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.
“The use of substances or compulsive behaviors is not the cause of addiction. These are, simply, unsustainable attempts at symptom suppression. Managing the underlying symptoms is the key to recovery.”
Now that we know how addiction works in the midbrain, let’s explore the symptoms of untreated addiction. When people have untreated addiction, they experience some or all of the following symptoms:
- Inability to focus or concentrate
- Poor memory
- Low energy
- Low motivation
- High frustration and irritability
- Intense boredom
- Inability to enjoy things, people, or experiences as fully as those without addiction
- Feelings of being lesser or inadequate when around others
- The “little pleasures” in life give no enjoyment
- Difficulty making connections with others
- An unreasonable fear or phobia of people or situations
- Impulsiveness and risk-taking
People with addiction typically do not suffer from all of these symptoms at once. Characteristically, clients report experiencing several of these symptoms at different times. Clients may also report never experiencing some of these symptoms at any time. Everyone is different, but clients with addiction will relate experiences and feelings that reflect struggling with at least some of these symptoms while in the “Untreated Addiction” phase.
The above is the graphic representation of how addiction works in the midbrain that was cited in an earlier post with the main elements of the disease included.
Without a complete addiction assessment, some of these indicators may possibly be present as the result of other mental health diagnoses including depression, anxiety and PTSD. Addiction shares some common symptoms with other illnesses, which is one of the reasons that it has, historically, been misdiagnosed.
You may be saying to yourself, “I’ve experienced some of these symptoms in the past and it never caused me to use substances or engage in compulsive behaviors to the point of addiction.” You’re right; everyone experiences some of these indicators at points in their lives. The difference is degree and persistence. When someone with untreated addiction experiences these symptoms, it is not a short-term experience. These symptoms are ongoing, and they progressively worsen. Normal solutions such as rest, engaging in other activities, or waiting it out, don’t work. People with addiction see their symptoms intensify to the point of being unbearable. Remember, this is a result of a breakdown in the survival/reward center of the midbrain. These symptoms are sending the false message that something is happening that is affecting one’s safety and survival. The unconscious message is, “If I continue to feel this way, I am going to die.”
The feedback I receive when discussing symptoms of addiction, with a group of clients is often profound. Rarely, in the past, have treatment professionals mentioned that how someone feels and thinks before using substances or engaging in behaviors is the true reason for those behaviors in the first place. This component of the disease explains why people feel compelled to engage in self-defeating actions repeatedly without regard for the consequences.
I’ll share an example used by a mentor of mine, Dr. Howard Wetsman, a nationally recognized authority in the addiction treatment field. Imagine yourself standing next to a busy interstate highway, with cars and trucks speeding past, and your favorite food is on the other side of the highway. Would you try to cross the highway to get that food? Of course not, attempting that would almost certainly result in injury or death. Now, let’s imagine that you have not eaten in three weeks and the food across the highway is the only source available to you. That changes things, doesn’t it? The survival/reward circuitry is fully activated and you are quite symptomatic. The focus on sating your hunger to survive overrides the possible consequences of getting hit by the speeding traffic. Whether you realize it or not, you are completely focused on symptom elimination that will stop the mid brain signal that says, “If I don’t eat that food I will die.” That is the same state that people with addiction experience as they go from untreated addiction into active addiction.
These are the forces at work in the brain when someone is suffering from untreated addiction. Past experience has taught them that certain substances or behaviors will give them quick relief from the false signal that their survival is in danger. By using those substances or behaviors they will become asymptomatic, even if only for a short period of time.
For some people, this malfunction in the brain, attributed largely by experts in the field to a genetic predisposition, is enough to develop these symptoms that result in active addiction. These are folks who report no stress, trauma or abuse in their environment. Many report they discovered substances or behaviors that made them feel “normal’ and that resulted in an ongoing compulsion to recreate that feeling.
