What Is an Addiction?
A Broad Definition of Addictions
Addiction has long been understood to mean an uncontrollable habit of using alcohol or other drugs. Because of the physical effects of these substances on the body, and particularly the brain, people have often thought that “real” addictions only happen when people regularly use these substances in large amounts.
More recently, we have come to realize that people can also develop addictions to behaviors, such as gambling, and even quite ordinary and necessary activities such asexercise and eating. What these activities have in common is that the person doing them finds them pleasurable in some way.
There is some controversy about which of the“behavioral” addictions constitute scientifically validated “true” addictions, with both professionals and the public failing to reach an agreement. More research is needed to clarify this issue.
So If You Can Be Addicted to Anything, What Makes it an Addiction?
Although the precise symptoms vary from one addiction to another, there are two aspects that all addictions have in common.
Firstly, the addictive behavior is maladaptive or counter-productive to the individual. So instead of helping the person adapt to situations or overcome problems, it tends to undermine these abilities.
For example, a gambler might wish he had more money – yet gambling is more likely to drain his financial resources. A drinker might want to cheer herself up – yet alcohol use contributes to the development of her depression. A sex addict may crave intimacy – yet the focus on sexual acts may prevent real closeness from developing.
Secondly, the behavior is persistent. When someone is addicted, they will continue to engage in the addictive behavior, despite it causing them trouble.
So an occasional weekend of self-indulgence is not addiction, although it may cause different kinds of problems. Addiction involves more frequent engagement in the behavior.
But If You Still Enjoy It, It Can’t Be an Addiction, Right?
Wrong. Because the media, in particular, have portrayed addicts as hopeless, unhappy people whose lives are falling apart, many people with addictions do not believe they are addicted as long as they are enjoying themselves, and they are holding their lives together.
Often people’s addictions become ingrained in their lifestyle, to the point where they never or rarely feel withdrawal symptoms. Or they may not recognize their withdrawal symptoms for what they are, putting them down to aging, working too hard, or just to not liking mornings. People can go for years without realizing how dependent they are on their addiction.
People with illicit addictions may enjoy the secretive nature of their behavior. They may blame society for its narrow-mindedness, choosing to see themselves as free-willed and independent individuals. In reality, addictions tend to limit people’s individuality and freedoms as they become more restricted in their behaviors. Imprisonment for engaging in an illegal addiction restricts their freedom even more.
When people are addicted, their enjoyment often becomes focused on carrying out the addictive behavior and relieving withdrawal, rather than the full range of experiences which form the person’s full potential for happiness. At some point, the addicted person may realize that life has passed them by, and that they have missed out on enjoying much other than the addiction. This often happens when people overcome addiction
What’s the Problem If It isn’t Doing Any Harm?
Addictions are harmful both to the person with the addiction, and to the people around them.
The biggest problem is the addicted person’s failure to recognize the harm their addiction is doing. They may have denials about the negative aspects of their addiction, choosing to ignore the effects on their health, life patterns and relationships. Or they may blame outside circumstances or other people in their lives for their difficulties.
The harm caused by addiction is particularly difficult to recognize when the addiction is the person’s main way of coping with the other problems they have. Sometimes other problems are directly related to the addiction, for example, health problems, and sometimes they are indirectly related to the addiction, for example, relationship problems.
Some people who get addicted to substances or activities are very aware of their addictions, and even the harms caused by the addiction, but keep doing the addictive behavior anyway. This can be because they don’t feel they can cope without the addiction, because they are avoiding dealing with some other issue that the addiction distracts them from (such as being abused as a child), or because they do not know how to enjoy life any other way.
The harm of addiction may only be recognized when the addicted person goes through a crisis. This can happen when the addictive substance or behavior is taken away completely, and the person goes into withdrawal and cannot cope. Or it can occur as a consequence of the addiction, such as a serious illness, a partner leaving, or loss of a job.
Help is available.
Sources:
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders” (4th Edition – Text Revision), Washington DC
Hartney, E., Orford, J., Dalton
Marks, Isaac. “Behavioural (non-chemical) addictions.” British Journal of Addiction 1990 85:1389-1394. 25 Aug. 2008.
Orford, Jim. “Excessive Appetites: A Psychological View of Addictions” (2nd Edition). Wiley, Chicester. 2001.
