Psychological inflexibility and the psychopathological profile in addicts

You don't wake up one day an addict. Addiction creeps in stealthily, disguised as relief. A drink to calm your nerves. A line to feel alive. One more bet, just one, to forget the rest. No one consciously chooses their prison. But when you least expect it, your life no longer revolves around pleasure, but around avoiding pain. And by then, escape is no longer an option. It's a reflex.

Behind substance use lies more than just drugs or screens: there is anguish, emptiness, an internal mechanism that doesn't know how to tolerate the discomfort of being alive. The tragedy isn't just the addiction itself, but the mechanism that silently fuels it: that internal rigidity that transforms any emotion into a threat, and any escape into a habit. That unseen inflexibility that governs everything.

This article isn't just about addiction. It's about the fear of feeling. And what happens when that fear becomes your compass.

What exactly is psychological inflexibility?

Psychological inflexibility, from the perspective of Acceptance and Commitment Therapy (ACT), is defined as a rigid pattern of functioning in which behavior is governed more by the attempt to avoid or control internal events (thoughts, emotions, sensations) than by one's own values or long-term goals. It is not a metaphor; it is a measurable construct with a solid empirical basis, operationalized through tools such as the Acceptance and Action Questionnaire-II (AAQ-II).

This pattern manifests itself through four core processes:

• Experiential avoidance: a persistent tendency to avoid, suppress, or escape from negative internal experiences, even when such avoidance seriously compromises quality of life.
• Cognitive fusion: the person becomes trapped in their thoughts, taking them as absolute truths ("if I feel anxiety, it means something bad is going to happen"), which restricts their behavior.
• Behavioral rigidity: loss of flexibility in action. Responses become automatic in order to alleviate immediate discomfort, without regard for long-term effects.
• Disconnection from values: when the focus is on ceasing to feel, what truly matters is abandoned. Life is no longer guided by personal principles, but by the avoidance of pain.

Psychological inflexibility is not simply "having emotional difficulties." It is a functional process that blocks adaptation and perpetuates suffering.

Psychological inflexibility as a transdiagnostic core

Psychological inflexibility is not limited to the world of addiction. It is a transdiagnostic factor identified in a wide range of mental disorders: depression, anxiety disorders, obsessive-compulsive disorder (OCD), borderline personality disorder (BPD), and post-traumatic stress disorder (PTSD), among others.

This aligns with the dimensional approach to psychopathology, which contrasts with classic categorical models like the DSM. From this perspective, the important thing is not so much identifying which disorder you have, but rather detecting which psychological processes are at work. And inflexibility (along with rumination, intolerance of uncertainty, and perfectionism) is one of those processes that appears across the board.

Chawla and Ostafin (2007) offered a review that supports this approach: people with very diverse diagnoses share the same flawed strategy for dealing with inner suffering. It is no coincidence that therapies like ACT are showing effectiveness in multiple disorders; they all work, essentially, on the same root: the individual's relationship with their internal experience.

What do all addictions have in common?

Beyond the specific substances or behaviors, all addictions share a functional pattern: the use of an external means to escape from an internal discomfort.

This is known as negative reinforcement: I'm not seeking pleasure, I'm seeking relief from pain. It's not so much "I love drinking/gambling/connecting," but rather "I can't cope with this anxiety/loneliness/guilt, and this takes it away for a while."

The automation of escape is another common characteristic. At first, the person chooses to use or act; over time, the behavior becomes an automatic response to any form of discomfort. The drug changes, but the mechanism does not.

This is what makes psychological inflexibility the glue that binds all forms of addiction together under the same maladaptive functioning pattern.

The psychopathological profile in people with addictions

Talking about addiction means talking about clinical complexity. It's very rare to find someone who only presents an isolated pattern of substance use. Most commonly, both in clinical practice and in scientific literature, addiction is accompanied by a wide range of psychological symptoms that form a complex and, in many cases, chronically established psychopathological profile.

High comorbidity: more the rule than the exception

Several population studies have found that between 60% and 80% of people with a substance use disorder (SUD) also meet the criteria for at least one additional mental disorder. This co-occurrence, known as dual diagnosis, can take many forms, but the most common are:

• Mood disorders, especially major depression and dysthymia.
• Anxiety disorders, such as social phobia, generalized anxiety, or panic attacks.
• Personality disorders, particularly borderline, avoidant, and antisocial traits.
• Post-traumatic symptoms not always formalized as PTSD.

The order of factors varies: some develop depressive symptoms after years of consumption and personal deterioration, while others begin consuming as a way to self-medicate in the face of overwhelming anxiety or an unresolved history of trauma.

