Who Understands Addiction?
Understanding addiction has never been an exact science, especially to those who are in the front line trying to help people in their recovery. It can be argued that addiction is a chronic relapsing illness. Many in the world, who don't understand this definition as applied to addiction, (and often the drug users themselves), think that perhaps addiction is just a matter of choice and making right decisions.
More Light and Less Heat Needed
Over recent years our understanding of addiction is gradually having some light shone upon it. The revelation is gradually unfolding a bit at a time. It's as if we weren't ready for it all in one go. Those who work with recovering addicts are often mystified at the high relapse rate especially when a person has completed, say, a 12 month programme and got a network of support around them. They just figure it's par for the course. If you want to work with addicts - get used to going to funerals!
What is the Question?
On the other side of this equation are the academics and scientists working on behaviour, and studying brain cells, to understand more about what is going on. Have these people ever met a drug addict outside of a clinical environment? Possibly not. Maybe that's the wrong question though, perhaps it should be, "Are they making a contribution to our understanding of the problem?" - I think we could answer that in the affirmative.
Whether we look at the problem close up and personal, or through a microscope, we need to constantly improve our understanding of addiction so that we can increase the odds in favour of those in recovery.
After Cold Turkey!
When the body starts developing a tolerance to the drug, and more is required in order to feel normal, the drugs addict has reached a stage of physical dependency. There will also be physical symptoms linked to withdrawal which are too painful (for most addicts) to think about. These may be 'flu like symptoms, sickness, cramps, headaches and hallucinations.
Withdrawal is uncomfortable and miserable, but it is the result of the body healing itself. It is part of breaking away from the physical addiction. Withdrawal can be achieved gradually in a controlled way at a detox centre, or by reducing the drug (or drug substitute) intake gradually over a period of time to help our bodies break the physical addiction.
The other option of withdrawal without the help of substitutes (cold turkey) requires much prayer and will power, but can provide a very effective learning curve for the recovering person.
The Three Month Syndrome!
Even after a detox it is important to maintain sobriety for at least three months to even be able to contemplate dealing with any underlying issues that need to be resolved. When working with recovering addicts, we recognised this 'three month syndrome' when residents would hit a wall in the recovery process.
Often after dealing with the initial depression, anger, anxiety and even boredom, the recovering person would derail their recovery. No amount of persuasion would convince that person to stay. We knew that 'the call' was too strong. The cravings and the compulsion to return to his old ways defeated common sense.
A Dog Returns to It's Vomit
Why would someone who had stayed clean for three months want to return to his old ways when the outcome could be (and sometimes was) fatal? Addicts can quit many times and still relapse. There must be something else going on.
When I asked this question of a recovered addict, he answered with a question, "Why does a dog return to it's own vomit? Because it's a dog! So why does an addict return to addiction? Because he's an addict! There is much wisdom in this statement.
An addict starts out using drugs because it makes him feel good. Eventually, as dependence kicks in, he needs the drugs to feel normal. But withdrawal takes a relatively short time, four to seven days should see the back of the symptoms. So why is it difficult to stay on course even after 3 months?
Drug Abuse or Drug Dependence?
Current thinking is that there is a difference between 'drug abuse' and 'drug dependence (addiction)'. Drug abuse in when someone, say, gets drunk every week enough to disable him, or uses some hard drugs often enough to knock him out and not have a recollection of what he did.
A drug abuser can even get physical withdrawal symptoms if they stop using (abusing). But if the circumstances changed, they lost their job, or moved to another town, or the supplied dried up, the abuser would simply stop abusing and may quit altogether.
An addict can't do this. Dependency means a preoccupation with his drug of choice. A love affair to steal for, and even die for. He gets to the place where the drug is abusing him, yet he still carries on the relationship.
A Created Disorder
David R Hughes, a recovered addict, in his internet article of 1997 argues that addiction is a neurologically based disease. Drug addiction, is not primarily a mental or free will issue that an addict could change if they wanted to.
One definition of addiction is "the loss of control over the use of a substance." The reason addicts have lost control is because they have suffered permanent physical neurological changes based in their brains and nervous systems.
Addiction is a self-contracted neurological disease. It is a 'created' disorder. Nonetheless, it is also a physical problem on a neurological level, and it is very real. To effectively "re-wire" his disordered nervous system, the addict must come to rely fiercely and absolutely upon the directions provided from an external support system (a rehab for instance).
By mentally changing what he relies upon, his neurological/nervous system undergoes a profound change. That is why rehabilitation over 12 - 24 months can work.
Keep Talking and Re-wire the Brain
It is to understand that the detox does not last for a week, but for probably 3 months while the re-wiring is taking place. Then various models of therapy can prove effective, like the new therapies or a therapeutic community model.
Recent evidence suggests that drug-induced changes in the physical brain over time may be the underlying reason for addictive behavior, and this is consistent with the general idea that addiction is a physical disease.
But it is probably better to state that it is a medical disease. Prof Carlton Erikson puts it well in his Addiction Today article "So, if addictions are a medical disease, why do we treat them behaviourally? What is the similarity between behavioural or talk therapies and pharmacotherapies in the way they work? Simple. Behavioural therapies probably change brain chemistry!"
