UNDERSTANDING & RECOGNIZING ADDICTION

WHAT IS ADDICTION?

If you have attempted to stop drinking, using drugs, or engaging in other addictive behaviors without help (or even with help!), you know how difficult it can be. By this time you may believe you are weak and be haunted by thoughts like, "If I were only stronger I could beat this thing." You may believe by now you just come from "bad seed" and are cursed to lose your health, family, financial security, standing in the community, and more. The shame cycle of addiction can be crushing.

Let's be clear: addiction is not about being weak or immoral. You may have disregarded your families, friends, and responsibilities in service to your addiction. You may have lied to keep the addiction going. You may have done some really bad things to acquire the drugs you are addicted to. You may have compromised your own moral compass in your addiction. You may even have robbed or sold your body just to get the fix your body was telling you it needed. Doing bad things does not make you a bad person.

Addiction is a brain disease. The nature of this brain disease is that the addiction to particular drug(s) or behavior(s) takes over your life, becoming your focus throughout each day. The addiction becomes more important than your partner, children, extended family, work, or reputation. It involves compulsive behavior that is incredibly hard to control. You do things you never thought you would or that you don't know why you are doing. The nature of addiction kicks the addicted person's self-esteem into the gutter. But you (or your loved one) is more than your (or their) addiction. You (and they) are a beloved child of God who suffers from a particular kind of illness. That doesn't make you any less loved or lovable.

When addicted, your brain and body become dependent on a certain substance and the chemical release associated with its ingestion or consumption. As your body becomes used to and then dependent on these chemicals, it needs more and more to achieve the same high, thus fueling the cycle of addiction. With many substances, once your body because accustomed to them, it becomes unable to function properly without them, triggering physical withdrawal symptoms such as shakes

It is also possible to be addicted to a behavior or set of behaviors. Such addictions are called "process addictions." For the first time, in the recent 5th Edition of the Diagnostic and Statistical Manual, gambling is listed as an addictive disorder. The essential quality of the addiction is that the gambling is uncontrolled and like the other addictions makes life unmanageable. Other process addictions include (but are not limited to) eating disorders, self-harm/cutting, pornography, and compulsive shopping.

THE ADDICTIVE PERSONALITY

Over the years of working with people who are addicted to a substance or activity and in working with my own addictive tendencies, I have found several personality traits that are characteristic of persons with addictions. Of course, not everyone who becomes addicted displays these traits, but they are more common in the addicted population.

Low self-esteem: Feeling inadequate is a common human experience. Getting through day-to-day life can be especially difficult when you have trouble thinking of yourself as worthy of love and success. Many people use coping skills to overcome this gap, but with an addicted personality, turning to drugs and/or alcohol becomes the easy way out. One of the miracles of 12-Step programs is learning to "live life on life's terms" rather than taking the easy way out.

Though it is somewhat counter-intuitive, low self-esteem can also manifest itself as narcissism. Narcissists believe, usually unconsciously, that they can protect themselves from feelings of low self-esteem by acting as if (and attempting to convince themselves and those around them that) they are the center of the universe.

All-or-nothing thinking: People prone to addiction tend to think in black and white terms, with little tolerance for gray or ambiguity. Thinking or talking in extreme terms limits the broad experience of emotions and possibility. Very rarely is anything (or anyone) "all good" or "all bad." Lack of nuanced thinking or emotions can lead to hopelessness, resignation, intolerance, and an inability to tolerate distress.

Inability to deal with stress: Being human is hard. Life is demanding. For people who have a difficult time dealing with stress, drugs and alcohol become a coping mechanism. If the stressed-out person zones out then the stress goes away ... until they sober up. Most addictive behaviors serve a numbing purpose. The inability to deal with stress (or distress) often leads to compulsive behavior.

Inability to delay gratification: The addicted person becomes angry when needs (real or perceived) are not met immediately. Not being able to delay gratification can lead to making poor choices to serve our short-term desires without regard for our long-term needs. While "good things come to those who wait," our society and the addicted personality have a hard time waiting.

Isolation: The deep loneliness of isolation can stem from situational reality or a fear of being social. This trait can run from anxiety in a social situation (thus making one afraid to interact) to a learned withdrawal due to lack of safety, to being antisocial. This antisocial aspect may stem from not conforming to society's ideal standards, past traumatic experiences, social anxiety, or a multitude of other factors.

Resentment: Taken together, these characteristics can generate a lot of anger. Addicts often have a difficult time handling or resolving anger in a healthy manner. This buried anger easily becomes resentment. Resentment overrides our rational mind and amplifies every slight we feel, real or perceived.

