Are you an Alcoholic or Drug Addict?
We are now in the second decade of the third millennium and yet there is still no consensus among authorities as to what causes or constitutes addiction to alcohol or drugs. Is addiction an expression of poor choices made by weak-willed people? Or is addiction a neurobiological disorder, one whose sufferers respond to the stimulus of mood-altering chemicals or alcohol, or to mood-altering behaviours such as gambling or sex, in fundamentally different ways to people who don’t have a neurobiological disorder? In other words, is addiction merely an expression of misguided choice, or is it an expression of a biological imperative?
Anyone can choose to drink or use drugs and consequently become intoxicated or high. But although people choose to drink or take drugs, no-one chooses to become an alcoholic or drug addict. Indeed, even when alcoholics and drug addicts realise that their substance use is causing problems and needs to be cut down, good intentions to do so will not be translated into control or abstinence for any length of time. In fact, it is well said that ‘the road to rehab is paved with good intentions’!
This absence of choice suggests that a neurobiological mechanism may be at work. However, although non-invasive brain scanning imagery has suggested some neurobiological basis to addiction, no biological marker for addiction has yet been identified. This does not mean that the condition does not exist: diabetes was recognized long before medical science had mapped out the biochemistry of the condition. But it does mean that the aetiology of addiction is currently out of our grasp.
Nonetheless, there is good evidence to suggest that addiction is an illness as opposed to just an unfortunate set of circumstances. For this to be the case, then, as with any illness, sufferers of the illness should have a shared symptomology and their illness should run a similar course.
The Course of Addiction: An Unfortunate Set of Circumstances or an Illness?
Addiction can be thought of as a pathological relationship with a substance of choice. At the beginning of the relationship, the addict may well be using an apparently harmless gateway drug like cannabis or hash, with low frequency (days per week) of use, low intensity of use (quantity consumed), and no apparent problems caused by the drug use. An outside observer would not, at this stage, be able to distinguish an addict from a recreational user; the drug use appears to be under control.
In this phase, the drug or alcohol use becomes more central to the addict’s life. Occasional use has become more regular use, but the addict still retains a large degree of choice. A tolerance begins to develop: increased quantities of alcohol or drugs are needed to achieve the desired effect. Dependence starts to develop: the addicted person will start to experience some psychological and/or physiological distress when not using their drug of choice. Importantly, the substance use will begin to interfere with the addict’s life: exams may be passed but the grades will be lower than they should be; recreational hobbies will start to drop off; blackouts may start to occur; drink-driving may become quite regular; the first drink or drug will be taken earlier in the day; friends and family may start to notice that something is wrong; the addict will begin to use alone and hide the extent to which they are drinking or taking drugs from friends and family; and there may be absenteeism and under-performance at work.
This phase is also when a denial system starts to develop. Denial is an unconscious ego defence system, designed to protect us from facing reality. For addicts, denial serves to perpetuate their using: blame, justification and rationalization will explain away any problems caused by the alcohol or drug use.
How long an addict remains in this phase varies: rapidly dependence-producing chemicals, such as heroin, crack and methamphetamine will cause things to accelerate to the next phase very quickly. Less powerful drugs, such as alcohol and cannabis, will cause the incubation phase to be extended and generate a slower transition to the next phase.
The critical phase is characterised by an increasingly diminished ability to control the consumption of drugs or alcohol. As control deteriorates, proportionately bigger negative consequences start to appear and these become difficult to resolve or conceal. It is this impaired control that is the hallmark of addiction.
Impaired control is, though, a difficult concept to operationalise. It is not just about an amount, but about what happens when drugs or alcohol are consumed. One way of thinking about it is that loss of control is related to consequences: the greater the consequences, the greater the loss of control. Thus, ‘I drink too much’ is a very different animal to ‘Once I start drinking I can’t stop’. The former would probably be an abuser who should drink less; the latter would probably be an alcoholic who should abstain completely from alcohol.
At this stage, the addict will still be able to exercise choice about whether to drink or take drugs. But he/she won’t be able to reliably predict how much will be consumed and what will happen. This unpredictability will occur regardless of whatever external controls the addict may have set in place (for example never buying more than one bottle of wine at a time, or scoring more than 1g of cocaine at a time).
To sum up: the crucial phase is about choice (to use/drink) but an unpredictable outcome.
In this phase, choice over whether to drink or use is lost. The addict is driven by compulsion, which can be defined as: doing things you know you shouldn’t be doing and don’t want to do, but you are unable to stop yourself doing them anyway.
In terms of a hierarchy of needs, the compulsion to use becomes continuous. Not surprisingly, this is when previously functional addicts find that the wheels come off. Thus, the addict may have been living a relatively manageable double life: one foot in a professional world and one foot in, for instance, a secret cocaine addiction. Sustaining this double life becomes almost impossible, as the addict engages in doomed attempts to conceal the use and the drug dependence.
It is the onset of the chronic phase that sees most addicts come into treatment.
Here, the addict is consumed by the need to use and this takes priority over all other survival instincts and needs. Indeed, the addictive relationship becomes the only need that the addict wants to satisfy. It has been said of the pre-terminal phase that ‘we lived to use and used to live’. Nothing has meaning and all life-purpose has been lost. There seems little reason to give up using, as there is nothing else left to lose (other, perhaps, than one’s life; there is always six feet left to play with).
People presenting for treatment in this phase will take a long time to recover and will benefit from extended residential rehab.
Recovery is not only possible but all addicts have a 100% chance of happy and sustainable long-term recovery if they commit to the process and follow suggestions. Assuming good counsellors, a motivation to recover and an appropriate programme, the key variable is length of treatment – outcome studies have found that recovery is most likely when treatment duration is 90 days or more.
This is why we at Start2Stop are taking no chances: our primary outpatient treatment programme is 100 days long. Thereafter, all our clients are warmly encouraged to attend free weekly Aftercare and become involved in alumnus activities.
Markers for addiction
- You know that your using is causing problems and want to cut down, but are unable to do so (compulsion).
- You find yourself using more and more of your substance of choice to achieve the desired effect (tolerance).
- You experience substance-specific withdrawal symptoms when you stop using (physical dependence).
- Thinking about using is occupying a very large part of your headspace (obsession).
- You have tried to cut down or stop but been unable to do so for any length of time (impaired control).
- You feel guilty and ashamed about things you do when using (erosion of authentic self and values).
- Using on your own, in secret.
- Your using is directly causing problems in various areas of life: marriage, partner, health, finances, occupation, legal and ethical, to name but a few.
- After periods when you have abstained, you start again and find that you are back where you left off very quickly.
- Lying to others about extent of your use.
- Dropping off of old hobbies and pastimes.
Are you an Alcoholic or Drug Addict?
If you’re unsure answer the following questions and see if you relate to them…