What is Addiction?
What Causes Addiction?
What is the Difference between a Habit and an Addiction?
What Are the Distinguishing Features of Addiction?
Why aren’t Negative Consequences Sufficient to Bring about Lasting Change?
What Should Women Know About Substance Use/Abuse?
What Should the Older Adult Know About Using Substances?
WHY Are Some People Reluctant to Reach Out for Help?
Why is it that You Seem to be Grouping all Addictions Together?
Is Addressing My Addiction Enough?
What about my Family Members?
What is Addiction?
It is a persistent behaviour of any kind that results in negative consequences and craving.
A more detailed response is included for those who may be interested in reading additional information for each question.
Addiction can be defined as any persistent behaviour whether it be alcohol or drug use, gambling, shopping, or any other compulsive pattern of behaviour in which the individual feels an overwhelming urge to engage in the behaviour and therefore continues it over time despite the negative consequences to self or others.
What Causes Addiction?
Addiction results from a complex interaction of physical, emotional, social, and environment factors. The combination of factors is different for everyone.
There are many reasons why people become dependent on substances or excessive behaviours. These include
- Genetic vulnerability plays a small role.
- Social and emotional factors, and past learning experiences all play a significant role.
- Personal characteristics:
The qualities that make you the person you are - interact with the people, events and day to day stresses of your life. Perhaps at one time having a drink, gambling or shopping made you feel more positive, more in control. You felt confident, attractive and perhaps, best of all, you felt a surge of positive energy and anticipation. You enjoyed those feelings and kept adding more of the substance or activity into your daily routine.
- Increasing engagement.
Perhaps you began to experience a need to stay engaged with the substance or activity for longer periods of time- almost a feeling of not being able to tear yourself away regardless of any responsibilities.
- Addiction occurs:
The substance or activity becomes your habitual response in almost every situation and without it, you experience craving. Unpleasant consequences begin in accumulate in your life. The behaviour that once seemed to support you through many of life’s experiences has, itself, become a huge problem.
What is the Difference between a Habit and an Addiction?
A habit is a routine behaviour of any kind that does not promote craving. The costs and benefits are about equal.
Behaviours can be placed on a scale or continuum depending on their frequency and the intensity of the relationship.
Continuum of Engagement: Addictive Behaviour
Initial Engagement Engagement Builds Intense Engagement Some Negatives Craving/Negatives
(1)_______________________________________________(5)_______________________________________________(10)
Appropriate Moderate Excessive/Severe
Continuums flow back and forth.
At the (1) end of the continuum and individual’s engagement with the substance or activity is occasional and appropriate. There is no intense relationship developing. No feeling of needing engagement that keeps getting stronger.
At the (10) end, it can be devastating to one’s health, relationships, and even one’s life. Despite the negatives, craving keeps driving the individual to continue with engagement. This is a severe or intense relationship.
Gambler A
Gambles once a month - occasional and appropriate – an enjoyable habit.
Gambler B
Gambles 18 hours every day - severe and excessive - no longer a normal routine of life. Not a habit.
In the above example, we have no difficulty identifying the individual who would be in the appropriate to moderate range on the Continuum of Use & Engagement Scale. We also easily recognize who would be at the upper levels of the scale and experiencing craving and negative consequences. We know which individual is in serious trouble because of the intensity of his or her relationship with gambling
- Habits, reside at about the 1 or 2 level on the continuum of engagement. The individual feels no life or death need to continue or escalate the behaviour – no overwhelming desire. He is not addicted. Example- purchasing a few needed items at the mall is a normal routine habit.
- Habits can escalate. Example - you can’t afford to put food on the table and your home is in mortgage default because of your shopping behaviour. Regardless of the consequences you keep on shopping. This is no longer a normal, routine habit.
- A habit can become an addiction when it is used excessively to cope with situations in life and the craving and negative consequences are adding up as a result.
Remember, it’s about the severity or intensity of the relationship and the craving that keeps the individual engaged with his or her choice of behaviour despite escalating negative consequences. The relationship doesn’t have to be pleasant. It just has to be in charge.
- The Continuum of Use is not a one-direction-only-progression. One can move along the continuum, up or down.
With help and support someone at the severe level of engagement can move down the continuum to a normal or occasional behaviour.
Someone who is at the appropriate and occasional level today may, under difficult or extreme circumstances, move up the continuum to the severe or dangerous level next year.
- It is all about the relationship – the strength of the desire to engage that the individual has with the substance or activity.
Take it or leave it experience – no craving, no negatives, no problem.
