Substance Abuse from a Classical Adlerian Perspective - Alfred Adler Institute of Northwestern Washington

Alfred Adler Institute of Northwestern Washngton

Substance Abuse From A Classical Adlerian Perspective

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Alfred Adler Institute of Northwestern Washington, (360) 647-5670, E-mail: HTStein@att.net .

The combination of depth Adlerian Psychotherapy and the philosophy of Alcoholics Anonymous (AA) is a creative integration which is extremely useful in the treatment of recovering addicts and alcoholics. Classical Adlerian Psychotherapy offers a unique and effective means of creating a bridge of cooperation among the therapist, the client, and the AA community. This bridge gradually awakens the creative power of the client and increases social interest. At this point AA is an important support system. However, it is not psychotherapy and can not assist the client in dissolving the style of life and fictional final goal that lie at the root of his difficulties. This is the task of psychotherapy.

There is some speculation that the founders of AA may have been influenced by Adler's ideas, especially his views of the interconnectedness of all of life, the importance of cooperation and social interest, and the feeling of inferiority as an impetus for striving toward completion or superiority. In Jack Alexander's well known 1941 Saturday Evening Post article, he stated: "AA is a synthesis of old ideas rather than a new discovery."

The similarities between the philosophy of AA and Classical Adlerian constructs have gradually become clearer to many people over the past several years. Most are Classical Adlerians, some are Substance Abuse professionals, fewer are both. Some parallels between AA and Classical Adlerian constructs will be discussed. This brief comparison will be followed by the discussion of the practical application of these constructs in the treatment of substance abuse.

Brief History of Alcoholics Anonymous

AA was founded by two alcoholics in 1935. One of them was a New York stockbroker (Bill Wilson), the other an Ohio physician (Dr. Bob Smith). It is possible that "Dr. Bob", as he is called by members of AA, may have been acquainted with some of Adler's work. He was an intelligent, well read, and educated man.

Both "Bill W." and "Dr. Bob" had made many attempts to stay sober--and failed. "Dr. Bob" had also been unsuccessful with his alcoholic patients. They believed they had tried everything until they became acquainted with a Christian fundamentalist group called the Oxford Group. The tenets of this group provided a spiritual basis for recovery from alcoholism (sobriety) and the new movement of Alcoholics Anonymous.

The co-founders of AA were definitely influenced by the Oxford Group, in particular the tenets of the need for a moral inventory, confession of personality defects, restitution, helpfulness to others, and the necesssity of a spiritual belief in God. Other influences were Hans Vaihinger The Philosophy of As If and William James' Varieties of Religious Experience. The first "Big Book" was published in 1939 under the title Alcoholics Anonymous and contains many similarities to Adler's ideas. It was from this title that the movement derived it's name.

Similarities Between AA and Adler

Alfred Adler, Bill Wilson, and Dr. Bob Smith were contemporaries and shared some influences, i.e. Vaihinger. Adler's first visit to the U.S. was in 1925. Between 1926-1935 he alternated six months in the U.S. and six months in Austria, until he moved to New York in 1935.

Adler's theory is an integrated, holistic model of human nature, psychopathology and treatment. It is a philosophy of living, not unlike AA. It is a value oriented psychology that envisions people as capable of profound cooperation in living together and striving for self-improvement, self-fulfillment, and contribution to the common welfare. His views of the interconnectedness of all of life, the importance of cooperation and social interest, and the feeling of inferiority as an impetus for striving toward completion or superiority are echoed in the AA philosophy. The twelve steps of AA have many similarities to these ideas.

Adler's position on alcoholism was that it is possibly an organ inferiority of the digestive system. "In alcoholism a special component of taste plays a part..." (Ansbacher) This is similar to AA's and the AMA's (American Medical Association) position that alcoholism is a disease, and possibly an allergy. In the forward of Alcoholics Anonymous, Dr. William D. Silkworth discusses alcoholism as an allergy to alcohol. Current research has found that alcoholics metabolize alcohol (in the liver) at 1/2 the rate of non-alcoholics. Ongoing research is attempting to determine how genetic and environmental factors interact in the development of alcoholism. i.e. Marc Schukitt's twin studies.

Adler also discussed self-indulgence as a life-style issue and viewed alcoholism as a form of retrogressive movement. He referred to alcoholics as "pampered failures" lacking in courage and social interest. "Very frequently the beginning of addiction shows an acute feeling of inferiority marked by shyness, a liking for isolation, oversensivity, impatience, irritability, and by neurotic symptoms like anxiety, depression and sexual insuffiency." (Ansbacher) Addiction is a specific form of neurosis, and as such is treated in a broad sense like any other neurosis. According to Adler: "The [neurotic] arrangement is most clear in the case of addiction to alcohol, morphine or cocaine, which will heal without leaving any trace only if the community feeling increases and vanity decreases." (The Neurotic Constitution).

