It is a year since Shantanu Majumdar KC’s excellent and entertaining article, ‘Seasonal Cocktails (the Health Edition)’ was published in the January 2022 issue of Counsel. This short article touches on something different but related; the extremity of altering one’s internal by use of the external: addiction. The Bar is full of characters, all human and fallible. The expression of view in this thumbnail might interest anybody wanting or needing to know more.

What is addiction?

A good definition of addiction is an illness characterised by compulsion, loss of control, and continued use or practice notwithstanding adverse consequences. For all the knowledge and resources of the pharmaceuticals industry, addiction knows no cure, and the condition is progressive; unless tackled at source, it can only worsen. Once the line of addiction is crossed, re-crossing to moderation and control is not humanly possible, as any recovering addict will attest. The absence of a cure supports this.*

What makes addiction so confounding, for both the addict and those within their sphere of destructive influence, is the addict’s persistence in the face of worsening physical, mental and emotional pain, and the engulfing damage caused to the lives of others: relationship breakdown, deep resentment, financial insecurity and the warped lives of blameless children are obvious examples.

Asked why they have done it again, often in the wake of contrary heartfelt assurances, the addict will usually have no reason, excuses and verbiage apart. Long gone is the chemical high generated by a particular substance or activity; other perhaps than the instant but tragically short-lived relief that comes with re-engagement, enjoyment no longer features in the addict’s repeatedly failing cycle, often driven by euphoric recollection, of desperately chasing something that will never materialise.

Addicted to what?

Addiction may relate to specific behaviours. In terms of substances, the Office for Health Improvement and Disparities statistics for substance misuse (latest, 27 January 2022) disclose 275,896 adults in contact with drug and alcohol services between April 2020 and March 2021. The two largest groups were opiates (56%, an increasing figure) and – half the opiates figure – alcohol (28%), followed by cocaine, cannabis, benzodiazepines and (much lower) ketamine. Some users presented in more than one substance. The difficulty with the statistics is that they say nothing about the numbers who suffer but never seek help. The data probably identifies the substances most likely to pose addiction problems.

Addiction versus consumption

Volume of usage does not dictate addiction. Counter-intuitively, the addict’s distinguishing feature is not consumption, although quantity may be a factor; addiction’s hallmark is lack of control despite damaging consequences. Why this happens is not fully understood. The non-addict can cut down and maintain enjoyment in harmless moderation; the addict cannot moderate but may be capable of giving such an impression, and genuinely believing the change him or herself, through a transient, even protracted, period(s) of abstinence. As a solution, however, this is flawed.

What does an addict look and sound like?

Not all addicts reside in the gutter in a literal sense. The connotations of the word addict are unhelpful. One hackneyed image of the alcoholic is the tramp on a park bench nursing a bottle of cider. Such addicts don’t have responsible jobs, employ elegant diction, go to dinner parties, take nice holidays, drink fine wines or anything in between. Addiction, however, isn’t stereotypical and doesn’t discriminate; sex, class or background doesn’t matter, and the addict’s nature learns to protect its inherent problem, as deviously as required. There are addicts at the Bar.

The functioning addict

The functioning addict is a dangerous animal and one not to be underestimated; often (but not always) the life and soul, engaging, a character, the type you might want at a party (or not), but just as often collapsing internally, coping, but gradually less well. Invariably well above average intelligence, the maintenance of an addiction in the face of a demanding life requires huge energy and stamina and no small degree of what might be termed covert and complex forward planning.

Generally, but often camouflaged and explained away through adept social skills, professional performance will be below what it could be (even if still well above average!), as will be self-maintenance (strong scent, mints and eye drops are common self-help techniques), health on all fronts, genuine interest in others and general social functioning. Until the sky falls in, however, catastrophe and just getting by is a non-negotiable risk despite the misery of the cycle into which the addict is locked and all of life that would otherwise be on offer and available to him or her. Markedly at odds with outward appearance, addicts often talk of an awful sense of loneliness and an ever-present sense of fear. There’s a reason this sounds like madness.

Imagine the nightmare of running endlessly on a hamster wheel turning too quickly, and trying to do everything else you’re supposed to be doing. Imagine: ‘Not a moment of my life is untainted by my addiction. If I am not engaged with it, then I am tormented by the shame of self-loathing in the mire of its aftermath or, amidst my responsibilities, I am planning when next I can engage with it. I know that there is no way out, that it is taking everything from me and will destroy me, yet in truth there is nothing and nobody to which my addiction would yield.’ Though choices may lead to it, nobody chooses addiction, and it is the very antithesis of glamour, however the media skews terms like rehab and recovery.

The hellish nature of advanced addiction is illustrated by research in the US that connects relapse from recovery with addicts losing conscious contact with the lowest point to which their illness took them. Although good recovery does not dwell in the past, addicts forget the miserable depths they plumbed at their peril. Getting well involves a life-long re-booting of everything, a reprieve from the truly awful, but lived only day-to-day – the right now is all there is – seeing everything in a different way that gradually becomes intuitive and informs behaviour and choices, but without losing touch with the reality of the addict’s unchangeable condition and ever-present susceptibility to it.

