Addiction, Stress and Trauma Resilience amongst Aid Workers
– by Mark Walsh, Achilles Initiative
I help people, particularly aid workers, stay happy, healthy and sane. One of the issues I come across time and time again is various kinds of addiction. To be blunt – the field is rife with people hooked on unhealthy things. By addiction I don’t just mean alcohol or drug abuse, though there is plenty of this around in many circles, but any addictive behaviour, and addictions to danger, sex and emotional patterns such as being needed can become compulsive too. I am writing this both as a professional resilience trainer and also someone who has been through some of these issues personally as I believe it to be a shadow of the industry that needs highlighting.
Addictions and compulsions – words used sometimes interchangeably and differently by different people – can be defined for the purpose of this piece as anything you don’t want to do but do anyway. The important thing with addictions of any kind is that they damage either health and happiness, relationships or work and are hard to stop. The reason they are hard to stop is that they offer temporary relief form a problem they then make worse creating a vicious cycle. On a psychological, emotional or social level they reduce stress temporarily and addictive issues are often related to trauma and burnout. Make no mistake, while it is common to say one is “addicted” to something one merely quite likes like chocolate, a true addiction is not fun and causes behaviour counter to person’s values, reoccurring damage to what a person cares about, and in many cases has very unpleasant consequences. Many addictions are ultimately fatal and all can lead to relationship breakups and disciplinary action at work.
Because addictions were, for a long time, seen as signs of moral weakness there is sadly a lot of stigma attached to them. This is a pity as it stops people having frank discussions and seeking help when they need it. For me addiction is better seen as either an illness that some people are prone to through no fault of their own, or in relation to stress and trauma. I would encourage those in leadership and HR roles in humanitarian organisations to support open discussion and compassionate policies and treatment. Put simply: an addict is not bad they are sick.
“As expat aid workers, we will not only drink all comers under any table anywhere, but we’ll also tell them exactly where, how and with what indigenous booze we acquired such powers of fortitude.” – From stuffexpataidworkerslike.com
While it is unsurprisingly hard to find figures on levels of alcohol consumption amongst aid workers, they, particularly ex-pat staff from Western countries, are renowned for drinking. I have worked in environments typical for the sector, where workload and stress was colossal and the normalised coping mechanism was to get drunk every night. These contexts both attract those with drinking issues who want to be somewhere where this is invisible (some of the “misfits” of the “mercenaries misfits and missionaries” aid worker stereotype) and makes people develop issues for the first time. Even in countries where alcohol consumption is not the cultural norm it is my experience that aid workers can often acquire it. Drugs may also be readily available – in Afghanistan where I have just returned from, this seems to be a problem currently for example.
Stress, Trauma and Burnout
Stress, trauma and burnout are common amongst aid workers and on the rise (see the Antares Foundation or Headington Institute for research on this). Stress involves uncomfortable emotions that many addictions numb temporarily, and addictions normally produce more stress, so the two go together. Addiction may speed people’s downward spiral to burnout and also be a symptom of the loss of meaning that comes with it. Traumatic stress can lead to symptoms such as hyper-arousal (anxiety and sleeplessness for example) which people may self-medicate with depressive drugs such as alcohol or opiates. It can also cause intrusive thoughts and dreams which people may try and block out with substances (“when I’m unconscious I don’t remember, it’s the only break I get”) and trauma can also cause physical and emotional numbing which intense addictive behaviours can be used to break through (“I just want to feel something”). Sex for example can be a welcome distraction to those in the field seeking comfort, both providing stimulation and distracting from less pleasant sensations. Many a good marriage has been broken due to inappropriate sexual conduct and this is often not so much about “loose morals” as coping with pain and isolation. This issue may be particularly prickly in faith-based organisations.
Trying to address addictive behaviours without looking at the stress, burnout and trauma they are being used as ill-fated solutions too is therefore ineffective. While there are, I believe, chronic “addictive personalities” with strong genetic predispositions for whom abstinence is the best solution, many compulsive behaviours will be reduced by managing stress and treating trauma – e.g. though cognitive behavioural therapy, somatic techniques such as TRE or through EMDR therapy. I am a strong advocate of emotional intelligence and mindfulness training for aid workers as it is only through developing the ability to stay present with oneself (as opposed to fixing something “out there” which the industry is built on) that the root of stress, trauma and addiction is addressed.
As well as stress and trauma other factors such as boredom and culture shock may encourage aid workers to abuse substances, I have been “compound bound” for example before with little entertainment but cards and wine and many aid workers have felt the loneliness of culturally isolation at some point. Working away from home of course can disrupts people’s normal social support networks, one of the main factors in preventing stress, trauma and burnout.
Danger and Emergencies
The cliche of the aid worker as adrenaline junkie is sometimes based in truth. The term “junkie” is also not far from the biological reality that fight or flight hormones such as adrenaline and noradrenaline are physically addictive – caffeine and amphetamines work in much the same way in stimulating this response. I have experienced myself how grey and dull the UK could be after returning from work in several areas of conflict and heard many an aid worker describe missing “the buzz” when working back at head office, although many organisations create a similar state of constant emergency even in home offices by overcommitting. “Too much to do” = “we said yes too much”.