So all you carers out there, keep up to date, but keep caring. And to you scientists, try to empathise, but keep looking through the microscope. Comments would be welcome
Understanding addiction has never been an exact science, especially to those who are in the front line trying to help people in their recovery. It can be argued that addiction is a chronic relapsing illness. Many in the world, who don't understand this definition as applied to addiction, (and often the drug users themselves), think that perhaps addiction is just a matter of choice and making right decisions.
More Light and Less Heat Needed
Over recent years our understanding of addiction is gradually having some light shone upon it. The revelation is gradually unfolding a bit at a time. It's as if we weren't ready for it all in one go. Those who work with recovering addicts are often mystified at the high relapse rate especially when a person has completed, say, a 12 month programme and got a network of support around them. They just figure it's par for the course. If you want to work with addicts - get used to going to funerals!
What is the Question?
On the other side of this equation are the academics and scientists working on behaviour, and studying brain cells, to understand more about what is going on. Have these people ever met a drug addict outside of a clinical environment? Possibly not. Maybe that's the wrong question though, perhaps it should be, "Are they making a contribution to our understanding of the problem?" - I think we could answer that in the affirmative.
Whether we look at the problem close up and personal, or through a microscope, we need to constantly improve our understanding of addiction so that we can increase the odds in favour of those in recovery.
After Cold Turkey!
When the body starts developing a tolerance to the drug, and more is required in order to feel normal, the drugs addict has reached a stage of physical dependency. There will also be physical symptoms linked to withdrawal which are too painful (for most addicts) to think about. These may be 'flu like symptoms, sickness, cramps, headaches and hallucinations.
Withdrawal is uncomfortable and miserable, but it is the result of the body healing itself. It is part of breaking away from the physical addiction. Withdrawal can be achieved gradually in a controlled way at a detox centre, or by reducing the drug (or drug substitute) intake gradually over a period of time to help our bodies break the physical addiction.
The other option of withdrawal without the help of substitutes (cold turkey) requires much prayer and will power, but can provide a very effective learning curve for the recovering person.
The Three Month Syndrome!
Even after a detox it is important to maintain sobriety for at least three months to even be able to contemplate dealing with any underlying issues that need to be resolved. When working with recovering addicts, we recognised this 'three month syndrome' when residents would hit a wall in the recovery process.
Often after dealing with the initial depression, anger, anxiety and even boredom, the recovering person would derail their recovery. No amount of persuasion would convince that person to stay. We knew that 'the call' was too strong. The cravings and the compulsion to return to his old ways defeated common sense.
A Dog Returns to It's Vomit
Why would someone who had stayed clean for three months want to return to his old ways when the outcome could be (and sometimes was) fatal? Addicts can quit many times and still relapse. There must be something else going on.
When I asked this question of a recovered addict, he answered with a question, "Why does a dog return to it's own vomit? Because it's a dog! So why does an addict return to addiction? Because he's an addict! There is much wisdom in this statement.
An addict starts out using drugs because it makes him feel good. Eventually, as dependence kicks in, he needs the drugs to feel normal. But withdrawal takes a relatively short time, four to seven days should see the back of the symptoms. So why is it difficult to stay on course even after 3 months?
Drug Abuse or Drug Dependence?
Current thinking is that there is a difference between 'drug abuse' and 'drug dependence (addiction)'. Drug abuse in when someone, say, gets drunk every week enough to disable him, or uses some hard drugs often enough to knock him out and not have a recollection of what he did.
A drug abuser can even get physical withdrawal symptoms if they stop using (abusing). But if the circumstances changed, they lost their job, or moved to another town, or the supplied dried up, the abuser would simply stop abusing and may quit altogether.
An addict can't do this. Dependency means a preoccupation with his drug of choice. A love affair to steal for, and even die for. He gets to the place where the drug is abusing him, yet he still carries on the relationship.
A Created Disorder
David R Hughes, a recovered addict, in his internet article of 1997 argues that addiction is a neurologically based disease. Drug addiction, is not primarily a mental or free will issue that an addict could change if they wanted to.
One definition of addiction is "the loss of control over the use of a substance." The reason addicts have lost control is because they have suffered permanent physical neurological changes based in their brains and nervous systems.
Addiction is a self-contracted neurological disease. It is a 'created' disorder. Nonetheless, it is also a physical problem on a neurological level, and it is very real. To effectively "re-wire" his disordered nervous system, the addict must come to rely fiercely and absolutely upon the directions provided from an external support system (a rehab for instance).
By mentally changing what he relies upon, his neurological/nervous system undergoes a profound change. That is why rehabilitation over 12 - 24 months can work.
Keep Talking and Re-wire the Brain
It is to understand that the detox does not last for a week, but for probably 3 months while the re-wiring is taking place. Then various models of therapy can prove effective, like the new therapies or a therapeutic community model.
Recent evidence suggests that drug-induced changes in the physical brain over time may be the underlying reason for addictive behavior, and this is consistent with the general idea that addiction is a physical disease.
But it is probably better to state that it is a medical disease. Prof Carlton Erikson puts it well in his Addiction Today article "So, if addictions are a medical disease, why do we treat them behaviourally? What is the similarity between behavioural or talk therapies and pharmacotherapies in the way they work? Simple. Behavioural therapies probably change brain chemistry!"
So all you carers out there, keep up to date, but keep caring. And to you scientists, try to empathise, but keep looking through the microscope. Comments would be welcome