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Symptoms of Addiction
Signs and Symptoms of Addiction to Look Out For
All addictions, whether to substances or to behaviors, involve both physical and psychological processes. Each person’s experience of addiction is slightly different, but usually involves a cluster of some of the following symptoms of addiction. You can still be addicted even if you do not have all of the symptoms.
There are many different addictions, but similar symptoms span them all.
Some of the common symptoms of addiction are:
· Tolerance - the need to engage in the addictive behavior more and more to get the desired effect
· Withdrawal happens when the person does not take the substance or engage in the activity, and they experience unpleasant symptoms, which are often the opposite of the effects of the addictive behavior
· Difficulty cutting down or controlling the addictive behavior
· Social, occupational or recreational activities becoming more focused around the addiction, and important social and occupational roles being jeopardized
· The person becoming preoccupied with the addiction, spending a lot of time on planning, engaging in, and recovering from the addictive behavior
Signs of Addiction
Symptoms can only be experienced by the person with the addiction, whereas signs can be observed by other people. You can never know what someone else is experiencing unless they tell you, so if you are concerned that someone else may have an addiction, look for signs as well as for symptoms.
You might see some signs in an addicted person but not others. These are signs which occur across many -- but not necessarily all -- addictions:
· Extreme mood changes – happy, sad, excited, anxious, etc
· Sleeping a lot more or less than usual, or at different times of day or night
· Changes in energy – unexpectedly and extremely tired or energetic
· Weight loss or weight gain
· Unexpected and persistent coughs or sniffles
· Seeming unwell at certain times, and better at other times
· Pupils of the eyes seeming smaller or larger than usual
· Secretiveness
· Lying
· Stealing
· Financially unpredictable, perhaps having large amounts of cash at times but no money at all at other times
· Changes in social groups, new and unusual friends, odd cell-phone conversations
· Repeated unexplained outings, often with a sense of urgency
· Drug paraphernalia such as unusual pipes, cigarette papers, small weighing scales, etc
· “Stashes” of drugs, often in small plastic, paper or foil packages
Caution
Most of the signs of addiction have other explanations. For example, someone can be secretive because they are planning a birthday surprise for a friend. People can have changes of energy for numerous reasons, health related and otherwise. They can make new friendships and end old ones for many reasons other than addictions.
Most of the signs of addiction are similar to normal teenage behavior. Unfortunately, teenagers are one of the groups most vulnerable to addiction. Parents who are concerned about their teenage child should be very careful when discussing addiction with a teenager.
Be cautious about jumping to conclusions. Unless you have found drugs or drug paraphernalia, or have some other obvious evidence of an addiction, it is likely there is another explanation. However, do not be naïve if you have found drugs or drug paraphernalia, as you may end up with legal problems if you do not address the situation.
The most important factor in finding out whether someone has an addiction or not is trust. Trust needs to be earned, so try to be supportive. A confrontation with someone with an addiction is likely to just lead to denial and rejection from the addicted person.
Signs and Symptoms of Specific Addictions
The links below will give you more details of the signs and symptoms of specific addictions.
Substance Addictions
· Alcohol – for example, wine, beer, liquor
· Amphetamine or similarly acting sympathomimetics – for example, speed, crystal meth
· Benzodiazepines - for example, Xanax, Valium
· Caffeine – for example, coffee, tea, sports drinks
· Cocaine – for example, coke, crack
· Hallucinogens – for example, acid, ecstasy
· Nicotine – for example, cigarettes, cigars, nicotine patches
· Opioids – for example, heroin, morphine, painkillers
· Phencyclidine (PCP) or similarly acting agents – for example, angel dust, ketamine
· Sedatives, hypnotics or anxiolytics – for example, sleeping pills, downers
· Computer – for example, internet, video games, social networking sites, cybersex,online gambling
· Eating – for example, overeating, binging
· Exercise – for example, weight loss, sports
· Gambling – for example, VLTs, casinos, slot machines
· Gaming – for example, computer games
· Shopping – for example, spending, stealing
· Work – for example, overwork, money, power
Sources:
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders” (4th Edition – Text Revision), Washington DC
Marks, Isaac. “Behavioural (Non-Chemical) Addictions.” British Journal of Addiction 1990 85:1389-1394. 24 Jul. 2008.
Orford, Jim. “Excessive Appetites: A Psychological View of Addictions” (2nd Edition). Wiley, Chicester. 2001.
Responsible Gambling Council. “Warning Signs: Signs Someone You Know May Have A Problem With Gambling.” July 24, 2008.
Society for the Advancement of Sexual Health. “Sexual Addiction.” July 24, 2008.
