Understanding Addiction: The Basics
Understanding Addiction:
The Basics
What Is Addiction?
A 2011 Public Policy Statement of The American Society of Addiction Medicine (ASAM) defined "addiction as a primary, chronic disease of brain reward, motivation, memory, and related circuitry." This definition emphasizes the neurobiological aspects of addiction and how it affects neurotransmission and interactions within the brain's reward structures. Dysfunction in these circuits can lead to characteristic biological, psychological, and social manifestations. The frontal cortex and its connections play a crucial role in altered impulse control, judgment, and the dysfunctional pursuit of rewards seen in addiction. This altered behavior persists despite the adverse consequences of substance use and other addictive behaviors. Addiction manifests as the persistent struggle to refrain, a loss of behavioral regulation, intense yearning, reduced awareness of consequential issues in personal conduct and relationships, and maladaptive emotional reactions. ASAM acknowledges the role of external cues in triggering craving and drug use, as well as in increasing engagement in potentially addictive behaviors. The organization also discusses the chronic nature of addiction, noting its tendency for recurring cycles of relapse and remission, noting such contributions of specific brain circuits, along with other neurobiological factors, such as stress, in triggering relapse.
ASAM's definition of addiction provides a comprehensive understanding of addiction as a chronic disease with neurobiological, psychological, and social dimensions. By highlighting the impact of addiction on brain circuits and neurotransmission, ASAM underscores the complexity of this condition and the importance of recognizing addiction as a complex disease that requires a multifaceted approach to treatment and recovery.
Towards Empowerment: Paradigm Shifts in Overcoming
Substance Use Disorder Stigma
By Peggy L. Ferguson, Ph.D.
Language has power. It shapes how we think and act, especially when it comes to substance use disorders. For a long time, there's been a push to use non-stigmatizing language when talking about addiction. This shift is about helping people get the necessary help and support. It is not merely a matter of semantics; instead, it reflects a deeper understanding of addiction's complexities and aims to reduce stigma while promoting more accurate and compassionate language. The transition from using the term "addiction" to "substance use disorder" signifies a paradigmatic evolution in how we perceive and address this multifaceted issue.
What is stigma?
Stigma is a negative stereotype that assesses someone with an undesired condition as less worthy. This form of bias often comes from beliefs about the cause of the problem and how much control someone has over it.
"People First" Language Fights Stigma:
Non-stigmatizing terminology takes a "people first" approach in addressing substance use disorder. A "people-first" framework involves using language such as "a person with substance use disorder" instead of "alcoholic," "addict," or "substance abuser." This shift in language can change the perception of someone with substance use disorder from someone to blame and shame to someone needing help and support. Using words that more aptly reflect what we know from research -- that addiction is a chronic brain disease involving complex interactions among reward, motivation, memory, and related circuitry, helps us keep in mind that someone with substance use disorder has an illness that affects their brain and behavior.
Why Is It So Hard To Change How We Look At Addiction?
As a culture, we are still struggling with myths and stereotypes about addiction. The way we use language reflects that. Stigma usually comes from perceptions about what caused the problem and how much control someone has over it.
Many people still believe that addiction is a choice. This argument posits that individuals willingly and consciously choose to engage in substance use or addictive behaviors. According to this viewpoint, addiction is a result of repeated decisions to use substances despite being aware of potential negative consequences.
We know from decades of research that substance use disorder causes changes in brain chemistry and neural pathways, leading to compulsive behavior and loss of control over substance use. Genetic predisposition, environmental influences, trauma, and mental health conditions can also contribute to the development of addiction, undermining the notion of pure choice.
When people understand that addiction isn't someone's fault—it's because of many factors outside their control-- things like genetics, environmental influences, or trauma—then they're less likely to stigmatize them. Stigma arises when addiction is perceived as a choice, leading to the attribution of blame to individuals with addiction.
When we think that someone did not choose to have a substance use disorder, we're more likely to have compassion. We tend to judge people when we believe that their problems are due to personal weakness or failure, lack of willpower, or a deliberate abdication of control and responsibility.
Language Change Takes Place Over Time:
Deeply ingrained stereotypes and myths are not the only thing standing in the way of a cultural paradigm shift. Although changes in the DSM-5-TR from addiction terminology to "substance use disorder" vernacular reflect changes in diagnostic criteria and classification systems, the transition is not without its challenges.
While the term "substance use disorder" may be more clinically accurate and less stigmatizing, it may lack the same level of recognition and resonance among the general public. The changes in the diagnostic structure for Substance Use Disorder (SUD) in the DSM-5-TR involve removing the term "addiction" from discussions about mood-altering chemicals. However, the term addiction is used in the DSM-V-TR to describe and label process addictions. "Addiction" is still used by many professionals to note a severe level of substance use disorder.
