Part Two: Drug obsession and character defects.
Suboxone has given us a new paradigm for treatment which I
refer to as the 'remission model'. This model takes into
account that addiction is a dynamic process— far more
dynamic than previously assumed. To explain, the
traditional view from recovery circles is that the addict
has a number of character defects that were either present
before the addiction started, or that grew out of addictive
behavior over time. Opiate addicts have a number of such
'defects.' The dishonesty that occurs during active opiate
addiction, for example, far surpasses similar defects from
other substances, in my opinion. Other defects are common
to all substance users; the addict represses awareness of
his/her trapped condition and creates an artificial 'self'
that comes off as cocky and self-assured, when deep inside
the addict is frightened and lonely. The obsession with
using takes more and more energy and time, pushing aside
interests in family, self-care, and career. The addict
becomes more and more self-centered, and the opiate addict
often becomes very 'somatic', convinced that every
uncomfortable feeling is an unbearable component of
withdrawal. The opiate addict becomes obsessed with
comfort, avoiding activities that cause one to perspire or
exert one's self. The active addict learns to blame others
for his/her own misery, and eventually their irritability
results in loss of jobs and relationships.
The traditional view holds that these character defects do
not simply go away when the addict stops using. People in
AA know that simply remaining sober will cause a 'dry
drunk'—a nondrinker with all of the alcoholic
character defects-- when there is no active recovery
program in place. I had such an expectation when I first
began treating opiate addicts with suboxone—that
without involvement in a 12-step group the person would
remain just as miserable and dishonest as the active user.
I realize now that I was making the assumption that
character defects were relatively static—that they
developed slowly over time, and so could only be removed
through a great deal of time and hard work. The most
surprising part of my experience in treating people with
suboxone has been that the defects in fact are not
'static', but rather they are quite dynamic. I have come
to believe that the difference between suboxone treatment
and a patient in a 'dry drunk' is that the suboxone-treated
patient has been freed from the obsession to use. A
patient in a 'dry drunk' is not drinking, but in the
absence of a recovery program they continue to suffer the
conscious and unconscious obsession with drinking. People
in AA will often say that it isn't the alcohol that is the
problem; it is the 'ism' that causes the damage. Such is
the case with opiates as well—the opiate is not the
issue, but rather it is the obsession with opiates that
causes the misery and despair. With this in mind, I now
view character defects as features that develop in response
to the obsession to use a substance. When the obsession is
removed the character defects will go way, whether slowly,
through working the 12 steps, or rapidly, by the remission
of addiction with suboxone.
In traditional step-based treatment the addict is in a
constant battle with the obsession to use. Some addicts
will have rapid relief from their obsession when they
suddenly experience a 'shift of thinking' that allows them
to see their powerlessness with their drug of choice. For
other addicts the new thought requires a great deal of
addition-induced misery before their mind opens in response
to a 'rock bottom'. But whether fast or slow, the shift of
thinking is effective because the new thought approaches
addiction where it lives—in the brain's limbic
system. The ineffectiveness of higher-order thinking has
been proven by addicts many times over, as they make
promises over pictures of their loved ones or try to summon
the will power to stay clean. While these approaches
almost always fail, the addict will find success in
surrender and recognition of the futility of the struggle.
The successful addict will view the substance with
fear—a primitive emotion from the old brain. When
the substance is viewed as a poison that will always lead
to misery and death, the obsession to use will be lifted.
Unfortunately it is man's nature to strive for power, and
over time the recognition of powerlessness will fade. For
that reason, addicts must continue to attend meetings where
newcomers arrive with stories of misery and pain, which
reinforce and remind addicts of their powerlessness.
The dynamic nature of personality.
My experiences with Suboxone have challenged my old
perceptions, and led me to believe that the character
defects of addiction are much more dynamic. Suboxone
removes the obsession to use almost immediately. The
addict does not then enter into a 'dry drunk', but instead
the absence of the obsession to use allows the return of
positive character traits that had been pushed aside. The
elimination of negative character traits does not always
require rigorous step work— in many cases the
negative traits simply disappear as the obsession to use is
relieved. I base this opinion on my experiences with
scores of suboxone patients, and more importantly with the
spouses, parents, and children of suboxone patients. I
have seen multiple instances of improved communication and
new-found humility. I have heard families talk about
'having dad back', and husbands talk about getting back the
women they married. I sometimes miss my old days as an
anesthesiologist placing labor epidurals, as the patients
were so grateful—and so I am happy to have found
Suboxone treatment, for it is one of the rare areas in
psychiatry where patients quickly get better and express
gratitude for their care.
A natural question is why character defects would simply
disappear when the obsession to use is lifted? Why
wouldn't it require a great deal of work? The answer, I
believe, is because the character defects are not the
natural personality state of the addict, but rather are
traits that are produced by the obsession, and dynamically
maintained by the obsession.
See: Part Three: Combining suboxone treatment and
traditional recovery.
----------------------------------------------------
Jeffrey T Junig MD PhD has worked as a neuroscientist and
as an anesthesiologist, and is a psychiatrist in solo,
independent practice. Additional information about suboxone
including the blog Suboxone Talk Zone can be found at
http://subox.info . Dr. Junig is available for patient
care, consultations, or educational presentations through
http://fdlpsychiatry.com .