Overwork and danger seeking then can become an addiction and this is also a security concern. My team often describes psychological resilience training as “psychological security” and it is no accident that we partner with Safer Edge a security training company as these two issues are so interlinked.
Another relevant issue is repetition compulsion – the notion first identified by Freud that people may try and repeat traumatic situations in an attempt to heal. This is a dangerous phenomena for aid workers that can keep them re-exposing themselves to danger and if people are in the sector to work though psychological issues of their own this can be unhelpful to all.
While physical addictions are common in the sector, it is emotional-behavioural addictions that are most endemic and often as harmful. One of the most common is addiction to being needed and putting other’s wellbeing first. Like many aid workers I enjoy being of use and the dark-side of this is the people I meet who get an emotional kick out of helping the poor people of…wherever…and justify self-abuse and unsustainable working practices to this end. This emotional pattern of projecting vulnerability onto the other (“I’m fine, they’re not”) and denying one’s own humanity while doing humanitarian work is the sectors core compulsive sickness (if I may be provocative). In newer aid workers the swing from idealism to cynicism when unrealistic expectations meet the reality of what can be done is a risky time. As one Ethiopian friend told me “you guys start too nice and end up too mean”. Trying to meet self-esteem or belonging needs by attempting to fix the world’s problems will always end in tears as will an addiction to perfectionism and the chaos of ill-defined roles and responsibilities. The key question here is “how do you know you’re job is done” because if you cannot know this you will always be stressed.
In many organisations the really dangerous addictions are to saying yes and not having boundaries around the work as mentioned. “We are too busy to rest” translates as “we overcommitted because of ego, needing to be saviours (the missionaries), denying our humanity etc”. We are not superheroes and this illusion is the most important addiction for this sector to give up. I have done many workshops on stress management and resilience and what is always at the heart of the solution to people’s stress is not a trick or technique, but a courageous facing of one’s shadow.
What to do about it?
All addictions have physical, mental, emotional and social components, and some would say spiritual too. An alcoholic for example may have a biological predisposition for anxiety that the alcohol “medicates” and have a physical dependence, finds emotions difficult and wishes to numb them or have difficulties with intimacy, drinks more when resentful and be prone to certain types of thinking, be encouraged to drink by their cultural background and social circle and have a spiritual crisis alongside increased use. Solutions to addictions therefore involve these elements too – for example:
- Physical: Maintaining physical health though diet, exercise and sleep, is a good basis for tackling addictions. This is admittedly sometimes a challenge in the field and what I have found is when this is given value and prioritised it is with a little ingenuity possible. The addiction of putting others needs before ones own is again often the key here.
- Mental: How we think is a key part of all addictions mentioned as it can be helpful to change one’s perspective by talking things though with a friend or professional. Many humanitarian organisations make counsellors available by phone or in person. Letting go of resentments and practising gratitude can be particularly useful.
- Emotional: Developing emotional insight and resources is key to all the addictions mentioned. People can set-up simple practices to develop emotional intelligence such as “checking in” and asking how you really are a few times a day when a reminder goes off. Training is also helpful in this regard.
- Social/ Cultural:P “We are inter-resilient”, only as strong as we are connected. Empathic listening can help with many of the areas mentioned and organisational leaders should be careful what kind of culture they are modelling and rewarding in regard to self-sacrificing and alcohol for example. 12-step groups such as AA can be very helpful for many addictions and are surprisingly widespread and also available online.
- Spiritual: Meditation, mindfulness and connecting to any spiritual beliefs can be very helpful for stress, trauma and addiction.
Another factor is the organisational structures and systems that a humanitarian organisation has in place in terms of staff selection and support for people pre, during and post assignment.
- Resilience training: http://www.integrationtraining.co.uk/achilles-initiative/
- Alcoholics Anonymous – links to support groups around the world: http://www.aa.org/ (similar organisations exist for drugs, sex, gambling, etc)
- Book – “Resilience” – Clarke & Nicholson – a good introduction to resilience
- Antares Foundation – http://www.antaresfoundation.org
- “PTSD Coach” – a surprisingly good iPhone app.
- Center for Humanitarian Psychology – who have a good stress management DVD
- Two great blogs on aid worker wellbeing: http://flowandrestore.me/ and http://mindfulnext.org/
- Youtube videos: Search: “how to be happy stress” and “preventing psychological trauma”
Mark Walsh leads the Achilles Initiative – a psychological resilience training for aid workers and others working in areas of conflict delivered alongside Safer Edge security. He has an honours degree in psychology and has trained numerous organisations such as Merlin, The House of Lords and The Army of Sierra Leone. Previous to starting a training company he worked in the non-profit sector on three continents, primarily in conflict resolution work.