Dr. Dodes, assistant clinical professor at Harvard Medical School and past director of several well-known addiction clinics, makes a compelling case that the meaning of addictions of all kinds have similar roots in feelings of helplessness. His revolutionary thesis posits that it is an individual's unconscious drive to overcome the feelings of helplessness that leads to addictive behavior.

Simply put, Dodes' model of addiction proposes that a constellation of individual and environmental factors converge to render an individual psychically helpless, and, when under sufficient stress, he or she feels something must be done to relieve the overwhelming feelings of impotence. Through a combination of factors, the individual discovers that the decision to take some action, be it gambling, sex, drugs, alcohol or another focus of behavior, can bring a temporary feeling of relief. The act is then repeated often enough to become a compulsive behavior and eventually an addiction.

Dodes states that addicts feel prevented from taking the unconsciously desired action that would directly relieve their helplessness, and learn to choose the substitute action in its place. The problems associated with the chosen substitute action are twofold: first, the decision to conduct the compulsive behavior only temporarily relieves the feeling of impotence; and, secondly, the compulsively repeated action often has disastrous side-effects resulting eventually in ruined relationships, poor health, interference with effective work and the like.

Dodes points to the statement of many addicts that they feel better the moment they decide to take action, concluding that the actual act of alcohol or substance use, gambling, etc., is secondary in importance. He further states that it is not the focus of addiction, such as gambling, drugs, sex, etc., that drives the compulsive action, but rather the individual's internal psychological need. As evidence, Dodes points to the ability of many addicts to readily exchange their focus of addiction among different drugs, sex, food or work, and other actions.

While acknowledging that a small minority of individuals do benefit from 12-step programs, Dodes believes that some of the tenants of Alcoholics Anonymous and other similar programs can actually be harmful to persons struggling to overcome addiction. For example, because Dodes believes that psychological helplessness is the basis of all addictive behaviors, he believes that asking the addict to "admit to his or her powerlessness over addiction" sets the person up for almost certain relapse, making the problem even more difficult to overcome.

Dr. Dodes' model of addiction is seen by many, including Dr. Howard Shaffer, the director of the Harvard Medical School Division on Addictions, as a much-needed breath of fresh air for both individuals dealing with addictions and their therapists. The Heart of Addiction is presented in a very readable style, filled with interesting case studies, and may represent a turning point in how addictions are understood and dealt with.

For more information on the work of Dr. Dodes as applied to a specific teen case, see http://tandemjourney.org.

Dr. Dodes' article on helplessness and addiction is a welcomed relief from the disease model. Any model that attempts to explain "why/what" addicts are trying to do with their drug use is a step forward. To lump them all together into a single lot of "ill" people, acting out the plans of some nefarious biological demon, allowed for the removal of some of the social stigma attached to addiction, but did little to further understanding about its nature. Addicts are people, and people typically "act" intentionally, purposively. The bizarre nature of some behaviors is not evidence to suggest they are not acting with intention and purpose. The disease model buries that fact in a one-size-fits-all mentality that offers little room for the idiosyncratic differences found between addicts, addictions of choice, drugs of choice, manner of use, etc.

I could fully agree with the good doctor's theory but for one point. I feel most addicts do experience a severe sense of helplessness. Helplessness over what, however? Addicts may well report that they felt relief from taking some action, using. But how does one separate that sense of relief from the true effects of whatever they used? The fact that many addicts "know" their drug of choice at first use, even after having "taken action" by using other drugs prior, indicates to me that there is a specificity of choice that goes well beyond the notion of action vs helplessness. That specificity allows for the notion of drug-of-choice. Addicts' willingness to switch addictions has more to do with availability and other factors dictating accessibility, than it does their willingness just to act. If simply "acting" were the issue, forcing oneself to go for a jog, begin college, get married, have a child; obviously the list is endless regarding alternative "actions" that could mediate feelings of helplessness.