The "Big Book" of AA states: "Our liquor was but a symptom. So we had to get down to causes and conditions." AA members also discuss "terminal uniqueness" (a form of vanity) and self-centeredness as "the root of our troubles". The solution? Fellowship in AA, working the 12 steps, "gaining interest in our fellows", and being useful to others. "The basic principles of the AA program, it appears, holds good for individuals with many different lifestyles,..." (italics by author). "To get over drinking will require a transformation of thought and attitude." ..."Then you will know what it means to give of yourself that others may survive and rediscover life." (Alcoholics Anoymous).

Practical Application

Substance abuse is so prevalent that the possibility of chemical dependency should be considered in any complete psychological examination, whatever the presenting problem. About 43% of U.S. adults--76 million people--have been exposed to alcoholism in the family. (National Center for Health Statistics-NCHS). An additional 13.9 million Americans 12 and over have used illicit drugs. Approximately 80% of all current illicit drug users are marijuana or hashish users. (National Household Survey on Drug Abuse-NHSDA).

The symptoms of substance abuse mimic other psychological disorders ( i.e. psychotic mood disorders, clinical depression, anxiety, sexual dysfunction, sleep disorders, antisocial disorders), medical problems (i.e. thyroid problems-hypo, hyper, Grave's Disease), and neurological disorders (i.e. head injuries, slurred speech, incoordination). Therefore, substance abuse/addiction MUST be ruled out before beginning psychotherapy.

Following is a chart which shows some similarities between Adler and AA as well as the practical application of Classical Adlerian constructs in the treatment of substance abuse. This is preliminary and "a work in progress".

Inferiority Feeling (IF)

Adler

AA

Practical Application

Experiencing a real or felt "minus" situation. The motivation for striving toward an imagined "plus" because of the individual's creative power.
Adler: "The feeling of inferiority rules the mental life and can be clearly recognized in the sense of incompleteness and unfulfillment, and in the uninterrupted struggle both of individuals and humanity."
The desire to strive, develop, achieve, complete.

"An egomaniac with an inferiority complex." AA jargon gives additional tools for discussing ideas in a common language the client can relate to and understand.
"...feelings of uselessness and self pity..."
Use of humor to recognize a generalized inferiority feeling and point toward a more positive direction.

Therapist must identify the client's specific IF and guide the client in the direction of recognizing and conquering it.
Childhood prototype.

Striving for Significance

Adler

AA

Practical Application

Striving for the illusion of significance in order to overcome the IF rather than striving for genuine significance.
"...the craving may start with a superiority complex in the form of boastfulness,...a longing for power." (Ansbacher)
The desire for significance, achievement, accomplishment.

"A piece of shit that the world revolves around."
"Terminal uniqueness."
Humility.
Anonymity/12th Tradition: "principles before personalities."
" When writing or speaking publicly about alcoholism, we urge each of our Fellowship to omit his personal name, designating himself instead as 'a member of Alcoholics Anonymous'." (Alcoholics Anonymous)
"We have found nothing incompatible between a powerful spititual experience and a life of sane and happy usefulness." (Alcoholics Anonymous)

Therapist is a "co-thinker" and works with the client to find genuine significance.

Feeling of Community

Adler

AA

Practical Application

The addict's feeling of community is very narrow. Interconnectedness with all of life has three components:
1. Cognitive - to know it
2. Affective - to feel it
3. Behavioral - to do it
Radius (external action and benefit to others).
The radius extends from one person (mother/primary caregiver) to the family, the group, ideally all people - the cosmos/universe.

Adler - Circles of Connection

"Selfishness, self-centeredness! That we think is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking and self-pity, we step on the toes of our fellows and they retaliate...So our troubles we think, are basically of our own making." (Alcoholics Anonymous)
3A's:
1. Awareness - to know it
2. Acceptance - to feel it
3. Action - to do it

AA Fellowship--"Life will mean something at last."
Sponsorship--"Helping others is the foundation stone of your recovery." (Alcoholics Anonymous)
The radius extends from one person (sponsor) to AA as "spiritual family," home group, all alcoholics, all people, and ideally God, the cosmos/universe.
AA - Circles of Connection

Therapeutic goal is to extend the feeling of community to everyone.

