UNDERSTANDING ADDICTION YEDEM & Believers Network Club GHANA.

UNDERSTANDING UNDERSTANDING ADDICTIONADDICTION

YEDEM & Believers Network Club YEDEM & Believers Network Club GHANAGHANA

What is AddictionWhat is Addiction

Definition by ISAM & ASAM – it is a Definition by ISAM & ASAM – it is a “DISEASE characterized by CONTINUOUS “DISEASE characterized by CONTINUOUS or PERIODIC: IMPAIRED CONTROL over or PERIODIC: IMPAIRED CONTROL over drinking/using drugs, PREOCCUPATION drinking/using drugs, PREOCCUPATION with drug/alcohol, use of alcohol/drugs despite with drug/alcohol, use of alcohol/drugs despite ADVSERSE CONSEQUENCES, and ADVSERSE CONSEQUENCES, and distortions of thinking most notably distortions of thinking most notably DENIAL.”DENIAL.”

Dictionary Definition: (Latin)Dictionary Definition: (Latin) Addictus:Addictus: Devoting or surrendering one’s life, giving self to Devoting or surrendering one’s life, giving self to

some habit or substance, losing one’s soul, being some habit or substance, losing one’s soul, being caught or hooked.caught or hooked.

Narcomania: In some languages (French, Russia and Narcomania: In some languages (French, Russia and Scandinavian languages) indicate madness about Scandinavian languages) indicate madness about drugs.drugs.

Alcoholism: Identifies the whole person with his/her Alcoholism: Identifies the whole person with his/her attachment to alcohol.attachment to alcohol.

The Addiction/Dependence DebateThe Addiction/Dependence Debate

a.a. Official scientific name has become DEPENDENCE Official scientific name has become DEPENDENCE

rather than ADDICTION in both: rather than ADDICTION in both: The World Health Organization (WHO), The World Health Organization (WHO),

classification of diseases ICD 10 and American classification of diseases ICD 10 and American Psychiatric Association (APA) Diagnostic and Psychiatric Association (APA) Diagnostic and Statistical ManualStatistical Manual

DSMIVDSMIV The term ADDICTION is thought by to be The term ADDICTION is thought by to be

derogatoryderogatory

b. ASAM and ISAM still use the term addiction. b. ASAM and ISAM still use the term addiction. Some very prestigious journals and institutions Some very prestigious journals and institutions still hold to the term e.g. The British Journal still hold to the term e.g. The British Journal ADDICTION, The National Institute of ADDICTION, The National Institute of ADDICTION etcADDICTION etc

c. Some say that is not less derogatory than c. Some say that is not less derogatory than addiction.addiction.

DSM-IVDSM-IV ICD-10ICD-10

1. Tolerance: needs more for the same 1. Tolerance: needs more for the same effecteffect

Same (4)Same (4)

2. Withdrawal syndrome2. Withdrawal syndrome Same (3)Same (3)

3. Taken in larger amounts or over longer 3. Taken in larger amounts or over longer time than plannedtime than planned

Difficulty in controlling use onset, level or Difficulty in controlling use onset, level or end (2)end (2)

4. Persistent desire/compulsive use, 4. Persistent desire/compulsive use, unsuccessful control of use.unsuccessful control of use.

Strong desire or compulsion to use (1)Strong desire or compulsion to use (1)

5. Much time is spent in obtaining, using 5. Much time is spent in obtaining, using or recovering from useor recovering from use

No similar criteriaNo similar criteria

6. Important social, occupational, 6. Important social, occupational, recreational activities given uprecreational activities given up

Neglect alternative pleasures or interests Neglect alternative pleasures or interests (5)(5)

7. Continual use despite adverse physical 7. Continual use despite adverse physical and psychological problemsand psychological problems

Persistent use despite clear harmful Persistent use despite clear harmful consequencesconsequences

Any 3 of the following Criteria

4. DSMIV/ICD10 CRITERIA FOR DIAGNOSIS OF SUBSTANCE DEPENDENC

12-step approach (AA, NA.. Etc) advocate 12-step approach (AA, NA.. Etc) advocate argue that the term substance dependence isargue that the term substance dependence is

1. not accurate in describing the 1. not accurate in describing the phenomenon.phenomenon.

