Understanding Addiction

When I tell you that Johnny is suffering from addiction, who do you see? A homeless man, a troubled teenager, a high-level manager? The person we see—our subjective view—dictates our response. In reality, Johnny can be anyone of us. We’re all susceptible to addiction. Misunderstanding the disease hinders recovering behaviors. Addiction is a psychological adaptation to life, distancing the drug user from the realities of his or her problem, protecting the ego by disconnecting from the normal and healthy.​ Understanding the nature of addiction helps increase empathy for those caught in the throes of addiction.

My beautiful boy is 28. He lost the last eight-years to addiction—heroin. Well-meaning people routinely share opinions on how to resolve my addiction crisis. “What you need to do is . . .” often prescribing “tough love.” This practice diverges from the tendency of parents and partners to enable. Tough love advocates allowing natural consequences to motivate change.

Consequences and Motivation to Change

​Painful consequences can motivate action. However, not all respond well to clashes with consequences, even the harsh consequences fail to teach. This doesn’t suggest we allow disruptive and dangerous behaviors to destroy the sanctity of our home. Sometimes, eviction is essential to protect sanity and safety; addiction exists in a chaotic mess that infects everyone. Understanding addiction doesn’t always solve the painful behaviors associated with the disease.

Tough love, however, isn’t a golden path to recovery. But I get it. When someone causes physical or psychological harm, they must go. Each family must make this heart wrenching decision. I harbored many misconceptions before my horrible baptism by the fire of family addiction. One night when my son showed up—broke and desperate—I thought I could cure him. I wrote a contract, explained expectations, and ordered several dozen urine test kits. I mistakenly believed the threat of homelessness would motivate recovery; I failed to understand the complex realities of addiction.

​My son’s recovery couldn’t be forced. After an eventful and chaotic month, he chose to leave, soon relapsed, and spent the next couple years living in a car. The nightmare is far from over; but we ‘ve progressed. I hold hope, enjoy momentary successes and suffer through heartbreaking disappointments.

I mistakenly believed the threat of homelessness would motivate recovery; I misunderstood the complex realities of addiction.

The Hard Reality of Addiction

The lucky, not yet acquainted with the dark world of addiction, can’t fathom the convoluted reality that exists in the addicted mind. They can’t understand addiction. Many habitual drug users don’t consider themselves addicted. They find ways to distance themselves from the disease by comparing themselves to “horrible others.” When we fail to attribute current circumstances with our problematic behavior, change is unlikely. Many of the dreadful consequences that “normal” people see as repulsive, often the drug user doesn’t perceive as bad.

Addiction is a cognitive adaptation that disorganizes healthy motivations for pleasure and pain. Living on the streets is unimaginable for most. I miserably slept in a rental car after a bungled hotel reservation. The threat of homelessness frightens me. Severe addiction is a slew of cognitive adaptations that softens aversions to the predictable perils of their lifestyle.

Maia Szalavitz explains her scrambled thinking when she was in the throes of addiction, “But as unbelievable as it now seems even to me, despite shooting up dozens of times a day and facing felony drug charges, despite being on a methadone program for heroin addicts and having dropped out of college following my arrest, I didn’t yet see myself as a real drug addict” (2017, location 285).

​The addict sees Johnny as someone different than themselves. They smugly point to someone in worse condition and proudly proclaim, “poor guy. I’m glad I’m not like him,” as they load a needle and shove it into their collapsing vein. Often the addict also doesn’t quite understand their own addiction.

The DSM and Addiction

In addition to problematic behavior or distress, A DSM-V diagnosis includes at least two of these eleven symptoms:

• Repeated use, resulting in a failure to fulfill major role obligations
• Repeated use in hazardous situations
• Continued use despite social/interpersonal problems
• Cravings
• Tolerance
• Withdrawal
• Use for longer periods or in larger amounts than intended
• Persistent desire or unsuccessful attempts to control the use
• A great deal of time spent on activities related to the use
• Reduced important social, occupational, or recreational activities
• Continued use despite physical or psychological problems

I discovered during my terrifying experience that dependence is different than addiction. They often co-exist, with dependence occurring first and progressing into addiction. Physical dependence develops from repeated use. The one-shot-of-heroin theory is a frightening fable. Dependence is a neuroadaptation that occurs after repeated use. The body develops physiological dependence on the substance—building tolerance and suffering withdrawal when the drug is withheld. Drug dependence is an easy diagnosis with clear biological criteria. I tried to cure my son’s addiction by addressing his drug dependence. If drug dependence was the only problem, we could easily address dependence with forced abstinence—three-weeks of incarceration.