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Addiction Diagnosis
The Assessment and Addiction Diagnosis Process
The diagnosis of an addiction can seem like a daunting experience, but it can be the starting point for making positive changes in your life.
Where Should I Go for a Diagnosis?
If you recognize the symptoms of addiction in yourself, the easiest way to find out whether you have an addiction is to make an appointment with your family doctor. They may decide to refer you to a specialized addiction clinic or clinician who specializes in addictions for a full assessment and addiction diagnosis if appropriate.
Who Will Make the Diagnosis?
Many different health care professionals are trained to conduct addiction assessments, including addictions counselors, physicians, psychologists, nurses, social workers and other therapists. They are often called “clinicians” when they are carrying out assessments or therapy.
Occasionally, there is more than one person involved in making the addiction diagnosis. For example, you may be interviewed once by a counselor and again by a physician. Do not let this put you off – you will have two experts’ opinions instead of one!
All health care professionals are trained to treat people with addictions with courtesy, respect, and a non-judgmental attitude. You can trust them to keep the information you give them confidential.
How Will They Decide If I Am Addicted?
The clinician will make the addiction diagnosis using a combination of objective criteria and clinical judgment.
Objective criteria are usually based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which lists the symptoms of addiction for substance and gambling addictions. As some addictions, such as sex addiction and computer addiction, are not included in this version of the DSM, the clinician should use the most recent diagnostic criteria published in scientific journals.
Diagnostic information can be gathered in several different ways, including:
· Standardized assessment tools and other questionnaires that the clinic staff will give you to fill out.
· Face to face “open-ended” interviewing, which is like a conversation, with the clinician making notes. This is best for history-taking so you can explain the circumstances in your own words.
· Face to face “structured” interviewing, in which the clinician will ask standard questions and write down your answers. It’s a bit like completing a questionnaire, but you can discuss questions as you go along.
The questions and focus of the discussion will involve some or all of the following:
· The history of your addiction, including when and how you started the addictive behavior, how it has progressed, and factors which have contributed to its development.
· Your current pattern of addictive behavior – what your addictive behaviors are, how much and how often you engage in them.
· Your current symptoms of addiction.
· The effects of your addiction on the other areas of your life, including your family, social life, work life and financial situation.
· Your readiness to change.
You may also be asked for a urine sample to assess the levels of drugs in your system. Blood samples are not routinely taken, but if you have signs or symptoms of serious physical illness, a clinician may request a blood sample, for example, to assess your liver function. Not all addiction clinics are set up to take urine or blood samples.
A good diagnostic assessment will also gather information on your general mental and physical health to assess whether you are suffering from another condition such as depression, anxiety disorder or personality disorder. You might be referred to medical physician if there are specific physical concerns, or to a psychiatric physician if there is an indication of another significant mental health issue. Inpatient or outpatient detoxification may also be advisable at this stage.
Co-existing conditions can and should be treated at the same time as the addictive behavior.
It will help the process if you follow these Tips for Getting an Accurate Diagnosis.
What Next
Most clinics will be able to give you a verbal addiction diagnosis right away. Occasionally, there may be a delay, for example, if a psychologist wants to score your standardized tests before making a diagnosis. If so, you should make an appointment to come back to get your diagnosis in person.
Your diagnosis and the information gathered will form the basis of your treatment plan. This plan will be made in consultation with you, with the opportunity to discuss their recommendations and the options available.
You are free to withdraw from the process at any time. Often times, just knowing your addiction diagnosis can be the start of making positive changes in your life.
Sources
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders” (4th Edition – Text Revision), Washington , DC
Miller, William R. and Rollnick, Stephen. “Motivational Interviewing: Preparing People for Change.” Guilford , New York
Orford, Jim. “Excessive Appetites: A Psychological View of Addictions” (2nd Edition). Wiley, Chicester. 2001.
Ryglewicz ACSW, Hilary and Pepper MD, Bert. “Lives at Risk: Understanding and Treating Young People With Dual Disorders.” Simon and Schuster , New York
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Addiction Treatment
What to Expect in Therapy
Approaches to addiction treatment depend on the needs of the individual, and may include:
· Individual therapy to help the person reach a greater understanding of their addiction and how to overcome it
· Group therapy to allow people with the same addiction problem to share understanding, support and encourage each other
· Residential treatment to give people the chance to get away from their usual lifestyle into a safe supportive atmosphere with intensive therapy
Many people successfully overcome addictions without professional help through “natural recovery”.
