In society we are challenged with many stigmas about addiction, regardless of whether they are related to sex, drugs, gambling, alcohol, food, gaming, or relationships. Any of these substances and activities can elicit an automatic response whenever they are witnessed or discussed. It is very important that we recognize this and attend to this issue objectively with the seriousness it deserves.
As we will come to discuss further in this blog, addiction is a disease and not a moral issue. Owning and accepting this allows us to effectively treat those with this disease. There are many ways in which people enact addictive behaviours, from using daily, to bingeing occasionally, all of which have serious implications for the addict as well as those around them.
Often misinformation, such as an alcoholic is someone that drinks from the moment they wake up, or an addict is someone living on the street injecting heroin, allows this stigma to be perpetuated. While these may be true for some people, there are many ways addiction can present itself.
How does an addict live with their addiction?
Several of the clients I have worked with throughout my 25-year career are high functioning addicts, doctors, lawyers, parents, etc., all of whom are successfully able to mask the consequences of their addictive behaviour from the outside world by showing up to their jobs or taking care of their families.
Like diabetes or heart disease it is essential, when wanting to assist an addict, that a specialist be sought out; these helpful professionals include support groups, therapists, medical doctors, and treatment centres. Their knowledge and experience are vital sources of guidance for those of us that are uninformed when it comes to addiction and recovery.
I often put forward the idea that the disease of addiction can be viewed as similar to a peanut allergy. What I mean by this is that very often if someone were to be told that they are allergic to peanuts, they would rapidly understand that their life is in legitimate danger from a substance that they have the potential to be exposed to every day. This exposure can come either through their own actions or even through the actions of the people around them. With the knowledge of this new potential threat, they need to adopt a new set of behaviours and personal considerations on a daily basis in order to protect themselves from the new threat.
They do this by becoming more disciplined and scrutinizing their own moment to moment actions and decisions (i.e., reading ingredients lists on food packaging before buying and consuming the product) where they were once able to live in a more carefree way. They must also become more open and honest with themselves and the people around them. For example, rejecting the offer of a particular food or restaurant choice made by a friend or becoming open enough to inform a stranger (a server) of their allergy to help ensure their safety. Unfortunately, it is quite rare for an addict deep in their addiction to have the drive and awareness to make this connection and implement these strategies.
Why do addicts defend their addiction?
What I often find is that addicts are creative in trying to protect their addiction and are very good at compartmentalising the various aspects of their addiction into separate categories. This separation of substances and behaviours allows the addict to defend and rationalize each individual substance or behaviour independently, instead of treating the root cause and their addiction. For example, someone could believe that drinking is the cause of their negative behaviours, but gambling or marijuana are just activities that help them to relax. Rationalising that gambling and smoking pot have less of a negative effect on themselves and the people around them. This compartmentalization and separation of their addictive behaviours allows them to defend some aspects of their addiction while “sacrificing” others.
I believe that these behaviours are often a response to the various stigmas placed upon addiction as well as an addict’s personal denial of the extent of their addiction and behaviour. To return to our analogy of the peanut allergy, this type of behaviour would be as effective as no longer consuming raw peanuts but still opting for the occasional PB&J sandwich or adding some peanut butter to your morning smoothie. All mood and mind altering substances are a potential threat to an addict, not just their drug of choice.
The effects of addiction on an individual and the lives of their family members are far reaching and the extent of damage that their addictive behaviours create are devastating. When an addict is in full blown addiction there is one key factor that they all have in common, and that is that they will defend their addiction at all costs – even with their own lives!
The Disease of Addiction is a family illness, and no family member is left untouched by the trauma and destruction involved. The different roles that family members and carers adopt can both influence and discourage the addict from seeking help. We must each take responsibility for our part in helping to bring about change.
One of the greatest hurdles and challenges we face is to tackle our own, as well as the addict’s well entrenched denial system. We don’t want to believe the situation is out of control and we are full of hope that next time, it will be different, just like the addict. You can read more about some of the more common defence mechanisms used by addicts here.
