An Altered State of Consciousness Perspective of Addiction

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Understanding addiction and recovery from a state perspective may be one of the missing links in contemporary addiction treatment programmes’ attempts to create sustainable treatment protocols. Addicts are obviously experts on states. Using substances or engaging in any mind-altering behaviour is an attempt to create an altered state of consciousness (ASC), and the specific psychoactive effect of various drugs and mind-altering behaviour creates various types of ASCs (Milkman & Sunderwirth, 2010). It follows that viewing addiction in terms of an ASC perspective is crucial for a complete understanding of the nature of addiction (Winkelman, 2001).

Some researchers have argued that the majority of addiction treatment programs fail to integrate a huge body of literature that highlights the therapeutic benefits for addicts in experiencing ASCs. They propose that a principal reason for the high relapse rate in treatment programs is the failure of those programs to address the basic need to achieve ASCs (McPeake et al., 1991). Some scholars believe that humans have an innate drive to seek ASCs (e.g., McPeak et al. 1991; Weil, 1972; Winkelman, 2001; Ken Wilber, personal communication, January 13, 2011). They believe that addicts follow a normal human motive to achieve ASCs, but they use maladaptive methods because they are not provided with the opportunity to learn “constructive alternative methods for experiencing non-ordinary consciousness” (McPeak et al., 1991, as cited in Winkelman, 2001, p. 340). From this viewpoint, drug use and addiction are not understood as an intrinsic anomaly, but rather as a yearning for an inherent human need to be met.
In some instances the etiological roots for certain individuals’ addiction may be a dysfunctional attempt, borrowing terms from Robert Assagiloi (1975), at “self-realization”, and the consequent flawed channeling of “superconscious spiritual energies,” energies to which these individuals are often sensitive but which have not found suitable ways to be actualised. It is obvious that drug use and addiction are associated with an alteration of consciousness; however addiction has seldom been analysed from the perspective of consciousness theory or cross-cultural patterns of the use of ASC. Weil (1972) and Siegal (1984) propose that humans have an innate drive to seek ASC. From this perspective, drug use and addiction are not understood as an inherent abnormality but as a striving to meet an innate human need.

Alcoholics Anonymous (AA) acknowledges the importance of an alteration of consciousness for recovery to be effective: it calls for “a new state of consciousness and being” (Alcoholics Anonymous, 1987, p. 106) designed to replace the self-destructive pursuit of alcohol-induced states with a more healthy life-enhancing approach. AA advocates meditation, a change in consciousness, and spiritual awakening as fundamental in achieving and maintaining sobriety.

Blum (1995) believes that addicts often have a neurologically based inability to experience pleasant feelings within simple life experiences and suggests that a neurological-normalising shift may happen as a result of neurotherapy which rectifies the endless quest for neurotransmitter balance, as explained by his Reward Deficiency Syndrome Model. In Integral Theory, states refer to the various states of consciousness available at any stage of development (Wilber, 2006).

Every human being engages in various activities to feel good. Feeling good and avoiding unnecessary pain are universal needs. To feel good, we seek out activities that alter our brain chemistry. Addiction can be understood as this normal need gone awry. Milkman and Sunderwirth (2010) state, “In light of the seemingly universal need to seek out altered states, it behooves researchers, educators, parents, politicians, public health administrators, and treatment practitioners to promote healthy means to alter brain chemistry” (p. 6). Addicts have found a dysfunctional way to meet this innate need through substances or certain behaviours to which they become addicted. Addicts normally have three dominant ways of seeking comfort and altering their consciousness: “We repeatedly pursue three avenues of experience as antidotes for psychic pain. These preferred styles of coping – satiation, arousal, and fantasy – may have their origins in the first years of life. Childhood experiences combined with genetic predisposition are the foundations of adult compulsion. The drug group of choice – depressants, stimulants, or hallucinogens – is the one that best fits the individual’s characteristic way of coping with stress or feelings of unworthiness. People do not become addicted to drugs or mood-altering activities as such, but rather to the satiation, arousal, or fantasy experiences that can be achieved through them” (Milkman & Sunderwirth, 2010, p. 19).

