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PLUM SPRING CLINIC
MICHAEL SHARP, MD

184 Lystra Estates Drive
Chapel Hill, NC 27517
Telephone: 919-945-0300
www.michaelsharpmd.com

The Hole

By Michael Sharp, MD

Those of us who are in the recovery community often hear about “the hole.” It is the term used to describe a feeling associated with an unfulfilled need, or an uncomfortable emptiness that some people experience that they are driven to try and fill. The discomfort associated with this feeling is ever present and the first thing we come across that offers a feeling of relief we are very likely to come back to. If the relief is intense, the drive to come back is strong.

Michael Sharp, MD

A curious aspect of this sequence is that many of the most immediately satisfying of the hole-filling behaviors or substances lead to a bigger hole in their “aftermath.” Casual sex may make our loneliness deeper, alcohol or drugs may make our lack of self-esteem more palpable, seeking comfort from food may make our lack of comfort more intense.

So in that paragraph I was able to put a label to the nature of many people’s holes: loneliness, discomfort, poor self-esteem. I can think of others—feelings of disorder, physical pain, worthlessness, hopelessness, helplessness and impending danger, economic and physical insecurity. There are others: anger, resentments, guilt, greed, grief—for example.

Any behavior or substance that offers relief may be addicting. Again, in the recovery community, we may hear about someone’s “drug of choice”—a generic reference to something that an individual is especially drawn to and that seems particularly effective at hole-filling. It is understandable that a person would seek and continue to seek the relief from their pain and that the seeking behavior would be more immediate and intense for those things whose relief is intense and immediate. And, to make matters worse, that the cycle would be accelerated by the extent to which the drug of choice made the original hole even bigger. This is the cycle of self-destruction for many people.

Genetics and Trauma

The role of genetics and trauma in addiction is becoming both more widely understood and accepted, and the view that addictions are a consequence of poor willpower or inferior morals slowly recedes. It makes quite a bit of sense that a child raised in an environment where he or she is taught ways of filling-holes through healthy behaviors and thinking would be more likely to avoid unhealthy ones—especially if the child had a genetic predisposition for addictions.

It is good to imagine a world where early child rearing might be filled with these approaches rather than one filled with strategies for looking good, being successful, having good morals, or developing a strong will power. It is my experience that those strategies don’t fill holes.

So if the hole has to do with loneliness, the challenge will be to help that person understand how to make deep and satisfying relationships; if the challenge has to do with various forms of discomfort the more precise nature of the discomfort might need to be explored in order to find a more healthy solution. Solutions for problems with self-esteem will be different for example than solutions for problems with physical pain.

In my observations of fellow travelers in recovery, I believe it is true that no one’s hole is purely one form of emptiness. Those of us whose hole was especially deep find it composed of lots of forms of discomfort and so it makes sense that our recovery needs to address understanding both the hole’s nature and the variety of ways to learn to satisfy those discomforts in ways that don’t make the hole deeper. And in a similar way, most of us don’t have just one drug of choice but a spectrum of unhealthy ways of looking for answers. The process of recovery can be complex and most of us realize that the journey is never really completed.

And one more important thing I think you need to know: the recovery journey is almost never travelled successfully alone—or even with only one or two others. The power to do this work is found in community. I’ll discuss this in my next column. Stay tuned!

To your health.