2. it is bound to make us miss the issue 2. it is bound to make us miss the issue of cross-addictionof cross-addiction

(cross-addiction is moving from one type of addiction to another e.g. moving (cross-addiction is moving from one type of addiction to another e.g. moving from dependence on drugs to dependence alcohol or sex. With the same from dependence on drugs to dependence alcohol or sex. With the same criteria of losing control, preoccupation and use despite knowledge of criteria of losing control, preoccupation and use despite knowledge of adverse consequences)adverse consequences)

3. It tends to make us focus on different 3. It tends to make us focus on different substances of abuse e.g. heroin, alcohol.. Etc substances of abuse e.g. heroin, alcohol.. Etc rather than focusing on a common process rather than focusing on a common process underlying all these “addictions” which is the underlying all these “addictions” which is the disease of addiction itself. (Miller 1995).disease of addiction itself. (Miller 1995).

USE AND ABUSE/HARMFUL USE USE AND ABUSE/HARMFUL USE AND DEPEDNCEAND DEPEDNCE

Abuse in the DSM-IV is defined as:Abuse in the DSM-IV is defined as: Use of substance:Use of substance:

1.1. Leading to failure to fulfill work, education, Leading to failure to fulfill work, education, home obligations etc.home obligations etc.

2.2. Exposure to physically hazardous e.g. Exposure to physically hazardous e.g. situations e.g. drive drinkingsituations e.g. drive drinking

3.3. Legal problemsLegal problems

4.4. Interpersonal problem.Interpersonal problem.

This is also closely related to the ICD This is also closely related to the ICD 10 definition of Harmful sue10 definition of Harmful sue

DSM-IV Criteria for substance abuseDSM-IV Criteria for substance abuse A. – A maladaptive pattern of substance use leading A. – A maladaptive pattern of substance use leading

to clinically significant impairment or distress, as to clinically significant impairment or distress, as manifested by one (or more) of the following, manifested by one (or more) of the following, occurring within a 12 months period:occurring within a 12 months period:

1. Recurrent substance use resulting in a failure to fulfill 1. Recurrent substance use resulting in a failure to fulfill major obligations at work (repeated absences or poor major obligations at work (repeated absences or poor work performances), school – (absences, suspensions, work performances), school – (absences, suspensions, or expulsions), or home – (neglect of children or or expulsions), or home – (neglect of children or household).household).

2.Recuurent substance use in situations in which it is 2.Recuurent substance use in situations in which it is physically hazardous; (driving a car or operating a physically hazardous; (driving a car or operating a machine when impaired by substance use).machine when impaired by substance use).

3. Recurrent substance-related legal problems (DUI, 3. Recurrent substance-related legal problems (DUI, arrest, reckless driving)arrest, reckless driving)

4. Continued substance use despite having persistent or 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance; exacerbated by the effects of the substance; (arguments with spouse, physical fights).(arguments with spouse, physical fights).

B.- The symptoms have never met the criteria for B.- The symptoms have never met the criteria for “SUBSTANCE DEPENDCE”“SUBSTANCE DEPENDCE”

SUBSTANCE DEPENDCESUBSTANCE DEPENDCE

A maladaptive pattern of substance use, leading to A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as clinically significant impairment or distress, as manifested by 3 or more of the following, occurring manifested by 3 or more of the following, occurring at any time in the same 12 months period:at any time in the same 12 months period:

1.1. TOLERANCE: as defined by either of the TOLERANCE: as defined by either of the following: following:

a. A need for markedly increased amounts of a. A need for markedly increased amounts of the substance to achieve intoxication or desired the substance to achieve intoxication or desired effect, effect, b. Markedly diminished effect with continued use b. Markedly diminished effect with continued use of the same amount of substance.of the same amount of substance.

2. WITHDRAWAL, as manifested by either of the 2. WITHDRAWAL, as manifested by either of the following:following:

a. The characteristics withdrawal syndrome for the a. The characteristics withdrawal syndrome for the substance (refer to criteria A and B of the criteria sets substance (refer to criteria A and B of the criteria sets for withdrawal from specific substances)for withdrawal from specific substances)

b. The same (or closely related) substance is taken to b. The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.relieve or avoid withdrawal symptoms.

3. The substance is often taken in larger amounts or 3. The substance is often taken in larger amounts or over a longer period than was intended.over a longer period than was intended.

4. There is a persistent desire or unsuccessful 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.efforts to cut down or control substance use.

5. A great deal of time is spent in activities 5. A great deal of time is spent in activities necessary to obtain the substance, use the necessary to obtain the substance, use the substance, or recover from its effects.substance, or recover from its effects.

