Now that we understand how addiction works in the brain and what the symptoms of untreated addiction are, let’s look at people’s experience at different periods of their disease. Remember, this is a chronic disease, so there is never a time when an individual is disease-free. Depending on how well a person (with the aid of their support system) is managing their disease, they will generally fall into one of three phases. I call these “The Phases of Addiction.”
1. Active Addiction
2. Untreated Addiction
Let’s examine each one.
Active Addiction is pretty self-explanatory. This is when an individual is using substances or engaging in compulsive behaviors to manage the symptoms of untreated addiction. As I like to point out to my clients, when they are in active addiction they are basically doing what works to feel normal. The problem in doing this is that managing this disease by engaging in active addiction is unsustainable. The signs and symptoms of this phase include isolation and engaging in behaviors that allow for continued substance use. Engaging in these behaviors creates a dopamine spike, followed by a crash, which results in the uncontrolled cycle of use.
Untreated Addiction is the stage in which the person is becoming increasingly symptomatic; for a wide-ranging list of these symptoms, please refer to my earlier post “Symptoms of Untreated Addiction.” The best description of someone in the untreated addiction phase comes from the “Big Book” of Alcoholics Anonymous: restless, irritable, and discontent. At this stage, one’s hedonic tone is so compromised that one cannot enjoy natural intensities of joy or pleasure, and may have difficulty experiencing a normal level of wellbeing.
In many cases this stage will intensify to the point that the person either lapses into active addiction or works toward the stage of Recovery. Simply put, it is very hard and unpleasant to stay in this stage indefinitely. Remember, at this stage the mid-brain is sending a message of survival to the cortex: “If I don’t feel better, I am going to die.”
Behavioral signs of untreated addiction may include: being short-tempered and touchy with others, being easily offended, engaging in risky or dangerous behaviors, increased isolation, and a reluctance to discuss one’s disease or recovery.
Untreated Addiction vs. PAWS
The symptoms of untreated addiction mirror the symptoms of Post-Acute-Withdrawal Syndrome (PAWS). This makes sense, as PAWS occurs shortly after physical withdrawal is complete (depending on the substance, about 15 days from last use) and continues for up to 6 to 24 months. It is during this period that neurotransmitter levels are stabilizing, new neuropathways are being formed, and individuals are integrating recovery thinking and behavior into their lifestyle. The more aggressively a person works toward recovery, the less intense and shorter the duration of PAWS.
PAWS is time-limited, whereas untreated addiction can return, no matter how long a person has refrained from using addictive substances or engaging in compulsive behaviors. Untreated addiction is not a function of time, but how well one is managing their addiction symptoms. Both conditions share some characteristics, including: poor focus and concentration, poor decision-making, poor memory, low energy, and emotional dis-regulation. The good news is that both conditions are managed by the same changes in thinking and behavior.
One is rarely completely in untreated addiction or recovery; it is much more of a continuum. This graphic represents the range. Where we are on this scale can and does shift from day to day and even moment to moment. If you find yourself closer to untreated addiction, all you have to do is change your thoughts, feelings and actions to immediately move closer to recovery. These examples of thinking, behaviors, and feelings are only representative samples. Everyone is different, and in early recovery we discover many emotions and behaviors that are either helpful or hurtful to symptom suppression. Furthermore, a crucial part of or journey in recovery is the ongoing discovery of new practices that bring us closer to and keep us in recovery.
It’s hard to see this graphic above clearly, so below each of the individual points are shown. These outline a person’s thoughts, feelings and behaviors as they move from extreme untreated addiction to strong recovery.
It’s important to remember that someone does not have to always be at stage 4 of the continuum. Frankly, it’s unrealistic to be at that stage at all times. The important thing is that the person knows where they are at all times and have the tools to move up the scale.
It’s my experience that everything we do, feel, and think will move us one way or the other even if it is just a very small distance. That’s why long-term recovery is marked by a strong sense of self-awareness. So, the knowledge of where we are on the scale and what we can do to move up it is incredibly empowering.
Just like how someone with diabetes has to check their blood sugar levels on an ongoing basis, people in recovery have to measure where they are on the untreated addiction/recovery continuum. Fortunately, as one gets more practice this becomes second nature. Like any other form of lifestyle change, this takes a great deal of effort when first starting out. Many people find that the structure and support of treatment and mutual aid will provide the missing elements that successful change requires.
In my next blog post, we will begin to explore some specific behavior changes that move people up the continuum.