6. Addiction: What, Why & How?


#1

Here we’ll cover:

  1. What does addiction mean?
  2. Why doesn’t the term ‘addiction’ help?
  3. Why does anyone become addicted?
  4. Assessing the current situation
  5. Taking care <3

1. What does addiction mean?

The word ‘addiction’ evolved from the latin word addicere, which most commonly referred to slaves who were awarded to Roman soldiers for their performance in battle.

The word addiction is rooted in enslavement, and by definition slavery is not a choice.

It can be hard to believe that what we put in our bodies isn’t a choice – of course it’s a choice to take a substance just as it is to eat an apple, or drink water.

Because of the brain systems we’ll explore in the next unit, though, for millions of people, choosing not to seek and repeat something that offers the powerful relief some substances do is MUCH harder than we might realize.

The mainstream medical establishment now defines addiction as:

“A chronic brain disease, associated with compulsive or uncontrolled use of one or more substances, that has potential for both recurrence (relapse) and recovery.”

(Surgeon General’s report.)

The author of In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Gabor Maté, says:

“Addiction is manifested in any behavior that a person craves, finds temporary relief or pleasure in, but suffers negative consequences as a result of, and yet has difficulty giving up.”

Journalist and author [Maia Szalavitz](www.chicagotribune.com/lifestyles/health/ct-shame-drug-users-says-best-selling-author-20170412-story.html](http://www.chicagotribune.com/lifestyles/health/ct-shame-drug-users-says-best-selling-author-20170412-story.html) adds, that addiction is more like a learning disorder than disease or moral failing because it is defined as compulsive behavior that continues despite negative consequences, or punishment.

“When a person fails to learn from punishment, there’s a problem with learning. Learning disorders are also usually restricted to a specific sort of brain circuit, as is habitual and harmful substance use.”

All of these research-backed ways of looking at addiction make one thing clear, and to know this one thing is game changing:

Habitual substance use is not a moral failing, but a brain system hijack. It is best understood from a compassionate and medical perspective.

Knowing this, we can begin to use language that connects us with the people we’re concerned about rather than using words that divide us!

2. Why doesn’t the term “addict” work?

There are two downsides to calling someone an addict.

  1. The first, is that it carries a social stigma
    This stigma makes it less likely for the person struggling to seek professional help to change, and also increases their isolation from relationships which themselves can be a positive force for change

  2. The second, is that it casts the individual in a role
    Ever heard someone say “Once an addict, always an addict?”; Addict is a title that, just like Mr or Mrs it is used in a way that makes it hard to disentangle from one’s identity. We don’t want to help cast our loved ones in this role for life.

What’s clear is that both downsides don’t help our ultimate goal. If that isn’t reason enough to stop using the term “addict”, here’s a little more background on the effects of using this word.

Calling someone an addict carries a social stigma that, for most, doesn’t immediately invoke compassion or openness.

‘Stigma’; can be defined as an attribute, behavior, or condition that is socially discrediting.

Why is this especially important for us to pay attention to?

Because “of the 23 million Americans who meet criteria for a substance use disorder each year, only 10% access treatment, and stigma is a major barrier to seeking help.”

Keeping in mind that what we want most is positive change and healing for our loved ones struggling with addiction, we can choose to use language that best serves this goal, language that reinforces positive self esteem, unconditional love, capability and potential to change.

The first choice, is to maintain connection because:

Connection is the opposite of addiction.

So if the language we use is a proven barrier to our loved one’s healing path, let’s change it!

Comparing addiction to other health conditions can help make this distinction clearer…

The Surgeon General’s 2016 report, Facing Addiction in America, tells us:

"…Addiction has many features in common with disorders such as diabetes, asthma, and hypertension.

All of these disorders are chronic, subject to relapse, and influenced by genetic, developmental, behavioral, social, and environmental factors.

In all of these disorders, affected individuals may have difficulty in complying with the prescribed treatment."

Yet, the way we speak about and treat each is quite different.

“A patient with diabetes has ‘an elevated glucose’ level.”

A patient with cardiovascular disease has ‘a positive exercise tolerance test’ result.

A clinician within the health setting addresses these results.

An “addict”; is not ‘clean’—he has been ‘abusing’; drugs and has a ‘dirty’; urine sample.

Someone outside the system that cares for all other health conditions addresses the results.

In the worst case, the drug use is addressed by incarceration."

We’e heard punitive language attached to drug use for so long that most of us think nothing of it, but when we see someone we love struggling with substances, we might begin to see things differently. The cracks in language like the ‘war’ on drugs or “you use, you lose” become more visible. “Just say no” becomes irrelevant and entirely not useful.

This language was meant to deter substance use, but as Maia Szalavitz pragmatically puts it:

"Addiction is defined as compulsive behavior despite negative consequences.

So if negative consequences were going to fix it, it wouldn’t exist in the first place."

Ultimately, it is most helpful to speak in a way that separates the person from the disease.

When we do, we and they, get to remember that their use is not a life sentence.

People can and do change. With time and support… Brains can and do heal! Habits can and do change.

SO… here in the Village, we’re tossing out the word ‘addict’. We use a few different terms we find most accurate and helpful instead:

  • Most medically correct: (Person or patient with a) Substance Use Disorder

  • More personally connected: Someone struggling with substance use

  • Getting to the heart of the matter and true for us: Loved ones

3. Why does someone become addicted?

Dr. Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction, often says:

"I’m not going to ask you what you were addicted to or for how long.