Addiction at the Bar

In contrast to the unhealthy, chaotic and unmanageable life of the addict, members of a naturally conservative Bar, operating as a free-market supplier of services, have a self-interest in exuding the very contrary; reliability, health, intelligence, trustworthiness, experience, wisdom etc. Addiction, its side-effects, and the impression those convey, are inimical to this image.

Mental health still carries with it a stigma, whatever the Herculean efforts for change. However collegiate and nurturing any working environment, it is not difficult to see why addiction mandates proactive acknowledgement (at least) given the understandable albeit sometimes imagined fear of the sufferer – who, remember, is ill – that any request for assistance, or even hint of weakness, might meet with rejection, disenfranchisement, loss of reputation, damage to practice or aspirations, none necessarily overtly.

A stiff upper lip, truisms and TLC, all have their place, as do cold showers. On willpower alone, and however subjectively genuine the wish to change, the truly resolute addict might sustain sobriety or good behaviour for a period, if only motivated by raw fear. Onlookers might be relieved at the problem’s apparent resolution, proud even – ‘[X] could always stop, and [they] have’ – although the same people are often the addict’s chief enablers: ‘[They’ve] always liked a drink’, ‘Go on, [you] deserve(s) it’, ‘Works hard, plays hard’, ‘We all need to relax’ etc. The problem with the sticking plaster consolation of white-knuckling abstinence is that the underlying addiction is not addressed; inevitably, the nature of this complex and confounding condition dictates that the addict will revert to type, sooner or later.

Who would care to admit defeat?

The distance down the proverbial scale at which lies the desperation of rock bottom varies from person to person. Many speak of the relief of reaching the point where they could go no further; the end of a prison sentence is a common analogy. When there is nowhere left to go – in some, this requires one or more relapses, as if further proof were needed – such desperation can be a powerful resource in driving the sufferer into the ground-breaking step of absolute honesty and acceptance of the truth. Accepting that life has become unmanageable, that the sufferer is beaten and needs help, means that he or she need no longer go daily alone and lonely into an unwinnable war. At this turning point, a spoken admission can be an emotional moment. If serious about it, for the long run, this is a huge step. Things can only get better, and how.

There is a solution

Acceptance that the hopeless addict is ill, not blameworthy or just weak and self-centred (although addicts are invariably self-centred), radically alters the complexion of the problem. There is no middle-of-the-road answer. The only durable solution lies in commitment to a programme of recovery. The 12-step programme of Alcoholics Anonymous – originally 6 steps soon after the formation of the Fellowship in the late 1930s when the only answer for the hopeless drunk was the sanitorium, if that – forms the template for similar organisations that target other forms of addiction and presents a workable structure, a bridge to normal living.

Many addicts and those around them imagine that abstinence is all that’s needed but, as invariably becomes apparent with commitment, the nature and scale of the addict’s problem calls for nothing less than a spiritual transformation and a life of ongoing maintenance by way of a daily reprieve. The upside is that a clean life opens the door to possibilities previously unimaginable, a surfeit of time for useful living and – this is key – one absent the desire for the addict’s previous weapon of choice. This is something truly remarkable.

Good recovery, for the addict and the lives of others, necessitates nothing less than a top to bottom inventory and overhaul. The process of dispelling the hopelessness and futility of life, as it has become, lies in honest self-searching, humility, the sharing of shortcomings with at least one other and rebuilding. This is not an overnight process. How could it be given the toxicity of the problem? The reward of engaging with this toolkit of recovery is an internal revolution in attitude to life, towards self and our fellows and whatever we acknowledge, individually, our own truth, as lying outside us. Preaching is not a part of the 12-step programme, but it is a transformational practice, and there is nothing else that meets that need. Millions testify to this miraculous solution, people who live fulfilling and positive lives, people no longer bedevilled by the Four Horsemen – terror, bewilderment, frustration and despair – people who would otherwise be dead or dying.

A concluding thought

None of us chose our constitution, whatever shaped us or much of our early experiences. Recovering requires a choice (and not one made simply for the benefit of others), surrender and following a path well-trodden by fellow travellers who will attest to a transformation that leads to a new way of living, beyond wildest dreams – however unlikely that might seem in the unlit depths of illness and despair – all without medication, payment, fees, indeed anything beyond a genuine willingness to recover and a preparedness to go to any lengths to that end. It is a process in which aloneness features not at all. The points of contact below are a first port of call; others are easily located. Those who want it will find that no shortage of genuine help awaits.

SOME POINTS OF CONTACT a most excellent resource featuring a range of talking therapies for download, including ‘Recovering from Addiction’
Alcoholics Anonymous (AA) 0800 9177650
Cocaine Anonymous 0800 612 0225
Marijuana Anonymous 0300 124 0373
Narcotics Anonymous 0300 999 1212
Gamblers Anonymous 0330 094 0322
*See Smith DE & Seymour RB (2004), The Nature of Addiction, in RH Coombs (Ed), Handbook of addictive disorders: A practical guide to diagnosis and treatment (pp.3-30) John Wiley & Sons Inc. There is an excellent discussion of the nature of the condition in Elizabeth Connell Henderson’s Understanding Addiction (2009), University Press of Mississippi.