On Wednesday 18 March, Susan Cheever talked with hundreds of Portlanders about addiction. She was supposed to make them uncomfortable, but she didn’t want to. Instead she looked for wisdom from the audience. As she said, Thoreau moved to a hut on Walden Pond to write a book about his brother, but when he went to speak about this book, his audience wanted to know what was it like to live in a hut on Walden Pond. The Illahee crowd wanted to know what it was like to be an addict.
Cheever’s opening joke:
A guy goes to a psychiatrist and says, “Doctor, I might be a sex addict. Do you have a test for that?”
“Sure,” says the doctor, and shows him a picture of a square with a dot in the middle, and asks, “what do you see?”
“Two people having sex in a square room.”
Then the doctor shows him a circle with dot in middle.
“Two people having sex in a round room.”
Then he shows him a triangle with a dot in middle.
And patient says, “What are you, some kind of pervert?”
What just happened? A shift in perspective. Cheever wanted to provide a shift in perspective on addiction. She wanted to get at the big question of “how should we live,” by shedding some light on a dark corner of our lives. There’s a lot of shame around sex addiction. But in contrast to drugs and alcohol, we embrace sex. A woman surrounded by desirous men? That’s a good thing. A guy surrounded by adoring women? We use that image to sell stuff.
At the same time, it’s surrounded by shame if you call it sex addiction.
Falling in love is great, until you do it too much and too often. Cheever got a lot of positive feedback for having so many lovers (she was desirable, right?). She didn’t even know sex addiction existed, and she thought she knew a lot about addiction, coming from an alcoholic family. But her addiction became apparent, so she went to various experts for answers. It turns out there is less agreement than you would think about what sex addiction is.
Here’s an encyclopedia definition of addiction: The chronic or habitual use of any chemical substance to alter states of body or mind for other than medically warranted purposes.
Cheever says addiction is desire gone wrong.
Benoit Denizet-Lewis, who wrote “America Anonymous” defines addiction as, “The use of a substance or activity for the purpose of lessening pain or augmenting pleasure by a person who has lost control over the rate, frequency of duration of its use, and whose life has become progressively unmanageable as a result.
Here’s Cheever’s definition: Addiction is the act of consuming more than you need. Therefore addiction is an environmental problem.
Whether or not we’re a nation of addicts, addiction is our number one public health problem. It costs us $500 billion a year. It’s increasing especially among the white middle class. Twenty-three million people are alcoholics and drug addicts. Sixty-one million people smoke. Almost half of fatal car accidents involve alcohol or drugs. One quarter of emergency room admissions, and most domestic violence involve alcohol and drugs. Seventy percent of children who have been abused or neglected have parents who are substance abusers. In some groups addiction has almost doubled in the last twenty years.
Something in this country almost seems to invite addiction. We love individual freedoms. We tend to value the individual over the community more than other countries. Maybe we’re just more open about our addictions than other countries. Stanton Peele writes, “Addiction is not an aberration from our way of life. Addiction is our way of life.”
And this is the way we talk: I’m addicted to lattes. I’m addicted to books. I’m addicted to buying houses.
Massive debt, obesity, and many others are all addiction problems.
You might think that writing a book about addiction was ‘a natural’ for Cheever. It wasn’t; it was an accident. She was sitting around one morning looking for way to avoid writing, when a Canadian publisher called about an anthology about addiction. They started talking about falling in love, what it was like, recollecting loves past, the obsession, the great literary passions like Katherine in Wuthering Heights: “If all else perished and he remained I should still continue to be, and if all else remained and he were annihilated the universe would become a mighty stranger.”
They talked about that state where the world narrows down to that one person. They talked about the transformation of addictive love. You can stay up all night. You can ski better. They talked about “the lack of satiety.” You say you’re just going to spend the afternoon with your lover and then go home to your children and then work the next day. And two days later you’re still with him.
They talked about the lover’s trance, where you do things you say you’re not going to do, about breakups and how hard they are, your heart being torn out of chest, and then a year later, you think “Michael who?”