Others, however, do report stress, trauma, or abuse in their environment and that has significantly contributed to the same compulsion for relief. This is the role that epigenetics, defined as “changes in the way genes are expressed that occur without changes in the sequence of nucleic acids,” (themedicaldictionary.com 2009) plays in addiction. Why do twins who are separated at birth and raised in very different homes sometimes display different health outcomes? That’s because a chaotic, stressful and/or abusive environment can increase the chances that predisposed individuals will see their genetic “destiny” made reality. Of course, the opposite is also true. A safe, structured, and healthy environment can decrease the chances that an individual will develop the symptoms of addiction that cause self-destructive behaviors, in spite of their genetic makeup.
So, if you look at this basket of symptoms as the initial cause of addictive behaviors, then the goal of recovery is not abstinence, but the successful management of these symptoms. It stands to reason that if we lower the intensity and frequency of the problematic symptoms, we lower the overriding compulsion to engage in self-destructive behaviors. As a treatment professional, it is my goal to educate the client as to how addiction is working in the midbrain, and then help develop and implement a treatment plan that will reduce or eliminate these symptoms.
How do we reduce or eliminate these symptoms of untreated addiction? First, there is no one-size-fits-all plan. People respond to interventions and lifestyle changes with varying degrees of success. A cursory examination of any group of people in recovery reveals that there are many different successful paths to recovery. There are also many elements to symptom management, and just to make things even more interesting, our symptomatic management needs evolve over time. That description of what is involved may seem overwhelming and daunting. Part of my job in working with clients is to help them reframe that belief, and to help them begin to look at this ongoing process as an exciting and enriching journey to a better, more fulfilling life.
In future posts, we will examine what those interventions are, and how they can be effective in building an enhanced, healthier life. These interventions and lifestyle changes can be placed into one of the following categories: medication, change in thinking, and change in behavior.
(2009). “Epigenetics,” Retrieved March 6, 2017, from the freedictionary.com.medical- dictionary.thefreedictionary.com/epigenetics
“The Survival/Reward system of the midbrain is very effective at prompting us to do things that will ensure our survival . . . when it works. When this system is broken, we call it addiction.”
In previous posts, we discussed how addiction is a chronic and progressive disease. Now, let’s spend the next several posts exploring how addiction works in the brain.
Addiction is centered in the midbrain. If you stick your finger in your ear (not too far!), and, with your other hand, place your finger in the middle of the top of your head, the point where the lines meet is approximately where your midbrain is located. This is one of the oldest parts of the brain. I like to call it the “survival/reward” center.
What was one of the earliest tasks that the brain had to perform when we first developed as humans? Creating a survival drive. It was critical to make survival an all-encompassing focus of our thoughts and actions. Without an unrelenting concentration on staying alive, both individually and as a species, we might not be here today. What is truly amazing and powerful is how our brain combines the survival instinct with reward or pleasure. When we get hungry enough (say, twenty days or so without a meal), we will do anything to get food. Once we eat, we feel satisfied, comfortable, relaxed and happy. It was that overwhelming drive that prompted us to create hunting tools, kill animals and eat what must have been considered some strange stuff at the time. The one-two punch of overwhelming negative sensations combined with the sublime positive sensations of having accomplished a survival activity is what has kept us alive and developing for all these millennia.
Can you think of some other human activities that are subject to the survival/reward combination? Some common functions include, sleep, thirst, and sex. When the negative feelings of deprivation get severe enough, we seek out the solution to the deficiency, and once obtained we experience feelings of pleasure, security, and well-being. So, this system is very effective at prompting us to do things that will ensure our survival . . . when it works. When this system is broken, we call it addiction.
Now that we have an overview of how the survival/reward system works, let’s look at specifics.