Must do it/must have it relationship – severe craving, many negative consequences, big problem. This individual is engaging at the upper end of the continuum and may be addicted.
Bottom line, if I must have this experience regardless of the negative consequences, at any price to myself or others, we can say addiction is present.
Please Note: The terms, addiction and dependence can be used interchangeably, but incorrectly.
The addict is dependent on the substance or behaviour. Without it he will crave it until he once again can engage in substance use or excessive behaviour. He has experienced negative consequences but every time the behaviour comes to mind, craving and anticipation begin to build. He is addicted.
The diabetic is dependent on daily insulin. He depends on it to live. He feels no craving to have more and more. He is not addicted.
What Are the Distinguishing Features of Addiction?
One or more of these features (usually more) will be present with addiction.
- Compulsion:
The urge, the craving, the overwhelming need, to engage in the behaviour whether it be using alcohol, drugs, gambling or any other excessive behaviour.
- Preoccupation, Obsession or Fixation:
The individual can’t stop thinking about the behaviour. It battles with thoughts that reflect his or her better intentions, but eventually the urge to engage in the behaviour rules the day.
- Persistence:
Despite every intention to stop or cut down, the behaviour happens over and over again.
- Negative Consequences:
The individual has experienced many negative consequences when engaging in the behaviour. Employer threats, family quarrels or breakdown, legal and financial hardships, tremendously embarrassing or endangering situations to self and others, all fail to bring about lasting change.
- Relapse.
“This time will be different” dialogue leads the individual into yet another ‘repeat it again’ situation.
- Impaired Control:
“Just one or at the most two” refrain is heard over and over again. An individual may be able to control the behaviour in certain high demand situations like having dinner with the employer, but he or she can not guarantee it 100% of the time. Usually it’s a no-win situation.
Why aren’t Negative Consequences Sufficient to Bring about Lasting Change?
- How we want to feel:
Everyone wants more than simple survival. We all want to live fully and feel life vividly. For some, using substances and/or excessive behaviours seems like the only way to achieve this desired feeling of ‘aliveness’. Despite the ever growing list of catastrophes, the addicted individual fears the loss of the substance or activity beyond measure. Having any quality of life without this powerful relationship seems impossible.
- Triggers and high risk situations.
Over time, an individual comes to associate the experience with certain cues or triggers and anticipated rewards ---for example, a clock signals quitting time at work. The individual responds to the trigger by looking forward to the substance or behaviour as he or she has done so many times before. Craving sets in. Because the rewards of engaging in the behaviour happen quickly – the high for example, craving and anticipation quickly build.
- Defense Mechanisms:
Self-deception: Today he or she feels capable of handling the situation. “I’ll only have one then head home.”
The lie of entitlement: “I deserve a drink after the day I’ve had.”
Rationalizations: “Jim gambles much more that I do. He’s the one with the problem”.
Minimization: “I don’t shop that much. It’s all stuff that the kids need anyway. If we didn’t need it, I wouldn’t buy it.”
Denial: “I don’t know what the big deal is all about. Everyone drinks like I do. I don’t have a problem.”
Positive anticipations and renewed feelings of entitlement, overcome any thoughts of the later negative consequences. Craving is in charge. Overcoming the craving seems impossible at this moment, and the individual usually gives in.
- Can’t live without it:
Fear of being told to relinquish the behaviour entirely is unimaginable.
Not everyone needs to give up the substance or behaviour completely. Some do.
Everyone requires assistance in determining where they stand.
What Should Women Know About Substance Use/Abuse?
Alcohol and other drugs affect women’s bodies in very specific ways.- Women develop problems related to alcohol use within a shorter period of time.
- Women substance users are at increased risk for certain health concerns. For example, women smokers are more likely than men smokers to develop lung cancer.
- Women who use alcohol and other drugs may experience problems related to their reproductive systems.
- Substance use/abuse during pregnancy can result in miscarriage or serious harm to the developing fetus
- Women are twice as likely as men to receive mood-altering prescriptions for “emotional” problems from their physicians.
- Women are more likely than men to combine alcohol and prescription medications thus increasing their risk for negative health and social consequences.
- 40 to 80 per cent of women who enter treatment programs for alcohol and other drug problems report having experienced physical or sexual violence at some time in their lives.
- Women are more likely than men to be victims of negative stereotyping and double standards.
What Should the Older Adult Know About Using Substances?
- Even small amounts of alcohol can worsen some health conditions such as diabetes, heart or blood pressure problems, liver or stomach conditions.
