Push and Pull

One of the interesting things about taking care of patients with substance use disorders is that the lessons and implications of substance use apply to all of us. One way of viewing addiction is that it is an extremely maladaptive reaction to an uncomfortable reality. All of us sometimes respond poorly to challenges we face– addiction is on the same spectrum, just at an extreme end. We all catch ourselves doing things that waste our time and don’t contribute to our happiness. We all do things that we wish we didn’t do– scrolling on our phones, watching too much TV, staying indoors too much… the list goes on.

Using a substance, or scrolling on our phone, is a way of not being present, a way of distracting ourselves, and a way of zoning out. But why do we do this? Why do we feel the need to not pay attention to the world around us, preferring instead some other headspace? What is so difficult about being attuned to the present moment?

When it comes to trying to tune out the present moment, I think about two different forces: a push and a pull. There’s a push out of reality, because we do not like reality. There’s also a pull toward whatever it is that we are using to zone out, because it feels good (at least in the short term).

When we disengage, it’s because there is something about the present that feels uncomfortable to us– often something emotionally uncomfortable. For example, we’ve just had an argument with our partner, or we are feeling stressed by the demands our work or children are placing on us. Perhaps we’re just feeling bored and aimless. Sometimes, if recognizing this discomfort is not something we are skilled at, we don’t even know what it is that is bothersome. Regardless of the specific cause, we are pushed out of the present moment.

In addition to the push, we are also often being pulled towards something. We like the feeling of whatever it is that we are doing to distract us. Whether it’s the little dopamine hits from playing a video game or scrolling through our phone, eating mindlessly, or the bigger dopamine hits that come from actually doing drugs, the pull makes us feel good. Not only is reality uncomfortable, but this other thing feels great. There is a pull towards it.

Of course, the types of things that pull on us this way do not really lead to happiness. We tend not to associate bad habits, wasting time, and addiction with things that are fulfilling. It would be strange if we said to ourselves, If only I hadn’t spent so much time with friends, or, going for a hike was really a waste. The things that pull us in this way, even though they feel good at the time, tend to leave us feeling disappointed and empty. If drinking soda is an empty food calorie, these activities are empty time calories.

How does thinking of this push and pull help us? First, it helps to just recognize what we are doing. When we find ourselves consuming empty time calories, the first step is just to notice what is happening. Here I am, scrolling through my feed again. Here I am, spending another hour playing video games. Once we notice this, you can ask ourselves, What’s the push? What is causing me discomfort? Is it that I’m bored? Tired? Hungry? Lonely? Angry? Feeling overwhelmed? Identifying that feeling, and the following where it leads, might offer a path to another way of resolving the discomfort. If we are able to identify the discomfort as loneliness, perhaps we could call a friend. If we recognize we are feeling overwhelmed, perhaps making a list of what needs to be done would quiet our mind.

Identifying the push is often challenging. Clarifying what bothers us, especially if we have become accustomed to coping in other ways, takes time to learn how to do. However, it is a learnable skill, not an inherent trait that some people possess and others lack. As a learnable skill, it gets better with practice.

If we realize that we are coping using empty time calories, we could switch tactics and try to fill our time with something that, instead of leaving us feeling lousy, leaves us feeling more fulfilled. We can much more intentionally ask the question, How would I like to spend my time? What will leave me feeling good? When we identify distress, rather than reflexively zoning out, we can recognize that we have a range of options for how to respond. Pick something that fills your soul.

If we do find we’ve been zoning out, what happens next can help inform our future direction. Often, we berate ourselves, get frustrated, and swear we’ll do something different next time. How well does that work? Instead, pause for a moment and recognize how that mindless activity has left you feeling. Notice the sensations in your body. Pay attention to the feelings. Recognize what’s buzzing around in your mind. It’s not usually a lovely feeling.

Take a moment to intentionally connect the mindless behavior to the lousy feeling. We are wired to avoid unpleasant sensations, so the more we can connect the mindless behavior to the unpleasant sensation, the less we tend to become attracted to the behavior.

Part of the reason that changing these types of behaviors is so hard is that fixing the behavior (whether that’s fentanyl or phone use) does not actually fix the push part of the equation. We can put ourselves in an environment where there are no drugs, lock our phones away from ourselves, but even if we fully find a way of blocking our access to the pull, we’re still left not liking reality. We are still left with the push. Half the reason we zone out is that we do not like our reality– the truth of our situation pushes us to find an alternative.

Because of this, until we address the push side, until we actually like the reality we live in, we remain at risk of being pulled away from the present by the next thing that feels good. The challenge is to get to a place where the push is not really there at all– or at least, is not that strong.

The bigger mess our life becomes (and when we are talking about substance abuse, the mess can be pretty big), the more uncomfortable reality is. Facing that discomfort, and changing it, takes time, courage and work. Eliminating the unhealthy coping mechanism– whether it is a chemical or device– just leaves us with the discomfort we started with. Learning what to do with that discomfort is a big part of the reason my work is endlessly interesting. Living happy meaningful lives is really the only antidote I know of to eliminating the push..


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