A FEW THOUGHTS ABOUT ADDICTION

My thoughts come unboxed and filtered through my experience of growing up in a family struggling with it and my work as a counselling therapist. I’ve worked in two inpatient addictions treatment centres, with inpatients and with family members impacted by their loved-one’s addiction. Friends and employers too sometimes.

I haven’t worked in addiction treatment for a few years – I left in 2016 for private practice. Since then I’ve learned some things that weren’t part of the treatment process when I was involved and I believe should’ve been – the impact of trauma and its relationship to addiction for instance. But that’s a topic for another time.

I suppose talking about what causes addiction is important.

But focusing on causes can run the risk of not being very helpful, especially when there’s no agreement about one root reason why some people succumb to it. So I’ll begin with what might be considered a cop-out: I don’t know what causes addiction.

But all the same there are many theories. A disease -illness – rooted in family-history. A genetic predisposition triggered by numerous risk factors, like early first use or adverse childhood experiences for example. The psychiatric definition calls it a disorder of the brain, a substance use disorder. Others dismiss the genetic factors and pin the blame exclusively on childhood trauma . Or, none of the above … and so on.

There’s an irony in this current state of ambivalence about cause and what to call it. Back some 75+ years ago the founders of Alcoholics Anonymous called it a disease. They did so to help remove the stigma of moral weakness or defective character that plagued sufferers – including themselves. Today, many believe that calling it a disease or illness pathologizes people …. and so it goes.

A fatal disease? People die of addiction. So, fatal, yes sometimes – too often. But it is treatable. The evidence of successful treatment is all around us.

I call it a disordered relationship.

The essential nature of addiction is, as far as I can tell, a relationship between a person and a substance (alcohol, various other drugs, food …), or a behaviour (gambling, shopping, work, sex, and so on) that continues in spite of negative consequences. It’s an emotional (love?) relationship. It becomes the most important relationship in a person’s life. It is an over-coupling that can be triggered quickly or develop slowly over a longer period of time.

And although they deny, even howl in protest that it’s not true, the evidence is there. The mystified, terrified one who loves them cries out in exasperation, “if you love me, why do you do it over and over again?”

This relationship with their drug or behaviour of choice is central. It is more important than every other relationship in their life. Which makes it disordered. That’s it.

All the complicated, clever and sometimes wise theories supported by evidence and data about the nature of addiction are secondary to, what I believe is, this one fundamental reality. It is a relationship that is primarily emotional, characterized by obsessive thinking and compulsive behaviour; denial, delusion, craving. There’s a disconnect between the reasoning, judging part of the brain and its emotional, behavioural responses. If you’ve ever loved a person with addiction you’ll know deep in your heart that it’s true.

Oh, and by the way, when we use the word ‘addiction’ to describe the ubiquitous experiences of craving we all know – chocolate addictions or the like – we demean and minimize the experience of the person whose disordered mental obsession and emotional compulsions are uncomfortable to a degree hardly imaginable or describable. Real addictive craving is overwhelming – intensely so. If this were not the case, addiction – er, substance use disorder wouldn’t be the life-threatening scourge that it is.

What about the ones who love them?

Something very strange, but at the same time not surprising, happens to people who become known by the label codependent. I go on record to say that I don’t like this term at all. For more on that see my column: Codependency: the loss of self