The Role of Substitution in Decision Making
Drug addicts will often substitute one drug for another. In many respects, the same is true for almost all people, whether they are reasonably healthy or suffering from mental health illness. Looking specifically at people who battle with severe dysfunctions, i.e. psychological and behavioral disorders that prevent such individuals from properly functioning in their communities without assistance, there is a pattern of avoiding necessary decisions and tasks that healthy people engaged in on a regular basis.
The fundamental reason why dysfunctional people avoid critical decisions, or make outright self-destructive choices, stems from how the dysfunctions of these individuals' skew their ability to tolerate potentially uncomfortable situations. Because all people exhibit some dysfunctional behavior from time to time, understanding how our tolerance levels for necessary discomforts affects what we do can help reasonably healthy and unhealthy people alike identify, as well as understand, their dysfunctional traits.
Substitution involves an attempt to avoid the consequences of one choice by embracing the less uncomfortable consequences of another choice. A drug addict, for example, will often substitute food, cigarettes, cutting, suicide, and/or sex for narcotics. Because ignoring the impulse to use drugs is extremely uncomfortable to these people, substitutes, which might be healthy or unhealthy, can be used to ease that discomfort.
Similarly, someone with OCD will use excessive cleaning to overcompensate for insecurities while the mother of a deceased child might seek to distract herself from the emotional deficit by "mothering" other children or adults. In reality, these substitutes are being used to avoid something far more uncomfortable, such as emotional pain; therefore, treatment for those using substitutes hinges upon the ability of such individuals, with the proper assistance of a support network, to move beyond the substitutes in order to address their underlying issues.
That said, given that the most fundamental mechanism behind all self-destructive behaviors is the avoidance of discomfort, substitution does not necessarily have to be harmful. Only when a substitute prevents an individual from addressing underlying issues does a substitute inhibit the healing process. Someone suffering from depression who uses a string of superficial relationships to avoid the emotional pain of past intimacy, for example, is engaging in a form of unhealthy substitution, because the sex is simply another means of avoiding the need to confront past feelings and potential pain of real intimacy.
Conversely, a smoker drinking a glass of water when in need of a cigarette is healthy as the act allows the smoker a chance to avoid the intense discomfort of not smoking until that discomfort is minimized. Consequently, healthy substitution affords damaged individuals the ability to function and live functional lives as they heal. Understanding the difference between healthy and unhealthy substitutes can empower individuals to overcome emotional and psychological roadblocks. Although it is essential to avoid over intellectualizing emotional issues, i.e. emotions cannot be reasoned away, this is especially important for people in crisis.
Life altering changes, such as prolonged unemployment, i.e. financial insecurity, or heartbreak, i.e. emotional insecurity, can lead to the need for individuals to adapt; however, that change sometimes requires too much discomfort. Suddenly, once functional individuals are unable to function in their new circumstances. Instead of dealing with the necessary discomfort of addressing unmanageable situations, people in crisis will seek to occupy their time with seemingly nonsensical activities. Such individuals will either become locked into old routines or seek substitutes to avoid the discomfort of dwelling on distressing circumstances.
In reality, all people tend to avoid what they find uncomfortable, yet most individuals find little to no significant discomfort in what must be done to establish and/or maintain a healthy lifestyle. When people cannot tolerate the discomfort of doing what they must, or cannot do what they need to do because of exasperating factors such as financial insecurities, substitution allows these individuals some comfort. In more dire circumstances, thoughtful, well-tailored interventions from family, friends, community, and/or trained professionals, can be used to funnel and harness the untapped potential of someone in need of a healthy substitute.
Moreover, when substitution leads to the resolution of underlying issues, such as the creation of a new job or improved relationships, it can be healthy. When substitution distracts individuals from dealing with their issues, it is unhealthy. As such, substitution can be a healthy or unhealthy mechanism, but understanding its role in our decision-making process affords us a powerful tool in our efforts to overcome everything from minor quirks to disabling mental health issues.