If you are loaded with guilt about your drug or alcohol addiction, please stop. As soon as possible.
For new patients— and most importantly, for an addict looking to recover — guilt and addiction do not mix. Feeling wrong about your alcoholism and drug addiction usually only increases it.
Most addicts and alcoholics have been through this. Go on a bender, sober up, then feel rotten about whatever you did while drunk or high. At some point along the way, when you begin to realize you are hurting yourself and others, you may end up feeling so bad about what you did that you use it again to numb the pain or tilt towards depression. It's a terrible cycle that, for some people, doesn't end until it's too late.
There is a claim saying that the only way members of the general public, and presumably policy-makers, opinion-formers, etc. too, can be persuaded to withhold blame and punishment from addicts for their troublesome behavior the only way to combat the stigma society attaches to them. Put another way, the claim is that a rejection of the BDMA is equivalent to believing and promoting the idea that addiction signifies a moral failing on addicts. This follows from the assumption that addiction is either a brain disease or a moral decline, with no further understanding of addiction possible.
The truth is that addiction is a disease. Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, just published a paper in the prestigious New England Journal of Medicine emphasizing that reality.
As the person who oversees the organization funding most of the world's research on addiction, Volkow points out step-by-step exactly how the pathology of addiction works in the brain. She also explains why modern medicine's pharmacological treatments should be used with patients who find quitting without an impossible task.
Volkow says three recurring addiction stages: binge and intoxication, withdrawal and negative affect, and preoccupation and anticipation.
She explains what happens that causes a person to become addicted through absolutely no moral failing of their own.
How Does The Public See Addiction?
The perception is something that has not to be talked about or given attention like t should have in recent times; meanwhile, the meaning of the term in the ordinary language has changed significantly over the years, and that more recent usage has expanded from psychoactive substances to a wide range of substance-related and non-substance activities, to the point arguably where ‘addiction' signifies little more than something a person spends a great deal of time doing.
Talking about this as a casualty, a scientist
Has suggested that the addiction concept offers modern society “a secular equivalent for possession as an explanation of how a good person can misbehave, and as an inner demon over which a hero can win.” If so, it should be noted that, as the concept of demonic possession, this attempted explanation is circular: Why do people repeatedly behave in ways that are bad for them and their direct relationships? Because of addiction; What is addiction? Behaving repeatedly in ways that are bad for you. Whichever way, providing a way for members of the general public and others to accept, superficially at least, that addicts should not be punished for their ill behaviors but should instead receive compassion and care. Indeed, the disease concept has been promoted from about the end of World War 2 as a mark of liberal and enlightened opinion. In contrast to the older ideas, addicts should be seen as bad people instead of as weak people, as it is now known that addicts ‘can't help behaving the way they do because they are compelled to act that way by their disease of addiction.
Stigma
Is it true that -the disease concept has been responsible for diverting many users of drugs and addicts from prison to treatment? And this is no mean achievement. As we have seen also, a more comprehensive claim is that, because addicts are not held responsible for their behavior, the disease concept can remove the stigma that would otherwise be attached to addiction in the public mind .?
To start with, general disapproval of the effects of addictive drinking or other substance abuse is an essential informal social control that helps to inhibit the progression to heavier use and more severe harm. Although society's attitudes to drug use and intoxication are fundamentally ambivalent, these informal social controls must be counted as a form of stigma but one presumably with mild effects. Any attempt to remove the stigma from drug use and addiction, not merely based on the disease concept, must take account of this inevitable barrier.
