What Is Addiction, Anyway?

Addiction is a global problem. It is a human problem. It is a non-discriminatory offender. It does not care about your gender identification, your financial status, your skin color, your sexual orientation, your religion, spiritual practice, or what political party you affiliate with.

In 2015, Australian researchers published the very first study citing worldwide addiction statistics. They found that about 240 million people around the world are dependent on alcohol, more than 1 billion people smoke tobacco products, and about 15 million people use injection drugs, such as heroin. Global estimates of problem gambling were not possible, but in countries where it had been assessed, about 1.5 percent of the population suffered from it. Problem gambling is an example of what is called a “process” addiction: It is a set of behaviors versus a substance that is ingested. Other behaviors, such as sex, internet gaming, spending money, bingeing, purging, and restricting food can become addictions as well.

Stigma, myth, and controversy continue to surround the concept of addiction; what it is, who ends up addicted, and what causes it. The focus here is to reduce stigma, dispel myths and hopefully clarify some controversy through focusing on the definition of addiction and offering three key strategies for recovery.

Is addiction a lack of willpower?

Many still think that if a person wants to stop using a substance, a behavior, or way of thinking, they can just will it to happen. If that were the case, addiction would not be such a global issue. If you think about it, those you call or consider addicts, have very strong wills. They go to almost any lengths to make sure they get their chemical or act out their behavior of choice. For example, scheming and manipulating multiple doctors to write prescriptions, planning to and actually stealing money to gamble, purchase alcohol, tobacco products, food, and/or illicit drugs. The effort of hiding, sneaking and keeping secrets also takes a whole bunch of will power!

Is addiction a moral failing?

No. Addiction is not about someone being a bad person or not knowing the difference between right and wrong. Many addicts are upstanding members of their community.

Addiction is a brain disease.

According to the American Society of Addiction Medicine (ASAM), addiction is a brain disease. It is “a primary, chronic disease of brain reward, motivation, memory and related circuitry…Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

In plain English, ASAM tells us that the brain has a chronic illness that significantly impacts a person physically, emotionally, socially, and spiritually. Altered brain function shows up as behavioral attempts to feel good and/or relief in spite of serious negative consequences to the person her/himself, or to those around her/him. In my thirty years of practice, one of the most common statements I hear from clients who suffer with addiction is “I have a big hole inside me that I have been trying to fill for a long time. This emptiness and feeling different from others has been very painful…the thing that has helped me the most is a sense community with others who understand me and a connection to something greater than me, be it nature, that community, or a more traditional sense of a higher power.”

Dr. Gabor Mate, renowned expert on addiction, pain and trauma, speaks of all addictions as “attempts to soothe pain.” He calls them “pain killers.” Mate has found that the majority of people who have addictions, also report some form of childhood or adult adverse experience(s). This is why, when meeting a patient, Mate first asks “Why the pain?” versus, “Why the addiction?” He reports that emotional and physical pain activate the same brain pathways, thereby validating the power of emotional pain from significant loss and traumatic stress and its pain’s role in addiction.

Further, ASAM characterizes addiction by “an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

In other words, this disease is progressive and can be fatal. It must be addressed. Relapse may be a part of the process. The brain changes that happen in addiction lead to a person losing control and choice over her/his use. They also contribute to not clearly seeing her/his role in relationship, work, and other problems.

Many addiction and traumatic stress authorities, such as Mate, agree that adverse childhood experiences contribute to the development and process of addiction. ACE’s, as they are called, create their own brain changes that contribute to this picture and make one vulnerable to addiction in the first place. They must also be addressed in order for there to be long term recovery.

Key Strategies for Recovery

• Become aware and validate. Addiction is a disease process that includes behaviors and substance use to medicate physical and/or emotional pain and relieve suffering. It is not evidence of you or your loved one being a “bad” person. Recovery is possible.

• Acceptance. Admitting and saying to your innermost self, “Okay, I am, or my loved one, is ill and in pain. I may not like it, but it is the truth.” A solution cannot be found without first admitting there is a problem.

• Take Action. Reach out and ask for help from friends, loved ones, and/or professionals. Research shows that active involvement in support or self-help groups is the most potent element in achieving and maintaining long term recovery. Smart Recovery, Refuge Recovery, and 12-Step groups, such as Alcoholics Anonymous, Narcotics Anonymous, Al-anon and Overeaters Anonymous, are just a few examples of those to contact for assistance.

Remember, you and your loved ones have a right to do whatever it takes to heal your pain and recover.