The complexities of addiction and recovery

Addiction is a concept that is variable, ambiguous and difficult to characterize. Webster defines addiction as "the process of giving oneself habitually or compulsively to something, such as alcohol or narcotics" (Soukhanov & Ellis, 1984, p. 77). While this description somewhat captures the desperate and sinister nature of this process, it remains an incomplete explanation. The Social Work Dictionary (Barker, 1987) refers instead to substance abuse or substance dependence and further describes the phenomena as " a disorder related to an unhealthy use of alcohol or drugs which includes related negative social, legal or vocational ramifications, a pattern of pathological use (episodic binges), psychological dependence including a desire for continued use and an inability to inhibit that desire, and symptoms of tolerance or withdrawal" (p. 160).

To further specify the parameters of addiction, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V, 2013) combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe and incorporates ten classes of addicting substances - alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.

The DSM-V delineates two groups of substance-related disorders: substance-use disorders and substance-induced disorders. Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result. Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorders.

The diagnosis of substance use disorder in DSM-5 requires two to three symptoms from the following list:

• Taking the substance in larger amounts or for longer than you're meant to
• Wanting to cut down or stop using the substance but not managing to.
• Spending a lot of time getting, using, or recovering from use of the substance.
• Cravings and urges to use the substance.
• Not managing to do what you should at work, home, or school because of substance use.
• Continuing to use, even when it causes problems in relationships.
• Giving up important social, occupational, or recreational activities because of substance use.
• Using substances again and again, even when it puts you in danger.
• Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
• Needing more of the substance to get the effect you want (tolerance).
• Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Additionally, Alcoholics Anonymous (A.A.), one of the most widely known self-help organizations for substance abusers, incorporates an acknowledgement of a social and spiritual dimension to both the addiction and recovery processes. Furthermore, countless volumes have been written on the topic of addiction in an attempt to understand and ultimately control the process.

And yet, despite all these professional sources, there remains a certain mystery about the enigma of addiction. In fact, one can really only get a true sense of the totality of this phenomenon either by experiencing it oneself or by listening to the many anecdotes and experiences of one who has struggled with addiction. The real definition of addiction lies not within clinical terms or diagnostic criteria, but rather in the many tragic life stories shared at A.A. meetings or in the autobiographies of recovering addicts.

Theories of Addiction

Inaba and Cohen (1993) outline three basic models regarding the etiology of addiction, including, The Addictive Disease Model, The Behavioral/Environmental Model and The Academic Model. The Addictive Disease Model is a medical model which theorizes that addiction is a heritable condition based on genetic abnormalities in brain tissue and neurotransmitters. Therefore, according to this orientation, addiction occurs when an individual with an innate genetic propensity to develop the disease is introduced to a drug and subsequently experiences a compulsion to misuse the substance. Current research involving animal experiments, twin studies and the A1 allele gene pair all lend support to this theoretical orientation (Inaba & Cohen, 1993).

The Behavioral/Environmental Model theorizes that addictions develop in response to the physical, mental and emotional stresses in the environment. This perspective outlines five stages in the development of addiction, including, experimentation, social/recreational, habituation, drug abuse and addiction. Research conducted on college campuses as well as classic experiments involving laboratory mice support the tenets of this theory (Inaba & Cohen, 1993).

The Academic Model is based on the psychoactive properties of drugs and their effects upon the body. This perspective acknowledges four physiological changes which characterize the process of addiction, including, tolerance, tissue dependence, withdrawal syndrome and psychic dependence. Both general medical and clinical experience and autopsy conclusions validate the precepts of this model (Inaba & Cohen, 1993).

Additionally, Friel & Friel (1988) present an Iceberg Model to explain the complex interaction of influences in the development of addictive behaviors. Their theory, based on a combination of psychodynamic and family systems orientation, concludes that the overt symptoms of addictive disorders are tied to deeper inner realities of guilt, shame and fear of abandonment learned in the family of origin.

Again, while each of these separate theories has merit, individually they constitute only a small piece of the whole picture of addiction development. Perhaps the best orientation is one that incorporates the many facets of this complex phenomena.

Related Issues

Denial is an issue addressed in virtually every theory of addiction and recovery. It is the systematic refusal, either conscious or unconscious, to acknowledge the uncontrollable nature of their compulsive drug use and/or its deleterious effects. Denial represents the defense mechanism which perpetuates maladaptive addictive behaviors and hinders any treatment approach.

Co-dependency and enabling are two additional issues commonly related to addiction. Co-dependency refers to the process of a person becoming dependent upon another person's addictive behaviors in order to fulfill some need of their own. Closely related to this concept is the process of enabling, whereby the co-dependent facilitates the perpetuation of the addicts behavior through such actions as colluding in refusal to acknowledge the addiction (denial), compensating for the addict's deficits which result from their drug abuse and rescuing the addict from the consequences of his/her behavior. In analyzing these complex issues so intricately tied to the addict, the accuracy of Inaba & Cohen's (1993) description of addiction as a "family disease" becomes obvious.

Treatment

Although there are multitudes of specific recovery program available, in general, the treatment of addictions involves a four-phase process throughout which abstinence is typically mandated. The initial phase of treatment is detoxification, involving a period of time for the body to rid itself of the drug and reestablish a normal balance of body chemistry. The second phase of treatment is initial abstinence, where deconditioning strategies are employed, the underlying problems which led to substance abuse are addressed, and the addict reconstructs his/her life. Long-term sobriety represents the third phase of recovery and is marked by an acknowledgement of his/her condition of chemical dependency and an acceptance of the ongoing treatment process. Finally, the fourth stage, recovery, is characterized by the addict restructuring his/her life and replacing substance abuse behaviors with healthy alternatives (Inaba & Cohen, 1993).

Perhaps the very nature of this disease, its progression and its treatment can be summed up in a few short, but powerful statements of fact. Addiction is a 100 percent fatal disease. Nobody survives addiction that is left untreated. However, the progress of addiction can be halted and the addict can enter recovery, if not be “cured.” Thousands of addicts are well today and have returned to happy and productive lives. Their road to recovery, back to reality and life, was not an easy one. It was, however, certainly worth the trip.

REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5e). Washington, DC: American Psychiatric Association.

Barker, R. L. (1987). The social work dictionary. Silver Spring, MD: National Association of Social Workers.

Friel, J. & Friel L. (1988). Adult children: The secrets of dysfunctional families. Deerfield Beach, FL: Health Communications, Inc.

Inaba D. S. & Cohen, W. E. (1993). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (2e). Ashland, OR: CNS Productions, Inc.

Soukhanov, A. H. & Ellis, K. (Eds.). (1984). Webster's new riverside university dictionary. Boston, MA: The Riverside Publishing Company.