I’ll only ask, what did it offer you?"

He reports that universally the answers are:

“It helped me escape emotional pain.”

“It helped me deal with stress, gave me peace of mind.”

“It gave me a sense of control.”

“It gave me a sense of connection with others.”

Maté says that such answers reveal to us that addiction is neither a choice nor disease, but a psychological and physiological response to painful life experience.

It originates in a person’s desperate attempt to solve a problem:

the problem of lost connection, of a deep discomfort with the self.

He famously asks, “not why the addiction, but why the pain?”

His research uncovers that the root is in childhood trauma, and he is quick to explain:

“Trauma is not restricted to horrific experiences. It refers to any set of events that, over time, impose more pain on the child than his or her sensitive organism can process and discharge.”

The Surgeon General’s 2016 report, Facing Addiction in America also lists factors that increase risk for substance use disorder: early life experiences, genetic and molecular distinctions, and co-occurring mental issues. It’s commonly noted now that differences in genes, biology, environment, relationships, culture, trauma and mental health all may contribute at some level.

While there’s no one answer as to why someone becomes addicted, research highlights factors that increase the risk, and knowing them helps us evolve our own understanding.

We soon learn that even if we remove the substance(s), all other problems are not immediately healed or solved. The roots that caused the habitual use to occur in the first place need attention in order for sustainable change to happen.

It’s great to know this upfront so we’re ready for the long game.

As with anything, the better we understand the causes and contributing factors, the more capable we are to continue taking effective action.

4. How can we assess the situation?

The questionnaire below is used by healthcare professionals in the US to determine the severity of a patient’s substance use disorder, ranging from mild to severe.

It is most accurate when carried out by your loved one with support of a medical professional, but it can be used to give you a sense of how severe you think the use is, since you are the one thinking it through right now.

Note down all that you’re certain apply to the person you’re concerned about.

  1. Taking a drug or alcohol in larger amounts and for longer than intended

  2. Wanting to cut down or quit but not being able to do it

  3. Spending a lot of time obtaining the substance

  4. Craving or a strong desire to use

  5. Repeatedly unable to carry out major obligations at work, school, or home due to use

  6. Continued use despite persistent or recurring social or interpersonal problems caused or made worse by use

  7. Stopping or reducing important social, occupational, or recreational activities due to use

  8. Recurrent use in physically hazardous situations

  9. Consistent use despite acknowledgment of persistent or recurrent physical or psychological difficulties from using

  10. Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired affect or markedly diminished effect with continued use of the same amount. (Does not apply for diminished effect when used appropriately under medical supervision)

  11. Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal (Does not apply when used appropriately under medical supervision)

If 2-3 statements were checked, the condition would be considered mild.

Action:

If 4-5, condition would be considered moderate.

Action:

If 6-7, condition would be considered severe.

It might be helpful at this time to connect with a specialist (hyperlink) to get support and guidance to understand how you’ve assessed the current situation. Here’s a way to make that connection now, or you can continue to explore the next action-based topic: Taking care.

5. Taking care

It’s possible to adapt to the behaviors of others so much that we no longer fully notice the effects they have on us. This short questionnaire is a reality check exercise to assess how their behavior in the last week has been affecting you. These reality checks are fundamental to taking care of ourselves on the journey.

  1. With the following behaviors, note down (yes or no) if it has occurred with your loved one in the last week?

  2. And then take a moment to reflect on how much it bothered you on a scale of 0 being Not at all bothered by it to 4 Extremely bothering.

0 = Not at all

1 = A little

2 = Moderately

3 = Very Much

4 = Extremely

  1. Sudden mood swings, irritability, or angry outbursts

  2. Visibly lethargic, spaced out, or passing out

  3. Unusually hyperactive or extremely talkative

  4. Unexplained change in attitude or personality

  5. Paranoid, anxious, or scared for no apparent reason

  6. Unusually withdrawn and isolating

  7. Stole from you or someone you know

  8. Lied about something you know to be false

  9. Missed work, school, or other agreed upon commitment

  10. Borrowed money

  11. Shifted blame - not taking accountability

  12. Broke the law

Today’s Action: Shifting the Focus to Me

Keeping in mind the affect our loved one’s behavior has been having on us in the last week, we might feel open to some self-care.

We can look at this part as rewards for ourselves or we can look at it as simply taking our quality of life up a notch, which is fundamental to showing our loved ones how simple and beneficial it is to take care of ourselves.

It is not selfish to to take care of yourself.

One more time.

It is not selfish to take care of yourself.

It may actually be the only way to sustain a genuinely positive outlook over time. A positive outlook not only benefits the person you’re concerned about, but is necessary for your well-being and the way you feel moment to moment on a daily basis which is really important too!

Do you know what constitutes a ‘good life’? The quality of your experience in every small or big moment. And it’s an inside job.

So… to support you in maintaining, practicing if you’ve forgotten, or regaining a positive outlook that will keep the grass growing in your internal landscape, weve compiled a list.

  • Transformation begins with one little step.

  • Choose one and do it today.

  • Plan to sleep 8 eight hours tonight

  • Call someone supportive for a chat

  • Move your body and get your heart rate up for 30 minutes

  • Take a bath or warm shower

  • Eat a warm meal slowly

  • Wash your sheets or clean your bedroom

  • Take 10 slow, deep inhales and long exhales

  • Watch a movie

  • Smile (hold a pencil between your teeth if you have to! it’s proven to improve mood :slight_smile: )

  • Give and receive a hug