Both natural recovery and addiction treatment can be enhanced through self help groups. The best known addiction self-help group is Alcoholics Anonymous or AA, which is a 12 step program, although there are many others which use different theories of addiction treatment.
How Do I Know Which Treatment Approach to Use?
In reality, people often use a combination of approaches to addiction treatment. It may take several different treatments to successfully overcome an addiction.
Quitting takes time, and involves several stages:
· The decision to change –- you may not be ready to quit, but services exist to help you make this decision.
· Preparing to change –- deciding on the best way to quit.
· Withdrawal from the addictive behavior – can last a week or two.
· Developing a lifestyle without the addictive behaviour.
· Finding non-addictive ways of coping.
· Maintaining a non-addictive lifestyle over the long-term – this will take the rest of your life.
Many different addiction treatments help people overcome addictions. The effectiveness of your therapy will depend on:
· Your readiness to change.
· How well you get on with your therapist.
· How severe your addiction is –- it is dangerous to withdraw from some drugs, including alcohol, without medical supervision.
· Your physical health –- you may have problems such as liver disease, which also need immediate treatment.
· Your mental health –- your addiction may be co-occurring with another mental health problem, which will also need immediate treatment.
· The amount of social support you have. Generally, family and friends who do not share the addictive behaviour can support your recovery, but people still engaged in the same addictive behaviour tend to make it more difficult.
· Your financial circumstances –- you may need to take time off work, and if you have difficult financial circumstances, treatment services can connect you with financial and housing support.
How Do I Begin Addiction Treatment?
The best place to start is to discuss your addiction with your family doctor. Some ways that they help are:
· Providing a long-term therapeutic relationship -– don’t underestimate the value of someone who can see you progress from being addicted to long-term recovery.
· Diagnosing physical and mental conditions you may not even be aware of.
· Referrals to other medical, psychiatric and formal addiction services.
· Advice on addiction treatment approaches.
· Medical management of your withdrawal –- they can explain how this will work, whether you need to go into a detoxification facility or hospital, and refer you to appropriate services.
You can also contact a helpline, to put you in touch with treatment services directly. Helplines provide immediate anonymous support and information, often 24 hours a day. You may still need a referral from your family doctor to get into a treatment program.
What Can I Expect From Addiction Treatment?
Addiction treatment services vary, but expect some or all of the following:
· Confidentiality with very few exceptions.
· Supportive professionals who will collaborate with you, accept you for who you are,empathize with your situation, encourage you to keep trying, and help you solve problems.
· Individual counseling to discuss how you became addicted, your reasons for quitting, and what will help you quit.
· Group therapy, where you will meet other people in addiction treatment, to support each other and learn about addiction and recovery.
Your addiction treatment service may or may not involve:
· Drug testing -– only if abstinence from alcohol or drugs is one of the goals you agreed with your therapist.
· Medication management by an on-site medical professional -– a great advantage if you are detoxifying, or if you have other mental or physical concerns.
· Family support and/or couples counselling to give support to people in your life who could help your recovery.
· Follow up –- to make sure that you are still doing OK after completing the treatment program.
Will I Be Judged?
Generally, healthcare providers take a nonjudgmental approach to treating people with addictions. Anyone working in the medical system should treat you with dignity and respect, and if they do not, you can make a complaint.
Sometimes people in group therapy are judgmental of others. A facilitator will prevent this from happening by setting ground rules for participants at the beginning of the session. It is part of their job to ensure that group members are respectful to each other.
The lack of facilitators is one of the difficulties of self-help groups. If you feel judged or uncomfortable with a self-help group you are attending, try a different group.
What if I Can’t Quit?
Successful recovery from an addiction takes time and patience. The most important factor is your commitment to quitting. Support is available, and if you relapse, you can always try again. It is common to have several attempts before you are successful.
Sources:
Miller, W.R., Brown, J.M., Simpson, T.L., Handmaker , N.S. , Bien, T.H., Luckie, L.F., Montgomery Boston
Orford, Jim. “Excessive Appetites: A Psychological View of Addictions” (2nd Edition). Wiley, Chicester. 2001.
Schulz PhD, William E. “Counselling Ethics Casebook.” Canadian Guidance and Counselling Association, Ottawa
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How to Help Addicts
How to Support Someone With an Addiction
People who know someone stuggling with an addiction often wonder how to help addicts. The decision to try and get help for someone you care about who has an addiction is never easy. Fortunately, with your support, they have a greater chance of overcoming their addiction. Each situation is unique, but there are some general guidelines that will help you approach this task.