"Addiction" is an institutionalized term. There are countless professional organizations and journals with the term "addiction" in the title. There are various initiatives, services, and programs related to addressing addiction issues in different contexts. These are helpful, worthwhile organizations whose raison d'etre is to promote recovery from "addiction." The infrastructure supporting recovery is not only built upon the cornerstone of "addiction" as a conceptual framework and unifying principle but also resonates deeply with the general information-seeking public. Collective or widespread use of the term addiction serves as a familiar entry point for individuals seeking knowledge and assistance, forming a crucial bridge between those in need and the resources available to support their journey toward recovery.
"Addiction" as a culturally ingrained concept is reflected in keyword analysis. Terms like "substance use disorder" receive a small fraction of the internet search traffic compared to more familiar terms like "addiction." Keyword analysis indicates the prevalence of using specific terms within a context or field. The popularity of search engine keywords changes over time, and "substance use disorder" and its related terminology will probably replace the emotionally laden term "addiction" eventually.
Why is Eliminating Stigma Important?
Stigmatized people face disadvantages, alienation, and exclusion. They could face discrimination or have trouble getting the help they need.
People with substance use disorders frequently face internalized stigma, which involves accepting and incorporating society's negative views about addiction and applying them to oneself. Internalized stigma leads to feelings of shame, self-blame, and low self-esteem. As a result, they may avoid seeking help out of fear of judgment or being labeled an "addict."
Revamping our terminology and language holds the potential for profound impact. Using respectful people-first language can help individuals feel more accepted and less judged, reducing barriers to seeking help. This change creates a safer and more comfortable environment for individuals to open up about their struggles with substance use. When people feel understood and respected, they are more likely to feel comfortable seeking support and treatment. Non-stigmatizing language encourages open and honest communication between individuals with substance use disorder and healthcare providers, family members, and friends. It allows for more productive conversations about treatment options, recovery goals, and support networks. People-first language promotes positive self-perception and self-worth among individuals with substance use disorder. People not defined by their substance use disorder may be more likely to seek the help needed to recover.
The way we talk about addiction matters. When we consciously use language that identifies the person as someone with an illness, rather than letting the condition determine the person, we empower ourselves with compassion rather than prejudice and resentment, and we help people with an affliction recover.
Addiction Treatment.
Addiction Recovery.
Not The Same Thing
By Peggy L. Ferguson, Ph.D.
People often mistake a treatment service or episode as "recovery." The term is frequently used interchangeably with "treatment" or "rehab". Yet even "treatment" is not a single modality or event. Treatment refers to services provided by professionals for the recovery process. Treatment involves types of therapy, modalities, and levels of care. Modalities usually involve individual, couple, family, and group counseling. Levels of care usually refer to treatment intensity, withdrawal management or detoxification, residential or inpatient, partial hospitalization or intensive outpatient, outpatient, and early intervention. Types of therapy for addiction could include medication-assisted treatment, Cognitive Behavioral Therapy, Motivational Interviewing, 12-step facilitation, Dialectic Behavioral Therapy, and Mindfulness-based interventions, to name a few.
Recovery involves a return to health and encompasses every aspect of your life while you establish and maintain sobriety. Recovery is the life-long process of growth in sobriety and beyond. "Recovery" has many different definitions based on the frame of reference of the person doing the defining.
The Substance Abuse and Mental Health Services Administration (SAMHSA) characterizes recovery as an evolving journey wherein individuals enhance their well-being, lead self-directed lives, and aspire to fulfill their utmost potential by undergoing transformative changes.
Recovery is a therapeutic response to a chronic illness. Abstinence, an ongoing process, is the beginning of the recovery process. It is usually a complex, painful process that occurs in growth spurts rather than as a linear, continuous process. Recovery is more than discontinuing the use of alcohol and other drugs and maintaining that abstinence.
Initially, to maintain abstinence from mood-altering drugs, including alcohol, the recovering person must learn to replace the chemical with healthy living skills. In active addiction, the person with substance use disorder uses the chemical for managing emotions, managing stress, and dealing with the problems of everyday living. A person in recovery must learn to live without the chemicals.
Recovery is a restoration of personal health. When the chemical as a "problem solver" is eliminated, the recovering person must replace it with another problem-solving behavior. When someone with substance use disorder uses alcohol and other drugs to deal with life's problems, they are not fully engaged in practicing living skills that are developed and refined over time with rehearsal. They may not have developed many living skills.
