The Reality of an Undertreated Disease
Addiction is incredibly complex, but it is also surprisingly common and can have profound effects on a person’s life. In addition to compulsive behaviors such as those related to gambling, food and sex, which may share risk factors and neurological changes with addiction, the best known substance-related addictions are alcohol, nicotine, opiates and benzodiazepines – tranquilizers better known by brand names like Valium or Xanax.
The National Center on Addiction and Substance Abuse estimates approximately 40.3 million Americans have addictions, with the National Institute on Alcoholism narrowing that down to 16.6 million adults 18 years and older with an alcohol use disorder. And in spite of research-backed treatments both medical and behavioral, many of those affected by addiction are equally impacted by the social stigma of being an "addict," which can deter patients from seeking help.
“The most common myth is that people who misuse substances are bad, character-flawed or immoral people who choose to continue their addiction behaviors without thought as to the consequences to themselves or others,” says Allison Johnsen, LCPC, BCC, a licensed counselor and manager of Behavioral Health Services at Northwestern Medicine Central DuPage and Delnor Hospitals. “The truth is addiction is a progressive disease that often cannot be reversed without medical or other treatment intervention. People from all walks of life, all races and cultures, all socioeconomic levels and all professions can be susceptible to addiction.”
The most often harmfully used substances are also those most often used recreationally. However, it goes without saying that addiction is significantly more serious than unhealthy habits.
Take alcohol for example: It can be vital to recognize the difference between drinking more than the recommended amount of alcohol – which is two drinks in a day for men, one for women – and developing a dependency or addiction. Johnsen recommends looking for visible signs: drinking early in the day, excessive drinking in the evening and binge drinking on the weekends. The amount of bottles and cans in the garbage or recycling bin can be an indication of this as well as excessive amounts of money spent in bars or at liquor stores. Planning social activities around drinking and difficulty drinking in moderate amounts can also be indications of a larger problem.
More broadly, behavioral changes can be warning signs of addiction. This includes a change in friends, hangouts and hobbies as well as the avoidance of old friends, a drop in performance at work or school and an increased desire for privacy. An unexplained need for money, chronic dishonesty, suspicious behavior and paranoia can also be indications of addiction. People dealing with an addiction can also undergo an overall shift in personality and attitude as well as deteriorating personal hygiene and physical appearance. They may also experience a loss of appetite, coordination and energy.
And while these signs sketch the profile of someone struggling with a substance use disorder, they are by no means the only way addiction can manifest itself. Functioning addictions occur when unhealthy substance use does not interfere with a person’s ability to go to work or perform daily responsibilities, yet it is still noticeable to the point that, while the person suffering may not recognize a problem, family, friends and peers do.
Like all addictions, a functioning addiction still poses risks to both the physical and emotional health of the individual. Substance misuse and substance use disorders can create permanent health problems to the extent that withdrawal without medical support can be dangerous. Addictions often result in interpersonal and financial problems, and illegal dependencies can create legal issues as well. As tolerance develops and addictions escalate, any and all of these risks can rise.
Treatment for addiction can be as multifaceted as the disease itself. It is more complicated than most treatments, first and foremost because the person needing care may not yet recognize that fact. There is also the ugly truth that many forms of addiction lead to entanglement with the law. Alcohol may lead to criminal behavior due to lack of judgment and harmful use of illegal substances is just that, illegal. Legal repercussions – as with financial and interpersonal ones – can also become obstacles to reaching treatment. But the fact remains: treatment is necessary and established.
“Addiction is a biological, physical problem,” says Johnsen. “It can also be a psychological problem. Both require treatment for long-standing recovery to occur.”
All forms of addiction can benefit from cognitive and behavioral treatment programs. This type of treatment addresses behaviors and thoughts formed by the addiction as well as the patterns contributed to substance use.
“A person in recovery from addiction must learn to change social activities, friends, thought patterns, habits and attitudes,” explains Johnsen. “Cognitive-behavioral therapy is the evidence-based treatment best suited for this.”
Those dealing with an alcohol or benzodiazepine addiction may also need medication-assisted detoxification.
“These withdrawals are dangerous to the body, and best treated in a medical environment,” adds Johnsen. “Opiate withdrawal is acutely uncomfortable, though not often life-threatening. Medication is very helpful in reducing cravings for the substance while a person is learning to eliminate the substance from his or her lifestyle.”
While evidence exists that treating addiction like any other disease is effective, therapy and medical support can often be expensive and is not always accessible to those who need it most.
Recognizing and normalizing drug and alcohol addiction as a disease – one that can and should be treated like any other – is an important step in not only addressing the stigma of addiction, but creating a more encouraging recovery environment. An open dialogue about addiction can help to reduce the blame, fault or shame that individuals and families can feel while also promoting treatment as a positive and normal course of action. It can also help educate those with addiction and their loved ones that relapse is part of the recovery process and not a sign of failure.
Addiction is a disease, not a choice, and when faced with the signs of addiction in your life or that of someone you know, awareness and acceptance can be crucial to getting help and treatment early.