If you have a loved one with an alcohol or drug problem, you’ve probably had the experience of confronting that person and having them flat-out deny their use of substances. And if you have tried to urge them toward recovery, the first things you may have heard are: “I don’t need it. I’m different than those people. I don’t have a problem.” This is because the disease of addiction makes your loved one incapable of seeing beyond their own self-centered view.
The Malady of Self-Centeredness
Twelve-step recovery defines addiction as a spiritual malady of self-centeredness. This inability to see beyond the self is often called “terminal uniqueness” or “personal exceptionalism.” It puts a strain on relationships and can cause the following problems:
- Inability to seek help and accept that they need help
- Poor communication and inability to listen to or hear others
- Dismissing attempts of intervention or discussion about drug rehab
- Feeling misunderstood and alone
- Believing they are not the same as other addicts and will not be helped by the same methods
- Feeling “special” and immune from negative consequences
- Feeling superior, or inferior, to others
- Seeing the world as “me against them”
- Inability to sense the pain of loved ones who are witnessing their downfall
- Assuming they will never relapse if they do seek treatment
Empathy Deficits in Addiction
Narcissism and lack of empathy are part of the disease of addiction. Because of these impairments, addicts cannot understand how their behavior impacts others. There are two kinds of empathy: physical and mental/emotional.
- Physical empathy. Also called compathy, this describes the experience of seeing someone in pain or distress and feeling it physically, or having the same reaction. Studies show caregivers often go through this. Loved ones of people with addiction may go through this as well because seeing a loved one distressed or in pain can stimulate a corresponding part of the sensory cortex. Among people with addiction, this empathic ability is numbed by substances.
- Theory of mind empathy. Also referred to as mentalism, this is the ability to see yourself in someone else’s shoes. It involves the prefrontal cortex and can be measured by psychological tests and functional MRIs. This kind of empathy is also impaired by alcohol and other drugs, which means addicts may be unable to care about other people's experiences.
Conditions That May Contribute
It is not uncommon for addiction to be paired with a concurrent mental illness or underlying vulnerabilities that can exacerbate the symptoms of terminal uniqueness. The most common include:
- Pathological narcissism or narcissistic personality disorder. It could be that narcissists are more drawn to drugs, but the other side of it is that drugs themselves cause people to behave in ways in which they seem to care less about other people. They essentially don't have the same emotional bridge or connectedness to others in the throes of their addiction.
- Alexithymia. This is the inability to know how you feel or how other people feel. This empathy deficit may be present before people become addicted. Though therapy helps, it can persist for many months after people become sober.
- Antisocial personality disorder. People with this disorder have much higher incidence of alcoholism than the general population. The antisocial personality is characterized by a lack of empathy. There is a kind of outlaw mentality: “The regular rules don't apply to me.”
Moving Beyond Terminal Uniqueness
The inability to access normal empathy occurs with all substance use, but there is often an extraordinary shift when people stop using. Once they’ve made progress in recovery, their ability to care about others and engage in emotional relationships can return and evolve.
Part of the success of 12-step recovery is that many of the steps are devoted to rebuilding an individual’s moral compass. They focus on ways of making people in recovery more aware of how they're affecting people around them and making better choices.
For example, the Fourth Step, “Made a searching and fearless moral inventory of ourselves,” calls people to own up to their shortcomings. The Fifth Step, “Admitted to God, to ourselves and to another human being the exact nature of our wrongs,” takes people beyond thinking about it to actually coming clean about it.
And then people must figure out a way to make amends. Step 8 is “Made a list of all persons we had harmed, and became willing to make amends to them all” and Step 9 is “Made direct amends to such people wherever possible, except when to do so would injure them or others.” The process moves the person in recovery to be willing to experience the emotional reaction of the people they’ve injured. As a result, they have their own emotional experience and response. This helps facilitate a kind of moral recovery.
Service is another important part of the recovery process because altruism is connected to empathy. People are hard-wired to feel good about being part of something that helps others. Giving back ― supporting peers through recovery, being of service to family, taking sincere action to make amends ― is part of the healing that takes people out of the self-centered focus of addiction by learning about and supporting the needs of others.
There is no medical cure for terminal uniqueness, but there are ways to restore the moral compass and transform the narcissism of addiction. The first step, always, is recognizing there is a problem.
David Sack, MD, is board certified in psychiatry, addiction psychiatry and addiction medicine. As chief medical officer of Elements Behavioral Health, he oversees a network of drug rehab centers that includes Promises Treatment Centers and The Right Step Texas drug rehabs.