Fictional Final Goal

Adler

AA

Practical Application

(Influenced by Hans Vaihinger)
The alcoholics's goal is too high for reality. Having a high goal isn't a problem. The problem is wanting to be in a high place without earning it. Vanity. This fictional future reference point pulls all movements in the same compensatory direction. The view of the future guides the person in the present, i.e. never feeling pain.

(Influenced by Hans Vaihinger)

"Act as if."

"Fake it till you make it."
"Rarely have we seen a person fail who has throughly followed our path. Some of us tried to hold on to our old ideas and the result was nil until we let go absolutely." (Alcoholics Anonymous)

Therapeutic goal is to reduce the size of the goal to an achievable level.

Style of Life

Adler

AA

Practical Application

Alcoholics are often self-indulgent, avoid responsibility. Themes of escape, distance from reality (seen as unpleasant or unmanageable), wanting an easy way ....

One central theme is reflected in every psychological expression, in the way the individual approaches/avoids the three tasks of life. Involves all or nothing thinking, rather than the flexible problem solving of a healthy person.

"We thought we could find an easier, softer way..."
Steps 4, 5, & 8 (see Jack Alexander's article and Alcoholics Anonymous)

"King Baby"

Therapeutic goal is to develop self-discipline, acceptance of responsibility.
Dissolving of the life style.

Antithetical Scheme of Apperception

Adler

AA

Practical Application

The view of the self and the world.
Limits ability to make realistic judgments, but serves the purpose of protecting fictional final goal and life style.
Gives motivation and justification to strive in the direction of the goal.

"Black and white" thinking.

"All or nothing".
"1-10."
"Recovery is two through nine."

Therapeutic goal is to eliminate antitheses and recognize grey, more subtle nuances.

Organ Inferiority

Adler

AA

Practical Application

Some organs that drugs affect are the digestive system; CNS; brain; heart; liver; gastrointestinal tract; respiratory system, and the reproductive system.
"...the organic functions are dominated by the style of life." Problems of Neurosis

Allergy.
"Put the plug in the jug."
Craving for sweets/sugar.
Alcoholism is a disease.
Health issues.

Therapeutic goal is the abstinence from chemical of choice.
Improve diet.
Treat allergic responses.
Exercise.

Private Logic

Adler

AA

Practical Application

Involves an antithetical scheme of apperception to rigidly classify self, others, and experiences. It is related to a child's need for security.
Feeling of entitlement. "I deserve everything I want because I had a terrible childhood, my mother died, my father was an alcoholic, my sister was the favorite," etc.

"Stinking thinking."
"I want what I want when I want it."
12th step - "carried the message" to other alcoholics.
Sponsorship: "Make it plain he is under no obligation to you, that you hope only that he will try to help other alcoholics when he escapes his own difficulties. Suggest how important it is that he place the welfare of other people ahead of his own." (Alcoholics Anonymous.)
"...nothing will so much insure immunity from drinking as intensive work with other alcoholics. It works when other activities fail." (Alcoholics Anonymous)

Therapeutic goal is to develop feelings of obligation to others.

Cooperation/Social Interest

Adler

AA

Practical Application

In an addict it is limited or conditional--other users, the family, etc.

"...his action is intelligent with respect to the goal of overcoming difficulties the easy way. It is not a common-sense but a personal solution." (Ansbacher)
Social interest is the capacity for generating cooperation, connection in ever widening circles.
Contribution.
Social interest is a multi-level concept:
Affective - feel a deep belonging and empathy for others. Feeling at home on the earth.
Cognitive - necessary interdependence with others. The welfare of any one individual depends on the welfare of everyone.
Behavioral - thoughts and feelings translated into actions aimed at self-development and cooperative movement toward others.

"I am responsible. When anyone reaches out for help, I want the hand of A.A. always to be there. And for that: I am responsible."
12th step work - "Though they knew they must help other alcoholics if they would remain sober, that motive became secondary. It was transcended by the happiness they found in giving themselves for others."
1st tradition.
"How A.A. members cooperate." (pamphlet)
AA Fellowship
Sponsorship: "...we became less and less interested in ourselves,...More and more we became interested in seeing what we could contribute to life." (Alcoholics Anonymous)

Therapeutic goal is to develop unlimited, unconditional cooperation/social interest.
The therapist must recognize and identify:
Movement to side and away from discomfort.
Lack of courage to face the tasks of life/difficulties.
Mistaken idea of normal--absence of pain of any kind.
Pampering/self-pampering. Alcohol high as reward for neglect.
Lifestyle - creative interpretation of what life should be.
"Paradise lost."
"I never had it."
Always a victim in the drinking/using.
Who suffers as a result?
Alcoholism as a weapon.
Alcoholism as a "temper tantrum."
Symptom is a compensation (feeling of intoxication) for what they felt was missing.

