxiety for a Better Performance?

So what distinguishes those that can use anxiety to enhance performance from those that that find anxiety debilitating? Several things. First, a person with a traumatic childhood is likelier to be debilitatingly anxious than those that grew up in a supportive and nurturing environment. Also, genes play a significant role in how adaptive we are to stress and anxiety. Researchers have identified about 150 aberrations in DNA associated with anxiety of the less adaptive kind.  For example, a child with a parent who suffers from OCD is five times more likely to suffer from the syndrome themselves that a child in the general population. Also, nurture influences nature and vice versa; nervous pups born to a nervous dad experience some kind of trauma of their own, reacting to it more negatively than a normal baby mice would.

Jennifer De Francisco, MPA, MSW, LCSW is a psychotherapist in the Newport Beach, Irvine, and Orange County area. She specializes in relationships and depression.

Please contact her at (949) 251-8797 to make an appointment.

Financial Infidelity Destroys Trust in a Relationship

Financial infidelity deteriorates trust in a relationship; infidelity, sexual or otherwise, creating distance in the relationship and thus making it virtually impossible for the couple to be emotionally intimate. Couples that engage in financial infidelity are sabotaging their relationship and denying themselves the tremendous emotional benefits that marriage has to offer. Often times they do not believe they deserve love and care from their partner, and are unconsciously pushing that person away through self-defeating behaviors.

Depression and Shopping Make a Dangerous Cocktail

Couples who commit financial infidelity often do so out of feelings of low self-worth, as shopping can be a brief anesthetic from emotional pain. These individuals have difficulty controlling their impulses and often have significant shame, guilt, and depression regarding this behavior, since they often do not understand it themselves. Buying something new may make them euphoric for a short period of time. The fix is temporary, however, and this brief jolt of excitement is usually not worth it for them; they ultimately do not enjoy their new purchase and feel even worse for having lied about it.

Money Means Something Different for Everyone

Sometimes financial infidelity occurs for far less deep reasons- a couple may simply have different ideas regarding spending and what money represents. Take flowers, for example. Perhaps the wife really enjoys having fresh cut flowers in the home as it brightens things up and adds life to the home. The husband might feel this is an extravagant, wasteful expense and that the money should go into the retirement or college fund, where it would be useful. To avoid conflict, the wife may say, “Mrs. So-and-So cut these flowers for me from her garden, isn’t that sweet?” or “they were only $2 at Trader Joe’s, what a bargain!”

Money Secrets are Disrespectful to Your Spouse

Unfortunately, this behavior creates more distance, less intimacy, and ultimately, is emotionally disrespectful. Friction and conflict are sometimes needed to become emotionally closer and it can take some emotional turbulence in the short-term to work through each other’s needs and expectations, financial or otherwise. It shows disrespect for the other partner’s views, feelings, and wants to not let this process happen.

Jennifer De Francisco, MPA, MSW, LCSW is a psychotherapist in the Newport Beach, Irvine, and Orange County area. She specializes in relationships and depression.

Please call her at (949) 251-8797 for an appointment.