Going back to NIDA and ASAM’s definitions we should note that both definitions use the word the ‘chronic’ when describing addiction as a disease. So what does the word ‘chronic’ mean?
Unlike an acute illness (which can be eliminated by medicine or by the body’s immune system) a chronic illness is one that doesn’t go away. In other words – it’s probably incurable. And while that sounds like bad news it’s actually quite common. Many diseases are chronic conditions (such as diabetes for example). The good news is that when chronic diseases like addiction and diabetes are treated effectively the symptoms go into remission and the person can lead a relatively normal life (providing they continue treating the illness).
This is a very important point for people who are living with addiction to understand because it explains why people still relapse after years of sobriety. When you begin to unpack the reason for a person’s relapse, it almost always comes down to the same thing. They stopped taking the illness seriously because they thought they were cured!
The two distinct areas of addiction treatment are:
- Medical interventions
- Ongoing psychological support (such as psychotherapy or mutual aid groups like Alcoholics Anonymous)
Obviously if an addicted person has been using a dependence forming substance like alcohol or opioids for some considerable time period, then they will most likely be physically dependent on that drug and will require medical supervision to reduce or taper themselves completely off that drug. But it is important to note that removing the physical dependency does not remove the addiction for all the reasons we have noted. Addiction is a condition that most likely exists before, during, and after any relationship you might have with a particular drug. Ultimately, addiction is not to do with drugs. It is to do with self-medicating unrewarded feelings. If we don’t address this underlying fact, then another source of brain dopamine will rapidly replace the one we have just removed (such as smokers who quit and then go on to gain massive amounts of weight due to overeating – just to give one example).
The prognosis (outcomes) for addiction treatment are actually very good. Studies have shown that abstinence results in bursts of neurogenesis (re-growth of brain cells).8 The important thing is that you understand that the addiction isn’t gone in two weeks after having a detox. It will always be there due to the amount of dopamine driven cues and associations that are retained by your brains memory and learning systems. Should you be tempted to try a bit of ‘controlled’ drug use, you will most likely find that your brains reasoning faculties (PFC) let you down eventually. Therefore, it is best to come to terms with living with the illness, and working what is known as a program.
A program is way of living that seeks to find healthy, long-acting, and slow release sources of brain dopamine. This could include many things but below are a few common examples:
- Boosting your self-esteem so you don’t feel ‘less than’ others – Stopping drug use is the first part of this process, and starting to re-build your life is the second.
- Bringing an end to your isolation – by belonging to a group of some sort that you can identify with, such as a support group or sporting activity*
- Increasing feelings of meaning and purpose – common examples would be spiritual or religious practice such as becoming interested in meditation retreats or re-connecting with your cultural faith.
- Being of service to others – helping others and locating our interest outside of ourselves seems to be highly dopamine reinforcing. It’s as though we are doing something of great importance. As the saying goes – “help one person – help the whole world”
*See further reading & resources for a list of self-help organizations relevant to addictive disorders.