Addiction - Fact Behind the Fiction

Preface:
The subject of addiction is very complicated and very controversial, with strong opinions that venture off in many different directions. What is written here is of my own personal opinion, and that opinion has been formed based on my personal experiences, and research that I have done during my own personal time. This is a shortened version of one of the chapters of the book I’ve been trying to write for the past few years. I hope to have it completed by the middle of 2010. As always I offer the opportunity to leave a comment, either here or directly to me by E-Mail, but please be respectful. I will try to respond to them all. Thank you very much for your interest in this very complicated subject…
J. D’Urbano…

Addiction is a world of unknown darkness. It is powerful, controlling, and destructive. It is one of the most powerful, and destructive controlling forces in human beings today. Most people simply don’t understand addiction. Not even in the basic sense. Even the medical community can’t seem to settle on how to define ‘addiction’. It’s been argued back and forth for many years whether it’s physical, psychological, behavioral, or a combination of the three. Many argue that addiction is strictly a behavior. Some even say that addiction is a choice. Addiction is NOT a behavior or a choice, but it CAN be the RESULT of poor choices or behavior. HIV/AIDS, some hepatitis, and sexually transmitted diseases are also examples of diseases that can be a result of poor choices or behavior. No, addiction IS a disease and it needs to be treated as a disease. Unfortunately addiction is often one of the most difficult diseases to diagnose and even more difficult to treat. Much of that difficulty is due to a lack of understanding of addiction, what it really is, how it affects life, and how it can be noticed. Unlike most disease there are no blood tests for addiction. It doesn’t show up on any X-Ray or CT. It can’t be found by any physical examination or office visit. Addiction is simply discovered by putting 2 and 2 together.

It is also believed by many that addiction is a psychiatric issue. That is only partly correct. Addiction is a medical issue, and it needs to be treated as such. Poor mental health can be even more disabling than poor physical health. It can also be just as fatal. I personally believe that the term ‘Behavioral Health’ is an oxymoron. It’s a poor choice of words. A person who suffers from poor mental health does NOT necessarily have a behavior problem. They have a disease that needs to be treated both medically and psychologically. Addiction is a disease that needs to be treated both medically and psychologically.

Diagnosing addiction takes real effort from both the Physician and the patient. The Physician has to have addiction on his mind as a possibility and ask the appropriate questions. The best set of tools a physician can ever have are the interview, and a good line of questioning. How and what a physician asks are the very tools that begin shaping the pieces to the clinical puzzle that is being presented. But even the best physician with the best tools is only going to be as good as his/her patient is honest and open. More often than not a patient withholds very important details from the interviewing physician for fear of being judged too harshly, or getting into trouble. Sometimes this is the patient who is being seen for an unrelated reason, but they may have a 2-year history of taking narcotic pain medications for a back injury. The use of pain medication is legitimate, and the patient may have even followed instructions properly. But after 2 years he/she is most certainly addicted to those medications. Fear of being judged too harshly often causes these types of patients to withhold this information from the physician.

Another example would be the person with a history of street drug abuse, and is now addicted to those drugs. He or she may want to ‘kick-the-habit’ but out of fear of being judged too harshly, or getting into trouble, may withhold information about the drugs. I can go on and on as there are many examples and situations similar to the two I’ve just given you. This stresses the importance of gaining a patients’ complete trust. If your patient has complete trust in you then they will openly tell you anything, which will enable you to take better care of them.

According to the dictionary addiction is defined as “compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal”. If it were only that easy. Addiction in itself is a very broad term that can be broken down into two main areas. There’s physical addiction and psychological addiction.

• Physical Addiction – There is a physiological need for a substance, and lack of that substance causes predictable physical withdrawal symptoms. It’s important to understand that a physical addiction also has a component of psychological addiction. Because of this the fear of not having that substance often leads to anxiety and sometimes the ‘feeling’ of certain withdrawal symptoms that may not actually be present yet. Withdrawal symptoms (sometimes referred to as “withdrawal syndrome”) from a physical addiction can actually be life threatening.
• Psychological Addiction – Habitual use for a substance that causes a psychological need for that substance. Fear of not having that substance can cause fear and anxiety, which can lead to other physical symptoms which can actually be dangerous, or even life threatening. A psychological addiction is just as real as a physical addiction, and just as difficult to diagnose and treat. It’s important to understand that a person with a psychological addiction does not necessarily have a mental health disorder. Addiction, whether physical or psychological, is a disease all by itself.

No human is completely invulnerable to the tight grips of substance addiction. Don’t misunderstand that. It doesn’t mean that everyone will become addicted to something. I’m simply saying that everyone has the ability to become addicted to something, although there are those who would aggressively argue that one. As stated earlier some believe that addiction is all psychological, some believe it is all behavioral, while others believe it is physiological. My personal opinion is addiction can fall under all three categories. Some psychologists believe that an addiction is nothing but a habit gone out of control by those with an addictive personality. I would wonder what their medical background is on the subject because the medical community has already proven that some addictions are, in fact, physiological.

Breaking addiction is as controversial as the subject of addiction itself. While I’ll never claim to have all the answers I will claim that I do have an educated opinion on the subject. My opinion is this. There is no one single simple answer to that puzzle. From as far back as I can remember to this very day the medical and psychological communities still cannot agree on what addiction really is, and they especially can’t agree on how to treat it. Given that I’ll tell you that I’ve personally observed several common ‘ingredients’ of an addiction cure.
1. Understand that there really is no CURE for addiction. If you’ve been an addict once then you can EASILY become an addict again. Some even say that once an addict always an addict. I’m a little wishy-washy on that one.
2. The very first thing that has to happen is the addict MUST be honest with him/her-self about the addiction COMPLETELY. Being only a little honest will lead to failure.
3. The addict MUST make the choice to quit voluntarily because they have to want it. There is no rehab on the planet that can effectively FORCE an addict to clean up. There must be an honest desire.
4. Breaking an addiction has to be a complete and total “life-changing event” because the addiction isn’t just a part of your life. It IS your life. To get away from it you have to CHANGE your life. Most often you have to build a brand new life and leave the old one in the past – all of it.
5. The addict must have a GOOD support system that includes who they can be completely open and honest with. No one can do it alone.

Whatever the truth is addiction is a subject that will probably remain as controversial as the legalization of marijuana. I will offer this as a final thought. How can a psychologist with absolutely no physical experience with medical patients who suffer from addiction, or no physical experience with personal addiction itself, offer a valid educated opinion on the subject and swear to the validity of their opinion? There is, indeed, a lot to say for ‘hands-on’ experience.

J. D'Urbano...

© 2010 – Reality…