During the process of psychotherapy, as in the process of recovery from addiction, it becomes necessary to take action in a more positive and useful direction. In both cases this direction involves the development of courage and social interest.
According to Adler, if a client is not willing to acknowledge his mistaken direction, he is not going to change his lifestyle or goal. The client must have courage to admit his mistake(s). One of the tasks of the psychotherapist is to encourage the client to overcome difficulties in a more useful direction, which builds courage and ultimately, cooperation.
In AA, if an alcoholic is not willing to honestly acknowledge his "character defects" (mistakes), get a sponsor, and work the 12 steps he will be unable to stay sober. Sobriety requires change and a certain amount of courage. "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. ...They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty." (Alcoholics Anonymous)

Acknowledgements:
A special note of appreciation to Dr. Stein for all of his help in formatting and editing this article. Without his encouragement and technical assistance this article would still be on my computer as a "work in progress." Thank you.
No work is done in a vacuum; I also thank Jim Wolf, Randy Katkus, and Jeanie Cotton for their editing and suggestions.
Dyanne Pienkowski

Recommendation for Additional Study:
Since many psychology text books and encyclopedia repeat the same common misconceptions about the theory and practice of Alfred Adler's Individual Psychology, students, professors, and mental health professionals who are unfamiliar with Adler's original writings or style of treatment are encouraged to read Classical Adlerian Depth Psychotherapy, Volume I - Theory and Practice: A Socratic Approach to Democratic Living. The book provides an overview and clarification of Adler's philosophy of life, theory of personality, model of psychopathology, and principles of psychotherapy.

