What is addiction?

There is a great deal of confusion about what constitutes "addiction". The Diagnostic and Statistical Manual of the American Psychiatric Association does not use this term at all. The professional term for these problems is "Substance Use Disorders". In the old system (DSM-IV), a distinction was made between "abuse" and "dependence". "Abuse" meant you were having problems as a result of your substance use. "Dependence" meant you also had signs of biological adaptation and true loss of control. In this view, either you had the disorder or you didn't.

In the current Diagnostic Manual (DSM-5), this distinction between "abuse" and "dependence" is erased, in favor of seeing these disorders as one disorder with a range of severity - mild, moderate and severe. This is a more realistic way of looking at the problem.

Many people ask, "Is addiction a disease?" There is a lot of emotion on both sides of this question. The more severe the level of the addiction, the more likely that the term "disease" applies. For these people, the biological components of the illness (brain and cellular adaptation) have taken over and are clear. For those who have struggled to attain and maintain abstinence and have been unable to do so; for those who are unable to say "no" to that first drink; for those who have been to rehab multiple times - for these people the ability to control their use is compromised or absent by disease factors. And with the acknowledgement of the disease comes a responsibility to do something about it; rather than a cop-out, this acknowledgement requires a commitment to a new way of living and thinking.

On the other hand, many people with mild or moderate levels of impairment have often been neglected in treatment settings; it was assumed that any symptom of addiction meant that the only resolution was complete abstinence and strict lifelong adherence to AA or NA. Research seems to suggest that this may not absolutely apply to those with mild or moderate levels of disorder.

In contrast with older schools of treatment, which provided a "one-size-fits-all" approach, it has become clear that different levels of problem require different kinds of interventions. It is also important to consider the degree to which a person is ready to acknowledge the problem and make changes about it.

Regardless of the diagnosis, my treatment philosophy begins with the assumption that you are the primary person who can define what goals you want to establish and develop a plan to achieve these goals.

A few important considerations:

    The symptoms of addiction appear to have strong biological, genetic roots. They are not signs of poor character, psychological disorders, or weak moral fiber. This is important to understand, as so many people avoid getting help out of shame over their condition.

    Not everyone has all the symptoms of addiction. For example, some people may never actually get drunk, but they may never go a day without drinking. Another person may not use cocaine for weeks at a time, but when they do they are unable to stop or limit their use.

    The more severe the addiction, the more likely that complete abstinence from all substances will be necessary for stable recovery.

    Addiction is a chronic disease. It doesn't go away over time. Like diabetes, it requires ongoing responsibility on the part of the patient to lead a stable life. Like diabetes (or asthma or other chronic diseases) you didn't create it, but without doing something about it, your life will gradually go downhill. The recovery rate for substance use disorders is similar to that of most chronic illnesses, and depends on your compliance with a program of recovery.