Is Addiction a Disease or a Decision?

This September, www.rtor.org is observing National Recovery Month with a guest blog series on addiction and substance use disorders. To kick-off the special series on addiction and co-occurring disorders we open with a guest blog post from Ken Seeley, an internationally acclaimed interventionist and founder and C.E.O. of Ken Seeley Communities.

Imagine waking up one morning and declaring, “My new goal in life is to become a drug addict!” Obviously, no one in his or her right mind would ever willingly decide to become addicted to drugs or alcohol. Amazingly, even in the presence of brain imaging and scientific research confirming addiction as a chronic, progressive, relapsing disease of the brain, some still hang on to the idea that somehow addiction is a conscious decision.

Actually, it is understandable that some people may look at the addict with an attitude of condemnation—“You made your bed, now lie in it.” They may consider that first sip of alcohol or that first joint as a conscious choice the individual made. The consequences, they argue, are an extension of that first bad decision. However, even if the first step in becoming an addict involved a decision at the outset, the resulting effects of that decision point to a profound altering of brain circuitry and neural pathways.

How else can you explain why one person who takes prescription opioids for two weeks time will become addicted to them, while another patient with the same opioid prescription easily stops? Why does one friend who drinks regularly never acquire an addiction to alcohol while another friend with the same drinking habits becomes hopelessly alcoholic? The unique features of each individual’s biochemical make-up, family history, personality traits and temperament, and life events conspire to predispose some individuals to the disease of addiction.

What Science Tells Us About Addiction

Ample studies have confirmed the fact that addiction is a disease of the brain. While it is difficult for someone to look at an addict and consider his or her plight as a disease like cancer or diabetes, scientific research on addiction provided by the National Institute on Drug Abuse (NIDA) provides this evidence. According to one of the articles posted by NIDA, “No More Addictive Personality,” the author states that regardless of which drug is abused, a full 50% of the risk of addiction is determined by genetics; alcoholism is 60% inheritable, states the author.

Addiction as a brain disease refers to the actual alterations that occur in the brain circuitry in response to drugs and alcohol. The neurobiological effects of these changes can lead to loss of control or free will over the compulsive drug-taking behaviors. This helps explain why the individual cannot “just quit,” even in light of the negative consequences caused by the addiction.

Co-occurring mental health disorders are also found to be prevalent in individuals who develop substance use disorders, especially anxiety, depression, and antisocial personality disorder. In addition, some personality traits, such as poor impulse control, can have underlying neurobiological roots.

Recent study has revealed that genes involving metabolic functions are identified in alcoholics, so this remains an ongoing focus of research in the area of genetic determinants. Identifying exactly which genes may be involved in inherited propensity toward addiction, and how these genetic factors interact with other factors, will eventually help addiction specialists in prevention and treatment techniques.

Recognizing the Warning Signs of Addiction

To date, science has not provided us with our own individual genetic addiction-predictor kit. Those who are genetically wired for addiction do not discover that until it is too late, unfortunately. However, awareness of the red flags that can help to alert someone, or their loved ones, to an evolving substance use disorder can be beneficial in obtaining early intervention. The sooner someone addresses an emerging addiction issue, the better the recovery outcome.

Warning signs of addiction include:

Increasing tolerance to the substance, leading to higher consumption
Mood swings, symptoms of depression, anxiety
Difficulty sleeping
Irritability
Neglecting responsibilities and obligations
Change in appearance, weight gain or loss, dilated pupils, bloating, hand tremors
Secretive behaviors
Withdrawing from friends and family, avoiding social events
Prioritizing drug or alcohol use, intense focus on obtaining the substance, having enough on hand, hiding the substance, using or drinking alone
Relationship problems
Declining work or academic performance
Continued use of drugs or alcohol despite mounting negative consequences
Financial problems caused by the habit
Legal problems, such as getting a DUI
Withdrawal symptoms emerging when substance is not available

Psychotherapy to Effectively Overcome Addiction

Detoxification from the substance only prepares the individual for tackling the treatment process. Unwinding addiction is an ongoing process that requires intensive psychotherapy. The individual has acquired learned reflexes to triggers and must make fundamental changes in these responses to overcome these engrained behaviors. In addition to medication-assisted treatment, such as naltrexone or Suboxone, psychotherapy is an essential treatment element in addiction treatment.

The most effective types of psychotherapy for treating addiction include:

Cognitive behavioral therapy (CBT): CBT is offered in both individual therapy sessions and group sessions, and involves exploring the individual’s thought and behavior patterns. Specifically, distorted or irrational thoughts that result in self-destructive drug-seeking behaviors are targeted and, over the course of several weeks, modified toward assessing coping strategies and more positive self-messaging.

Motivation enhancement therapy (MET): Many times individuals enter into rehab with ambivalent feelings about giving up their substance of choice. MET helps them acknowledge these mixed feelings about sobriety, and counsels them to become internally motivated about recovery.

Contingency management (CM): CM is a behaviorist therapy rooted in operant condition, where incentives are used to invoke change. By offering the individual small rewards in exchange for clean drug and alcohol tests, this helps reinforce positive behavior choices until they become habit.

Dialectical behavior therapy (DBT): DBT focuses on a four-step method of conquering roadblocks to recovery. These include communication skills, coping skills, emotional regulation, and impulse control. By improving these skills and behaviors the person is better equipped to manage triggers in recovery.

Addiction is a disease of the brain, activated by early lifestyle choices that impact a segment of those who make those exact choices, just a disease such as lung cancer may result from the choice to smoke, or the disease of diabetes may have resulted from dietary choices. With this in mind, addiction can hopefully be viewed through the lens of compassion.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.

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About the Author

Ken Seeley is an internationally acclaimed interventionist, having years of experience in this field. Certified as a Board Registered Interventionist-Level 2, Seeley has worked full-time in the business of recovery and intervention since 1989. He is a regular contributor to CNN, MSNBC, NBC, CBS, Fox, and ABC on the topics of addiction and intervention. He was one of three featured interventionists on the Emmy Award winning television series, Intervention, on A&E. He is also the author of “Face It and Fix It,” about overcoming the denial that leads to common addictions while bringing guidance to those struggling with addiction. Ken Seeley is the founder and C.E.O. of Ken Seeley Communities, a full spectrum Palm Springs rehab addiction recovery program in California.

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The opinions and views expressed in this guest blog do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in this article or linked to herein.