The quotation above clearly points to the need for addicts in recovery to find healthy behaviours and activities to manifest their preferred coping style, since this preferred coping style (satiation, arousal, or fantasy) correlates with their drug of choice (Du Plessis, 2012).

References to this blog post can be found in my articles as indicated on my Publications and Research page of my website

The Need for a New Ontological Foundation of Addiction

I believe one of the central problems in addition studies is that research and theories are based on “outdated” ontological assumptions about human nature. In philosophy the term ontology is often used within the context of metaphysics, and refers to what exists or what can exist in the world. Epistemology refers to the nature of human knowledge and understanding that can be obtained through various types of investigation (Slife, 2005).

Ontological and epistemological questions often concern what is referred to as a person’s Weltanschauung or worldview. Philosophers and theoretical psychologists point out that all theories have ontological and epistemological ancestry or foundational assumptions, whether implicitly or explicitly stated (Bishop, 2007; Polkinghorn, 2004; Slife, 2005). Consequently conceptions of addiction, like conceptions in any science, are based on certain philosophical assumptions, which influence the trajectory of the development of the concept (Richardson, 2002; Bohman, 1993). In addiction science these initial assumptions often go unnoticed and consequently are uncontested once treatment methodologies are employed and made the objects of research (Hill, 2010).

For example, Ribes-Inesta (2003) commented “…psychologists have paid little attention to the nature of concepts they use, to the assumptions that underlie their theories, and the ways such concepts are applied in the study of behaviour”. Within the field of psychology there exists various ontological worldviews and hidden assumptions (Hill, 2010).Hill (2010) points out that theories about and definitions of addiction and treatment methodologies may in the same manner been influenced by ontological assumptions which often remain implicit. In his PhD dissertation, An ontological analysis of mainstream addiction theories, Hill (2010) says that there are certain (often unrecognised) ontological assumptions made by those who study addiction (or any human behaviour), and he points out that most of these assumptions are abstractionist or positivist, which he believes is problematic. The popular biopsychosocial model of addiction is such an example.

In the last ten years the field of addictionology has seen a progressive movement toward compound models of addiction (DiClemete, 2003). The integrated or compound approach to addiction is an attempt to integrate the divergent and often conflicting philosophical foundations of the biomedical, psychological, and sociological perspectives of human behaviour (Graham et al., 2008; Levant, 2004; Pilgrim, 2002; Wallace, 1993).Although the BPS model approach could be viewed as approximating a comprehensive integrated approach, there are still considerable positivistic, ontological and epistemological underpinnings and assumptions which hinder a comprehensive conceptual framework. It has been argued that the BPS model does not provide an adequate integrative conceptual framework for the many antecedent variables that it acknowledges, and for which it provides a semantic linking, at best (DiClemente, 2003; Hill, 2010; Alexander, 2008).

I proposed that that an adequate foundation can be found for addiction studies by developing an integrative meta-approach, a unifying approach – a pluralistic ontological and epistemological foundation for the study of addiction (Du Plessis, 2012, 2013, 2014). I will expand on this proposition in other blog posts.

References to this blog post can be found in my articles as indicated on my Publications and Research page of my website

Myth of the brain disease model of addiction

images2The brain disease model of addiction is one of the most prevailing myths in our understanding of addiction. It is indubitable that addiction has a significant neurological component, but to reduce addition to neurophysiology is a gross error. The reason this way of thinking is so readily accepted is that it is congruent with the prevailing scientific materialistic worldview that dominates most analysis of addiction, and human behavior. Although many adherents of the brain disease model acknowledge the interplay of psychosocial factors with physiology, they nonetheless place primary emphasis on biology. Below is will briefly try and point out that viewing addiction as a brain disease is making an error in assigning addiction an ontological status, that is not befitting of its true complexity.

Integral scholar Sean Esbjörn-Hargens (2010) describes that the ontic status of a phenomena can be understood as having three potential orders of complexity, “the first order is characterized by phenomena that we can more or less ‘see’ with our own senses. The second order is the result of using various extensions of our senses (instruments, computer programs, charts) to see the phenomena … The third order cannot be seen with our senses nor indirectly by our instruments, but only by indications” (p. 159). Certain phenomena can be adequate accounted for when viewed as a first or second order ontological complexity, but certain phenomena has to be understood as a third order complexity, to avoid running the risk of developing over-simplified and reductionist understanding of the phenomenon.

