This article explores the psychological definitions of addiction as detailed by the DSM IV (Diagnostic and Statistical Manual of Mental Disorders 4th edition) and considers some specific life problems related to addiction that are commonly identified by clients in treatment programs. This article challenges some of the widely-held beliefs regarding the nature of these problems and explores how current societal approaches to treating “addicts” could hurt the client while trying to help them.
In this writer’s experience, the definition of the word “addiction” is often confused. I have had people try to explain their understanding of addiction using such phrases as “hooked”, “need it”, “powerless”, and “controlled”. Very commonly, “addicts” do feel those things, however, a simple definition for addiction could be ‘continuing to do something (ie chemicals, behaviors, relationships, etc) despite negative consequences’. Continued use of a substance after any negative consequences is the basic criteria for the “Substance Abuse” diagnosis in the DSM IV. Subsequent progression of consequences, time spent in active use behaviors, and physical withdrawals elevate the diagnosis to “Substance Dependence” and once “dependent” an individual works toward “remission” on “agonist” or “antagonist” medications and other psychotropics or otherwise abstain. These are the common perspectives on the criteria for identifying addiction which influences the direction of the treatment.
Through interacting with individuals labeled “addicts”, however I have been unable to avoid the suspicion that the “powerless” and “controlled” characteristics of the dependent individuals may in fact have very different roots than those on which the above criteria are based. For example, in sitting with clients and asking them to discuss negative consequences of substance use, common answers include:
Arrest and probation (mandated not to use or incarceration)
Physical dependency and withdrawals
Looking at these problems superficially, we recognize how the DSM IV criteria is clearly met, however the more I have heard stories of clients, the more I am concerned that things have gone terribly wrong with regard to how problems are defined and how the systems operate. I have often struggled to fully identify and discuss with a client the true nature of their problems because of the realization that they are in fact “powerless” and “controlled” and cannot win.
Exploring the above identified problems, being incarcerated for possession or selling of illegal substances, is a common problem reported by clients. Some believe, however, that these behaviors are in fact victimless, wherefore they cannot actually be considered crimes. Commonly these clients have no internal motivation to stop their use of substances, have not victimized anyone, and do not identify the substance as a problem for them. They are, however, mandated upon threat of incarceration not to use again. This leads to a great struggle.
To explore this through a new lens, consider another example. Consider a client who is in a domestic violence relationship and also loves to sing. The abusive other, however, demands that the client refrain from song unless ordered to do so. The client gets caught singing, however, and is beaten, but continues to sing when she thinks she’s alone. In this particular scenario, does the client have an addiction to singing? The client experienced negative consequences for a behavior and continued to do it. It meets the criteria but just does not seem to be the logical conclusion. The conclusion most counselors would come to is that the client has some level of dependency on the abusive other or they are in fear for their life or else they would have left the relationship. In this example, we can see that it’s not that which is being controlled that is the problem, the problem is the controlling aspects of the relationship.
With regard to the controls over substances I do find it confusing and troubling. As an aspiring herbalist, my shelves are stacked with books about plants from all over the planet that I believe strongly interact with our body’s functioning on many levels when smelled, touched, or consumed. Many can be used medicinally for boosting mood, energy, and motivation, to calm and assist with restful sleep as well as to promote healthy digestion, circulation, and other body functions. There are sometimes warning notations in the books regarding plants that are toxic for human consumption, and this is obviously useful information. What I find concerning is that at some point someone started assessing these lists of plants being used medicinally and, like the abusive other, demanded that the cultivation of some plants cease unless permission given and the assessing agencies profit. Relative to the domestic violence scenario, if the “addict” continues to cultivate and use the now “illegal” plant, should we consider that the problem is not the use of the plant but the controlling aspects of the relationship?
This is not to say that the prohibition of substances is the cause of all the troubles a substance dependent person may experience. There are many individuals who continue to use legal (alcohol, caffeine, nicotine) as well as illegal substances and engage in destructive behaviors despite their own true desire to stop. Some also neglect responsibilities to themselves and others with regard to parenting, medical care, hygiene etc. These appear to be individuals who have very personal problems that do desperately need to be addressed to avoid death or a life of misery. This is not the fault of the chemical, however, but a result of the underlying personal issues of the clients. These people, I feel, are more commonly seeking treatment for themselves and are not mandated. This writer assumes these individuals make up only a small percentage of the “addict” population, however, and in fact the majority have the following problems:
Physical dependency- Neuropsychological and Epigenetic studies seem to indicate that the likelihood a person is to become dependent on a chemical can be predisposed. Neuropsychological studies indicate that individuals may be born with lower-than-average production of certain neurochemicals, wherefore the use of the chemical feels necessary once experienced. With regard to this, the person who is using a chemical is doing so to bring their body chemistry to a state where they are feeling better than they were without it. If a potent form of the chemical is ingested regularly and then is stopped, the body chemistry is thrown off and the effect is changes in mood, motivation, energy, pain sensitivity, digestion, etc. Clients commonly state they do not want to be chemically dependent to feel “normal”. Could it be, however, that it is the prohibition and regulation of substances that actually promotes dependency? For example, if clients were able to cultivate poppies and marijuana plants in their yards and make themselves cups of opium or cannabis tea, they may not consume nearly the amounts of potent chemicals as they will when consuming the accessible substances such as heroin, Oxycontin, Methadone, Xanax, Wellbutrin etc. Further, it is possible they would experience the increase in mood and motivation they seek without serious withdrawal issues or other side effects as compared with “street” and other “pharmaceutical” drugs. Illicit drug manufacturers and pharmaceutical companies tend to value “more bang for the buck,” wherefore accessible forms of chemicals under prohibition and regulation are very potent. Could it be that prohibition and regulation actually keep only the most potent and addicting forms of highly demanded chemicals available, wherefore actually promoting physical dependency? How about generations of chemically dependent people? Epigenetic methyl marks are said to be passed from one generation to the next, wherefore, chemical depletion and dependency in a parent seems very likely to result in low neurochemical production and predisposition to chemical dependency in offspring. It is extremely concerning that this cycle of dependency seems likely to continue.