The graphic above is a representation of the survival/reward system. This is a lot simpler than it looks at first glance. We are going to discuss two types of elements in the brain: clusters of neurons, and chemicals that carry signals (commonly known as neurotransmitters). Let’s start with the cluster of cells known as the ventral tegmental area (VTA). This is where a neurotransmitter called dopamine is produced and stored. Dopamine is the chemical that triggers the feeling of euphoria. When released in sufficient enough quantities, it trains us to do things more than once. Dopamine is released from the VTA, then travels to the next cluster of cells called the nucleus accumbens (NA), which is a bit of a tricky process. First, the dopamine molecules are released into the space between the VTA and the NA, called a synapse. While in that space, the receptors on the NA (represented in the image as yellow rectangles) act like vacuum cleaners and attract the dopamine molecules into the NA. When enough dopamine molecules are absorbed by the NA, two things happen. First, another neurotransmitter called serotonin is released to the prefrontal cortex (which is not located in the midbrain but toward the front of the brain). Serotonin makes us feel happy, relaxed, self-confident, and secure. The second result is that a neurotransmitter called enkephalin is sent back to the VTA. Enkephalin is one of the body’s “natural opiates”, which possesses powerful painkilling properties. The same process is followed for both serotonin and enkephalin: the molecules are floating in a synapse and must be attracted by receptors that draw in the molecules in enough quantity to trigger the next reaction. When the VTA gets enough enkephalin, it says, “Wow, that was great, let’s do it again.” Thus, a feedback loop is formed.
Folks without addiction see this system work automatically. Some dopamine is released, then some serotonin and enkephalin are released, and the process continues to repeat itself. When events happen in which the survival system is activated, such as getting very hungry or very thirsty, we see a drop in dopamine tone, which prompts us to urgently act. Once we eat or drink, the system rebalances itself.
Here’s an example of the survival/reward system in action: Let’s say you are on the side of a busy highway and there is a pizza on the other side of the highway. Would you try to cross the highway to get the pizza? No, of course you wouldn’t. That would put you at grave risk of injury or death. But what if you haven’t eaten in three weeks and your brain is telling you that this pizza is the only solution to your hunger? This scenario has quite a different ending. That is the power of the survival/reward system. When activated, it overrides rational thought.
People with addiction suffer from a malfunction of this system. Now, that breakdown can be in any number of places in the system. Perhaps the brain is not making enough of the neurotransmitters (dopamine, serotonin, and enkephalin), or the neurotransmitter molecules aren’t staying in the synapse long enough to be attracted by the receptors, or perhaps the receptors are damaged in some way, or maybe it’s a combination of any of these variables. Once this breakdown has occurred, the individual becomes symptomatic. That means the patient starts to experience a set of physical reactions, emotions, and thoughts associated with untreated addiction. It’s important to note that these symptoms are experienced before any addictive or compulsive behaviors occur. These symptoms, when intense enough, are what drive the patient to engage in the behaviors that will give relief. Unfortunately, medical science has not yet developed the diagnostic tools to determine specifically where the breakdown is occurring in individuals. But based on signs, symptoms, and client reporting, we can quickly start the process of treatment.
In my next post, we will explore in more detail the symptoms of untreated addiction.
 I will cover the stages of addiction in a future post.
 Treatment modalities will be covered in a future post.
What is addiction? Part 3
In my first two posts we discussed how addiction is a chronic, primary disease. We are now going to discuss the progressive nature of addiction.
Simply put, if allowed to remain active, the effects of addiction will get more severe over time. This is true of most chronic diseases. Let’s look back at our example of type 1 diabetes. Without proper treatment, diabetes will damage the circulatory and nervous systems of the body, along with several vital organs. Typical results of untreated diabetes include amputations, blindness, renal failure, and eventually death.
What make the progressive effects of addiction unique are the various aspects of a patient’s life that are affected. For many people, active addiction affects relationships, professional and work life, legal status, socioeconomic status, along with the physical effects. These consequences are a main reason there is so much misunderstanding about the nature and cause of addiction. After all, how many other illnesses cause such extensive personal destruction? It’s understandable to look at someone whose disease has caused family breakups, financial hardships, loss of careers, arrests, or children being taken out of the home by child protection agencies, and believing that this person is just immoral, uncaring and extremely selfish. If that is true, why do most people in recovery retake their place in society as law-abiders, caring parents, and hardworking providers for their families? My experience working in this field has convinced me that my patients are not bad people trying to be good, but sick people trying to get better. It’s the active phase of their disease that results in these consequences. Patients are not their disease, but are profoundly affected by active addiction.