You may be thinking to yourself, "I have every one of those characteristics; am I in trouble?" Not necessarily. Many people who live somewhere on the spectrum of these personality traits never become addicted. Some do. These traits are not determinants of addiction, but determinants of the likelihood of addiction.

People with addictive personalities often fall victim to multiple forms of addiction. When an addicted person begins to stop one addictive behavior, it is easy to transition to another addiction. This process is called cross addiction, replacing one substance or behavior for another that gives a similar feeling as what you have been used to. A person may go from abusing alcohol to abusing prescription drugs or from an opioid addiction to gambling addiction. This tendency is also called "urge surfing." The urge is still there; the way to mollify it has changed. To truly move into recovery, the urges themselves must be addressed.

If you have an addictive personality and you are addicted to a substance, caution is advised. You are likely to be at a higher than normal risk of becoming addicted to another substance or behavior.

Many addicts carry a dual diagnosis, meaning that they have a psychiatric diagnosis separate from the diagnosis of substance abuse. A person may have anxiety or depression. Or a person may have a diagnosis of bipolar disorder or schizophrenia alongside the diagnosis of substance abuse. Often the addiction has developed as a way of coping with or self-medicating for the underlying disorder. If a person has a dual diagnosis, which is highly likely, then being attentive to how the issues interface with one another is very important for you and your doctor. Having a frank discussion with your medical team about your drug/behavior of choice and your history of addiction will help your medical team prescribe appropriate medications to maximize your success in recovery. (For example, someone with an anxiety disorder who has a history of abusing sedatives should only be prescribed sedatives under very close supervision, if at all.)

Do not be afraid, ashamed, or embarrassed to be honest with your care providers. Your goal (and theirs!) is a successful and sustained recovery. Moving into recovery requires honesty both with the people around you and yourself. It is impossible to get better without owning that you have a problem. Still, it is easy to deny your history or your problem. If you hear yourself saying things like, "If I can go three days without shooting up, then I'm okay," or, "I can control my drinking or drugging by using scotch rather than whiskey," you are likely going to return to the same self-abusive behaviors. But how do you know if you are in denial? How can you tell if you are addicted?

AM I ADDICTED?

By this time, you have several questions to answer. I encourage you to use the "rigorous honesty" encouraged in Alcoholic Anonymous and other treatment programs as you answer these questions:

1. Do you crave a drug that is either a depressant or stimulant? Do you crave the release or rush of engaging in a particular behavior?

2. Do you have a drug or behavior of choice?

3. Is the drug you are currently taking or behavior you are engaging in your drug/behavior of choice? Do you find yourself urge surfing?

4. Are you physically dependent on a high from drugs or addictive behaviors? The clearest way to answer is to ask yourself, "Do I ingest enough drug to change my physical, mental, emotional and/or spiritual condition?" When you stop the drug/behavior do you have withdrawal symptoms that are physical, mental, emotional and/or spiritual?

5. Do you have a continued need for the high even though it is giving you physical, mental, emotional, or spiritual problems?

6. Does your drug or behavior use cause interpersonal problems with family, friends, co-workers, or others?

7. Does your use interfere with your work (paid, volunteer, or within the family)?

8. Has your drug or behavior use caused encounters with the criminal justice system or medical establishment? Examples of this could be driving under the influence; arrest for possessing, selling, buying, or attempting to buy illicit drugs; public intoxication; or illicit actions in the service of obtaining drugs (burglary or prostitution). Have you been banned from certain doctors' offices or emergency rooms as a "frequent flyer" for pain meds? Have you gambled money that was not yours?

If you consult a mental health worker or medical professional concerning your possible addiction, they can be expected to ask certain questions about your drug use or behaviors.

1. What type of drug/behaviors do you use?

2. What is your specific drug/behavior of choice?

3. How much do you use?

4. How often do you use?

5. For how long you have been using?

6. If you have attempted to stop, what have you done?

7. How long did it work and what withdrawal symptoms did you have?

8. How many times have you attempted to stop?

The medical or mental health professional will also want to know about difficulties you have had that have been a direct effect of drug or behavior use: relationship issues such as a partner threating to leave or having left you, occupational issues such as job loss or being sent to treatment as a qualification to return to work, encounters with the law (tickets, house arrest, incarceration, drug court), etc.

Now is the time to ask, based on all the information above, "Am I addicted?" Being honest with yourself in this moment can be terrifying, but it can also be extremely liberating.