Financial problems- With regard to this, many clients come into treatment discussing their inability to pay bills because of spending large amounts of money on illegal chemicals. In comparison, many uninsured clients stress over inability to pay bills because their legally prescribed medications cost too much. It is common for people who are desperate to feel better to engage in behaviors that do victimize others in order to obtain the financial means to do so. In exploring this, however, it seems that the reason the chemicals are so expensive is because they are prohibited and/or regulated. Often, it seems that the cost is actually very low to grow the plants from which the chemicals are derived. Illicit manufacturers, however, appear to adjust their prices relative to the cost of the pharmaceuticals and those costs are often quite significant. If clients were able to cultivate their own medicines, however, there would be no need to pay exorbitant amounts of money to feel the way they want to feel. In this situation, it seems they would no longer have the financial problems associated with this “addiction”.
Employment problems- Many clients come to treatment unemployed and/or with low to no income. It could be assumed that the chemically dependent person acted irresponsibly on the job and was terminated for it, however, this is not always the case. Commonly, missed work due to withdrawal sickness is a factor, however criminal record checks are also a major barrier when the individual has drug-related charges. The client may further be subject to drug testing by employers under the expectation that the only allowable chemicals are those that are legally permitted. This systematic enforcement of prohibition is often a major barrier for individuals who are otherwise capable of stable employment.
Relationship problems- Relationship problems are common in chemically dependent and non-dependent people alike. Often, clients report that conflicts related to chemical use are actually a result of the problems already described above. Their significant other is commonly very distressed over the fact that their loved one is getting arrested, going to jail, spending all the money, getting sick all the time, and can’t get a job. This seems like it would cause a great deal of conflict in any relationship. The question is, could this family be healthy and well if able to cultivate their own medicines? Would the “addict” still be labeled so and would they struggle with withdrawals, arrests, financial, employment, or relationship problems? It is hard to tell.
As stated before, it is clear that some people take enjoyable experiences to the extreme and end up having negative consequences as a result. These people may benefit from assistance if they’re interested in making changes in their lives. Making specific plants off-limits to most and giving the rights of production and distribution to a privileged few, however, does not seem to be the solution. The “war on drugs” appears to be about cultivating generations of chemically dependent people and waging war on them. This does not seem to be improving the situation.
To some extent, however, nearly everyone could be considered subject to this control. It seems that even though much of society believes themselves to be “free” individuals, many are living in conditions similar to those of a domestic abuse victim. For example, imagine you are operating your vehicle in a safe and reasonable way and you see a law enforcement officer. Does your heart start to beat rapidly? Does your breathing become quick and shallow? Do you become anxious and hyper-vigilant? Although many would consider themselves safe drivers who do not endanger others and report no accidents, quite a few have had the unfortunate experience of being stopped, intimidated, and fined under penalty of incarceration for their “illegal” behavior. For many, the response to being around law enforcement officers is not dissimilar to that of the domestic violence victim around her abuser. It goes beyond that as well.
Many do not agree with the wars being waged overseas and on the homeland in the name of “America.” Many do not consent to the amounts of tax money spent on political campaigns, politicians’ salaries, vacations, and lifelong pensions. Many do not agree with the mandatory curricula taught in public school systems or do not agree with the methods of teaching. Many do not believe an economy propped up by lobbying, gambling, and deceptive manipulation can be sustained. Many do not agree that initiating force, fraud or coercion is a good solution or that the current legal system does much to actually rehabilitate or restitute. Despite this, the same people often continue paying to support things with which they disagree. Taxes are taken from paychecks and “registration”, “licensing”, “processing” and “certification” fees are paid. It seems people do so because they do not want to leave this country, yet also do not want to be imprisoned. Without some form of independent wealth, there seems to be little other way to survive in the world. It appears this is the problem many face. “No way out,” “powerless”, “controlled”, and “stuck” supporting things to which they do not actually consent . Is this not similar to domestic violence victims who feel they may lose their lives if they try to leave the relationship?
In concluding this article, this writer is motivated to try to propose a solution to this highly concerning situation, however, it seems difficult. It could be argued that the nature of “addiction” is far different from what many have come to believe. The most destructive behavior continuing despite negative consequences seems to be the support of an abusive relationship. This dependence seems based on fear deeply ingrained in society. To change this, a relationship paradigm based on non-aggression would need to be embraced. An understanding that aggression is not the answer to solving problems would need to permeate the collective consciousness and people would need to start respecting and honoring one another, not attempting to forcefully fix or change them. This writer proposes that the more individuals can view each other through a lens of empathy and compassion and less through a lens of greed and dominance, the safer and healthier society could become. This is true with regard to working with people who are labeled “addicts”, but also true with regard to interacting in healthy relationships in general. This understanding is reflected in Alcoholics Anonymous’ Serenity Prayer for “the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”