The Disease of Addiction

When I started going to school for addictions counseling, I had a dream and a desire. Much like when I started nursing, I wanted to help people. Nursing, I did because I saw all the awesome nurses (my Mom included) who took care of my Dad when he was battling cancer. I wanted to be one of those people who sat by a patient's side, helping them get better. 

Once I got into the thick of things with nursing, I was quick to realize that things out in the real world are much more difficult than that romanticized version I was playing out in my head. I walked on the floor to find a 3 hour med pass, 30 patients, detached and disillusioned staff and my dreams of being "that nurse" fading into oblivion. I made a promise to myself, however, no matter how bad things got, I wanted to be a good nurse. I did that, for the most part. 

I think I had the same vision with going into addictions counseling. I wanted to help people get into recovery. Living a life of addiction is so lonely and hard. I wanted to be out there educating about addiction, helping people find resources. Well, I have hit about the 5 month marker in the field and I believe I am having a bit of a "nursing" moment now. I am realizing the reality in the world of addictions counseling. It's a bit of bitter pill to swallow. Fortunately, I made the same commitment to myself in this field as well. No matter what the scenario, I will do the best that I can. 

It's a good thing that I am feeling more steadfast in my beliefs and values than I did when I first started school. In early recovery, I was very much interested in finding out who I really was. The alcoholic Julie was a basketcase on good days and raging mess on bad days. Now that life wasn't like that anymore, who is Julie? Just an alcoholic? Just a nurse? Just a human being without a path? It took a full year of soul searching and reading to figure out that sober Julie is going to be force to be reckoned in all the right ways. I was going to take the addictions world by storm and make a difference. Grad school was the first stop to making this happen. Now what?

For the first time in my paid career, I found that I am at ideological different place than many in the addictions field.  I was a bit naive to think that my ideas and conclusion were that of all other professionals in the field. So, I want to have a frank discussion about the one thing I will not budge on when it comes to the discussion of addiction. Addiction is a disease of the brain. 

I wrote a blog while I was in grad school about the disease model. I really felt that by giving addiction the title of a disease was kind of a cop out. It absolves the addict of responsibility. "I have a disease I can't help it." A few years later, I believe I have solidified this belief 100x over. Yes, you have a disease, but, YES you can do something about it. Why is addiction considered a disease in the first place?

In really basic terms, the brains of addicts process drugs and alcohol different than our friends we all "normies" in addiction-land.  In more complex terms, please follow this link below - gets really nitty gritty on all the science. 

http://science.education.nih.gov/supplements/nih2/addiction/guide/essence.htm

The imaging between addicts and non-addicts shows fundamental changes in the way the brain processes things. The "reward" area of the brain becomes corrupt. The reward center of the brain is a primal part of the brain. If you ever watch Celebrity Rehab, Dr. Drew put it nicely "The brain actually believes it is dying without the drug...." which makes it pretty hard to stop.
 "How Does Addiction Take Hold in the Brain?
The rewarding effects of drugs of abuse come from large and rapid upsurges in dopamine, a neurochemical critical to stimulating feelings of pleasure and to motivating behavior. The rapid dopamine “rush” from drugs of abuse mimics but greatly exceeds in intensity and duration the feelings that occur in response to such pleasurable stimuli as the sight or smell of food, for example. Repeated exposure to large, drug-induced dopamine surges has the insidious consequence of ultimately blunting the response of the dopamine system to everyday stimuli. Thus the drug disturbs a person’s normal hierarchy of needs and desires and substitutes new priorities concerned with procuring and using the drug.

Drug abuse also disrupts the brain circuits involved in memory and control over behavior. Memories of the drug experience can trigger craving as can exposure to people, places, or things associated with former drug use. Stress is also a powerful trigger for craving. Control over behavior is compromised because the affected frontal brain regions are what a person needs to exert inhibitory control over desires and emotions.

