Understanding Addiction
by Stephen F. Grinstead, Dr. AD, MA, ACRPS
I will be using the term addiction and addictive
disorders to discuss what the DSM-IV classifies as substance use disorders
and others refer to as chemical dependency. In this article I use the following
definition of addictive disorder: An Addictive Disorder is a collection
of symptoms (i.e., a syndrome) that is caused by a pathological response
to the ingestion of mood altering substances and it has ten major characteristics.
These Characteristics are covered below.
Euphoria
People use drugs because they work. This is true
of pain medications and other potential drugs of abuse. If a person experiences
a unique sense of well being or euphoria when they use a drug or medication,
they are in high risk of getting addicted to that drug.
Recent research shows that when a person is genetically
susceptible to being addicted to a specific drug, their brain will release
large amounts of brain reward chemicals whenever that drug is used. It
is this high level of brain reward chemicals that cause the unique feeling
of well being that many addicts experience when using their drug of choice.
In this book we will call this unique feeling of well being euphoria.
It is important to distinguish between euphoria
(the unique sense of well being experienced when using a drug of choice)
and intoxication (the symptoms of dysfunction that occur when a person’s
use exceeds the limits of their tolerance to a drug). Addicts do not use
their drug of choice to get intoxicated and become dysfunctional. The opposite
is true. Addicts use their drug of choice to feel good and experience a
unique feeling of well being that will allow them to function better.
People become addicted to this state of euphoria.
They crave this unique sense of well being. They feel somehow empty or
incomplete when they can’t feel this way. They feel deprived when they
can't experience this euphoria. They may even experience deprivation anxiety,
which is a fear that if they can’t get their drug of choice (i.e. are deprived
of it), they won’t be able to feel good or to function normally.
This positive reinforcement is biopsychosocial
in nature. Biologically the drug of choice causes a release of pleasure
chemicals that create a unique sense of well being. Psychologically, "I
come to believe the drug is good for me because it makes me feel good in
the moment." This is called emotional reasoning (if it feels good it must
be good for me). I then begin adjusting my social network to accommodate
these beliefs. "Anyone who supports my use of my drug of choice is my friend.
Anyone who challenges the use of my drug of choice is my enemy." The result
is the development of a drug-centered lifestyle.
The stronger the positive reinforcement that is
experienced when a person uses their drug of choice the greater the risk
that they will become addicted. This is because strong biological reinforcement
from drug use creates a craving cycle.
Craving
Addiction starts when someone receives a reward,
payoff, or gratification from taking the drug. This reward may be the relief
of pain or the creation of a feeling of euphoria. Because the drug provides
a quick positive reward, the person continues to use it.
With a pattern of consistent drug use people come
to rely upon the drug to provide the reward. This leads to an addictive
disorder, which is called dependence by DSM-IV. People need to use the
drug to successfully accomplish one or more life tasks. Once people become
addicted, they experience psychological distress when the thing they are
dependent upon is removed. So when people become addicted to a drug for
relief or euphoria, they experience anxiety when the drug is no longer
available. Albert Ellis calls this deprivation anxiety. The person is anxious
because he or she has been deprived of a drug that that they believe they
need to function normally.
The deprivation anxiety then causes the person
to start thinking about the drug. Obsession is out-of-control thinking
about the reward that could be achieved by using the substance. Obsession
can lead to compulsion—the irrational desire for the drug. Obsession and
compulsion combine together to create a powerful craving or feeling the
need for the drug.
This cycle of obsession, compulsion, and craving
creates a strong urge or compulsion to seek out and use the drug even if
the person consciously knows that it is not in his or her best interest
to do so. Over time this reward continues to be reinforced, leading to
an increased need for the drug. This leads to Tolerance.
Tolerance
There is a biological component to developing
tolerance. The increased need for the drug leads to drug seeking behavior.
There are also psychological and social components to this developmental
process.