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Inferiority Feeling (IF)
Adler	AA	Practical Application
Experiencing a real or felt "minus" situation. The motivation for striving toward an imagined "plus" because of the individual's creative power. Adler: "The feeling of inferiority rules the mental life and can be clearly recognized in the sense of incompleteness and unfulfillment, and in the uninterrupted struggle both of individuals and humanity." The desire to strive, develop, achieve, complete.	"An egomaniac with an inferiority complex." AA jargon gives additional tools for discussing ideas in a common language the client can relate to and understand. "...feelings of uselessness and self pity..." Use of humor to recognize a generalized inferiority feeling and point toward a more positive direction.	Therapist must identify the client's specific IF and guide the client in the direction of recognizing and conquering it. Childhood prototype.
Striving for Significance
Adler	AA	Practical Application
Striving for the illusion of significance in order to overcome the IF rather than striving for genuine significance. "...the craving may start with a superiority complex in the form of boastfulness,...a longing for power." (Ansbacher) The desire for significance, achievement, accomplishment.	"A piece of shit that the world revolves around." "Terminal uniqueness." Humility. Anonymity/12th Tradition: "principles before personalities." " When writing or speaking publicly about alcoholism, we urge each of our Fellowship to omit his personal name, designating himself instead as 'a member of Alcoholics Anonymous'." (Alcoholics Anonymous) "We have found nothing incompatible between a powerful spititual experience and a life of sane and happy usefulness." (Alcoholics Anonymous)	Therapist is a "co-thinker" and works with the client to find genuine significance.
Feeling of Community
Adler	AA	Practical Application
The addict's feeling of community is very narrow. Interconnectedness with all of life has three components: 1. Cognitive - to know it 2. Affective - to feel it 3. Behavioral - to do it Radius (external action and benefit to others). The radius extends from one person (mother/primary caregiver) to the family, the group, ideally all people - the cosmos/universe.	"Selfishness, self-centeredness! That we think is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking and self-pity, we step on the toes of our fellows and they retaliate...So our troubles we think, are basically of our own making." (Alcoholics Anonymous) 3A's: 1. Awareness - to know it 2. Acceptance - to feel it 3. Action - to do it AA Fellowship--"Life will mean something at last." Sponsorship--"Helping others is the foundation stone of your recovery." (Alcoholics Anonymous) The radius extends from one person (sponsor) to AA as "spiritual family," home group, all alcoholics, all people, and ideally God, the cosmos/universe.	Therapeutic goal is to extend the feeling of community to everyone.
Fictional Final Goal
Adler	AA	Practical Application
(Influenced by Hans Vaihinger) The alcoholics's goal is too high for reality. Having a high goal isn't a problem. The problem is wanting to be in a high place without earning it. Vanity. This fictional future reference point pulls all movements in the same compensatory direction. The view of the future guides the person in the present, i.e. never feeling pain.	(Influenced by Hans Vaihinger) "Act as if." "Fake it till you make it." "Rarely have we seen a person fail who has throughly followed our path. Some of us tried to hold on to our old ideas and the result was nil until we let go absolutely." (Alcoholics Anonymous)	Therapeutic goal is to reduce the size of the goal to an achievable level.
Style of Life
Adler	AA	Practical Application
Alcoholics are often self-indulgent, avoid responsibility. Themes of escape, distance from reality (seen as unpleasant or unmanageable), wanting an easy way .... One central theme is reflected in every psychological expression, in the way the individual approaches/avoids the three tasks of life. Involves all or nothing thinking, rather than the flexible problem solving of a healthy person.	"We thought we could find an easier, softer way..." Steps 4, 5, & 8 (see Jack Alexander's article and Alcoholics Anonymous) "King Baby"	Therapeutic goal is to develop self-discipline, acceptance of responsibility. Dissolving of the life style.
Antithetical Scheme of Apperception
Adler	AA	Practical Application
The view of the self and the world. Limits ability to make realistic judgments, but serves the purpose of protecting fictional final goal and life style. Gives motivation and justification to strive in the direction of the goal.	"Black and white" thinking. "All or nothing". "1-10." "Recovery is two through nine."	Therapeutic goal is to eliminate antitheses and recognize grey, more subtle nuances.
Organ Inferiority
Adler	AA	Practical Application
Some organs that drugs affect are the digestive system; CNS; brain; heart; liver; gastrointestinal tract; respiratory system, and the reproductive system. "...the organic functions are dominated by the style of life." Problems of Neurosis	Allergy. "Put the plug in the jug." Craving for sweets/sugar. Alcoholism is a disease. Health issues.	Therapeutic goal is the abstinence from chemical of choice. Improve diet. Treat allergic responses. Exercise.
Private Logic
Adler	AA	Practical Application
Involves an antithetical scheme of apperception to rigidly classify self, others, and experiences. It is related to a child's need for security. Feeling of entitlement. "I deserve everything I want because I had a terrible childhood, my mother died, my father was an alcoholic, my sister was the favorite," etc.	"Stinking thinking." "I want what I want when I want it." 12th step - "carried the message" to other alcoholics. Sponsorship: "Make it plain he is under no obligation to you, that you hope only that he will try to help other alcoholics when he escapes his own difficulties. Suggest how important it is that he place the welfare of other people ahead of his own." (Alcoholics Anonymous.) "...nothing will so much insure immunity from drinking as intensive work with other alcoholics. It works when other activities fail." (Alcoholics Anonymous)	Therapeutic goal is to develop feelings of obligation to others.
Cooperation/Social Interest
Adler	AA	Practical Application
In an addict it is limited or conditional--other users, the family, etc. "...his action is intelligent with respect to the goal of overcoming difficulties the easy way. It is not a common-sense but a personal solution." (Ansbacher) Social interest is the capacity for generating cooperation, connection in ever widening circles. Contribution. Social interest is a multi-level concept: Affective - feel a deep belonging and empathy for others. Feeling at home on the earth. Cognitive - necessary interdependence with others. The welfare of any one individual depends on the welfare of everyone. Behavioral - thoughts and feelings translated into actions aimed at self-development and cooperative movement toward others.	"I am responsible. When anyone reaches out for help, I want the hand of A.A. always to be there. And for that: I am responsible." 12th step work - "Though they knew they must help other alcoholics if they would remain sober, that motive became secondary. It was transcended by the happiness they found in giving themselves for others." 1st tradition. "How A.A. members cooperate." (pamphlet) AA Fellowship Sponsorship: "...we became less and less interested in ourselves,...More and more we became interested in seeing what we could contribute to life." (Alcoholics Anonymous)	Therapeutic goal is to develop unlimited, unconditional cooperation/social interest. The therapist must recognize and identify: Movement to side and away from discomfort. Lack of courage to face the tasks of life/difficulties. Mistaken idea of normal--absence of pain of any kind. Pampering/self-pampering. Alcohol high as reward for neglect. Lifestyle - creative interpretation of what life should be. "Paradise lost." "I never had it." Always a victim in the drinking/using. Who suffers as a result? Alcoholism as a weapon. Alcoholism as a "temper tantrum." Symptom is a compensation (feeling of intoxication) for what they felt was missing.