However, understanding addiction requires more than citing a list of sysmptoms.

Addiction More Complicated Than a DSM Definition

Addiction is more complicated, inviting fuzzy definitions from psychology and sociology. The clarity of biology is smeared with complexity. Relapse is a poignant example. Long after detox, sufficient time for neuroadaptations to reset and the noxious drug to be expelled, psychological elements remain, often prompting devastating relapses.

Carlos DiClemente defines addiction in the context of change. DiClemente is best known for his theory of stages of change. He makes a compelling argument for drug treatment utilizing this framework of change. Basically, the behavior is learned, and therefore, can be unlearned.

Szalavitz has a similar view “. . .the role of learning and development in addiction means that. . .cultural, social, and psychological factors are inextricably woven into its biological fabric. Pull any thread alone and the entire idea unravels into an incomprehensible tangle. Label addiction as merely biological, psychological, social, or cultural and it cannot be understood. Incorporate the importance of learning, context, and development, however, and it all becomes much more explicable and tractable” (2017, location 145).

The American Psychiatric Association defines addiction as “a brain disease that is manifested by compulsive substance use despite harmful consequences.” Sue Rusche, author of False Messengers, expands on this, “The best working definition of addiction that we have is the loss of control of drug-taking behavior.” She continues, “When drug users reach a fully developed state of addiction, they feel compelled to use drugs, no matter what the consequences may be. A person’s behavior changes as he or she becomes an addict, and it becomes radically different from what it was before drug abuse started” (2007, p. 142).

Addiction and Pleasure

The drug becomes the primary source of pleasure, as well as an adaptive reaction to pain. Learning theories suggest that behaviors are motivated to avoid pain and pursue pleasure. Drugs accomplishes this astonishing well, confusing normal pleasure seeking and pain avoiding. Rusche writes, “. . .nearly all drugs of abuse mimic the actions of the neurochemicals that make people feel pleasure when their brain reward systems are activated” (2007, p.3).

​Disturbingly, drugs activate the reward system with more potency than natural rewards. So, for them, the answer to the anxiety of homelessness is take more drugs. The answer to a turbulent relationship is take more drugs. The drug is the universal answer. Eventually, the good things in life no longer motivate.

Understanding the Stages of Addiction

Drug use moves through a process from first use, repeated use, dependence and eventually settling into an addiction. Rusche describes, “as drug tolerance develops, many users escalate their drug doses, setting the stage for the development of physical dependence and later, if abuse continues, addiction” (p. 116).  The addiction is learned psychological adaptations in response to the consequences of physiological dependence.

Exactly where addiction begins is difficult to pinpoint. DSM-V provides a precise definition; but in real life, the shift from tolerance, withdrawal and psychological adjustments happens on a continuum. Jim Orford dedicated decades to addiction research. He wrote, “Addiction is by no means an all or none matter” (2013, p. 40). This is consistent with theories of learning development, naturally the longer the addiction the more embedded the learning.

“Drug use moves through a process from first use, repeated use, dependence and eventually settling into an addiction.”

~T. Franklin Murphy

Addiction Develops From Different Paths

Childhoods vary, not every story begins the same, and not every child at risk falls into addiction. Risk factors and protective factors intertwine in complex manners, sometimes leading to devastating consequences. Some childhoods begin with trauma and abuse, creating conditions that give rise to dysfunctional adaptions; but high risk children are not the only susceptible candidates. Some children with ‘good-enough’ care givers also are ravished by addictions. We may scratch our heads, dumbfounded. Learning is complex. Biological sensitivities, happenstantial exposures, faulty predictions of benefits and costs combine with many other unrecognized influencers, leading to the unfortunate ending.

Once established, the addiction continues to rewire the brain, suspending normal pleasure seeking and harm avoiding activities in favor of satisfying emotional disruptions with the next high. Life in addiction may have a simple motivation—obtain and use—but achieving this goal is quite chaotic. Understanding of the hold of addiction on psychological processes helps move towards the ultimate goal.