On the biological level, after this drug-seeking
behavior has been established, the brain undergoes certain adaptive changes
to continue functioning despite the presence of the drug. This adaptation
is called Tolerance.
Psychologically the person starts believing that
they need the drug. When people start to experience difficulty obtaining
enough of the drug, they start feeling anxious and afraid. Socially they
begin to experience difficulty with other people because of the time and
energy they are expending.
Loss Of Control
The final stage of the craving cycle and development
of tolerance is a loss of control over drug use. The person begins to develop
an even higher tolerance for the drug. In other words, it takes more of
the drug to get the same effect. If the person keeps using the same amount
of the drug, they experience less of an effect. So the person begins using
more of the drug or seeking out stronger drugs that will give the same
reinforcing effect.
At times the drug is taken in such large quantities
that the person becomes intoxicated or dysfunctional. This dysfunction
creates life problems. At this point, if the person stops using the drug,
they will experience uncomfortable physical and emotional problems. This
leads to lowered motivation to stop the drug use.
Withdrawal
This stage is marked by the development of a specific
withdrawal syndrome upon the cessation of use. In some cases patients may
use the same or a similar drug to relieve or avoid the withdrawal syndrome.
Once tolerance and loss of control take place,
further abnormalities occur in the brain when drugs are removed. In other
words, the brain loses it capacity to function normally when drugs are
not present.
Low-grade abstinence-based brain dysfunction is
distinct and different from the traditional acute withdrawal syndromes
Low-grade abstinence-based brain dysfunction is
marked by feelings of discomfort, increased cravings, and difficulty finding
gratification from other behaviors
Low-grade abstinence-based brain dysfunction creates
a desire to avoid the unpleasant sensations that occur in abstinence.
The desire to avoid painful stimuli is called
negative reinforcement
Inability To Abstain
As a result of their experiences created by the
biological reinforcement and high tolerance, the person comes to believe
that the drug of choice is good for them and will magically fix them or
make them better. They start to develop an addictive belief system. They
come to view people who support their drug use as friends and people who
fail to support it as their enemies.
At this point the person is experiencing both positive
and negative reinforcement to keep using. If they continue to use they
experience euphoria and pain relief. This occurs because the brain releases
large amounts of reward chemicals when they use their drug of choice.
If they stop using, they experience dysphoria or
pain and suffering. They start to experience a sense of anhedonia that
is marked by a low grade agitated depression and the inability to experience
pleasure. They begin to believe that they have no choice but to keep using.
Addiction Centered Lifestyle
The person attracts and is attracted to other
individuals who share strong positive attitudes toward the continued use
of drugs (the problematic pain medication). These people usually have enabling
support systems that condone and encourage their continued use. They become
immersed in an addiction centered system.
Addictive Lifestyle Losses
The person distances people who support sobriety
and surround themselves with people who support alcohol and drug use. The
pattern of biological reinforcement has motivated the person to build a
belief system and lifestyle that supports heavy and regular use.
The person is now in a position where they will
voluntarily use larger amounts with greater frequency until progressive
addiction and the accompanying physical, psychological and social degeneration
occur. The person’s life becomes unbearable and unmanageable. They start
experiencing a downward spiral of problems.
Continued Use In Spite Of Problems
Unfortunately, this downward spiral leads to continued
drug use in spite of the consequences. This inability to control drug use
causes problems. The problems cause pain. The pain activates a craving.
The craving drives people to start using the drug to get the relief that
they believe they need.
As a result, when addicted people experience adverse
consequences from their addiction, the adverse consequences cause cravings
instead of correction. So addicted people keep using drugs to gain the
immediate reward or relief in spite of the progressively more serious life
problems.
Substance Induced Organic Mental
Disorders
The progressive damage of alcohol and drugs on
the brain create growing problems with judgment and impulse control. As
a result, behavior begins to spiral out of control. The cognitive capacities
needed to think abstractly about the problem have also been impaired, and
the person is locked into a pattern marked by denial and circular systems
of reasoning.