APPROACHES TO TREATMENT & RECOVERY

If you have come to believe an addictive substance or behavior is interfering with your living a full and contented life, I invite you to continue reading. If you have decided you want recovery and you will do anything to get it, or even if you are willing to entertain the notion, I am going to give you as much help as I can to get you successfully started toward recovery.

The initial question to answer is which type(s) of help is most appropriate for you. If you don't know who to contact for help, your best bet may be to start with your doctor. He or she can help you understand your options and connect you with a therapist and/or treatment facility or group. Several options are described below. Many addicts will participate in a combination of these treatment modalities in their recovery journey.

Individual counseling: Most often individual counseling helps you learn what intrapsychic pain led to the addiction. Since each of our stories are unique, this time of discovery will be about your journey and when you went from firm ground (if it ever was) to the quicksand of addiction.

Your individual counseling will also assess for any co-occurring disorders such as depression, anxiety, other addictions, etc. The counselor will make referrals as appropriate to physicians for medication, clergy for the spiritual aspect of recovery, local support groups, or vocational rehabilitation for regional resources in job preparedness. Counselors often suggest you become involved in Alcoholics Anonymous, Narcotics Anonymous, Sex Addicts Anonymous, or another group so that you are in a program of recovery.

Individual counselors use a wide variety of counseling theories to help people. However, with substance abuse issues (as well as mood disorders such as anxiety and depression) cognitive behavioral therapy is often used. This therapy helps combat negative thoughts by recognizing and stopping negative patterns of thinking or behaving. A negative thought might be, "I am so lonely now that I can't go out to the bars with my friends anymore." To change that thought pattern, you might say to yourself, "I am so glad when I wake up in the morning I will know what I said last night" or, "I'm thankful I will not have to search for my car tomorrow morning," or even, "I can still go out to dinner with a friend, and I won't have to worry about blue-lights flashing behind my vehicle on the way home." Dialectical behavior therapy (DBT) is a specific kind of cognitive behavioral therapy emphasizing skill development in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

Group counseling: Group counseling is often used in conjunction with individual counseling. Group counseling, also known as group therapy, is facilitated by one or two trained mental health workers. The advantages of group counseling including learning that you are not alone in your story, developing deep trust within a group or between group members, and a experiencing a sense of belonging to combat the isolation that fuels addiction.

Being aware that other people have felt what you are feeling now can also validate what you are feeling. This, again, has the potential to reduce the sense of isolation that so often occurs with addiction, particularly the later stages of the disease. Group members share the journey and hold each other accountable. Group counseling costs less than individual counseling, so it may be more accessible and sustainable for some people.

Inpatient treatment: In-hospital treatment beyond three to seven days of medically supervised detox is rare, mostly due to insurance and financial issues. Inpatient treatment for co-occurring issues such as depression or schizophrenia, however, is more common, though it, as well, often spans just a few days. Inpatient treatment takes place in a behavioral care hospital, a behavioral care unit within a hospital (many Veteran Administration hospitals have a substance abuse unit), or an inpatient specialty hospital that focuses on addiction.

Residential treatment: This type of treatment is commonly known as "rehab." The length of stay is most often thirty to ninety days. There may be an intake period, such as detoxing or re-feeding treatment when dealing with eating disorders. Rehab will also include addiction education, medication management, individual counseling, group counseling, family counseling, follow-up care, and, depending on the facility, 12-Step meetings. Your treatment facility will also help you set up continuing care, known as "aftercare," often involving individual, group counseling, and family counseling.

If you don't know where to start, you can find rehab or recovery treatment facilities near you by searching on the web. You will likely have many results come up. The ease of finding a rehab center shows the enormity of the problem of addiction. If possible, take care to research different approaches and specialties of different facilities so you can find one that will be most useful on your journey. Quality of treatment facilities vary widely; if possible, seek out recommendations from your doctor, therapist, pastor, or other caring professional. Do not, however, let not finding the perfect facility keep you or your family member from entering treatment.

Partial hospitalization programs: This level of treatment is not an inpatient hospitalization, though it is sometimes held at a hospital. Nonetheless this is intensive treatment which you attend multiple times a week for most of the day. It is sometimes referred to as day treatment. It is imperative that a person be stabilized enough to benefit from this type of treatment, given the freedom that such structure allows outside of treatment hours. In partial hospitalization treatment you can expect to spend the day in treatment and return home in the evening. You will have individual counseling, group counseling, family counseling, and education about addiction, coping skills, and relapse prevention. You will also begin to make plans for aftercare or your next steps in recovery treatment. Partial hospitalization programs will often be able to treat dual diagnosis such as PTSD, anxiety, or bipolar disorder, and multiple addictions.