By the end of their conversation, they had created this textbook definition of addiction: Obsession, transformation, acting out, lack of satiety, remorse. And Cheever realized that falling in love was an addictive experience.
She re-read the Bible, Withering Heights, Anna Karenina, Madame Bovary and concluded that all of these were addiction stories. You’re not supposed to do it, you do it, you’re not supposed to do it, you do it. And so on.
Then she read about brain chemistry, and learned that falling in love is a hit of a powerful drug – dopamine. The hedonistic highway lights up for love and alcohol.
Cheever interviewed all sort of experts, and learned that there’s a wide variety of theory and treatment regarding addiction. In one memorable interview she got into a tiff with a rehab director over whether drunk driving was a sign of addiction (he insisted it wasn’t). Several months later he was arrested for DUI.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders doesn’t recognize sex addiction.
For many, remorse is not a part of addiction, but for Cheever addiction is breaking a promise, to yourself or to someone else. When you’ve repeatedly broken the same promise, then you’ve entered the land of addiction. Adultery is the drunk driving of sex addiction, the breaking of the biggest promise.
Like all addiction, sex addiction is time limited. Like drugs and alcohol, you always need more. In the case of sex, it’s more partners rather than more booze. You fall in love for eighteen months, then you need a new person. People are the substance.
We’re used to saying, “Oh you’ve fallen in love. That’s so wonderful. Get married and have children.” What we should say is, “Oh you’ve fallen in love. That’s so wonderful. Don’t get married for five years.” Because the addiction wears off and they get divorced in two to three years. Because love is so powerful, so dazzling.
What causes addiction? We’re in the early days of understanding it. Cheever lists three causes: genetics, trauma, and environment. Some researchers think genetics is responsible for about 50% of addiction. Trauma causes some people to see “too clearly” and feel things as if they had no skin to protect their nerves. They reach for something to mitigate what they see, and often it’s a substance. When life becomes too painful you just want to blunt it somehow. Environment is not fashionable like brain chemistry, but it’s clearly causative. Consider Bruce Alexander’s experiments with rats and morphine. Alexander recognized that his morphine-addicted rats had miserable lives – quite apart from their morphine addiction – living in their little cages. So he developed “rat heaven” with lots of space, boy and girl rats, toys, wheels, and lots of food – everything a rat could want. And guess what? Rats in cages were nineteen times more likely to hit the morphine button than rats in “rat heaven.” This suggests that a miserable life can cause addiction.
So how do we combat addiction, besides living in the rat heaven of Portland (actually Portland has been ranked “the unhappiest city” in the United States)?
We all strive for meaning in our lives by telling ourselves stories. Like “I’m 65 but I’m still pretty cool.” Or “I’m always behind.” We constantly engage in this kind of self-narrative. It’s the way we understand ourselves. Many of our stories come from our childhood. Others from the environment that’s around us. The stories we tell ourselves control who we are. The first step is to look very carefully at the stories we tell ourselves about who we are and why we do what we do. We can change those stories. We can find new ways to think of ourselves both as individuals and as a nation.
And the thirty questions:
1. My addiction is food and weight, so I started a new job, eating all day long, like the rat in the lab cage.
So you’re a rat in a cage. But it’s complicated. Many people who have miserable jobs are not addicted. You need to find a job that’s like rat heaven. I’ve tried to create existence that’s most like rat heaven.
2. What about REAL environmental causes of addiction, like long nights and alcoholism in northern latitudes?
If it’s dark all the time, cocktail hour starts earlier.
3. So love lasts two years, but what about people happily married for twenty years?
Long lasting love is affection, which is different from falling in love (dopamine love). That’s a myth that’s pumping up our divorce rate, and destroying a generation of children.
4. What about polyamory, and other alternative lifestyles? What happens when the promises are different?
That’s fine. If you say you’re going to drink a bottle of whisky a day, then you’re not an alcoholic. (A murmur from the crowd.) But if you drink two, then you’re an alcoholic. If your wedding vow does not say you’re going to be faithful, you’re not committing adultery. If you’re not breaking a promise, it’s not addiction. (But see this entry in Alison Wiley’s blog, The Diamond-Cut Life.) The question of whether addiction requires remorse is a controversial one in addiction studies. Quantity is not a predictor. It’s not about what you actually do. It’s about intention.