What are the characteristics of addiction as a disease?
In 1956 The American Medical Association (AMA) classified alcohol abuse as an illness, while in 1974 Drug Abuse was also classified as a disease. This was ground-breaking as it took addiction from being considered a moral problem to being a diagnosable medical illness. This change prompted the widespread construction and development of treatment centres around the world as an alternative for those diagnosed with addiction as opposed to the previous management of these individuals where they were inserted into the criminal justice system (which only exposed them not only to potential harm but increased the likelihood of further addictive and criminal activity as well).
The Disease of Addiction can be characterized as Primary, Progressive, and Chronic. The primary characteristic explains that addiction itself is the primary issue, not the consequence of other things. Very often clients that I work with will attribute their addictions to an external stimulus, be it stress at work or problems with their spouse or relationship etc… I often find myself pointing out that what they don’t realise is, the fact that they are using is often causing or perpetuating these issues and that it is the addictive behaviour itself that should be the focus of their rehabilitation and corrective practice. This approach will have wide reaching benefits that will help them to address and correct the other external stimuli that are in their own minds, causing them to use more.
Addiction is also characterised as a progressive disease, meaning that it will only continue to get worse over time. There is a common thought amongst addicts who relapse or decide that they would like to re-introduce their addiction of choice in a moderated sense (i.e., only drinking on the weekends), that they will be able to manage with this new moderated usage. However, I often find that those who attempt this very rapidly fall back into their old habits, using the same amounts if not more than they used to. This is unfortunately often the cause of overdoses as the addict falls back into using the same or a similar amount as they did during the peak of their addiction, however, their bodies have lost the ability to tolerate this extreme toxicity over time. It is important to understand that regarding progression, we cannot regress down the ladder, we only continue to move forward further and further from where we started.
The final characteristic of addiction is that it is a chronic illness. Much like a diabetic understands that their treatment is a longform process where they will need to continue to adjust and monitor their eating for the reminder of their lives. An addict truly seeking treatment must understand that this is a lifelong process, the practice of recovery does not end, it simply becomes more manageable with time.
For more information about the medical definitions of disease as an addiction follow this link: https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
How do we identify and confront addiction?
How do we identify and confront addiction?
An effective exercise to assist an addict in confronting the severity of their illness and one way to challenge their denial, as well as our own, is to objectively measure their loss of control of their addictive behaviour. We can do this through 3 metrics in the form of time, money and amounts of substances used.
These metrics are very effective because they don’t rely on opinion and are an evidentiary reference point for all those involved. Keeping a written record of commitments made as well as actions done provides a tangible, inarguable reference for the addict as well as their loved ones. This will help to reflect any loss of control which, in my experience, has shown to be the key element in distinguishing use and abuse from addiction.
Time
An example of this loss of control with reference to time could have the addict informing their loved ones that they are going out for one drink with some friends before coming home for dinner, where in fact they end up stumbling home later than their designated time having consumed far more than one drink. Using time as a metric in this way helps the addict to realise that by coming home late, even if it wasn’t their intention, they are slowly losing control over this aspect of their lives due to their use.
Money
Another way to objectively measure this loss of control is through money. The amount of money that individual allocates toward their chosen vice or vices. For example, at the beginning of the night setting out to spend a maximum of $100 on a given activity or substance, however, realising at the end of the night that they ended up spending far more or even any more than they planned. Whether this is done through dipping into their own bank accounts, borrowing money from a friend or loved one, or even going so far as to pawn off some of their possessions the overarching point remains true.
