Escaping Or Accepting?

By Joseph A. Troncale, MD, FASAM

Escaping Or Accepting

As far as I’m aware, there has been no time in history when the human race has had the majority of human beings attempting to accept their feelings rather than attempting to escape them. Escape is a natural way of avoiding pain and unpleasantness. This technique works for short term relief, but it impedes the individual from working through events and feelings. Often leading to emptiness at best, and guilt or shame at worst.

It is my belief that escape is at the heart of all addiction. Brene Brown in her book Daring Greatly, points out that shame and guilt are fostered by our attempts to escape our feelings. She identifies three primary ways of escaping feelings, and I suspect there are quite a number more, but for purposes of this article, I will stick to her paradigm.

Escape mechanism number one is the set of behaviors I see in patients such as drugs, alcohol, eating disorders, sex or gambling addiction etc. Engaging in mind-altering or body-numbing behaviors tends to take one out of reality and suspend time, so that life seems better in the short run.

The second escape is perfectionism. On the surface, perfectionism doesn’t sound like escaping, but in fact, we all know the phrase “Nobody’s perfect.” So if that is true, then perfectionism by definition, is a set up for failure. Trying to control everything with perfectionism is another short term escape. In the end, the imperfection that is predestined leads to shame and guilt because one is never able to achieve what one believes one “must” do. We see so many patients that have the bar set so very high that failure is unavoidable, and yet it is taken personally.

The third mechanism is what Brown calls “waiting for the other shoe to drop.” How many people, when things are going well, cannot enjoy the moment because “it can’t last.” Being “too good to be true” is the escape that allows people to suffer in the face of prosperity and good times.

Acceptance-Commitment Therapy (ACT) which is an evolution of Cognitive Behavioral Therapy (CBT) attempts to teach us to stay in the moment (so as to deal with whatever is in front of us) move towards our values (as opposed to moving toward suffering). When we actually apply our values to our lives, we achieve happiness. At the heart of escape is the feeling of self-invalidation. As crazy as it may sound, there is no difference between the treatment of chronic pain and chronic addiction because they both stem from the feeling of a need to escape.

It is important to help individuals recognize that the disease of addiction carries with it the voice of shame and invalidation. When that voice is speaking, there seems to be only one way out. What we are trying to instill in our patients is for them to be nice to themselves first. Self-care, proper eating, good sleep, having a job they enjoy, doing things with free time that is meaningful, honest and having open relationships all contribute to this.

The disease of addiction is powerful, but addiction is not more powerful than living one’s values through self-validation, honesty and love.

Joseph Troncale, MD is Retreat’s Medical Director. Over the past 35 years Dr. Troncale has established himself as one of the premier physicians working in the field of addiction. He is both a fellow and a member of the American Society of Addiction Medicine (ASAM) and was named Outstanding Clinician by Addiction Magazine in 2010. He has publications in journals such as The Journal of Addictive Diseases and other peer-reviewed journals.