Addiction is a neurobiological disease (a disease of our nervous system) characterized by an overpowering desire and repeated compulsion to consume a substance or engage in a behaviour despite negative consequences.
When we hear the word addiction we usually think of drugs and alcohol, but people can become addicted to processes too. These are known as the behavioural addictions, and they include gambling, eating, sexual addiction, and compulsive spending.
The American Medical Association recognized addiction as a neurocognitive disease in the 1950s. When a person is addicted, whether to a substance like drugs or alcohol or to a behaviour like gambling, there are changes that happen to their brain chemistry and circuitry that persist beyond intoxication. These changes cause the person to have serious difficulties controlling any behaviours related to their substance or behavioural addiction.
Addiction is not a choice.
Addiction involves behaviours (drinking, drug use, eating, gambling) that are voluntary in nature. It may seem like the person is deliberately choosing to engage in these destructive behaviours or that they don’t want to get well or change. However, the brain changes caused by addiction can mean a person is unable to exert control over these voluntary behaviours.
How Can I Tell If Someone is Addicted?
Doctors often use the “Three Cs” as a shorthand when assessing addiction. The first C stands for craving, which is the powerful desire and urge to use. In active addiction, a person becomes intensely preoccupied with their substance or behaviour of choice. It is difficult for them to think about or enjoy anything else. Craving is also an emotional experience. Someone who is addicted might feel anxious if they are unable to access their substance of choice (for example, they might not want to go somewhere in someone else’s car because they are worried they won’t be able to leave if they feel the need to drink or use). A person might become irritated or upset if their consumption is delayed or interrupted; for instance, they might be annoyed if a server takes too long to bring their drink order, or angry if the bar is shut down at a work party.
The second C stands for control. This refers to the repeated compulsion to use or engage in a behaviour; this impulse is experienced as so overpowering that a person feels unable to manage or control it. A loss of control might look like trying to quit but being unable to stop. Or it could look like trying to manage the behaviour but not being able to do so. This might mean planning to stop gambling when down by 50$ but going back to the casino to try to break even, or intending to drink only one glass of wine but not being able to stop until the bottle is empty. It could mean wanting to be home by 11 p.m. but staying out until 3 in the morning, planning to consume only cannabis but opening a bottle of wine once high, or trying to drink only on weekends but not being able to make it past Wednesday.
The last C is for consequences. These are the troubling and disturbing outcomes of a person’s addiction. Consequences include conflict in their personal relationships, negative impacts on mental and physical health, debt, trouble with the law, or difficulty managing the responsibilities of work and school. Often, people assume that someone cannot have an addiction if they are still working and have a roof over their head, but this is not true. Many people with addictions are functional for most or all of their active substance addiction. In fact, of all the consequences, loss of employment is often the last outcome to occur.
My Friend Has a Problem. Why Can’t They See It?
Often when people are in active addiction they cannot see their own loss of control. For example, someone might say “I changed my mind about coming home by 11pm because I was having so much fun. I knew I could use a sick day anyway”. In active addiction, it is also hard for people to associate the consequences they experience with their using. Someone might say: “I was fired because I was late too many times” – not acknowledging that they were usually late because they were hungover. Someone with an expensive cocaine habit might say “I got into debt because my car needed costly repairs”, not acknowledging that their cocaine use eats up most of their paycheque. The inability to recognize the reality of one’s condition is actually a key characteristic of addiction. The medical term for this is anosognosia, but you may recognize it by a more commonly-known expression: being in denial.
When Should Someone Get Help With Addiction?
This is an important question because people in active addiction often do not recognize that they have a problem. What’s worse, because addiction is a seriously stigmatized condition, therapists, doctors, HR managers, and other professionals may be reluctant to even ask someone about their drinking or using, let alone let them know that help is available. In fact, many people tell us that they sought professional help for years before anyone else suggested that they needed help with their drinking, substance use, or behavioural addiction.
This is a shame because like all mental health diagnoses, addictive disorders occur along a spectrum from mild to severe. The disorder tends to progress over time, and the earlier in the progression that a person seeks treatment, the better their outcomes for long-term recovery.
People still associate addiction with the most severe stages of progression, which is the point where the disease is most resistant to treatment. The negative stereotype of the alcoholic living under the bridge is inaccurate; that is the most severe end of the spectrum and accounts for only a small proportion of people with this disease. The suffering person with an addiction is also among our friends, neighbours, employees, co-workers, loved ones, and family.
I Know Someone Who Needs Help With Addiction. What Can I Do?
At Renascent we have successfully treated people at all stages of the disease, for all forms of behavioural and substance addictions. If you think your friend, loved one, colleague, or employee needs help, reach out to us. We can let you know what type of treatment might work best and help you compare different treatment options. We will support you in figuring out how to start a difficult but important conversation with the person that you know needs help.
If you are the one struggling, don’t wait. Call us today to see if we can help. There is no need to suffer any longer. Wherever you are on the spectrum of addiction, we understand and help is available.
A portion of this article is adapted from an excerpt from the upcoming book Hope Against Hope, authored by Renascent’s Clinical Director Michael Lochran and Consulting Psychotherapist Laura Cavanagh, and anticipated for release in 2022.