People with substance use disorder often start using alcohol and other drugs in adolescence. Therefore, when they use chemicals for problem-solving across various domains of one's life, they do not develop fundamental living skills. When they sober up, they may not have many living skills. They must learn to manage the daily difficulties and stressors without relapsing on chemicals. Active engagement in recovery activities, such as applying acquired skills and techniques for problem-solving in every area of one's life, enables the recovering person to see improvement in their physical, emotional, behavioral, and spiritual health., behavioral, and spiritual health.
Recovery involves continuing to take responsibility for overcoming challenges. In the process, recovering people learn and practice effective ways to meet their needs, be responsive to others, and confidently be productive members of society.
Recovery often demands new living skills. People in recovery frequently learn, for the first time, how to deal with feelings appropriately—to communicate them in a way that maximizes the probability that they will have their needs met and be able to function in relationships fully. They may learn how to be present in the lives of others once again. They may gain skills for taking responsibility for their feelings, decisions, and behavior.
Recovering people learn to make amends to others when they wrong them. They may move from a self-centered, self-absorbed focus to a more balanced interest in others. They may gain interest in being of service to others. Recovering people accept themselves and others as less than perfect yet worthwhile.
All of these positive changes are commonplace in recovery. Self-esteem returns as one gets to know oneself again is present with others and learns to deal with life on one's terms. Many people in recovery cultivate a higher power concept, initially for relapse prevention and furtherance of their recovery efforts. The ultimate outcomes of these recovery efforts result in productive functioning as a person, family member, worker, and citizen.
Other Addiction-Related Pages
The Stages of Change Model Because Recovery is a Process
By Peggy L. Ferguson, Ph.D.
The Stages of Change Model, (1984) developed by James Prochaska and Carlo DiClemente, provides a framework for understanding the process of behavioral change. It has become a cornerstone in addiction treatment and various other behavioral interventions. The model outlines five stages individuals typically go through as they work towards significant lifestyle changes.
This model tailors interventions to an individual's readiness to change. Treatment methods and strategies are matched to the client's stage of change to improve the likelihood of successful recovery. For instance, motivational interviewing techniques are often employed in the pre-contemplation and contemplation stages to help individuals recognize the need for change and prepare for action. This stage-based approach meets clients where they are in their journey towards recovery.
The five stages of change defined in this model include the following:
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Pre-contemplation: Individuals aren't considering changing behavior and are often unaware of a problem.
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Contemplation: Individuals acknowledge a problem and think about overcoming it but haven't committed to making a change.
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Preparation: Individuals intend to take action relatively soon. They often have unsuccessfully attempted to do so over the past year.
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Action: Individuals work to modify their behavior to overcome problems. This stage requires a great deal of time and energy.
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Maintenance: Individuals work to prevent relapse and solidify their gains.
Source: James Prochaska and Carlo DiClemente (1984) Toward a Comprehensive Model of Change, Chapter 1 of Treating Addictive Behaviors: Processes of Change, Editor - E.Miller, Plenum Press, NY.
Understanding the Journey: From First Taste to
Alcohol Use Disorder
By Peggy L. Ferguson, Ph.D.
In the beginning, someone who now struggles with alcohol use disorder picked up a drink. People usually start drinking to try it or to have a good time. People typically place an ordinary or reasonable level of importance on drinking. Then, they discover what alcohol can do for you. They quickly discover that if you are shy, alcohol can lower inhibitions and ease social anxiety. If you are worried, you can let it go for a while. It can take the edge off of any uncomfortable feeling or change it altogether. Alcohol begins to serve as problem-solving. Initially, alcohol might seem like a solution—it makes the person feel good, better, or even not at all. Alcohol is serving a function - relaxation, social lubricant, or escape. It works for the drinker.
For many, the journey into alcohol use disorder follows a predictable pattern: a) They find joy or pleasure in drinking. b) They start drinking more frequently, although it might not be daily. c) They begin to use alcohol purposefully for more and more problems. d) Many people develop a tolerance, meaning it takes more alcohol to achieve the same effect. e) They eventually experience more and more problems related to their drinking, yet they continue to drink. f) With some level of awareness that drinking is associated with those problems, someone with alcohol use disorder may eventually try to cut back on their consumption or quit altogether. Doing so may bring about "withdrawal symptoms" that are unpleasant (or even dangerous) enough to return to drinking to avoid them. Increased tolerance and withdrawal symptoms reflect changes in body chemistry.
Even in the early days of alcohol use disorder, there may or may not be indicators of a problem. Alcohol use can change for those susceptible to substance use disorder. Relief drinking, where alcohol serves psychological or emotional purposes, begins relatively quickly. The person applies purposeful drinking to more areas of their life, and alcohol assumes more central roles, leading to changes in daily behavior and the brain.