For example, a 35-year-old woman who comes to therapy with benzodiazepine dependence may, after a more in-depth evaluation, reveal a long history of social anxiety and isolation, intensified since adolescence. In that case, the drug appears not as a recreational use, but as a desperate solution to function in environments that her mind perceives as hostile. The comorbidity is not accidental: it is functional.

Common features: beyond the diagnosis

Beyond diagnostic labels, what is usually repeated in the psychological profile of a person with addiction is a set of transversal clinical traits, which configure a specific vulnerability:

• Impulsivity: the tendency to act without considering the consequences, especially in distressing situations. The person acts before thinking about what they are doing. For example, a young person who, frustrated by a breakup, shops compulsively and goes into debt until they are paralyzed by anxiety.
• High emotional reactivity: emotions appear intensely and with a low threshold. A small criticism can trigger anger, a feeling of loneliness can lead to uncontrollable crying, or an image can activate traumatic memories with disproportionate force.
• Difficulties with emotional regulation: a very limited repertoire for managing distress is detected. The person does not know how to calm themselves without resorting to a substance or external behavior. It is not just that they do not want to feel; it is that they have not learned to do so in any other way.
• Anhedonia: a marked loss or decrease in the ability to experience pleasure. This not only fuels apathy but also reduces the motivation to seek alternatives to substance use. A patient might say, "I know that playing sports would help me, but I just don't care about anything."
• Low self-esteem and impaired self-image: Many people with addiction carry a deeply negative internal narrative about themselves. They consider themselves flawed, beyond redemption, and worthless. This view is often fueled by the cycle of relapse, guilt, and shame.

Individual differences without falling into reductionism

It is important to emphasize that there is no single type of addict. There is no fixed psychological phenotype that accurately predicts who will develop an addiction. What does exist is a set of shared dysfunctional processes that increase vulnerability: avoidance patterns, difficulty regulating emotions, lack of purpose in life, a history of trauma or abandonment, among others.

Two people can be dependent on the same substance and yet have radically different medical histories. An executive with alcohol addiction may exhibit a high level of external control but experience a complete disconnection from their emotions and chronic loneliness disguised as success. In contrast, a woman with problematic heroin use may have suffered childhood abuse, been through multiple social care facilities, and have a history marked by neglect and violence.

Both may share the same diagnosis, but the emotional driving force behind the consumption will be different, as well as the type of attachment, cognitive schemas, support network, and available personal resources.

The common thread: inflexibility as fertile ground

In this context, psychological inflexibility acts as a kind of common substrate that underpins the psychopathological profile. Not as the sole cause, but as a facilitator of difficult clinical trajectories. A person with high experiential avoidance, cognitive fusion, and disconnection from values will have more difficulty processing psychological pain adaptively and will be more likely to resort to addiction as an automatic response.

This idea helps to depathologize without trivializing: it's not that the addict wants to be unwell, but rather that they have very few available paths to wellness. Addiction becomes the shortcut that their mind and history have taught them to be functional, even though it's destroying them.

Experiential avoidance: when not feeling becomes a strategy

At the heart of psychological inflexibility lies a learned, repeated, and ultimately automated strategy: not feeling. Avoiding any painful internal experience. This process, known as experiential avoidance, is probably one of the most powerful drivers of chronic human suffering, and in addictions, it operates as a kind of "way of life."

What does it mean to avoid inner experience?

Experiential avoidance is not just rejecting an emotion, but actively trying to control, reduce, or eliminate unpleasant thoughts, physical sensations, emotions, or memories, even when those attempts involve negative consequences for the person's life.

It's not something abstract. It's drinking to forget. It's gambling to stop thinking. It's isolating yourself to avoid feeling shame. It's sleeping to avoid dealing with anxiety. In short, it's taking measures, often drastic ones, to escape your inner world.

For example, a person experiencing a panic attack might start avoiding supermarkets, train stations, and gatherings—not because they hate those places, but because they fear what they feel in them. Over time, their world shrinks. Avoidance has won.

In addiction, avoidance takes the form of consumption. It's not that the drug is desired for its own sake, but rather that it becomes the quickest way to silence the inner noise.

Why does it work in the short term?

Because it does work. And that's part of the problem.

Drinking alcohol, inhaling cocaine, compulsive gambling, disconnecting in front of a screen… all these acts manage to reduce or suppress, at least temporarily, unpleasant emotions such as anguish, guilt, loneliness or anger.

This immediate relief is perceived as a triumph. It feels like returning to calm, even if it only lasts for minutes. This effect is so powerful that the brain registers it as a useful strategy. And the person confirms it: "When I use, I stop thinking."