- Older adults are usually more sensitive to the effects of mood altering substances.
- Alcohol reduces alertness, co-ordination, judgment and reaction time increasing the risk of falls or accidents.
- Older adults are prescribed tranquillizers and sleeping pills more readily than younger adults. Using alcohol in conjunction with these medications can be deadly.
- Older adults are more likely to use prescribed and over-the counter medications at the same time.
- Older adults are affected by different life issues than younger people. Personal losses and aging stressors can be devastating. It is certainly very understandable that the individual might seek a substance or activity to alleviate such painful concerns. These issues must be addressed during the counselling process or the individual feels that the therapist is just another person, in a long list of people, who simply fail to understand his or her reality, feelings and needs.
WHY Are Some People Reluctant to Reach Out for Help?
-
Time Constraints – People often fear that seeking assistance will mean an extended time away from home or work in a treatment facility.
- Confidentiality – People are concerned that reaching out for help will “advertise” their problems in public manner. Often they fear that a group setting will undermine their anonymity.
- Treatment Goal – Many individuals are apprehensive about having a treatment goal imposed on them that they find initially unacceptable.
- Treatment Labels – Many adults resist the stigma of having to accept or being labeled an “addict” or “alcoholic”.
- Negative Stereotypes – Assumptions and generalizations are often made about older adults and women that result in a patronizing assessment of their personal experiences.
- Double Standards – Women worry that others will judge them by a more exacting moral standard than their male counterparts.
- Lack of Identification – People often feel alone with their difficulties. They are concerned that no one will understand or accept their unique problems and life experiences.
- Fear of Judgment – Individuals who abuse alcohol and drugs or engage excessively in other behaviours are frequently racked by feelings of guilt and shame. Because they judge themselves so harshly, they fear others will do the same.
Many Experts Consider Alcohol or Drug Addiction a Stand-Alone Disease. Why is it that You Seem to be Grouping all Addictions Together?
- Addictions are not a collection of different disorders. They are an expression of a single underlying process that can be expressed in many ways.
- All addictions, substance related or not, share similar states of mind such as craving and shame, and behaviours such as deception, manipulation and relapse.
- All addictions involve the brain’s pleasure pathways.
- Any activity that creates increased motivation – that feeling of intense anticipation – and then rewards the motivation with a feeling of elation or euphoria when engagement occurs (like shopping or gambling) is active in the same region of the brain as alcohol or drugs.
- People assume that behavioural addictions are less destructive than alcohol or other drugs. The devastation to the life of a severely addicted gambler may be such that he or she has lost virtually everything and everyone. By then, health is destroyed and life on the streets may well be the only option. Again, it is a question of degree or severity. The hard core drug user is at the extreme end of the continuum just as the gambler is.
- Milder addictions, either substance related or behavioural can also cause serious problems in life. Remember, an individual can move up or down on the continuum.
Finally, the pursuit an individual is most affected by – alcohol, gambling, shopping, internet addiction and so on is a matter of personal choice based on his or her past experiences and temperament.
Is Addressing My Addiction Enough?
It might be helpful if you begin to think of changes in your addictive habits as the first step in a new, lifelong process of personal growth. With encouragement and support you begin the process by making changes in troublesome behaviours, restoring a balanced approach to living life and expanding your horizons in many new and exciting directions.
It’s important to begin to get an understanding of the personal factors that seem to have set you up for addiction. You begin to reflect on your life. Was the manner of living and growing in your household like other kids you knew? If not, what was different? What did your home feel like? Was it safe and comfortable to be your own person or was it fearful and tense? What impression do you think these differences made to your developing belief system and emotional well being?
As we begin to make positive changes in our lifestyle and habits, these changes have a nurturing influence on our self-awareness, confidence and self-esteem. It becomes a self-generating process. Making changes in mood-altering behaviours is the necessary first step.
What about my Family Members?
Your family members and loved ones probably believe that once you have changed the addictive pattern of behaviour, all of their difficulties will be solved as well. Unfortunately, problems in the family and in other significant relationships do not magically resolve when the situation improves. Just as addressing your troublesome behaviour is a first step toward building a confident, healthy and rewarding life for yourself, your family members must engage in a similar life process for themselves and for the family as a whole.
If change is to last, new patterns of interaction must be developed that are flexible and respectful of every family member’s needs. In addition, family members and other loved ones will frequently need help in validating and making sense of their own thoughts, feelings, values and attitudes as the ever-changing situation they find themselves in continues to unfold.
