Don't Bogart that joint, my friend ...

Blogger favorite, and deservedly so, psychologist -- glad she’s not my shrink because I think I’d end up falling in love with her in one of those Freudian ‘transference manifestations -- Dr. Deborah Serani http://drdeborahserani.blogspot.com/offered a perceptive and thought-provoking piece on Feb. 7 that looked at the impact of the cerebral insula on addiction.

The addictions connection comes about, so a study indicates, from observed situations in which the insula area of the brain has become damaged, and smoking patients reportedly lost their cravings to light up. Dr. Serani suggests, and I agree, that more study of this connection between the Insula and addiction could rid society of many of its psycho-social woes.

There is one consideration that must be regarded, though, when looking at addiction. While a craving can be killed in a physical sense, there is also a psychological one that is agonizingly pervasive.

Many smokers (despite the fact the practice is deemed, aside from being unhealthy, also to be loathsome, dirty, icky, smelly and yucky in the eyes of non-smokers) really, really like to smoke.

“Oh, yeah. I should try to quit (yet again), but my problem is that I really like to smoke. I wish it wasn’t so unhealthy because it’s truly one of my pleasures in life.”

Smokers like the ritual. They like breaking open a fresh pack and unwrapping the cellophane. They like looking at the cigarettes all neatly in a row in their little (coffin-like?) pack. They like lighting up and seeing the smoke wafting into the air. They think of Bogey in Casablanca, or Mitchum in countless ‘noire’ flicks, and they somehow feel, in their heart-of-hearts that they look sexy and sophisticated.

There is a similar connection with other drugs. Many people successfully kick alcohol addictions via counseling, rehab, and involvement with AA. But, there are countless others who don’t. It’s not that they can’t, they just don’t want to. Again, they are seeking the psychological solace and esthetics of the ritual. They like pouring a fresh scotch into a glass and swirling it around; they like the look of a frosty bottle of Corona with that slice of lemon or lime stuck into the neck. Of course they do, and the advertising racket caters to this human impulse.

“Each time I crack open that bottle, I vow that this won’t lead to a binge,” clients would tell me. Each time, of course, it did. But such individuals were determined not to give up something they ‘liked’ so much, even if it was ruining their lives. They just wanted to learn how to drink without the woes of the addiction. Good luck.

With illicit drugs it was the same. There is an inviting process in rolling a doobie and passing it around, a distinct ritual with cocaine – the mirror, the razor-blade, the lines. A female friend once told me that she, in her cocaine days (she has been clean for many years now) would come very close to orgasm just watching the ‘blow’ ritual. That part was more important and stimulating (even sexually stimulating) to her than the rush that came from the drug itself.

That’s the problem with all addictions; people do them because they ‘like’ them. And as long as they like them, the therapist has an intolerable problem to face because somehow he or she has to convince the client that there is nothing to like in what is being done.

I once asked a former colleague, who was in the later stages of terminal lung cancer, if he had quit smoking.

“Of course not,” he replied. “Why would I bother now? Anyway, I still enjoy it.”