The journey into alcohol use disorder often begins innocently as individuals pick up a drink to socialize or relax. Over time, alcohol begins to serve as a solution to various problems, providing relief from discomfort and anxiety. As tolerance increases, so do the frequency and severity of drinking, leading to a cascade of negative consequences. Despite awareness of the problems caused by drinking, individuals with alcohol use disorder may struggle to cut back or quit due to withdrawal symptoms and changes in body chemistry. Even in the early stages, signs of a problem may not be apparent, highlighting the complexity and insidious nature of substance use disorder.
Stages of Recovery: Gorski's Developmental Model
By Peggy L. Ferguson, Ph.D.
Establishing abstinence in the first stage of recovery, known as transition, poses significant challenges. This period marks a pivotal moment when the detrimental effects of substance use disorder become unmistakable, demanding attention from both the individual and their family. Despite mounting evidence to the contrary, many cling to the belief that they still maintain control over their substance use, often rationalizing it as social drinking or recreational drug use.
However, individuals battling substance use disorder experience an internal struggle as they confront the destructive consequences of their behavior. While acknowledging the problem may be tentative, there's often a wavering recognition of the necessity for abstinence or recovery efforts. Motivated to take action, they frequently rededicate themselves to finding a solution that allows them to regain control, perpetuated by defense mechanisms and self-talk such as "this time will be different" or "I'll quit when..."
Fueled by a desire to regain control, these efforts often lead to futile attempts at change, whether through altering social circles, employment, or lifestyle habits. Despite employing conventional problem-solving techniques, these efforts fail to address the underlying complexities of addiction.
Breaking free from the self-perpetuating cycle of addiction typically necessitates external support, particularly as individuals navigate the complexities of withdrawal symptoms, social pressures, and accumulated life challenges. Many individuals in early recovery find themselves overwhelmed by these obstacles, prompting them to seek assistance.
As individuals embark on the journey to abstinence, the focus shifts towards stabilization—addressing the physical, psychological, and situational damage inflicted by addiction. This phase requires problem-oriented and directive treatment efforts, as cognitive challenges, emotional turmoil, and crisis management characterize it. Through detoxification and crisis resolution, individuals acquire essential recovery and stress management skills, laying the groundwork for sustainable change.
A comprehensive recovery plan is crafted with clarity of mind, encompassing an evaluation of past behaviors, substance use patterns, and relapse triggers. Education on relapse prevention becomes paramount, empowering individuals to identify cues and develop effective craving management strategies. Engagement in support groups or structured activities promotes abstinence and fosters a sense of community.
Transitioning into early recovery signifies a period of adjustment as individuals acclimate to the realities of abstinence. With the compulsion to use diminishing, they confront feelings of shame, guilt, and remorse, learning to cope with life's challenges without resorting to substance abuse. Applying newfound insights to various facets of their lives enables newly recovering people to make progress toward repairing past damage and seeking balance.
Middle recovery represents a crucial phase where individuals actively rectify the repercussions of their past actions while striving for equilibrium in various aspects of their lives. During this stage, principles learned in early recovery are applied comprehensively to all facets of existence. Central to middle recovery is the endeavor to mend fractured relationships—with family, friends, and colleagues—acknowledging and addressing discontent. Embracing accountability, individuals embark on the process of making amends, earnestly working towards reconciliation and restitution. Through these efforts, a concerted pursuit of balance ensues as individuals endeavor to foster harmonious relationships and cultivate a fulfilling, well-rounded life.
In the subsequent stage of late recovery, individuals confront the underlying obstacles to healthy living, often stemming from childhood experiences in dysfunctional families. By acknowledging past traumas and honing effective problem-solving skills, individuals lay the groundwork for sustained recovery.
Maintenance, the final stage, embodies a profound acceptance of the impossibility of safely using alcohol or drugs. Through the diligent practice of daily recovery rituals, individuals safeguard against relapse and embrace a fulfilling life journey.
Ultimately, recovery is synonymous with change, requiring clear goals and actionable plans. Transitioning from stabilization to maintenance is a gradual process, occurring over many years as individuals survive and thrive through the complexities of addiction and recovery. They engage in a transformational process that creates not only sustained sobriety but also lends itself to self-actualization.
Source: Gorski, T., (1997) Passages Through Recovery: An Action Plan for Preventing Relapses, Hazelden. Note: Gorski's Developmental Model, summarized in this book, is based on the assumption that the recovering person is participating in a 12 step abstinence based program and actively engaging in relapse prevention activities.