Substances
The final metric to measure a loss of control would be through the addition of substances and habit-forming behaviours. An example of this would be going out for a drink with some friends and after the drinks start flowing joining your friends in introducing new substances that were previously outside the scope of your use (eg. Cocaine or ecstasy). This can also take the form of habit-forming behaviours as opposed to substances. For example, consistently taking part in anonymous sex or gambling after a night of drinking. These additional substances and habit-forming behaviours are not the intention when setting out for the night but end up happening due to the use and abuse of the addict’s initial substance of choice.
Another lens that the substance metric could be viewed through is the amount of a particular substance that is used. To return to a previous example, going out for one drink with friends after work, turning in to 3, 5 or more, is another sign that the addict is losing control over their use of that substance.
Each addict is different, and their pattern of use may vary, from using daily to binging occasionally. All types of addictive behaviours need to be addressed in the same manner. In other words, someone who drinks daily is no worse or better than someone who binges once a month. Addiction is addiction. It is often unhelpful to invite these types of comparisons into the conversation as it is a short segway into denial (e.g. My use isn’t so bad, I only binge once a month, at least I don’t drink every day.)
You can find some more helpful information regarding the identification of addiction here: https://www.healthline.com/health/addiction/recognizing-addiction#next-steps
MYTH BUSTERS
There is a significant difference between addiction and abuse!
Not everyone that uses and abuses drugs or alcohol is an addict!
Drugs and alcohol alone are not the problem! We are not seeking abstinence but recovery. We are not simply trying to not use a substance; we are trying to correct or treat addictive behaviours.
Addicts do not need to be ‘ready’ to change for treatment to be effective. While I have worked with a diverse scope of individuals, at varying degrees of readiness for treatment, all of them have gained incredible insight.
What are some of the first steps to entering recovery?
People who are not addicts can stop acting out on their using behaviour with minimal difficulty and support, once they recognize the consequences have gone too far, and decide to stop. This is not at all the case with addicts. Long term treatment is imperative to ensuring long term recovery. It is important to remember that we are speaking about recovery, not abstinence.
What I have come to understand is that only when the consequences of the addict’s addiction outweigh the benefits will the addict stop acting out on the addictive behaviours. Unless there are significant consequences the addict will continue to minimize them and continue to seek that behaviour as a medicator when they are feeling stressed.
In order to help the addicts along the road to recovery, we need to learn to set healthy boundaries, and in doing so, facilitate enhancing the consequences. Every addict will resort to all sorts of defence mechanisms and tactics to try to get the person (family member, friend, work colleague etc.) to back off when confronted about his/her addiction. Firm boundaries, a unified approach and professional assistance are essential.
It may be necessary for carers and family members to seek help too, in order to establish the best manner to assist the addict. As well as get support in figuring out how best to set boundaries.
We often speak of an addict needing to ‘Hit Rock Bottom’, this is different for all addicts, and no one can really know when or how this is going to happen. If you or a loved one are looking to take the first steps into the road of recovery, here is a helpful resource for initiating into drug and substance abuse recovery: https://www.verywellmind.com/the-four-stages-of-alcohol-and-drug-rehab-recovery-67869
Final thoughts
In my years of working within the field of addiction, it is encouraging to know that many addicts can sustain a long-term healthy recovery, living meaningful lives. With the support of their family those addicts that have found recovery, have a far greater success rate in sustaining their recovery. This success is sustained further in cases where those closest to them are willing to accept support and engage in a recovery journey alongside them. Recovery is within reach, especially for those willing to put in the work together.
If any of you feel that you know someone or if you yourself need additional support, I invite you to reach out to me to set up an appointment and discuss a potential way forward.
We all need help from time to time and everyone experiences their own journey through life and recovery. If you have had any experiences you would like to share or lessons you have learned along your own journey, that you feel would be helpful to others along their own path please feel free to comment down below so that we may all continue to learn and grow together.
If the messages contained in this blog resonated with you and you would like to pass it on so that others may benefit as well, please help us by sharing it so that we may continue to reach out and hopefully find those that need it.
Keep moving on the path and don’t forget to take care of you,
Toni
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