5. Is sugar a gateway drug?
The gateway drug is the drug you use first. Each addict has their own gateway drug.
6. How do you think social norms play into addiction? Because in different cultures, consumption is different.
This is the environment question. Smoking is no longer OK. It’s no longer OK to get falling down drunk in NY. When people do that, we say, “Oh they’re from out of town.”
7. Spouse selection – should we fall in love or select spouses via pre-arranged marriage?
These are the two extremes of the spectrum. Maybe we should develop a middle.
8. But when we compromise we fall into a mediocrity.
Moderation is a good thing.
9. You define addiction as broken promises, but I define it as when I build my life around it (alcohol, coffee, chocolate).
That’s the first step in addiction, obsession. You start planning your life around that obsession, whether it’s chocolate, coffee, a novel or a man.
10. Does classifying all sorts of things as addiction trivialize the concept, and make it easier for people to not take responsibility for their actions (oh, it’s my “addiction”).
Agreed. The addict may be helpless, but still profoundly responsible. So trivializing addiction makes it less serious, because we’re uncomfortable.
11. So just be responsible, right?
Wrong. Addiction exists outside of our normal faculties. Will power doesn’t work. Intelligence doesn’t work. Many people think, addiction is just the lazy person’s word for indulgence.
12. So how do we hold addicts responsible?
People are responsible, period.
13. What is the percentage of sex addicts in the United States?
We don’t know. We don’t have reliable numbers, partly because so much of the research and rehabilitation is anonymous. We need a Framingham Study for addiction, because we just have no idea.
14. Expand on recovery and the stories that one tells oneself.
I used to tell myself stories about how bad I was. I was mischievous, a prankster, etc. My whole life had been about get, get, get. So when I switched the emphasis to give I became much happier. A great example is the St. Francis Prayer. I first heard it at the funeral of a woman whose daughter I was sleeping with the same person I was sleeping with. And I thought, boy what a sucker. You know the prayer, “It is better to love than to be loved. Etc.” But it turned out to be true.
15. I toured Stepping Stones, and the curator denied that Bill Wilson, the founder of AA, was a serial adulterer. Assuming you’re right about Bill Wilson, is multiple addiction typical?
Yes, and Bill Wilson died of lung cancer. Eighty percent of people who have gastric bypass surgery find another addiction. The addict isn’t addicted to the substance, so much as they’re addicted to feeling better. We find that women that often have four, five or six addictions, so that none of them really manifest. Addiction has this whack-a-mole quality to it. You stop drinking, so you start to gamble.
16.How do you see the connection between fear and addiction, in the sense that the addicted person thinks I’m going to die if I can’t do this, and that starts to overpower that resolve not to do it?
This is related to trauma, but what you’re really talking about is withdrawal, because initially the substance works for you. What once worked for you becomes the problem.
17. How do we get to rat heaven? What do we do?
I don’t know. Universal health care? Guaranteed annual income? Reform the tax code? More toys?
18. Can you compare and contrast addiction, which is physical, versus psychological dependency, which is not a physical problem?
I’m not sure there’s a difference. The behavior matters. Some things, of course, can be shown physically, where as others are harder to demonstrate, but the behavior is the same, so it’s unclear if there’s a useful distinction between the two.
19. Do we trivialize addiction by using the term too loosely? Like oh, I’m addicted to oxygen.
Yes, but we also don’t use it when we should. So we use it too loosely, as in “I’m addicted to lattes.” But we also say, “Oh, he just has a little drinking problem.” We want to use it when it’s meaningless, but we don’t want to use it when it really applies.
20. What role does spiritual belief play in breaking addiction, for example with the twelve step program?
For me the spiritual dimension of addiction and recovery is everything. But I know enough to know that every addict is addicted in a different way. So, I think the 12 steps are an unspeakable miracle in my life, in the life of my family, in the life of my father. And I’m so grateful that he got sober, so that I could see what an extraordinary transformation it causes in a person. And I hope that some of that transformation has happened in me. But for other people, there are as many kinds of alcoholism as there are alcoholics. So I don’t want to describe it further.