At the highest level of abstraction lies the notion of an individual’s addiction-in-the-world, which is a staggeringly complex phenomenon beyond our senses or instruments. So addiction “is two steps removed from our direct experience (the first order) and our perception of it relies on many abstract indicators (the second order), which are epistemologically distant and ontologically complex” (Esbjörn-Hargens, 2010, p. 159). Therefore is best viewed as a “probability continuum” of ontological complexity, co-arising and enacted through different methodologies and worldviews. For example, a first order ontology could be the experience of being high on the drug. It is available to our senses. A second order ontology could be the pharmacological effect of a drug on neurotransmitter levels or unconscious psychological drives as risk factors to substance abuse. This we can understand only through measurement and calculations, and through a metapsychological perspective. Both these approaches can grasp only partial aspects of human existence.

When understanding addiction as a third order ontology, we begin to understand why certain models of addictions, especially the single-factor models, give rise to such partial and reductionist explanations. They are good at explaining certain “archaic features” of addiction in the realm of its enacted first or second order ontology, but methodologically and epistemologically, they are incapable of enacting addiction on a third order ontology. Technically, a third order ontology is actually the level of ontological complexity where the notion of addiction exists (a first or second order ontology cannot articulate a complex phenomenon like addiction, and can only enact “archaic-addiction” probabilities).
Most of the models of addiction have as their foundation a worldview of scientific materialism and positivistic methodology that are typically adequate for exploring phenomena existing on the first and second order of ontological complexity. However, such models are hopelessly inadequate in explaining complex phenomena such as addiction (or any human behaviour) which “exist” on the third order of ontological complexity. For example, reward deficiency syndrome (Blum, 1995) can only be understood as one of many possible physiological risks that interact with other aspects of being human, without having to reduce human behaviour and motivation to neurotransmitter levels. Simply put, even though an addict has abnormal neurotransmitter levels, at the molecular realm of brain physiology concepts such as addiction are meaningless. To talk at molecular level about addiction is like saying that an amoeba, which only primarily exists in a primitive level of ontological complexity, has abandonment issues originating from poor object relations.

Medard Boss (1983) points out that the natural scientific method has its limitations in explaining the human realm, as it originated from and is only sovereign in the non-human realm (natural sciences). Boss’s approach of Daseinsanalysis, based on Heidegger’s (1962/1927) ontology, could be described as an ontic “articulation of Heidegger’s” ontology. In our current context we could say that by using Heidegger’s method in exploring psychology and psychiatry, Boss echoes the dangers of explaining higher-order complex phenomenon (which includes any aspect of human-being-in-the-world) by using methodology (i.e. empirical observation) and epistemology (i.e. positivistic) dominant in lower orders of complexity. He believes that in Freud’s metapsychology (and most other theory of human existence) there is inevitably an abstraction and tapering from our lived engagement in-the-world (human-being-in-the-world reduced to first and second order ontology).

In summary: the phenomenon of addiction is best understood as a third order ontology, which can only be co-enacted (“brought-forth-in-the-world”) when juxtaposed with associated “methodological variety” and “epistemological depth” (Esbjörn-Hargens, 2010). The notion of epistemological distance highlights that some facts of addiction “speak louder” than others and some elements of addiction facts are only enacted within certain worldviews. Methodological variety refers to the fact that “the more epistemological distance and ontological complexity increase, the more methodological variety will increase. Thus, the more multiple an object becomes (the What), the more methods and disciplines you will need to study and make sense of it (the How), and the more perspectives there will be on what is or is not the nature of that object (the Who)” (Esbjörn-Hargens, 2010, p. 162). In short, trying to reduce any human’s being-in-the-world to a first or second order ontology, as the “brain disease” model tries to do, is fundamentally flawed. Addiction is caused by, affects and manifests in all areas of our being-in-the-world, and only paradigms (or rather meta-paradigms) that function on this level of ontological complexity may suffice, if we are ever to understand, and successfully treat this colossal nemesis.

References to this blog post can be found in my articles as indicated on my Publications and Research page of my website