A final point: Many, many addicts who do recover report that they had to stop "because the drugs stopped working…they didn't stop the pain anymore." This was not a result of their unwillingness to act. This is, in fact, the heart of addiction. Addicts are certainly "trying" to do something with their various behaviors. I would suggest, from both personal and professional experience, the vast majority would say, "I'm trying to stop the pain". I know that is what self-harmers and bulimics say: Junkies, too. I DO feel helpless, when it comes to stopping the pain.

Yes, addicts use because they feel helpless. Again, they are purposive intentionally driven beings. We don't need a proposed mysterious "subconscious inability to act" to get the ball rolling. Ask any dope fiend, people who cut on themselves, eating disorder clients, gamblers, etc. and you will (I have over decades of dealing with these populations) inevitably hear their intention…their purpose for using……to stop the pain. If addicts feel helpless, that helplessness is rooted in an inability to ease an underlying intra-psychic pain that dominates their lives. Ironically, A simple drug addict has a certain degree of pain; a drug addict that also cuts himself has a somewhat different degree of pain; by the time you get to the drug addicting (multi-diagnosed) self-harming bulimic one is likely talking about pains of incest, rape, abuse the likes of which literally shatter their sense of self and life. Finding "healthy" ways of "acting" does little to touch the pain of these people, and those who have recovered often speak of therapy helping to minimize the pain to a manageable level.

Thus, yes Dr. Dodes I agree addicts feel helpless. However, the buck does not stop there. Your hypothesis is very encouraging and enlightened. However, I am a Ph.D. in Clinical Psychology, who has worked with adolescents and adults multi-diagnosed with compulsive disorders. My last placement was an inpatient eating disorders program. I have worked with addicts for years, and I spent ¼ of a century banging heroin and cocaine, myself. An analogy of an infection: The specific behaviors of the addicts (drugs, sex, eating, etc) are like the fever of the infection. Helplessness may well be a motivator to act, just like inflammation, discoloration, soreness, coughs, may be the overt symptoms of the infection that spawn people to seek help. When we get to the physician, he is concerned with the infection…that caused the overt symptoms and fever. If you don't address their PAIN, you miss the core of addictions. This truth is even more paramount with eating disorders and self-harm. Dr. thank you for your work. We are on the same page, albeit possibly coming at it from different directions.

Very interesting article, and I, an addiction therapist and also a teacher of students with emotional and behavioral problems agree wholeheartedly with these findings. I also agree with the idea that when a person admits to being powerless over and over as in 12 step programs that this reinforces the concept of powerlessness and leaves too many 'outs' for the addict to relapse. The same goes for 'so-called' triggers for addictive behaviors such as having money, or hearing an old song or whatever other such nonsense.

In order for a person to overcome this "sense of helplessness" or "powerlessness" he or she has to do a thorough self-examination of their faulty belief systems and the "realities" or constructs that they have created as realities in the mind and begin to work on some of their faulty defense mechanisms that they have developed over time as a way of dealing with life. The inability to deal with life on life's terms that comes from the feelings and beliefs about being powerless and helpless can be overcome. For alcohol or other drug users, they first have to get clean and get the drug out of their system so that the part of the brain that deals with reason and logic can function. It is pointless to counsel with or otherwise try and reason with a person under the influence of drugs, legal, prescription, or otherwise. This is not to say that some medications are not needed for some, but all too many prescriptions are written for people who cannot deal with life on life's terms, and all the drugs do is mask the problem and the person does not learn how to restructure their thinking, which leads to the feelings, which leads to the destructive or otherwise counterproductive behaviors.

Anyway, this is interesting and I hope that many more people in the addiction and counseling field will begin taking and using different approaches. Reality is this: most everybody is lacking in some area of emotional development which leads to problems and most everybody could improve in some area of their lives, some more than others. All too many addiction professionals and novices do a disservice, in my view, by telling people that they need to admit over and over that they are powerless and going along with that, is helping people find excuses, and call them triggers. The only thing I have with a trigger is my gun, my drill, and my saw, and I have to make a choice whether or not to put my finger on it and pull it.

Thanks for this book review, and I will check it out for myself.

Happy Trails to you--

M. Jerome Ennis, M.ed.
Master's Level Addiction Professional
Tuscaloosa, Alabama
jgreyh960@aol.com