Addiction: Disease or Behavior?

It is not as simple to say that an individual is "cured" of the "disease" of addiction after completing treatment. Treatment targets both physical aspects of addiction as well as psychological/behavioral. Completing treatment may make the individual less likely to engage in further behavior that led to the addiction but it is possible and, unfortunately, likely the individual will relapse at some point(s) in their lives. Addiction is more than a disease that could be cured, it is a complex culmination of genetic/biological predisposition to chemical dependency, lifestyle, social environment, upbringing/family history, thought patterns, past experiences, mental/emotional health, current social ties, and overall motivation of the individual. Any one of these factors can be tipped to make a relapse more likely for an individual. Due to the number of factors that can contribute to addiction, treatment is often complicated and needs to be tailored specifically to the individual's unique needs. If the individual is not motivated or is not ready to address the issues that have led them down this path of abusing substances, no treatment can be successful.

There is a lot of research to support that abuse and or use of an addictive substance can create a physical dependency over time. This research explores how substances affect receptors in the brain, act as various neurotransmitters in the brain, and change the landscape of our receptors where we begin to prefer and act as though we need the artificial substance over our natural chemicals and neurotransmitters. We somehow create a physical dynamic within ourselves that allows our bodies to stop craving what is good for us and instead, crave not only what is harmful for our bodies but also what will eventually kill us.

Shortcomings of the disease model: Viewing addiction as a medical disease that must be cured (by a doctor/professional/someone else) tends to leave the individual powerless over what is actually in their power- their behavior, their choices, their lifestyle changes. This model also lends itself to believe that there is a cure or magic bullet for addiction. Only approaching addiction from this angle leaves the individual without the essential tools to effectively change their lifestyle and address the personal issues that have led to substance abuse. Lastly, the model allows the individual to slip into a vulnerable position of unrealistic belief and, therefore, they are cured and can do exactly what they have been doing- increasing the risk of relapse.

Addiction can be related to the addicts lifestyle or behaviors. We choose our lifestyle and behaviors although making some lifestyle changes are easier than others. Alcoholics Anonymous and Narcotics Anonymous are self-help groups available available to alcoholics and addicts that offer support when one chooses to make these lifestyle changes. Other alternative self-help groups are also available in some locations with slightly different approaches that may benefit those that are not buying into the AA/NA philosophy such as:

• Life Ring Secular Recovery
• Moderation Management
• Rational Recovery
• Secular Organizations for Sobriety
• SMART Recovery
• Women for Sobriety (this is also available for men in some locations)

Although the philosophies, "steps", literature, and approaches to ultimately achieving lifestyle change vary from one organization to the next, they all have the following in common:

• Changing lifestyle involves creating a sober social support
• Addiction involves addressing "people, places and things" meaning the environment and the setting that encourages or predisposes an individual to abuse substances.
• Addressing the unhealthy thinking patterns (as well as emotions at times that lead to the thoughts) that then lead to poor decisions and behavior that trigger an individual to make the choice to use substances again.
• Addressing denial, the need to not address important issues in one's life, and the importance of facing the addiction and the reasons for substance abuse.

Shortcomings of addressing addiction strictly through behavior: There is a medical component to addiction. Depending upon the severity of addiction and the substance used, many addicts require medical stabilization plus an inpatient environment that could also meet additional medical needs as they experience physical withdrawal from the substance. The fastest way to stop physical withdrawal symptoms- some of which could be life-threatening- is to use again which is one of the most common reasons for relapse. The whole individual was be supported throughout the recovery process. Once the medical component is addressed, it is more than just the behaviors that need to be targeted. The individual needs to become aware of the emotional, cognitive, and social reasons behind the substance abuse and work towards addressing each issue at the root cause.

Typically an addict or substance abuser finds themselves following this pattern in treatment:

Due to the nature of addiction, the substance abuse often hits "rock bottom" before seeking treatment or having their life threatened by the substance abuse where emergency treatment is first imposed on the individual.

1. The individual is in the ER due to medical issues related to their addiction
2. Once the individual's health is stabilized and health complications are addressed, the individual could be referred to a detox (possibly for 7 days) depending upon the nature of the addiction.
3. After detox, or if detox was not necessary, the individual is referred to a 30 day inpatient drug and alcohol rehabilitation program. Unfortunately, most insurance will only fund these inpatient rehabs for a few days.
4. After inpatient rehabilitation, the individual is referred to outpatient rehabilitation this may be a step down, day treatment type model at the same facility or this may be a new facility that will determine which level of treatment is appropriate for the individual.
5. As the individual makes progress in treatment, treatment is slowly decreased in intensity. Example: 5 days a week down to 3 evenings per week, 3 evenings per week down to 2, or 2 sessions per week down to 1.

There are programs that exist that attempt to avoid the development of addiction and the need for such intense treatment. When individuals are first involved with the justice system related to substance abuse, they are often mandated to educational services associated with substance abuse or a more clinically appropriate level of treatment if the individual is showing signs of dependency. This treatment may follow the following:

1. 6 months of meeting once weekly for an educational series
2. If success completion, the individual returns to their regular lives without further mandates. If the treatment center has found the individual could not keep clean for the 6 months and could not successfully complete the course, they would be referred to a more intense level of treatment.
3. Just as the level of treatment decreased over time for the individual that slowly showed they no longer needed a higher intensity, the clinicians would recommend the individual pursue a more intense level of treatment if they were not successful with their current level as evidence by relapse and continued use. For example, an individual who initially started with an educational series may move up to 2 clinical sessions per week. If still not successful with 2 clinical sessions per week, they may move up to 3 clinical sessions per week. If the sustance created significant health problems that needed hospitalization, this also may be step.

It is not as simple to say that an individual is "cured" of the "disease" of addiction after completing treatment. Treatment targets both physical aspects of addiction as well as psychological/behavioral. Completing treatment may make the individual less likely to engage in further behavior that led to the addiction but it is possible and, unfortunately, likely the individual will relapse at some point(s) in their lives. Addiction is more than a disease that could be cured, it is a complex culmination of genetic/biological predisposition to chemical dependency, lifestyle, social environment, upbringing/family history, thought patterns, past experiences, mental/emotional health, current social ties, and overall motivation of the individual. Any one of these factors can be tipped to make a relapse more likely for an individual. Due to the number of factors that can contribute to addiction, treatment is often complicated and needs to be tailored specifically to the individual's unique needs. If the individual is not motivated or is not ready to address the issues that have led them down this path of abusing substances, no treatment can be successful.

Relapse can be seen as "harder" or worse the second, third, or fourth time around after recovery. This could due to a few factors.

1. The individual does not have tolerance to the substance as they did in the past yet they started to use the substance at the last dose they did. This is often the cause of why heroin acts die from their first relapse after being clean for a certain about of time.
2. The individual did not address the reasons behind their drug use. Any issues we leave unaddressed will continue to worsen. If drug use was our way of coping, we will need to cope that much stronger.
3. Drug addicts are often perceived as needing to hit rock bottom before they finally stop and realize how serious their addictions are. Continues relapse will result in the drug addict pushing the limit closer and closer to "bottom."