Let’s look at a typical example of the progressive nature of one MER: alcohol. Patients may try alcohol for the first time in their early teens, and quickly start drinking for effect. They will soon experience getting drunk on a regular basis, blacking out, and doing embarrassing things while drinking.
The patient may discover that it is becoming harder to control his or her drinking. Predetermined limits on how much to drink become very hard to abide by. I have had patients report to me, that at this point in the disease it is easier to not drink at all then to try and limit oneself to only three or four drinks in an evening. This is when the “cycle of compulsive use” starts to manifest itself. Family members and friends begin to notice that the patient’s drinking is becoming problematic and may urge the patient to “slow down.”
As the patient passes through this stage more consequences become apparent. Perhaps the patient is starting to drink on weekdays or during the day. Drinking may start to affect job performance, resulting in reprimands or firing. Legal issues may arise, such as public drunkenness, fighting or DUIs. Interpersonal relationships become strained: partners get angry and frustrated, and children get worried and become embarrassed and upset at the home situation. In many cases the family creates strategies and roles that allow everyone to accommodate the reality of a family member’s addiction.
Perhaps the patient is a functional alcoholic and holds a job and is able to maintain a sense of personal continuity. That level of functioning can last for many years. But in many instances maintaining any type of successful life performance is short lived. Either way, the person’s alcoholism is affecting the body in profound ways. These include: liver damage, jaundice, tremors, internal bleeding of the stomach and esophagus, high blood pressure, higher instances of some cancers, getting sicker more often and longer recuperation times, heart attacks and strokes. These are just some of the physical consequences of moderate to advanced alcoholism. In end stage alcoholism, we see cirrhosis of the liver and profound neurological damage.
Addiction to other substances, basically, takes the same course. Early use develops into regular use, develops into uncontrollable use, which then takes over the patient. As the disease progresses, the patient probably experiences wrecked relationships, legal problems, occupational or educational difficulties, and is at increased risk for a whole host of physical and psychological consequences.
Some addiction related causes of death include, cirrhosis, overdose and alcohol/drug poisoning. However, statistics related to the fatal nature of addiction can be misleading. Many times the recorded cause of death does not indicate addiction. For example, it may be a stroke, liver failure, a heart attack, a car accident, or suicide. In such cases, the family and close friends know the real cause of death.
I don’t want to end this blog on such a sad note. Yes, addiction is a chronic, progressive and fatal disease, but it is very effectively treated. Over 20 million Americans today are in long-term recovery. No one has to endure the pain of active addiction. If you or a loved one is suffering with addiction, please speak to a professional about treatment options. If you have tried before and have relapsed, try again. Most people in long-term recovery have had to recuperate from several relapses before entering long-term recovery.
In upcoming posts, I will discuss the latest trends in treatment and how to evaluate treatment options.
 I will cover the three phases of addiction in a later post.
 Most Effective Reward, a more accurate term for what used to be called Drug of Choice. I will discuss why the language we use, when discussing addiction and recovery, is so important in a later post.
In my previous post, I began a discussion on the ASAM definition of addiction, and its nature as a primary disease, which means it can manifest in the body without any other accompanying disorders.
The second characteristic of addiction is that it is a chronic disease. There are two types of medical conditions: chronic and acute. Chronic conditions are long-term and persistent, and there are no permanent cures for them, but they can be brought into remission and kept there indefinitely when properly managed. Acute conditions have a rather rapid onset and a short duration. An example of an acute disease would be the common cold. You sense when it starts, you experience it when it is at its peak, and you know when it has run its course. The significant factor in determining if a condition is acute is whether it can be cured, and the patient can return to their previous state of health.
Chronic diseases are different. Once you have been diagnosed with a chronic disease the typical course of treatment will include: stabilization, education, and lifestyle change. These elements are designed to help the patient effectively manage the disease and avoid any additional consequences associated with the disease remaining untreated. When you follow the recommendations of your healthcare providers you are deemed to be “compliant with your treatment plan.” You will hear me use that phrase a lot as we go forward. That’s because being compliant with your treatment plan is the way to successfully manage the disease of addiction. Being non-compliant in most cases results in symptom reemergence and a return to active addiction.
