By Christa S. Nuber Did you know that each one of us has the potential for addiction? This doesn’t mean all of us will become addicts, but neuroscience reveals that all of us are wired for it, to some degree. All it takes is a certain environment or an unfortunate set of circumstances, and perhaps a chemical imbalance in our brains and bodies, to tip us in that direction. This may be a hard pill to swallow for people who believe that addiction is simply the result of moral weakness, poor choices or a debauched lifestyle. The truth is a bit more complicated. An important thing to remember about addiction is that no one chooses to become an addict. Poor choices may lead a person to first try a drink or use a drug, or even engage in a compulsive behavior. The aim is usually to find some measure of relief from pain, anxiety, fear, agitation, sorrow … any number of feelings that bring discomfort. Addiction is not the goal for anyone. Addiction education and awareness can go a long way to improving our understanding, reducing stigma and engendering more compassion for people who struggle with alcohol and substance use disorders. Let’s take a closer look at the disease of addiction.
Addiction 101
Addiction is a chronic, cycling disease characterized by periods of remission and relapse. Addiction is defined as compulsive drinking, drug use or repetition of an addictive behavior (i.e., gambling) despite negative or harmful consequences. For a person in active addiction, the addiction often comes first and at the expense of everything else, including work, family and social obligations. The addicted person is unable to stop. Some experts consider addiction a brain disease because it affects judgment and behavior by altering cognitive functions such as impulse control, learning and memory formation. Addiction can be physical, mental or both. Sometimes addiction begins as a physical tolerance to a certain medication that develops over time, motivating the user to seek higher doses to achieve the same beneficial effects. Physical tolerance can become physical dependence that can escalate into addiction. Once a person develops dependence or addiction, they experience withdrawal symptoms — physical, mental and emotional — when the drug of use is stopped. Withdrawal can be quite debilitating. Unbearable withdrawal symptoms are further motivation to continue using, drinking or doing. Although genetics, family environment, co-occurring mental health disorders and certain personality traits make some people more vulnerable to addiction than others, it can happen to anyone. Even certain professions — and their associated pressures and environments — can make a person more likely to fall into addiction. For example, the overworked physician, nurse, anesthesiologist or dentist who works in a clinical environment and has lots of stress also has easy access to many substances of addiction. Healthcare professionals often feel the need to succeed in a demanding environment and can fall prey to temptation as their job pressures build — sometimes they use in an effort to keep going during grueling double-shifts, and sometimes in an effort to relieve undue stress. In these scenarios, even a highly educated person who understands the inherent risks can develop addiction.
Addiction Education for Professionals and the General Public
Surprisingly, even though addiction represents a public health crisis in the U.S., there aren’t many doctors who specialize in treating addiction. In fact, doctors in general practice or other specializations don’t typically receive adequate addiction education or information about the disease as part of their medical school training. In the U.S., fewer than 10% of medical schools offer courses in addiction treatment. Addiction education in the healthcare community. Doctors are trained to provide comprehensive care for other chronic diseases, such as diabetes or hypertension, but they aren’t necessarily trained to provide disease-oriented care to people with addiction. Physicians understand that patients being treated for chronic diseases like diabetes and cancer need to be monitored for the rest of their lives and have different healthcare needs than before they were diagnosed. Until very recently, this understanding has not always applied to addiction. Why? When it comes to addiction, even the medical profession has been somewhat behind the times. While recent scientific research tells us that addiction has all of the hallmark characteristics of a chronic disease, this view has not yet been widely embraced in the medical literature. Things are changing, though slowly, due to the influence of psychiatry experts working on the front lines of addiction treatment who aim to shift professional perspectives and discourse toward a more disease-oriented mindset. Still, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, does not include many behavioral addictions as specific diagnoses (i.e., it includes gambling addiction, but not sex addiction or Internet addiction), though it includes many updates regarding addiction and associated disorders. Revised in 2013, the DSM-5 is the manual of descriptions and symptoms of mental disorders that are classified by the American Psychiatric Association (APA), and is widely used by U.S. clinicians as the basis for mental health diagnoses. Addiction education in the news. The Associated Press (AP) recently updated its well-respected and widely used “AP Stylebook” for journalists in an effort to provide better guidance and more appropriate language for stories on addiction. This is a progressive and timely move by the AP, which aims to assist the more than 15,000 media outlets that are trying to keep pace with updates on the national drug addiction crisis that has already reached epidemic proportions. Its recent style changes aren’t just about political correctness, says the AP. There has been widespread media misunderstanding of the nature of addiction, which perpetuates dangerous misconceptions among the public regarding how the disease of addiction should be managed. According to the AP’s updates, a “person with addiction” is preferred over the term “addict,” and “people with substance use disorder” or “people with heroin addiction” is the language preferred over “substance abusers” or “heroin users.” Always astute observers of current semantics, the AP realized that the language used to discuss addiction is changing as views among medical professionals are changing. By providing us with a more suitable and updated vocabulary, the AP is facilitating more accurate press coverage, addiction education among the general population, and hopefully, a shift in public discourse and perspective to reflect a more humane understanding of addiction. If perspectives and awareness of addiction in all its manifestations continue to advance in the medical field, it is very likely that the next update to the DSM will reflect the shift in professional understanding and discourse. As the media continues to run stories about people (including public figures) who have addictions to opioid painkillers, marijuana and heroin as well as those with behavioral or process addictions to “sexting” and social media, video games and shopping, the end result may be improved addiction education and awareness for all. The hope is that increased knowledge will translate to increased access to appropriate treatment and long-term support for people with addiction. Sources: Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research. J Mennis, et al. International Journal of Environmental Research and Public Health, June 2016. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse, NIH, December 2012. Introduction to Behavioral Addictions. JE Grant, et al. American Journal of Drug and Alcohol Abuse, September 2010. 4 Ways Addictions Are Harder to Treat than Other Chronic Diseases. David Sack, MD. The Huffington Post, April 2017. The AP Learns to Talk About Addiction. Will Other Media Follow? Maia Szalavitz. Undark, June 2017. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association (APA), May 2013. DSM-5 Changes: Addiction, Substance-Related Disorders & Alcoholism. John M. Grohol, PsyD. Psych Central, May 2013.