Understanding Addiction

By: Rachael Livingston MA, LPC, CAADC, EMDR Provider

Addiction and recovery are often extremely misrepresented aspects of mental health. These topics are infrequently talked about and, when they are approached, the conversation tends to be based more on stereotypes and stigma than facts. Given that September is National Recovery Month and that rates of addiction and relapse have increased over the course of the COVID-19 pandemic, it seems especially pertinent to shine a more accurate light on these topics.

Misinformed approaches to addiction have shaped the public view of this problem over the years; ultimately causing common misperceptions that addicts are dirty, manipulative, and lack a moral foundation. Consistently shifting professional views of addiction further adds to confusion. For example, there are several different theories of addiction, which have driven treatment over the years. When these views are used in isolation of one another, they have the ability to add to public and professional misunderstandings of addiction. One approach to addiction, in particular, which has negatively contributed to these stereotypes when viewed on its own is the choice theory. This perspective suggests that addiction occurs purely as a result of choices made by the individual. While individuals do typically make the initial choice to take their first drink or use their first drug, the problem with choice theory is that it does not account for physiological changes that occur as a result of substance use or behavioral addictions.

Specifically, when individuals are engaging in substance use, the brain is flooded with dopamine. This neurotransmitter is related to motivation and pleasure. Therefore, when the brain is flooded with dopamine, it becomes a natural sign that drugs are pleasurable and to be repeated. With continued use, the natural baseline to experience pleasure through dopamine surges decreases and causes substances to be one of, if not, the only thing that allows for a typical experience of pleasure and dopamine; even this typical level continues to decrease with time. Even more notable, this dysregulation of dopamine is easily exacerbated in those who have predispositions toward addiction. To learn more about this process click here.

Clinically, addiction is presently viewed and treated as a disease; an approach that is very much influenced by those physiological changes. In fact, addiction is considered a disorder of the brain, which is both progressive and marked by distinct symptoms. While symptoms of some more commonly discussed diseases may present physically such as with headaches, GI distress, chronic pain, muscle weakness and fatigue, symptoms of addiction tend to present more behaviorally. For instance, criteria to diagnose a substance use disorder include substance use that is hazardous, withdrawal from hobbies and interests, disruptions to social relationships and significant life roles, experiences of tolerance and withdrawal, cravings, and repeated unsuccessful attempts to quit. Prolonged use can even lead to some of the more commonly considered symptoms that are listed above.

What is more, addiction can result from a multitude of factors, similar to many other diseases. For example genetics have been shown to play a role in increased predispositions to developing addictions. Experiences of trauma, co-occurring mental health disorders, and even chronic pain have also been linked to the onset of addiction. This is because substances are often used to help alleviate or escape some of those concerns; particularly if healthier coping skills weren’t modeled. Because there are varying factors that contribute to the onset of addiction, it is important to acknowledge that this is not a disease that solely impacts one group of people. Addiction is not discriminating and can impact individuals of all different backgrounds and walks of life. All of this does not negate the choice factor in addiction; meaning an individual who never chooses to use substances will not become addicted, regardless of the number of predisposing factors; this statement is not necessarily applicable to behavioral addictions such as gambling and sex addictions. For more information regarding behavioral addictions click here.

It is worthwhile to note, though, that the disease model of addiction does not exist without criticism either. Critics of this perspective have expressed concern that approaching addiction as a disease is primarily a way to facilitate insurance coverage. Additional points of contention with the disease model also point out that this view of addiction allows for fragilization of addicts by focusing on the problem rather than possible solutions or treatments and, ultimately, enhances feelings of helplessness. Because of this it is important to highlight that addiction is treatable and treatment is available.

Ultimately, the view that each individual has on addiction heavily impacts their approach to recovery. Each professional theory of addiction has important aspects to consider when discussing and treating addiction. It is important to acknowledge that our brains often have an incredible capacity to heal, when given the chance. This means that the physiological disruptions that are noted within the pleasure center of the brain can be “reset.” To do so, however, requires acknowledging the aspects of addiction that are  within each individual’s control as well as those that are not. Each individual has the power to identify their addiction as problematic and seek support. It is through these steps that the impacts of addiction, as well as the factors that led up to it, can be addressed.

In order to increase the likelihood of those who are struggling taking these initial steps it is important that we as a community continue to have these open discussions about addiction. Doing so helps to reduce the stigma surrounding this disease and increases overall understanding and empathy toward those who find themselves struggling with it, as well as their family systems. Ultimately that increased understanding will allow for a reduction in the shame that typically prevents addicts and their loved ones from identifying the problem for what it is and reaching out for treatment. Many people have already taken the steps to learn more about addiction and are working to reduce the stigma. What is even more notable is that a remarkable number of people already have significant recovery time under their belts; many have for decades.

Recovery is possible!