21. I quit tobacco, then quit drugs, and then quit alcohol, then quit biting my nails. I had a lot of fun with my addictions. Now that I’m getting into my golden years, I need some addictions that aren’t quite so damaging as the ones I had before. What kind of addictions can we look forward to help us through?
Maybe you could make a suggestion, since you clearly have quite a bit of experience. Do the one you found the least damaging.
22. What about just trading addictions? Heroin for methadone is maybe not so good, but certainly coffee for cigarettes is a good trade. What do you think?
In theory all addictions are bad, but in practice some are worse than others. Now I’m addicted to books, staying up all night reading, which wrecks me for the next day. And I used to be a carrot addict. So juggling addictions is something that some of us need to do.
23. We seem to have a big gambling problem in Oregon, but in contrast to other addictions, gambling seems to have no limits.
That’s how it seems.
24. Extend your thinking to a more sociological / macro level. Are we denying an addiction to consumerism? Is this economic model addictive?
People say to me, “You think everything is addiction.” And I think, it is. The day Lehman Brothers went belly up, television showed an empty gin bottle on a trader’s desk. Big surprise. But a lot of what we’re doing now is trying to dig ourselves out of addiction. The stock market is gambling. And we’ve brought down not just ourselves, but the whole world.
25. What about your family of origin, and all the publicity about your father recently, and the role of alcohol in your family and different sexual practices? How has this informed your views and what you’ve written about and think about?
My father, his father, his brother, his great uncle were all alcoholics. A lot of it’s genetic. But not all children of alcoholics are alcoholics. Sometimes it goes sideways. Sometimes they’re addicts, but with different substances. The latest biography on my father by Blake Bailey is excellent. The book was a happy accident, and it is wonderful.
26. You talked about genetics and environment. In terms of environment, what did you learn in your family’s environment?
We didn’t talk about it. We talked a little about it when he got sober. My mom still doesn’t think my dad was an alcoholic.
27. I’m fascinated by non-addictive personality traits. Why would a rat in a cage not be addicted to heroin? Is addiction the norm?
Not all rats were addicted, just most of them. It was really just how many times the rats went for the lever. Three reasons why people are not addicts: Genes, environment, and trauma. The standard statistic is that 50% of people are not affected by addiction. Non-addiction is normal.
28. I’m a recovering alcoholic, drug addict, and sex addict. I’ve replaced that with going 100 mph on my Ducati, and with books, painting, alternative friendships, and coffee shops. Is there some form of addiction that’s healthy?
I’m an addict. I do everything addictively. So I try to find addictions that are less destructive. For some people everything they do is addiction. So it’s better if what you’re doing is vegetables instead of heroin.
29. I’m a recovering bureaucrat. Is our recession a self-corrective moment where we kick our consumption habit?
Was a little credit card debt really addiction? I’m not sure. Were Americans really consumption addicts? I’m not ready to blame them, but rather the real gamblers on Wall Street. A good friend, a VP of Citibank, had to quit because his boss was asking him to lie all the time. They were gambling with our money. We got the message that total consumption is not a great idea, but I’m not sure it’s connected to addiction.
30.What’s the line between addiction and having a passion? Is there a connection between self-esteem and addiction?
As they say in AA, “Low self esteem would be a step up for me.” There’s often a connection between low self-esteem and trauma. Low self-esteem is often an expression of some kind of trauma. As for the line between addiction and passion, addiction happens when you when you promise yourself over and over “I will not,” and then you do. And find yourself saying, “I wasn’t going to do that.” There’s this kind of trance. You say, “For so many reasons, I will not.” And then it’s as if you’re inhabited. Because all of a sudden, you’re looking back and you did it. You had that drink. You slept with that person. And you knew better than anybody why you shouldn’t. And you promised yourself that you wouldn’t. And then, weirdly, you did. And that’s addiction.