PEMS: A Model for All Addictions
Jan wrote this article in July 1992 after we had submitted the manuscript for the Addictionary but before it was published. It is a good general introduction to the PEMS model.
What do all addictions have in common? Certainly not the chemical that is taken into the body from outside. In many addictions, like gambling, exercising, and work, there is no foreign substance involved. If a substance is part of the process, the role of that substance may be vastly different. Compare alcoholism with tobacco addiction.
For some time I have believed that food addiction is a real key to understanding all addictions. Here there is a substance involved, but like nicotine, its mood-altering capabilities do not seem in the same league with alcohol. Yet a food addict cannot just quit using the substance, like the alcoholic or smoker.
We have found a model that helps explain this addiction business. It is neither original nor novel. It just works well. We see addiction from four perspectives: Physical, Emotional, Mental, and Spiritual (PEMS). If you ignore any of these aspects, you miss much of what addiction is about.
The physical aspects include any mood-altering or mind-bending effect from substances involved in the addiction. The substances that have gotten the most attention are those that are exogenous (produced outside the body). But even with alcoholism or other drug abuse, it is often the endogenous (internal) biochemistry that is most important.
There is nothing baffling about the effect of an alcoholic’s tenth drink in less than an hour. Almost everyone can understand why her behavior is so counterproductive. It is the obvious effect of alcohol intoxication. What is mysterious to many people is why she would start drinking again after months or years of sobriety and a far better living situation. The relapse may have a lot to do with her internal biochemistry. After all, most of the drugs that are abused simply mimic the action of neurotransmitters that are naturally present. Any condition that can cause an excess (or even a deprivation) of those neurotransmitters can lead her to a situation where she has no mental defense against a relapse.
The physical perspective also includes the physical environment and your physical realities. Whether you are going to meetings, reading recovery literature, making phone calls, or the things you do that result in your being too hungry, angry, lonely, or tired.
The emotional perspective is how you feel now — happy, sad, afraid, proud, joyful, guilty, angry, hopeless, excited, or a combination of these and others. How you feel may or may not have anything to do with your addiction, your environment, or anything outside yourself.
This emotional dimension has produced a lot of confusion in addiction. A critical point in addiction is the question of whether the emotions cause the addiction, or the addiction causes the emotional turmoil. This becomes a black-and-white issue, and it is much more useful to think of the emotions as part of the addiction process instead of the single cause or sole result.
What is true is that any addiction will use emotions, whether related to the addiction or not, as a justification for drinking, using, bingeing, gambling, or any other addictive behavior. It does this through the mental mismanagement of the disease.
The mental perspective is how you think about your behavior, your substance(s), yourself, your feelings, and your choices. Your thinking includes your decision making process and your judgment. When you have lost control of your drinking, and you are feeling guilty and ashamed, the mental aspect of addiction is what says, “So I might as well go get drunk.”
A mental aspect that feeds into the disease is the illusion of control. Addicts keep struggling to try to control that which is uncontrollable. When they lose control, standard practice is to maintain an illusion or a facade of control. In later stages this often becomes a source of uncomfortable jokes as the addict tries to keep up the appearance of control when everybody else can see that the disease is in charge.
Finally, suppose you are in addictive behavior, feel rotten about yourself, and have the screwy thinking process of most addicts. Under these circumstances, how could you escape this physical, emotional, and mental spiral without some outside help? So the spiritual perspective on addiction has to do with a relationship to somebody or something outside the self. This can be a traditional God, a Twelve Step program, people in the program, or sometimes (hopefully not for long) just a single person in the program, like a sponsor.
We have seen many different ideas of a higher power. Most of them can work fine. All that seems to be required is that whatever you choose as a higher power can provide the guidance and strength that you lack in your addiction. If you believe in a traditional God, perhaps the disease has set up barriers between you and your God, at least regarding the addiction. Sometimes that is very subtle, like, “I know God has spared me from alcoholism, but I don’t feel right bothering God about this problem with the food.”
If you reject traditional ideas of God, you can still gradually trust the program, or your group, or recovering people who seem to have what you want. You can surrender, releasing the illusion of control, even if you aren’t quite sure what or who is going to control the addiction on your behalf. It sounds crazy, but it works.
How Much Recovery in the Rooms?
For those with addictions other than or in addition to alcoholism, there may be another problem. For compulsive eaters, compulsive gamblers, sex addicts, workaholics, and others, there may not be as strong a recovery community for these addictions as for alcoholism. In many places AA is strong, but many other Twelve Step groups are weak, with little abstinence or long-term freedom from obsession in their meetings. If so, you can bet that at least one perspective, Physical, Emotional, Mental, or Spiritual, is being ignored or misinterpreted. In food addiction, for example, if there is a belief that relapse is inevitable, no wonder there is no long-term abstinence.
If sponsors hand out rigid rules and food plans like dysfunctional parents, there is little chance for spirituality to grow. If addicts assume that solving codependency issues will take care of their addiction, they deny the physical aspects of addiction.
Recovery is Progressive
You can recover from addiction. All addictions. If you have more than one addiction, you do not have to work 24 or 18 Steps — there are only twelve. You may have to go to more than one kind of meeting. You may have to start a new meeting if there are none for your particular addiction(s) or if the existing meetings are off track. But it can be done.
Go to AA
Go to open AA meetings if you are not an alcoholic, if only to compare with your other Twelve Step groups. Get some literature, and talk openly about what seems wrong, and right about the recovery process in your area. Use the Physical, Emotional, Mental, and Spiritual model as a quick and easy inventory of your group, or your own recovery. Keep learning, getting more honest with yourself, and share the road of recovery with others. It gets better.
— Jan R. Wilson, 22 July 1992
Addictionary 2 by Jan & Judy Wilson
is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.