6. Important social, occupational, or recreational 6. Important social, occupational, or recreational activities are given up or reduced because of activities are given up or reduced because of the substance.the substance.

7. The substance use is continued despite 7. The substance use is continued despite knowledge of having persistent or recurrent knowledge of having persistent or recurrent physical or psychological problems.physical or psychological problems.

Some scholars are currently applying the same Some scholars are currently applying the same criteria of substance dependence on other criteria of substance dependence on other kinds of addictive behaviors e.g. gambling, kinds of addictive behaviors e.g. gambling, love and sex addiction, co-dependence ( the love and sex addiction, co-dependence ( the addiction of being controlled or trying to addiction of being controlled or trying to control life of others), overeating, anorexia control life of others), overeating, anorexia (loosing control over dieting and an obsession (loosing control over dieting and an obsession with loosing weight, bulimia (anorexia with loosing weight, bulimia (anorexia alternating with binge eating).alternating with binge eating).

THE DISEASE CONCEPT VRS THE DISEASE CONCEPT VRS THE SELF MEDICATION THE SELF MEDICATION

THEORY THEORY The disease concept defines addiction as a primary The disease concept defines addiction as a primary

disease implying that:disease implying that:1.1. All other manifestations e.g. depression, lack of All other manifestations e.g. depression, lack of

responsibility, anger, aggression, lack of balanced responsibility, anger, aggression, lack of balanced life are consequences of the disease.life are consequences of the disease.

2.2. Trying t find a reason behind the addictive behavior Trying t find a reason behind the addictive behavior is futile. And may be harmful.is futile. And may be harmful.

3.3. Lifelong abstinence is a must because the disease is Lifelong abstinence is a must because the disease is seen as seen as controllable controllable but incurable. If an addict but incurable. If an addict resumes drinking or using he or she is bound to resumes drinking or using he or she is bound to relapse to the former state of addiction.relapse to the former state of addiction.

4. The process recovery implies a spiritual 4. The process recovery implies a spiritual lifelong journey. If you are an addict you lifelong journey. If you are an addict you never be come an “ex-addict” or “recovered never be come an “ex-addict” or “recovered addict” you have always to be an addict addict” you have always to be an addict “recovery” or a “recovering addict”.“recovery” or a “recovering addict”.

5. Addicts need to attend 12-step groups and live 5. Addicts need to attend 12-step groups and live the steps for the rest of the lives. If they do not the steps for the rest of the lives. If they do not they are increasing the probability of their they are increasing the probability of their relapse.relapse.

Self-Medication TheorySelf-Medication TheoryAdvocates of this theory claim that addictive behavior is a way Advocates of this theory claim that addictive behavior is a way

the addict is trying to alleviate his/her pain. Pain may be the addict is trying to alleviate his/her pain. Pain may be readily identifiable or it might be hidden. Some variations readily identifiable or it might be hidden. Some variations of this theory include:of this theory include:

1.1. Hurts of the past are thought to be the cause of addictive Hurts of the past are thought to be the cause of addictive behavior behavior

2.2. Inability to balance the inner world and the outer world Inability to balance the inner world and the outer world (Khantzian)(Khantzian)

3.3. Family problemsFamily problems4.4. Problem in childhood developmentProblem in childhood development5.5. A desire to destroy one self (Meninger) and dozens of A desire to destroy one self (Meninger) and dozens of

other theories.other theories.A stable recovery is thought to be achievable once the cause of A stable recovery is thought to be achievable once the cause of

addictive behavior is discovered and dealt with addictive behavior is discovered and dealt with

Definition of Addiction in the Definition of Addiction in the Therapeutic Community ApproachTherapeutic Community Approach

Mellnick and DeLeon (1999) defines drug abuse in the Mellnick and DeLeon (1999) defines drug abuse in the TC approach as: a deviant behavior, reflecting :TC approach as: a deviant behavior, reflecting :

(i)(i) Impeded personality developmentImpeded personality development

(ii)(ii) Chronic deficits in social, educational and Chronic deficits in social, educational and economic skillseconomic skills

Its antecedent lie in,Its antecedent lie in,

(i)(i) Socioeconomic disadvantageSocioeconomic disadvantage

(ii)(ii) Poor family effectivenessPoor family effectiveness

(iii)(iii) And in psychological factorsAnd in psychological factors

Some general notes on the Some general notes on the development of Addictive Behaviorsdevelopment of Addictive Behaviors

Genetic predisposition to certain addictive behaviors is Genetic predisposition to certain addictive behaviors is strongly supported by research now. Alcohol and strongly supported by research now. Alcohol and nicotine dependence being substances most nicotine dependence being substances most commonly studied.commonly studied.

