Addiction
The most important things about Addiction
Introduction
We have learned a lot about addiction in the past thirty or forty years. I have listed here what are considered the most important things we now know about addiction and its treatment. Addiction is a complex phenomenon which requires detailed and sensitive understanding as well as compassion from all those involved.
Addiction is compulsive Behaviour
An individual’s behaviour with various addictions like alcohol, drugs, gambling, pornographic websites, food, sex etc. becomes increasingly compulsive. It leads to a dehumanized state of compulsive behaviour, that is the addictive 'lifestyle'. 30 years ago the state was defined by three stages: dependency, tolerance and withdrawal. The present challenge is to understand the development of compulsivity at a neurochemical level not only for drugs, but for the whole range of behavioural addictions.
Complusive Drug seeking is Not Conscious
Addictive behaviour seems to involve processes outside of consciousness by which cues are acted upon by primitive areas of the brain before consciousness occurs. This below conscious awareness process challenges the accepted view that people chose with ‘free will’ to use drugs. The initiation of drug-seeking behaviour engages a pattern of learned compulsive behaviour that overrides the ability to change course when future negative consequences are finally considered.
Nature and Nurture
30 years ago alcoholism was considered a family disease. Today, genes and environmnet are no longer considered as seperate, but are understood to be intimately interconnected.
Comorbidity
Addiction often occurs with three common disorders - social phobia, major depression and post-traumatic stress disorder. Approximately 75% to 85% of those with alcohol or drug problems will also suffer from these common psychological difficulties.
Chronic Relapse
About one out of three people with alcohol dependence will achieve abstinence following treatment in the short to medium term. Continuous ongoing abstinence in those with alcohol or drug addiction, is relatively unusual in the long term.
The majority will experience chronic relapsing of their addiction, although many will have long periods of stability and improvement along the way. Addiction is a ‘chronic relapsing disorder’.
Miraculous long-term continuous abstinence cures are still expected for people entering addiction treatment, both by the public and many professionals. But such unrealistic expectations usually inhibit people initially presenting for help, and worse, put them off re-presenting when a relapse has occurred.
Different treatments produce similar results
Studies show that there is no significant difference in treatment outcomes despite quite different psychological methods being employed. A strong therapeutic alliance is most important. Such a collaboration requires the qualities of being a good friend - being flexible, honest, trustworthy,interested and warm.
Quiet Listening
The rejecting comment, ‘come back when you’re motivated’, is not an acceptable response. Bill Miller through the development of his motivational interviewing (MI) has changed this type of response from noisy confrontation strategies to quiet listening approaches.
Addiction treatment is no different than other health disorder interventions. Successful treatment combines internal and external methods of engagement, persuasion and relapse prevention in helping clients with their complex problems.
More Individualized the treatment the Better
The indivudualized approach of tuning into the uniqueness of each client and making a plan together, that addresses the individual's needs, is the optimum strategy. Often solutions to social problems are required in the plan as well as medical and family issues. The more a treatment plan addresses the individualized needs of a client the more effective it is.
Epiphanies are Rare
One of the most fascinating aspects of addiction is the occasional dramatic recovery a person has, that may be independent of his treatment. However dramatic they are, these life-changing experiences are hard to duplicate and it would be unrealistic to expect them.
Change takes Time
Recovery from addiction is more a matter of changing one’s brain than changing one’s mind. Recovery involves making substantial changes to your ‘whole pattern of living’. Recovery is a life-style change, and for that reason formal treatment must eventually give way to self-management as follows:
- Treatment which picks up the pieces of a failed life-style
- Rehabilitation or constructing a new life-style
- Aftercare or practising the new life-style
- Self-management which means living the new life-style
Patience and Persistence
Overcoming compulsive behaviour is having the patience to practice new behaviours for a long time. Clients often exhibit low persistence and therefore benefit from a persevering therapist who joins in the process, genuinely valuing their small improvements and continuing despite disappointments.
Conclusion
Addiction involves a biologically influenced set of behaviours that become increasingly compulsive with repetition, with little or no consciousness required for the changes to take place. Most addicted clients have multiple problems, and experience chronic relapsing of their addiction problems. Various psychological treatments produce similar results, but the more individualized and broad-based, the better the outcomes. Empathic listening is central to the beginning of the change process but life-style change takes time, even with those who recover following a miraculous life-changing experience.