That's why many treatments fail when they only focus on substance use, without offering real alternatives for emotional regulation. If this quick escape isn't replaced with another way of coping with distress, the person simply reverts to the only resource they know.

Why does it destroy in the long term?

Because the price of relief is life.

Constant experiential avoidance closes doors: the person stops doing what they value, loses relationships, avoids challenges, and gives up on goals. The discomfort doesn't disappear; it transforms into free-floating anxiety, anhedonia, and dissociation. And the behavioral repertoire dwindles until only one option remains: avoidance by feeling less, and consumption by increasing.

Furthermore, avoidance intensifies the original problem. What isn't confronted—grief, insecurity, repressed emotion— doesn't resolve itself over time if it's avoided. On the contrary, it often grows. Unprocessed pain becomes chronic suffering, and that generates even more avoidance.

Thus, a cycle is created: I feel → I avoid → brief relief → negative consequences → more discomfort → more need to avoid. And each turn of this cycle causes the person to drift further from their life and become more entangled in their addiction.

Inflexibility, brain and habit: when escape becomes automated

From a neurobehavioral perspective, inflexibility translates into a loss of control. The reward circuits reinforce addictive behavior, while the stress circuits overactivate in response to any discomfort, amplifying the urge to escape.

Avoidance learning becomes a habit: I no longer need to think to act; my body already knows what it "has to do" to avoid feeling. And that's why wanting to stop isn't enough.

Addictive behavior is not maintained solely by conscious choice, but because it has colonized the automatic response system. This is where neuroscience intersects with therapy: changing this habit requires retraining not only the behavior itself, but also the relationship with the internal signals that trigger it.

Sex differences and modulating variables

Studies show that women with addictions tend to exhibit greater psychological inflexibility and a greater psychopathological burden, especially in affective matters (anxiety, depression, trauma).

But these differences should not be interpreted as simple biological determinism. Social context, early emotional learning, and traumatic experiences play a key role.

For example, a woman may have learned from childhood that showing pain is dangerous, and therefore develops more intense avoidance. Conversely, a man may have learned that he is only allowed to express anger, and channels his distress into impulsive behaviors. The pattern is the same: not knowing how to be with what one feels.

Clinical implications: treat the root cause, not just the symptom

If addiction is a rigid response to internal pain, treating only the behavior (abstinence) is like patching a crack without checking the foundation.

Addressing psychological inflexibility involves changing the relationship with internal experience, not just eliminating substance use. This is where models like ACT offer a powerful approach: not because they are a panacea, but because they focus on the root of the problem.

Evidence shows that increasing psychological flexibility is associated with a lower risk of relapse, a higher quality of life, and more sustained improvements. It's not just about quitting, but about learning to live without the constant need to escape.

When learning to feel becomes treatment

Therapeutic work with inflexibility revolves around three pillars:

1. Emotional exposure: gradually confronting what hurts, instead of numbing it.
2. Acceptance of discomfort: understanding that suffering is part of living, not a sign of failure.
3. Reconnecting with values: regaining a sense of why it is worthwhile to endure discomfort.

It's a radical change: from control to contact. From fleeing to staying. Not because it's comfortable, but because it's the only sustainable path.

Conclusion: getting out of the labyrinth is not running away, it's staying.

We return to the beginning: addiction is not just a behavioral problem, but a desperate attempt not to feel.

Psychological inflexibility is the thread that weaves this story: the more I run from what I feel, the more I lose control of my life. The goal of treatment is not only to cut that thread, but to learn to hold onto it without it suffocating us.

Escaping the labyrinth of addiction isn't about finding an external exit. It's about learning to walk within the labyrinth with your eyes open, without running, without avoiding. It's about staying with yourself. Even when it hurts. Especially when it hurts.

Reflection

Because in the end, addiction isn't just a story of excess, but of avoidance. It's not only about what someone consumes, but about what they're running from. And as long as we continue treating the symptom without addressing the root cause—that intolerance of human suffering, that urge to silence what hurts—we will continue losing the battle where it truly matters.

Psychological inflexibility doesn't scream or hit. It manifests in small decisions, in repeated patterns, in the difficulty of being alone without anesthesia. But when we learn to face fear, sorrow, and broken desires head-on, then the true detoxification process begins: not from substances, but from the rejection of feeling.

And perhaps there, in that openness to discomfort as part of living, lies the way out of the labyrinth. Not as an escape, but as a return. To oneself. With all that that implies.

The problem is not what one becomes addicted to, but what one is trying to escape from, which leads to addiction.

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