What is Addiction?
In its report on neuroscience of use and dependence on psychoactive substances the World Health Organisation (WHO) defines addiction as an illness which is both emotional and physical with a genetic predisposition. Other organisations such as the National Institute of Drug Abuse and the American Society of Addiction Medicine also define addiction.
At Fundación RECAL we define addiction as a disease – because substance abuse or addictive behaviours modify the structure and function of the brain. The characteristics are:
- Primary: It is not a consequence of other diseases,
- Chronic: As it persists over a long period of time
- Progressive: Cumulative physical, emotional and social changes which grow whilst the abuse continues
- Fatal: Fatal consequences for the addict themselves and eventually people around them.
Addiction does not only destroy the lives of the addict, but also of their loved ones. We estimate that for every addict at least three more lives are affected, be it those of their parents, partner, spouse, siblings, children or colleagues etc.…
To help better understand the disease it can be broken down into two illnesses: a physical illness and a mental illness.
Over time the physical illness causes what can be considered an ‘allergy’ to substances, be it alcohol or drugs. This ‘allergy’ means that the addict cannot stop using a substance despite the fact they are slowly becoming more and more intoxicated by it.
Many people suffer from allergies to seafood, wheat and milk as well as many other foods, and whilst they will not eat them again, the problem and difference comes when the addict continues to consume with no concern for the consequences such as loss of work, family, money and even their own life. This is the mental illness. Addiction is formed from two concurrent illnesses; the physical, which forms the allergy or compulsion and the mental, which causes the addict to repeat the process, the obsession.
Addiction is characterised by continuous or periodic uncontrolled episodes, despite the negative consequences, and also due to the distortion of thinking, in particular the denial of the disease and its consequences.
This definition is based on our own experience with people suffering from a wide range of addictions and also on professional and scientific opinions such as that of the World Health Organisation (PDF→).
Development of an Addiction
THE MOST COMMON SEQUENCE OF EVENTS WHICH SOMEONE GOES THROUGH WHILST DEVELOPING AN ADDICTION HAS FOUR CONSECUTIVE STAGES:
EXPERIMENTATION → Use → Abuse → DEPENDENCE
Initially, the person begins to use drugs or behaviours as a means to escape or ‘be ok’ and gradually the routine or drug becomes necessary to ‘be normal’ until its abuse allows the user to ‘be normal’ for shorter and shorter periods of time.
In addition, addiction is a disease that affects the person in various ways at once:
Spiritual, a loss of connection with oneself and others due to what is occurring. According to recent studies this is defined as a loss of ability to contact and connect with oneself and others.
The Recovery Process
Our experience with patients and families which we have accompanied, both in and after treatment, is that the degenerative and destructive process can be stopped, and the addict and their family environment can begin what we call their RECOVERY process which allows the addict to stop using, and begin to live without their drug or behaviour of choice. There is a notable and sustained improvement of those affected in all areas of their lives.
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OBJECTIVE DATA IN THE FORM OF STATISTICS EXISTS AND EMPIRICALLY DEMONSTRATES THE REAL EFFECTS OF ADDICTION IN THE POPULATION.
The 2015 report by the Spanish Observatory on Drugs and Drug Addiction(1), demonstrates that most people are under 24 years old when they start using most substances:
- 16 years old – tobacco and alcohol
- 18 years old – cannabis
- 19 years old – inhalents
- 20 years old – amphetamines and hallucinogenics
- 21 years old – ecstasy, cocaine powder and heroin
- 23 years old – cocaine base
These statistics show a similar pattern in the different provinces.
One of the best options for individuals suffering from problems with drinking and other drugs are the treatment concepts that form part of the Minnesota Model and the 12 steps.
A recent review of five national databases (with a sample of 1582 individuals) found positive results between the attendance of AA groups and the number of days clean(2). 77% of the sample was still clean after 3 months and 74% after 15 months.
A follow up (> 5 years) of young people who received treatment with the Minnesota Model revealed that there were significantly lower levels of relapse as well as diagnostic criteria for the corresponding disorder than their counterparts in the control group (3).
In this sense, another study of more than 9000 people showed an important link between beliefs and behaviours around total abstinence and drug and alcohol consumption, within the concept of recovery that individuals had who participated in mutual self help groups (4).
Lastly, it is worth noting that this model has been particularly effective in the treatment of behavioural addictions. An example of this is seen in pathological gambling. A study revealed that 6 months after finishing treatment half of the participants showed a significant improvement and nearly 30% remained abstinent (5).
(1) OEDT, Ciudades C. Informe 2015 Alcohol, tabaco y drogas ilegales en España. Minist Sanidad, Serv Soc e Igual. 2016. doi:10.1007/s13398-014-0173-7.2.
(2) Humphreys K, Blodgett JC, Wagner TH. Estimating the efficacy of alcoholics anonymous without self-selection bias: An instrumental variables re-analysis of randomized clinical trials. Alcohol Clin Exp Res. 2014;38(11):2688-2694. doi:10.1111/acer.12557.
(3) Winters KC, Stinchfield R, Latimer WW, Lee S. Long-term outcome of substance-dependent youth following 12-step treatment. J Subst Abuse Treat. 2007;33(1):61-69. doi:10.1016/j.jsat.2006.12.003.
(4) Kaskutas LA, Ritter LA. Consistency between beliefs and behavior regarding use of substances in recovery. SAGE open. 2015;5(1):2158244015574938 - . doi:10.1177/2158244015574938.
(5) Stinchfield R, Winters KC. Outcome of Minnesota’s Gambling Treatment Programs. J Gambl Stud. 2001;17(3):217-245. doi:10.1023/A:1012268322509.
The effects of each drug and/or behaviour and their potential for addiction are also different.
The behaviour of an active addict can vary as well as the consequences of their behaviours. However, the disease has a base of common behaviours which all addicts share.
All manifestations of addiction, over a greater or lesser period of time, have destructive consequences in people’s lives. Depending on how the illness progresses other activities can seem less pleasant or intolerable in comparison because they do not reinforce the pleasure centre in the brain with the same intensity. At this point drugs or addictive behaviours become necessary for the user to feel minimally ‘normal’ and function – or survive – in their daily life – ‘use to live’. In the final stages of an active addiction, functionality is reduced to a minimum and the person affected feels lonely, embarrassed and feels a desire to die or ends up in hospital or prison.
From our experience the incapacity of a person to have healthy relationships with others and manage their emotions in a healthy way is the essence of addiction.
This is why the addiction is eventually transferred to the family exponentially and for every addict an average of approximately four family members are affected, changing the relationships between them with a range of attitudes and negative emotions, which they share with the addict and prevents their recovery to a greater or lesser extent, depending on the case:
In addition the family members involved in this process can also end up having problems in their own lives (work, relationships, obsessions, etc.)
The abnormal becomes normal, despite generating feelings of embarrassment.
The severity of the condition and the reach of the consequences for the addict and their family environment are proportional to the time during which the addiction is active:
With these fundamental points in common, the recovery process consists of starting and maintaining a process of commitment and comprehensive learning, which allows emotions and attitudes to be controlled, and healthy relationships without drugs or addictive behaviours.