The Relationship Model of Addiction ™(TRMA™) humanizes addiction. TRMA™is intended for clinicians providing education, conducting assessments and formulating treatment plans. It will also prove invaluable to those in recovery and interested in learning more about addiction and recovery.
For the past 65+ years, the Disease or Medical Model prevailed as the sole and primary source of education about addiction and treatment.
When alcoholism was deemed a disease by the American Medical Association in the early fifties, the impact was huge, as it significantly reduced the stigma attached to alcoholism and to being an alcoholic. Alcoholics were shunned and shamed by society, seen as weak and defected. As society began embracing the notion disease, alcoholics began feeling safer to come out of hiding and seek help because mostly everyone - significant others, as well as practitioners, were responding more compassionately and intelligently. The AMA defined the disease of alcohol is as a “pathological dependence” that caused the loss of control and uncharacteristic behavior, and viewed the phenomenon as strictly as a medical problem, using medical terminology when talking about it. Research had indicated correlations between the incidence of alcoholism with biochemistry and genetic factors, which led to an explanation or assumption of linking biochemical and genetic factors with predisposing conditions and cause. The problem for me was that there were always numerous exceptions suggesting other factors to consider. The ascription of disease was also tremendously helpful in treatment planning by establishing that achieving a sustained period of sobriety or abstinence has to be the first order of business, before any other co-occurring conditions can be effectively treated. However, now after 65 years getting to this point, sustained stabilization seems to have gotten confused with recovery and growth. We may have boxed ourselves into a mindset, something along the lines of - that you’re okay as long as you’re sober. TRMA and the Three Stages of Recovery goes way beyond sobriety. Disease also implies progressive, meaning that over time, there is a steady diminishment of functioning on all levels - it only gets worse – doesn’t stay the same or get better. Disease also meant permanent, “Once an addict, always an addict;” alcoholism as a life sentence, incurable. Treatment planning generally consisted of entering a program to get and stay sober, and mandating ongoing and lifelong participation in the 12-Step program. While this standard of treatment has proven to help millions of people, we’ve seen untold numbers of people seeking recovery who do not resonate with 12-Steps program and its philosophy, particularly its reliance on an externalized Higher Power or God. TRMA™picks up where the Disease Model left off. TRMA is my attempt to humanize addiction by looking at it outside of a medical context, and highlighting the emotional, psychological, experiential and relationship aspects, and in a way that applies to everyone and everyone can relate to. TRMA™ is based on the premise that the need for love and connection (inclusive of other emotional needs) are basic human needs, and when these needs are denied, there is going to be pain. Another premise is that the need to relieve pain is also basic human need. Newton’s Law - for every action, there is an equal and opposite reaction may apply. The more pain there is, the greater the need to relieve it. The more relief derived from the means, the greater the attachment to and dependency on it will be. The need for relief of emotional pain is a pre-cursor to addiction. TRMA™ defines addiction as a relationship with a means of relief of pain from unmet emotional needs – that becomes all consuming, very much like carrying on a “secret love affair” (with a means of relief. The need to relief of pain (from unmet emotional needs) is the underlying driving force of addiction. Predisposing conditions are explained in terms of the level of pain that had built up from a lifetime of deprivation. Again Newton’s Law aptly applies. The more pain, the susceptible or predisposed to become addicted. The less pain, less susceptibility (regardless of the presence of genetic or biochemical factors.) TRMA attributes the cause of addiction to be the relationships, past and present, that fail to provide adequate emotional nourishment, that leave a backlog of pain that traps the addict in a vicious cycle of relief seeking. Within TRMA framework, recovery is a transitional journey out of unhealthy relationships and into healthy ones. There are Three Stages of Recovery: I – “Breaking-up;” II- Developing the Relationship with Self; III- Creating Emotionally Relationships (relationship training.) Passing through Stage I into Stage II is, for all intents and purposes, is saying, “Good-bye” to a ‘bad’ relationship and “Hello” to your new best friend; one replaces the other. This newly developing relationship gives you access to internally based resources that provide guidance, creative inspiration and nourishment from within, which, up to that point, hadn’t ever been utilized or known to exist. Having a relationship with your Self and increased Self-awareness are pre-requisites for crossing the threshold into Stage III. Creating Emotionally Nourishing Relationships. Stage III is about gaining the knowhow to empower the transformation of all of your relationships and ‘relating encounters,’ to who make deeper connections and develop emotionally nourishing relationships. When you are in emotionally nourishing relationships, the addiction – the relationship with the means of relief - naturally extinguishes itself. When your need for love and connection is getting met (from your relationship with your Self and relationships with others), “secret love affairs” will no longer be the lure they were as when there was far more pain and desperation for relief.
Let’s identify the key over-arching themes running through TRMA, that have the most powerful implications for professionals, as well as those on a path of recovery.
Addiction is a relationship with a means of relief of pain from unmet emotional needs.
The need for love and connection are basic human needs, and when denied, there is going to be pain. The need to relieve pain is another basic human need. The need for love is inclusive of other basic emotional needs, i.e. for connection, understanding, to be seen, heard, accepted, embraced.
We can consider the cause of addiction to be the same as the cure – relationships. If the cause is unhealthy relationships that fail to provide adequate emotional nourishment, it naturally follows that the cure must be healthy relationships that provide adequate emotional nourishment, in which the need for love and connection get met and which translates to a reduction of pain from unmet emotional needs.
Self is the Highest Power; that the relationship with Self is the most important relationship; that the quality of our lives and relationships reflect the quality of the relationship with Self.
Recovery is a lifelong and ongoing process and practice of developing the relationship with Self and relationships with others.
To all of you health professionals, academia and recovering people out there, for more info about addiction, recovery and relationships, check out the free and always accessible online information resource, the RelationshipVision website.