Addiction is an equal opportunity disease. It can affect the educated, the uneducated, the rich as well as the poor. What is certain is that it destroys families and society if left untreated.
Everyone has their own understanding of this terrible condition that can affect up to 15 per cent of the population. Loved ones and addicts themselves often frame it as moral failure or weakness because despite multiple apologies and promises to do better, the addict continues to relapse with the associated secrecy, lying, stealing, shame and guilt. Few look at the scientific advances to better understand this brain disease that robs individuals of their ability to resist the behaviour be it alcohol, tobacco, illicit drugs or gambling. The consequence is the deterioration of the addicted person physically, psychologically and morally, and not the other way around as is commonly understood.
Current research identifies at least three brain circuits involved in the addictive process. These circuits mediate reward and pain, appetite, learning and memory. In the addicted brain, it is thought the activation of these circuits override the self control circuits despite the best intentions not to use. In other words, the brain has been hijacked and the person loses control. What underlies this is the genetic risk interacting with social, economic and environmental factors to cause the brain to malfunction.
These phenomena have been incorporated into the definition of addiction as a chronic relapsing brain disorder by the American Society of Addiction Medicine and the symptoms include cravings and withdrawal with observable consequences such as loss of control and continued substance use despite negative consequences to self or others. These have been codified into criteria in DSM 5, the psychiatric diagnostic tool, to facilitate reliable diagnosis.
It should be noted that the legal status of the drug doesn’t necessarily correlate with the harm caused. Alcohol and tobacco are addictive, can cause as much or worse damage and are often harder to quit than some illicit drugs. Consequences of heavy alcohol use, for instance, range from cirrhosis to many kinds of cancer, and socially from drunk driving to increased violence.
Addiction is more about the maladaptive pattern of behaviour than the drug itself, or the amount used per se. Therefore, urine drug tests cannot diagnose addiction, only confirm use of an addictive drug. And most people fail to recognize their addiction because the social norms of “getting wasted” or high is tolerated in their home, social and work environment.
The tragedy is that despite addictions being treatable with a combination of medications and behavioural counselling, the stigma associated with this disorder leaves many people relying heavily on will power alone to get better. Curiously, the very organ, the brain, that will need to be engaged in the recovery process is compromised by the addiction itself. Therefore, the most important first step for friends and families is to address the denial and refrain from any action that perpetuates the addictive behaviour. This is how the motivation to change can be kick-started facilitating the true appreciation of the consequences of the addictive behavior by the addict. Ideally this leads to self-realization. It can be facilitated by work places, colleagues, friends, bosses and family members reflecting concern to the addicted person or holding the addict accountable for their actions. Patients will often tell us that prior to seeking help, it was the intervention by others that got them to realize the impact of the addiction. Many people are afraid to speak up due to fear of damaging their relationship and not knowing what to say. However, if done with compassion combined with clarity and firmness the relationship is not likely to be harmed. In fact, the expressed concern might just motivate the person to make a change.
Relapses are common and therefore the goal of treatment is to help the person stop, stay stopped and ensure that relapses are treated swiftly should they occur. With the right support and care, people with addictions can become fully themselves, as well as fully productive members of society.
Dr. Peter Selby is chief of addictions at the Centre for Addiction and Mental Health (CAMH)
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