Let’s look at a chronic disease that closely parallels addiction: type 1 diabetes. It is associated with a family history of diabetes and there is no cure for it. The treatment protocol starts with stabilization. That means quickly bringing the patient’s blood sugar levels to a normal range and treating any ancillary condition, such as poor circulation.
Once the patient is stable and feeling better, education begins. The patient is taught about how diabetes affects the body; typically, diabetes damages the blood vessels, which affects the heart, lungs, brain, kidneys, eyes, feet, and nerves. Next, the patient is shown how to manage the disease. This includes learning how to check his or her blood sugar levels, which medications to take and when, and the proper way to self-administer insulin. The patient is also taught the importance of a healthy diet and regular exercise, what the early symptoms of unregulated diabetes are, and what to do to quickly get his or her symptoms back under control.
Then the treatment team works with and monitors the patient to help in turning the tools of diabetes management into long-term lifestyle changes. This is easier said than done, which is why the treatment plan non-compliance rate for people with diabetes is similar to that of those with addiction. This period of lifestyle change has the highest risk for relapse. Accordingly, the treatment team is ready to repeat the process of stabilization, education, and lifestyle change as many times as needed.
Addiction treatment follows that same set of steps: stabilization, education and lifestyle change.
The stabilization step oftentimes involves detoxifying from the substances being used. Depending on the severity of a patient’s active addiction this may be accomplished in an inpatient hospital setting or an outpatient clinic setting. It is best to get an assessment using ASAM’s criteria from a trained clinician to decide which setting is indicated. This is also an element of treatment for patients who are experiencing post-acute withdrawal symptoms. This may occur in a patient’s first six months of treatment. Strong and consistent clinical and medical interventions are indicated during this “high-risk” period.
The education step encompasses learning about the disease of addiction, exploring and experiencing the various tools that patients use to achieve and maintain recovery, learning how addiction can affect a patient’s physical and mental health, spiritual life, and relationships.
The lifestyle change step involves taking the tools and concepts the patient has learned in the education phase and putting them into action. It involves changing one’s thoughts and behaviors for a long enough period for them to become second nature. 
For those of you who have struggled with the disease of addiction or have loved ones who are suffering with addiction, you may find what I just wrote rather glib, or “easier said than done.” I wholeheartedly agree! What I wrote might sound simple and straightforward, but let me assure you, I understand how difficult doing this can be. Many people struggle with the process of maintaining long-term recovery, only to find themselves back in relapse mode. Relapse is an element of any chronic disease, not just addiction.
If you have tried to stop in the past only to relapse, I strongly urge you not to give up. Many people have achieved long-term recovery after numerous attempts at treatment. We really don’t know why one attempt works when previous ones have not. There are so many moving parts of treatment; it’s hard to identify which components need to be changed. It might be because of a difference in the treatment team or clinical approach. Perhaps the patient’s personal situation has changed and they are looking at their disease from a different perspective. Another possibility is that the patient’s disease has progressed to the point where physically and psychologically the patient wants to fully embrace the process of lifestyle change. My experience indicates, most times, it’s a combination of them all.
This brings us to the third characteristic of addiction: its progressive nature. I will discuss that in my next post.
 I will discuss these topics in relation to addiction in future posts.
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!
My name is John Antonucci, and I have been in long-term recovery since March 18, 2006. If you follow my posts you will learn the details of my journey into recovery, and discoveries I have made along the way. I have been working in the addiction treatment field since 2007. Currently I am a Master’s student in University of New Orleans’ Counseling Program; expected graduation December 2015. The addiction treatment field is a dynamic, ever changing landscape. Many of my blogs will center on my ideas, theories, and experiences in addiction treatment.
Just as important as my work is my life. Living in New Orleans is always a blast. I write about the lifestyle, music and culture of New Orleans.