Socio-cultural factors play a major role in the Socio-cultural factors play a major role in the development of addictiondevelopment of addiction

Psycho-dynamic elements may play a rolePsycho-dynamic elements may play a roleBehavioral and social learning elements are important.Behavioral and social learning elements are important.Religious and spiritual elements are more and more Religious and spiritual elements are more and more

proving to be of utmost importance in the proving to be of utmost importance in the development and treatment of substance abuse and development and treatment of substance abuse and dependence.dependence.

ADDICTION IS THOUGHT TO BE A BIO ADDICTION IS THOUGHT TO BE A BIO PSYCHO SOCIAL DISEASEPSYCHO SOCIAL DISEASE

If you recognized the SPIRITUAL ROOTS and If you recognized the SPIRITUAL ROOTS and IMPLICATIONS.IMPLICATIONS.

You will call it a Spiritual Bio Psycho Social You will call it a Spiritual Bio Psycho Social Disease Disease

IMPLICATIONS FROM IMPLICATIONS FROM CHRISTIAN PERSPECTIVECHRISTIAN PERSPECTIVE

1.1. Many advocate that the addict is as good as Many advocate that the addict is as good as any of us. I say yes but it is better put as we any of us. I say yes but it is better put as we are as bad as any addict.are as bad as any addict.

We have all sinned and fell short of the glory of We have all sinned and fell short of the glory of God Rn 3:23. It is essential to understand God Rn 3:23. It is essential to understand that “we” normal balanced, respectable that “we” normal balanced, respectable people are not different in the core of our people are not different in the core of our being the worse sinner, indeed not any better being the worse sinner, indeed not any better from any addict.from any addict.

2. Addicts as mush “Normal” people are:2. Addicts as mush “Normal” people are:(i)(i) Created in the image of GOD Gen 1:26,27Created in the image of GOD Gen 1:26,27(ii)(ii) Are deeply loved by Him and have an everlasting Are deeply loved by Him and have an everlasting

value in His eyes. Jn 3:16value in His eyes. Jn 3:16

3. Our separation from God manifest itself in 3. Our separation from God manifest itself in surrendering one life to false gods. Money, fame, surrendering one life to false gods. Money, fame, sex, success, a “balanced productive life” or just sex, success, a “balanced productive life” or just living for one self.living for one self.

Addiction to alcohol, drugs or non-substance addictions Addiction to alcohol, drugs or non-substance addictions (gambling, food, diet, love/sex, codependence, (gambling, food, diet, love/sex, codependence, religion.. Etc)religion.. Etc)

The disease is what makes people addicts just than The disease is what makes people addicts just than normal, balanced successful sinners.normal, balanced successful sinners.

““we have been created for you Lord and our souls will we have been created for you Lord and our souls will not find rest until it finds in you”. St Augustin.not find rest until it finds in you”. St Augustin.

Addiction is a chronic disease, a deceitful enemy and so Addiction is a chronic disease, a deceitful enemy and so is the “flesh”, “The old man”, The body of sin”is the “flesh”, “The old man”, The body of sin”

Addiction will not be cured by a one time experience or Addiction will not be cured by a one time experience or mere decision of the will. Not cured by a glimpse of mere decision of the will. Not cured by a glimpse of spiritual reality. spiritual reality.

Not cured by the right doctrines.Not cured by the right doctrines.To overcome WE-addicts and non addicts-we need a To overcome WE-addicts and non addicts-we need a

life long journey.life long journey.One day at a time surrender to God and reliance upon One day at a time surrender to God and reliance upon

Him.Him.True understanding of addiction brings you closer to the True understanding of addiction brings you closer to the

One True God.One True God.The Higher Power has a name and His name is The Higher Power has a name and His name is

Wonderful, Counselor, Mighty God, Everlasting Wonderful, Counselor, Mighty God, Everlasting Father, and Prince of Peace. His name is Jesus.Father, and Prince of Peace. His name is Jesus.

Knowing this is not enough to live day by day in this Knowing this is not enough to live day by day in this knowledge is what we need knowledge is what we need