Over the years I have worked with many people who suffer from addictions of all sorts –drugs, alcohol, food, sex – you name it. Most were/are in recovery or have attempted to deal with their addictions in other ways. But one thing I’ve noticed that they have in common is that most have Social Anxiety Disorder as an underlying problem. That is not to say that all addicts have this. But when you think about it, for many it makes sense. Addictions mask emotions and help with symptomatology. They initially make things easier – brighter if you will. Drugs & alcohol lower inhibition and can help ease the way for social interaction. For most, alcohol lightens the mood and lowers inhibitions and may make things more pleasant. But social discomfort is major problem for those with Social Anxiety Disorder. People can shake, stutter, withdraw, become mute and can’t make contact even in the seemingly most benign circumstances. Think of Rojesh from TV’s “Big Bang Theory”. He is a caricature for sure, but not so far from hitting the nail on the head. The powerful underlying truth of what many with Social Anxiety Disorder deal with is that their discomfort is so great, they can’t connect. Or they suffer greatly when trying to interact. Drugs or alcohol can produce a major shift for them. It is self-medicating, and many even forget what is lurking underneath – especially if they become chronic users. But when sobriety is achieved it is there – just as it was from the beginning. The trick is to find other ways of dealing that might bring about some real change.
Tag Archives: Addictions
Psychotherapy: Have The Issues Changed Much in 30+ Years?
Someone asked me if the problems people come to see me about have changed much over the course of my practice. I had to think about it, but the answer I gave is basically “no”. The externals or presenting problems can look very different and how people approach things and what they look for in the way of solutions has changed. We live in a high stress world but in my view the underlying issues are essentially the same.
The only real difference that I can pinpoint is that people are more open in talking about certain things. A good example is that people are less reluctant to talk about sexual issues. Sex in general is talked about more openly. Sexual orientation and identity are no longer taboo topics. Adoption and fertility issues are talked about more openly. Addictions too are not hidden or denied as much. As a culture I think we are more open and accepting – at least in my neck of the woods. And so because the culture in general has changed, there is very little that is off limits. Topics that used to be considered shameful or impossible to even mention, are talked about. That is not to say that people don’t feel shame and pain. They do. But at least the world gives them permission to speak. I consider that one of the most positive outcomes resulting from the diversity and transparency in our modern world.
Most people can talk about what was once off limits even if it is hard to open up and takes a while. But the underlying problems regarding relationships, intimacy, self-esteem, trauma, abuse, feelings of loss of control, depression, anxieties, self- hatred – the list can go on – those remain much the same. We are all creatures of the human condition and so the problems we experience in our core are still the same. It’s one of the reasons I believe in psychotherapy. It’s a methodology that can hopefully reach us in that core.
Paula Zuckerman, LCSW. Random thoughts on a 30+ year psychotherapy practice 