Working with Addictive Processes in Therapy: How IFS Offers Hope

Addiction is often viewed as a brain disease or an uncontrollable habit that signals a lack of willpower. Following disease model logic, the primary intervention would be  biochemical – just find the right medication. The ‘lack of willpower’ issue is murkier, often leading to power struggles between clients not yet ready for change and therapists tasked with getting high-risk activities under control, eventually devolving into ‘resistance’ issues and clinical drop-outs. Billions of pounds spent treating drug, food, alcohol, sex and gambling issues does not seem to be meeting the burgeoning need or addressing the vast suffering we see daily.

Where does that leave psychotherapists? Too often, polarised and confused. We readily treat anxiety, depression, relationship issues and avidly pursue ‘trauma training’. Yet if our client reports an addictive issue with gambling, sex/food preoccupations, or substance use, we often refer them out. We do this knowing full well the client isn’t likely to follow through – they aren’t ready to commit to a sober group and the few specialists around don’t have many openings. Yet, we’ve conveyed the message that they should ‘focus on their addictive issues’ and then come back for their therapy.

This is distressing and stigmatising for hurting clients, and often leaves them with nowhere to turn. Even community centres may demonstrate this polarity, setting up one doorway for therapy services and a separate entrance for ‘substance users.’ In the US, where I practise, residential recovery programmes often house distinct units dividing trauma treatment, substance use and eating disorders.

Yet, we know our clients don’t easily fit into one category. They suffer with bulimia, drink too much, obsess over a jobless boyfriend – and endured a childhood burdened by neglect and managing a mentally ill mom and young siblings. Or, they drink, use cocaine, spend money on sex workers, feel depressed, are desperate to stay married – and suffered devastating sexual exploitation by a beloved coach. Even a well-functioning but stressed and overworked client who is uneasy with their pattern of restrictive eating or alcohol use doesn’t fit neatly into a single category of treatment. Do they need treatment for a budding eating disorder, or nascent drinking problem, or just ‘anxiety’?
 

A parts-based approach to addictive processes

The Internal Family Systems (IFS) model offers a paradigm shift. Rather than viewing addiction as a unique and self-destructive pathology, we see addictive behaviours as desperately trying to help. United in their drive to do ‘whatever it takes’ to protect the system, the parts engaged in soothing, avoidant activities are committed to addressing underlying pain.

When no one is available to come to the rescue and relieve underlying trauma, these parts take charge. An addictive process develops over time. As chaos, risk and consequences increase, another team of parts is driven to keep the system afloat and combats addictive activity with desperate, self-loathing efforts to get in control. This entrenched battle cycles between two well-intentioned, driven teams and further burdens sensitive parts underlying the system, who already bear the strain of early trauma or attachment wounds.

IFS therapists learn to recognise the addictive cycle and guide their client to form internal connections to the parts that make up their inner teams of protectors. Starting with acceptance and a non-judgmental context, the client is guided to explore the inner intentions and reasoning behind high-risk parts and befriend them. We then help the client connect in a safe way to parts carrying underlying pain and trauma, releasing old burdens, freeing protectors from their roles and restoring balance to the system. Clients begin to experience more access to their core, compassionate sense of self and feel empowered to try new choices.  

IFS therapists work integratively, often collaborating with medical providers to offer appropriate medications, coordinate with self-help groups, couple and family therapists, and with more intensive treatment programmes whenever necessary.

We’ve all been addicted to something. Everyone knows the experience of struggling with a behaviour or pattern we’ve tried to change for months, or years. Many therapists also experienced family and loved ones with addictive issues, who may or may not have been able to find the right help.

In IFS trainings we invite therapists to get to know our inner systems, and connect without judgment or shaming to our own hurt or abandoned parts and further understand how we have tried to protect ourselves. We can bring this compassion, clarity, skill and deep acceptance to our clients with addictive processes; we don’t have to send them away.