The Heart of Addiction

by Lance M. Dodes
Quill, 2002
Review by Fred Ashmore on Jun 6th 2003

I found The Heart of Addiction really interesting and worth reading. Dodes is a psychologist of the psychodynamic school (hope the phrase is right) who reports his perceptions of what lies at the heart of addiction, backed up copiously by personal stories from people he has worked with -- I was going to write "case reports" but he tells sensible illustrative stories about real people and explains what he thinks about them, which I like much better.

His view is that addictive behaviors are a response to feelings of powerlessness and loss of control and that the behaviors allow a person to establish his or her own area of control of life.

"But surely" was my first response, "addiction is all about being out of control. Else why look for help?" That's a very traditional 12-step view, and I think that Dodes provides good reasoning why that view may be hard to support. Although it's a long time since I practiced abusive drinking. I recall well the feeling that I was by God going to do what I wanted to do, so here's how, people! I was in charge (for a while)!

Dodes expands his propositions very well, presenting analysis of the patterns of thought and habit associated with addictive forms of behavior that is compelling and clear. Chapters include a series of illustrative case histories, a lucid explanation of the nature of addiction, how one may distinguish between abuse and addiction, a section on myths of addiction and some of the less mainstream addictions such as internet, shopping and exercise. His comments on teens and couples I found particularly helpful and interesting.

His views on other methods? He is refreshingly frank about some of the weaknesses in the 12-Step approach to addiction, giving sensible reasons why it works for some people and is worse than useless for others.

Dodes casts a few brickbats at the superficiality of behavioral methods. I think his comments were so much "cast in passing" that it's hard to take exception, even though I have personally found these methods very helpful. And indeed, one of my pet gripes on first acquaintance with Rational Emotive Behavior Therapy was being told that digging into personal background and history is pretty much a waste of effort, present behavior and changing it is all that is important. Dodes presents quite a different approach, and I think he is right. If a person is addicted and wants to change, it seems only sensible to try to understand why, although it is also a pretty good idea to desist from serious addictive behavior as soon as you can handle it and regardless of whether you have the first set of answers.

Among the many fascinating chapters in this book are two about gambling and about sexual addiction. The opinions on whether these are true addictions can be fairly vehement, but explained in Dodes' terms I would say they have the characteristics. He also, almost absent-mindedly, offers an explanation for some forms of compulsive behaviors and their relationship to addictive behaviors which is another question that anyone who's met a few such people wants to understand.

Does he have answers? Well, no quick instant fixes, that's for sure. I find this reassuring. A habit of mind that someone's taken a lifetime to acquire shouldn't yield to a magic wand, in my opinion.

Dodes is a clever man and he comes across as an attractive and caring personality. This book is also really well written, which is a courtesy to the reader and a great selling point.

Who is it for? I expect professionals in the field would find it a fairly non-confrontational starter, which might prompt them to deeper investigation. I think anyone interested in addiction -- addict, spouse, family, observer or whatever could benefit considerably from reading it. As for me, I'm going back to read it again.

Fred Ashmore is a member of the public with a strong interest in drugs, drink and addiction and how people recover from them. He is active as a meeting host for the SMART Recovery® program, which offers help for people who seek to modify harmful and addictive behavior.

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