That is why addiction is a brain disease. As a person’s reward circuitry becomes increasingly dulled and desensitized by drugs, nothing else can compete with them—food, family, and friends lose their relative value, while the ability to curb the need to seek and use drugs evaporates. Ironically and cruelly, eventually even the drug loses its ability to reward, but the compromised brain leads addicted people to pursue it, anyway; the memory of the drug has become more powerful than the drug itself."
~http://science.education.nih.gov/supplements/nih2/addiction/guide/essence.htm~

I did believe for a short while that calling addiction a disease took away the responsibility. However, it really does not. If I have a bum pancreas or heart, I have a disease right? The doctors are going to give me all sorts of medical, physical and dietary changes to combat my issues. Eat better (healthier, less carbs, less processed food), start exercising more, stop smoking and/or drinking, reduce stress. You want to know the ironic thing? These are all the things we will tell a newly in recovery addict to do. Among other things like support groups. Diabetics have support groups. Cancer has support groups. Not many people make fun of those on TV, just alcoholics. They have "funny" traditions. We ask our addicts to make life changes and just like diabetes and cancer and obesity and organ failure, and, and, and there is a lifestyle change that needs to happen in order for the condition to improve. 

So, I have a lifelong condition that needs daily monitoring. That description could really be any disease. Just recently, I have been in contact with folks who are not interested in having the discussion about addiction as a disease. Not really into the whole "disease"thing. My thought is to present the information we have and let the client decided what they believe. There is always more than one way to view a condition. My questions usually to the non-addiction-as-a-disease crowd - then what it is? Mental illness has been proven over and over to be a chemical imbalance of the brain. That falls under a disease to me. So, if you call addiction and mental illness (which I also believe this too) we are still talking about a disease. With mental illness the same lifestyle changes are request in conjunction with medications. Less stress, eat better, get exercise, be a routine in order to minimize exacerbations of a mental health condition. 

I would hope as a society, we have turned away from addiction as a moral issue. Although, that is probably very wishful thinking on my part. There are still lots of whispers when someone says "I went to rehab...." AA had the hopes of getting people to understand that addiction was not a moral failing. It doesn't affect just one "type" of person. Rich, poor, celebrity, guy under the bridge, mothers, fathers, sisters, brothers, presidents....anyone can suffer from addiction. I think we are slowly getting there in helping people understand what is going on when someone becomes addicted to drugs and alcohol. Because people addicted to drug engaged in amoral activities, it is easy to assume that there is something "morally" wrong with this person. If you talk to an addict though, they will often say "I never thought I would do something like that. In the moment, I just went with it because I thought it would make me feel better." I had a line in the sand that I was never going to drive drunk. Well, I crossed that barrier 4 years before I stopped drinking. The only time I drove drunk is when I needed more alcohol. The idea of sitting the rest of the evening without liquor versus driving to the liquor store 10 blocks away? Liquor always won. I was a woman under the influence. I made stupid and bad decisions. If you had taken a snapshot of my brain when I was making those decisions, I believe that my "business brain" would have been dark as midnight. I am a moral failure? I sure felt that way the next morning and drank even harder the next night to quash the guilt I felt, only to promise to never do it again. Then when it happened again, I just cycled out of control. 

The shame of thinking I was a moral deviant kept me from getting into treatment. I had this idea that the world was going to hold me back once I admitted I was, indeed, an alcoholic. I was truly shocked when I got into treatment the first time to see this whole list of things that people do when they are addicted. There was an established pattern of behavior associated with addiction. I had done everyone of those, for sure. I was out of control and that was because I was stuck using. Once out of that pattern, I had the opportunity to make different and better choices. I am not a bad person. I am a person with a disease. I choose to follow my brothers and sisters before me to do something different. I manage my disease. I just will not back down on my stance that addiction is a disease. It is one of the many incurable diseases out there.  However, we, as addicts, have a much better chance at living a long and prosperous life. In order to get to that life, we have to understand what brought us down in our addiction. It is not that you are a bad person, or that you are a person with no will power. You are not weak willed or stupid. You are not your addiction. If you keep using and search for no other lifestyle, you will surcumb to your addiction. I was well on my way to drinking myself to death. For those of you who cannot possibly conceive why person would do this? You don't suffer from addiction. The idea of a life without alcohol was so terrifying that I would protect my relationship with it over all other things. 

The journey is not easy, but let me tell you ~~ You have a disease that can be managed. In the past four years, I have done more positive things for my life than the previous 18 years combined. I have released active alcoholic Julie into sober Julie, proud recovering alcoholic with a serious agenda. Before the "normie" get out there and tell us everything is wrong with us, please do your research.

Hugs & Kisses 

Julie

---