Addiction is deadly and has an arsenal of means with which to kill. The actor Phillip Seymour Hoffman was recently found dead in his apartment with a needle in his arm of an apparent overdose of heroin. It would be more accurate to say that he committed suicide. He had relapsed about a year earlier after 23 years of sobriety.
One of the many problems with addiction is that when you relapse, you don’t start over as a first-time user. You start where you left off.
According to the American Society of Addiction Medicine (ASAM), addiction is characterized by:
“an inability to consistently abstain, impairment in behavior control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.” (www.asam.org)
The “inability to consistently abstain” is a concept that sometimes confuses loved ones and family members close to the addict. They wonder, “how is it possible that the addict can eventually abstain if addiction means that’s something they can’t do?”
The confusion is understandable. On their own, addicts lacks the ability to consistently abstain without help. Most would stop their compulsive behaviors on their own if they could. It’s just that most can’t do it alone.
An addict’s inability to consistently abstain or practice behavior control manifests in many ways. He may make promises to himself that he won’t do a particular behavior again or tell himself that after a certain date in the future he will quit. Of course, these promises are rarely kept.
The craving for the addictive substance or behavior increases over time and the addict usually experiences an increased tolerance. If he’s an alcoholic, he may require more alcohol to get the same level of intoxication.
In sex addiction, the addict may increase the time spent engaged in a particular sexual behavior over time or he may begin to engage in increasingly more risky behaviors to get the same level of intensity or “high.” “Acting out” is a commonly used phrase to describe the addict’s compulsive behaviors.
Because of the inability to recognize the extent of the problems related to their behavior, addicts usually experience serious life consequences.
They have chronic feelings of low self worth and shame due to the secret, double lives they lead. They often suffer from under-performing at work due to preoccupation or a “hangover” effect from having recently acted out or binged. They may even lose their job due to poor performance or for violating employer policies.
Addicts may suffer financially because of work-related issues or spending large sums of money on the addictive substance or behavior. Some addicts manage to avoid financial or career consequences but their intimate relationships are almost always negatively impacted.
There are two primary types of addictions: substance addictions and process addictions.
Substance addictions include alcohol and illegal drugs or prescription medication. Process addictions are different than substance addictions because they involve a set of behaviors rather than the ingestion of a substance. Examples of process addictions are gambling, food disorders and sex addiction.
In many ways, process addictions (especially food disorders and sex addiction) are more challenging to overcome because they involve normal, healthy human behaviors. In alcohol and drug addiction treatment, abstinence is simply abstaining from alcohol or drugs. On the other hand, it is not realistic to abstain from food or for the average person to choose not to be sexual for the remainder of his life.
Addiction is considered a life-long, chronic issue similar to medical conditions like diabetes.
There is generally consensus among mental health and other professionals who work in the field of addictions that they are never “cured.” However, they can be managed with guidance and support, usually in the form of counseling, psychotherapy, 12-step groups, and in more serious cases in-patient treatment. The phrase “once an addict, always an addict” is the approach most addicts and treatment professionals take when working with addiction.
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© Vicki Tidwell Palmer, LCSW (2014)