The person is unable to recognize the pattern of
problems related to the use of alcohol and drugs. When problems are experienced
and confronted, they begin to experience physical, psychological and social
deterioration. Unless they develop an unexpected insight or are confronted
by problems or people in their life, the progressive problems are likely
to continue until serious damage results.
Reprinted with permission of Stephen
F. Grinstead, Copyright 2004, Stephen F. Grinstead. Any use of this information
other than for patient/client education, without permission from Stephen
F. Grinstead is prohibited. For training and consultation services in Addiction-Free
Pain Management, contact Steve Grinstead at info@addiction-free.com, (916)
419-1674 or info@cenaps.com, (352) 596-8000.
Santa and The GrandsPlace
Christmas Fund Need Your Help
I know its kind of early in the year to be thinking
of the winter holidays for most people, but here at GrandsPlace we need
to start now in order to provide a christmas gift under the tree of every
child that needs on but who's grandparents cannot afford to provide extras
like gifts.
Each year when the holiday come around we tell
our children tales of Santa and reindeer that fly all over the world bringing
toys to the good little girls and boys. We hit the stores on the look out
for the perfect gift that will wow the children on Christmas morning.
But in some homes the advent of the winter holidays
just brings stress and tears. Over 20% of grandparents that are parenting
their grandchildren are living below the federal poverty level. They have
enough trouble just paying the rent and putting food on the table let alone
buying holiday gifts. Often a grandparent has to tell a child that Santa
will not be coming to their house this year. The Child is left wondering
what he did wrong that got him on Santa's naughty list this year.
GrandsPlace has teamed up with Santa to help these
families but we need your help. Each year we collect money for Christmas
and Hanukah gifts for needy GrandFamilies. Then On December first we divide
the amount of money collected by the number of children on our Christmas
List and send a check to the grandparents so she can buy gifts for her
children. Its never very much. Usually about $20 per child but a small
gift is better than no gift and the knowledge that Santa did not pass the
children by.
To donate to the GrandsPlace Christmas Fund by
credit card on PayPal log on to,
https://www.paypal.com/xclick/business=weaver4@cox.net&item_name=GrandsPlace&item_number=CHRISTMAS
This link will lead you to a web safe and secure
site we use for online donations.
OR send a check or money order made out to “GrandsPlace”
to
GrandsPlace,
154 Cottage Rd,
Enfield CT 06082
If you are a grandparent
or other Kinship caregiver that cannot provide a gift for your child please
contact me before December 1st. I encourage you to apply for other programs
like Toys For Tots and The Salvation Army in your communities but if your
child does not qualify for those please do not let him or her go without.
send an e-mail to kathy@grandsplace.org
giving the child's name, age and your name and mailing address so that
I can send a gift. All requests are confidential. No one but me sees these
requests and I don't gossip about the haves and the have nots. I cannot
promise much. Funds are very limited but I will see that each child on
our Christmas List gets a gift.
Any Questions? Call Kathy at 1- 860-763-5789
Together we can make a difference in the life
of a child.
GrandsPlace Chat Room
Want to "talk" live in real time with grandparents
and other kinship caregivers that are living the same life as you? Join
us in the GrandsPlace Chat Room! Some of us are just starting this new
adventure of parenting again and others are old hands at it. This is the
place to come laugh and cry, to find answers to your questions, get sympathy
and advice when you are down and celebrate your successes with people that
understand. Chatting is free and easy. Hope to see you there!
Chats are held nightly at 9 pm easter standard
time. Join us by logging on to http://grandsplace.org/gp2/chat.html
or http://grandsplace.org/gp2/chat.html.
Both sites will take you to the same chat room. For people like me that
are time zone challenged it's:
9pm Eastern time
8pm Central time
7pm Mountain time
6pm Pacific time
Recipe Of
The Month
New-Style
Chicken Waldorf Salad