On another note, the straightforward proposal that seeing the behavior as the effects of disease necessarily leads to benign attitudes to it can be empirically examined and is found considerably wanting. Some 30 years ago, scientists carried out a survey of the general public in Scotland regarding their attitudes to the disease concept of alcoholism and the treatment of alcoholics. Although concerned with only one kind of addiction, this survey's findings are directly relevant to the issues under discussion and have not received the attention they deserve. They gave a representative sample of 200 members of the general public in Dundee a questionnaire on beliefs about alcoholism and attitudes toward alcoholics. They then subjected responses on 5-point Likert scales to factor analysis, and the results showed that the majority of the public, over (70 %) endorsed the disease concept by agreeing that “Alcoholism is best seen as a form of disease or illness.” This finding was comparable to figures reported in the American attitudes literature up to that time and suggested that even 30 years ago and before the BDMA had been promoted, the widespread publicity campaign to have alcoholism recognized as a disease had ostensibly met with success, at least in the north-east of Scotland. Though, factor analysis showed that whether or not respondents endorsed the disease concept of alcoholism had little directly to do with whether or not they had a sympathetic attitude to the treatment of alcoholics and believed that public funds should be devoted to treatment, etc.; more general better predicted the latter, non-condemnatory and humanitarian attitudes to socially deviant groups as a whole, a philosophy we dubbed a “humanitarian worldview.” Recent times had seen a growth in humanitarian attitudes toward most deviant groups in Western societies. It seems that this cultural trend, rather than an endorsement of the disease concept, largely accounted for positive historical change in attitudes to alcoholics.
Binging and Intoxication
Regardless of which drug is used, addictive substances get a person hooked by occupying the brain with dopamine, which relaxes the user. Eventually, the dopamine stops being produced in response to the drug, and instead, cells begin to make it in anticipation of the drug. “This process involves the same molecular mechanisms that strengthen synaptic connections during learning and memory formation,” Volkow and her colleagues write in the paper. “In this way, environmental stimuli that are repeatedly paired with drug use – including environments in which a drug has been taken, persons with whom it has been taken, and the mental state of a person before it was taken – may all come to elicit conditioned, fast surges of dopamine release that trigger the craving for the drug.”
So, for example, let's say you're a cocaine addict who frequently purchases the drug at your favorite watering hole. If you're there and you see one of your dealers walk in, your brain will say, “I must have cocaine!”
This is why, in abstinence, people with alcoholism and addiction are told they should change the faces and places they see. Saying goodbye to the people and places you associated with substance use is about more than just hanging out with so-called “good people” instead. It's not about judging your old friends. But your brain won't let you get sober if you keep going back into the same situations where you used to get high.
Withdrawal and Negative Affect
After a while, your brain chemistry changes in ways that make pleasure hard to attend, even from things that naturally produce rewards, such as food, sex, or other activities that you once found pleasurable. That's why the drug used to get you so high may not offer the same effects anymore with time. Often, an addict may think they are just getting “bad stuff.”
With some drugs, such as heroin, the brain changes in ways that cause withdrawal symptoms to be so bad that people use the drug to avoid withdrawal. It's not even about getting high anymore. This is why pharmacologic treatment such as naltrexone sometimes is the only hope for breaking free from a severe addiction to opioids.
“In the addicted brain, the anti-reward system becomes overactive, giving rise to the highly dysphoric phase of drug addiction that ensues when the direct effects of the drug wear off or the drug is withdrawn,” the paper explains.
Preoccupation and Anticipation
When the addiction becomes particularly severe, the brain begins to focus primarily on seeking the drug or alcohol. The administrative process – which controls things like making rational decisions – becomes impaired.
“These effects explain why persons with addiction can be sincere in their desire and intention to stop using a drug and simultaneously impulsive and unable to follow through on their resolution,” Volkow and colleagues explain. “This altered signaling in prefrontal regulatory circuits, paired with changes in the circuitry involved in reward and emotional response, creates an imbalance that is significant to both the gradual development of compulsive behavior in the addicted disease state and the associated inability to reduce drug-taking behavior, despite the potentially catastrophic consequences voluntarily.”
Volkow et al. say more research into how the brain responds to and influences addiction is needed to inform public policy better.
“Despite the scientific evidence and the resulting advances in treatment and changes in policy (such as the Mental Health Parity and Addiction Equity Act of 2008, which requires medical insurance plans to pay for substance abuse and mental health treatment the same as any other illness), the concept of addiction as a disease of the brain is still being questioned,” the authors write.
The takeaway? Don't be fooled by what others tell you – if you're having trouble shaking your addiction, it isn't your fault. And you deserve to become healthy. Science says so, and government entities increasingly are saying so, too.
Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. He is a freelance medical writer specializing in creating content to improve public awareness of health topics. We are honored to have Ben writing exclusively for Dualdiagnosis.org.