Expect Difficulties
There are many reasons that helping someone you care about with their addiction can be difficult:
· They may not agree that they have a problem.
· They may not want to change what they are doing.
· They may fear consequences e.g., losing their job, going to prison.
· They may feel embarrassed, and not want to discuss it with you.
· They may feel awkward about discussing personal issues with a professional.
· They may be engaging in the addiction as a way to avoid dealing with another problem that bothers them more.
There is no fast and easy way answers to the question of how to help addicts. Overcoming an addiction requires great willpower on the part of the person with the addiction, so if they do not want to change what they are doing, trying to persuade them to get help is unlikely to work.
However, you can take steps that will help your loved one to make changes over the long term, and will help you to cope with a loved one with an addiction.
Step 1: Establish Trust
This can be hard to do if the addicted person has already betrayed your trust. However, establishing trust both ways is an important first step in helping them to think about change. Trust is easily undermined, even when you are trying to help.
Avoid the following trust-destroyers:
· Nagging, criticizing and lecturing the addicted person.
· Yelling, name calling and exaggerating (even when you are stressed out yourself).
· Engaging in addictive behaviors yourself, even in moderation (they will think you are a hypocrite).
Be aware that:
· Although you just want to help the addicted person, they may think you are trying to control them, which can lead to them engaging in the addictive behavior even more.
· They probably use the addictive behavior at least partly as a way to control stress. If the atmosphere between you is stressful, they will want to do the addictive behavior more, not less.
· Building trust is a two-way process. Trust is not established by putting up with bad behavior. If you have no trust for your loved one, and do not feel it can be established at the moment, you should read Step 2.
· People with addictions rarely change until there is some consequence to their behavior. Don’t try too hard to protect the addicted person from the consequences of their own actions (unless it is harmful to themselves or others, for example, drinking and driving).
Step 2: Get Help for Yourself First
Being in a relationship with a person who has an addiction is often stressful. Accepting that you are going through stress and need help managing it is an important step in helping your loved one, as well as yourself. Here are some suggestions for getting support for yourself.
Step 3: Communicate
Although you may feel tempted to let your loved one know that their addiction is a problem, and that they need to change, the decision to change is theirs. They are much more likely to be open to thinking about change if you communicate honestly but in a way that does not threaten your loved one.
These tips on communicating with an addicted loved one should help.
Step 4: The Treatment Process
The treatment process will vary according to the kind of treatment your loved one is getting.
If you are involved in your loved one's treatment:
· Remember to keep working on establishing trust. Re-read Step 1 before going to counseling with your loved one.
· Be honest about your feelings, what you want to happen, and what the addiction has been like for you.
· Do not blame, criticize or humiliate your loved one in counseling. Simply say what it has been like for you.
· Do not be surprised if your loved one says that things you are doing are contributing to their addiction. Try to listen with an open mind.
· If you want them to change, you will probably have to change too, even if you don’t have an addiction. If you show you are willing to try, your loved one will be more likely to try as well.
If your loved one has treatment alone:
· Respect their privacy in everyday life. Do not inform friends, family or others about your loved one’s treatment.
· Respect their privacy in therapy. If they don’t want to talk about it, don’t push for them to tell you what happened.
· There are many different approaches to the challenge of how to help addicts, but remember, change does not happen overnight.
Sources:
Gottman PhD, John and DeClaire, Joan. “The Relationship Cure: A 5 Step Guide to Strengthening Your Marriage, Family, and Friendships.” Three Rivers Press, New York
Hartney, Elizabeth , Orford, Jim, Dalton
Love EdD, Patricia and Stosney, Steven PhD. “How to Improve Your Marriage Without Talking About It: Finding Love Beyond Words.” Broadway Books, New York
Orford, Jim, Dalton , Susan, Hartney, Elizabeth
Orford, Jim, Natera, Guillermina, Copello, Alex, Atkinson, Carol, Mora, Jazmin, Velleman, Richard, Crundall, Ian, Tiburcio, Marcela, Templeton, Lorna and Walley, Gwen. “Coping With Alcohol and Drug Problems: The Experiences of Family Members in Three Contrasting Cultures.” Routledge: London and New York
Communicating With an Addict
Supporting Family Members of Addicts
Addiction Affects Relationships
