Addiction is a complex issue, the nature of which is poorly understood by many. Is addiction just about drugs and alcohol? Is it rare, or is it prevalent in our society? Is addiction just a matter of willpower? Is addiction a disease, or is it some form of moral failing? Why can’t people just stop?
One reason addiction is so often misunderstood is because of the intense feelings active addiction creates. If you suffer from active addiction, you may feel desperate, trapped, or hopeless. In my years of experience in the treatment field, I have had clients, with desperation in their voices, say to me, “Why do I keep doing this, when I know it’s killing me and tearing my family apart?” or “I hate this, but I just can’t stop.” People, who in every other aspect of their lives excel and have a history of accomplishment, can’t find a way to manage their addictive behavior.
Family members experience the same conflicting feelings. They see loved ones, who desperately try to stay clean and sober only to inexplicably relapse and revert to someone with such destructive behaviors, and they are forced to take previously unimagined steps to protect their property and even their safety. This “Dr. Jekyll and Mr. Hyde” pattern generates intense feelings of anger, desperation and hopelessness.
If this describes you, or someone you know, then this blog may help give you some clarity, and help to distinguish feelings from facts. My blog posts are designed to build on one another. So by starting at the beginning you will be able to use information from earlier posts to help understand the details and concepts of later posts. It is my hope to explain concepts and details in ways that are understandable and relatable to people’s practical experience. I also hope this becomes a two-way communication vehicle. I will reply to comments to provide clarity or pursue significant ideas stemming from issues and ideas discussed. I don’t have all the answers, so I look forward to learning from your experiences.
I also approach this project as a jumping-off point for my readers. I will provide resources that will allow you to pursue your study of addiction far beyond my limited knowledge. Let’s start with one of the most important resources for the latest thinking and treatment intervention in the field of addiction, the American Society of Addiction Medicine (ASAM). ASAM is the professional organization of medical doctors and clinicians whose specialty is addiction treatment. One of its most important contributions to the field of addiction treatment is the latest definition of addiction, the short version of which I have quoted below:
” Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
That’s a mouthful, I know. So let’s unpack this definition so we can gain some clarity as to what ASAM is saying.
“Addiction is a primary . . . disease. . . .”
That means, simply, someone can suffer from addiction without being diagnosed with any other physical or mental health disorder. This is a really important concept. For many years, healthcare professionals saw addictive behaviors not as a primary, or “stand-alone” disease, but as a symptom of some other illness. For example, people who exhibited addictive behaviors were diagnosed with depression, bipolar disorder, or anxiety. Healthcare professionals and their patients thought by effectively addressing those diseases the addictive behaviors would disappear. However, these other conditions are treated differently than addiction, so it is not surprising that addictive behaviors are not reduced or eliminated through such methods.
When a client is focused on a diagnosis of depression and anxiety as the problem, and various treatment plans do not help with symptoms or behaviors, several things often occur. First, the client can start to feel hopeless and will stop seeing his or her healthcare provider because “no matter what the (provider) does,” he or she still is struggling and feeling bad. Also, the client will use the diagnosis of depression, anxiety, etc. as focal point, and not begin to consider addiction as the possible cause. Many clients have come to me and said, “Doctors have told me I have a depressive personality, and that’s why I drink. I have tried to address my depression and nothing helps; drinking is the only thing that works for my depression.” The client is clinging to an erroneous diagnosis that is keeping him or her from being open to exploring other possible causes for his or her behaviors, and is using it to justify further addictive behaviors. Additionally, the client is using a depressant to try to address “depression,” which really doesn’t work too well.
It is a testament to the power of addiction, and the shame and stigma commonly associated with the disease, when clients latch on to other diagnoses even though addiction has a better potential of remission when a proper treatment plan is followed.
My next post will continue to explore the ASAM definition of addiction. I look forward to your comments and feedback!