"I alone can do it, but I cannot do it alone"
"If nothing changes, nothing changes"
"If not now, when?"
"If nothing changes, nothing changes"
"If not now, when?"
We offer this description of Addiction, written by our colleague, Francis de Aguilar as a way of getting to grips with what is an often misunderstood term.
What is Addiction or Dependence?
The concept that Addiction is a disease stands up to scrutiny.
In order for something to be classified a disease it needs to be diagnosable, and in order for it to be diagnosable you need to be able to identify a consistent set of symptoms.
This is the case with addiction or ‘Dependency’ as the medical profession calls it.
As far back as the 1980’s the term 'Alcohol Dependency' appeared in a book called DSM (Diagnostic and Statistical Manual of Mental Disorders). The term also appeared in another book called ICD (The International Statistical Classification of Diseases and Related Health Problems). These are the two manuals of diagnostic criteria used by the medical profession worldwide.
They are in there because there is, an identifiable set of symptoms.
There are also the terms ‘Alcohol or Drug Abuse’ and these are separate diagnoses that require different approaches.
It soon became clear that these symptoms fit a wider range of substances and behaviours, so they work for alcohol, drugs and a range of other ‘addictive processes’, gambling for example.
Importantly, the distinction between dependency and abuse is that those who are diagnosed as dependent rarely manage to control their use, and so abstinence from all mood altering substances is often the treatment of choice for this group. This is why a thorough assessment is so critical. Having established whatever the problem is, we are able to offer relevant services to address it.
As soon as we accept that Addiction is a disease, a number of possibilities open up. First; we see the person with this illness as the sufferer, rather than as a bad or weak person, who is somehow wilfully continuing in this behaviour. This means that the continuing substance use is not freely chosen; rather the excessive drinking or drugging is now beyond the control of the sufferer.
If I were to conclude I had an illness where before I had seen myself as a bad or weak person, I would have something I could feel hopeful about, something that was not bound up in shame and guilt, something I could do something about.
OK let’s look at some of these symptoms, what do they look like:
A dependent person consistently fails in attempts to control the use of their substance (or behaviour) of choice.
"Our greatest glory is not in never falling, but in rising every time we fall."
They take/do more than they mean to. Attempts to, ‘cut down’ are short lived.
They have a tendency to return to previous levels of use/behaviour very rapidly after a period of abstinence or apparent control.
Negative consequences have little impact on use/behaviour.
Rationalization, blaming and justification are deployed to deflect any link between what’s happening and the individual’s substance use or behaviour. (Denial)
Using/acting out increasingly gets in the way of social, occupational, recreational and family activities.
It is as if the dependent person has become powerless. This is very frightening place and is usually resisted or dismissed by the dependent person. A typical response is to 'act powerful'.
This reaction is usually referred to as denial.
So it would seem that:
Yes, it is classified as a disease.
The disease model is a helpful concept in terms of approach.
It is supported by outcomes.
Those who meet the criteria for dependence fare much better when they are treated by abstinence based programmes that subscribe to the disease model.
Treatments that promote or condone controlled use, or use of separate mood altering substances on the basis that 'they are not the problem' tend to have poor outcomes with dependent individuals. For example if an individual who has been dependant on Heroin continues to drink alcohol or use so-called 'soft drugs' the probability of a meaningful recovery is reduced dramatically. Yes, there may be some lifestyle and health improvements. The probability of a return to acute dependence remains very high.
It is important not to confuse 'Physical Dependence' with the term 'Addiction'. The two are not necessarily linked. Yes a Heroin addict will be physically dependant and will experience withdrawal symptoms when the substance is removed, just as an alcoholic will experience withdrawal symptoms when the alcohol is removed.
No one should attempt a detox without the help of a healthcare professional. To do so carries great risk.
Completion of detox; i.e. when the 'Physical Dependence' is no longer a factor and withdrawal is complete does not mean that the 'Addicted individual’ is recovered. Far from it. This is when the real work of recovery and treatment begins.
The psychological element of Addiction is a complex matter that requires an intelligent and sophisticated treatment response.
If this process is not entered into by the dependent person, the probability of a return to addictive use is statistically very high.
Francis de Aguilar ©2017