In the book Drug Addiction and Families, Marina Barnard describes the devastating impact a parent’s addiction has on their children. The child’s needs typically wait until the needs of the addiction are satisfied. She explains, “Energy is invested in a repeating cycle of the search for money and drugs, irrespective of mealtimes, appointments, commitments or weather” (2006, p.66).  “For the addict, drug use has become a career in itself and the very reason for being” (Rusche, 2007, p. 141). Everything in life, including children, must yield to the physical dependence.  Everything swings on this hinge. The mind bends and rewires to this reality. As my son confessed, “Living out of my car only sucked when I was trying to get clean.”

Understanding a Life of Addiction

Life is structured to secure the next high, blind to associated consequences. Bourgois and Schronberg followed the lives of several heroin addicted men and women. They depict the drive for the next fix this way, “They have subordinated everything in their lives—shelter, sustenance, and family—to injecting heroin. They endure the chronic pain and anxiety of hunger, exposure, infectious disease, and social ostracism because of their commitment to heroin. Abscesses, skin rashes, cuts, bruises, broken bones, flus, colds, opiate withdrawal symptoms, and the potential for violent assault are constant features of their lives. But exhilaration is also just around the corner” (2009, P. 5).

The reorganized brain sets new priorities. Habits, relationships, and morals adapt to fit the new context of survival. These learned behaviors stubbornly remain after drug use has ceased. We can remove the drug, but psychological patterns continue to hinder recovery. This is an essential element of addiction we must understand.

Changed Motivational System

The adapted brain doesn’t immediately respond to normal motivations. A recovery plan created by a concerned parent with a contract and threats of expulsion doesn’t elicit normal fear. The menacing future fails to excite their system into action. “The ability to choose freely has been altered because long-term, repeated, high-dose drug abuse has changed the addict’s brain” (2007, Rusche p. 148).

“If an individual comes under the thrall of any of these drugs, his or her lifestyle is likely to be radically affected, which means that they will need to make a radical readjustment when they stop” (Addenbrooke, 2011, p. 3). The brain self-reinforces the addiction. Mitchell in her harrowing account of personal addiction wrote, “I needed more and more substances to cover up the mess I have made of my Life,” She later added, “My body was ravaged by the very substance that maintained my existence.” (2017, location 407-593). The numbness of intoxication counteracts the cognitive dissonance of a conflicted life. The rapture of highs allows for the neglect of children to continue without guilt searing the conscious. Another fix and the suffering cries of the child melts into the ecstasy of an escape; loneliness disappears, and security becomes unnecessary, all that is wrong momentarily is righted.

Mitchell explains that, “Heroin controls every element of your life. Heroin dictates your finances, your sex life, your family relationships, your mental health, your physical health, your spiritual condition” (location 187). She sees addiction as “a constant state of dissatisfaction and disconnection with the positive things in life.”

Hope for Recovery

While addiction creates a measure of powerlessness, there is hope. Research studies show that addiction is the psychiatric disorder with the highest odds for recovery (Szalavitz, 2017, location 128). Millions of people, even those that lose prime developmental years have emerged from darkness to live happy and successful lives. Two authors cited in this article (Mitchell and Szalavitz) are living proof. They lived the nightmare. They escaped. And ultimately, they recovered, finding purpose and re-establishing themselves in society.

While detoxing is necessary, eventually the recovering addict must return to the community where reeducation occurs. The motivational instinct—the reward system—must learn appropriate reactions to social emotions, moving with pleasure and pain in a manner conducive to sustained growth, entering the lengthy process of reintegration into society. Part of recovery is understanding the true nature of addiction and recognizing the power it has in our lives and the lives of those we love. Ultimately, healing is expressed with a new relationship to the positive things in life—relationships, goals, joy, and purpose.

References:

​Addenbrooke, M (2011). Survivors of Addiction: Narratives of Recovery. Routledge; 1 edition.

Barnard, M. (2006). Drug Addiction and Families 1st Edition. Jessica Kingsley Publishers.

Bourgois, P., Schonberg, J. (2009). Righteous Dope fiend (Volume 21) (California Series in Public Anthropology). University of California Press; 1 edition.

DiClimente, C. C. (2018). Addiction and Change, Second Edition: How Addictions Develop and Addicted People Recover. The Guilford Press; Second edition.

Mitchell, T. H. (2017). The Big Fix: Hope After Heroin. Seal Press; Reprint edition.

Orford, J. (2013).  Power, Powerlessness and Addiction. Cambridge University Press.

Rusche, S. (2007). False Messengers: How Addictive Drugs Change the Brain. Kindle Edition.

Szalavitz, M. (2017). Unbroken Brain. Picador; Reprint edition.

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