Since my column is titled, Dr. Dawn’s Rx. I thought I would write something at least tangentially medical on occasion. Now that 2013 is arriving, typical topics in meetings include new beginnings, resolutions, Step One, etc. Let’s have fun in this column starting the New Year by looking at and learning a bit more about how addiction specialists look at our disease. Below is the official short Definition of Addiction used by The American Society of Addiction Medicine
The long definition covers about nine pages and can be found at the back of my book, From the Edge of the Cliff.
Short Definition of Addiction: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. * Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
* Emphasis mine
While that is a mouthful, it does describe what I know as addiction. Shortened, the three-part definition we often use is:
- Craving and compulsive use
- Inability to control the amount used
- Continued use in spite of adverse consequences or harm
We can use some of this official stuff to be reassuring to newcomers and old-timers alike. How many times do we see new people struggle to get clean, saying they just cannot stop craving? Almost every craving leads to using and if they continue to seek recovery, they collect multiple “welcome” chips, coins or tags. Some eventually get clean; many do not. At some point, the early AAs began a tradition of recommending daily AA meetings for the first three months of sobriety, “90 in 90”. Now, many years later, science has shown that there are significant physiological changes in our brains for the first 90 to 100 days of abstinence from alcohol and other drugs! Those early alcoholics knew intuitively that we need intense involvement and support during the first three months if we are going to survive the cravings without using. They instinctively urged intense participation in recovery from day one. We can reassure newcomers that by sticking very close to their 12-step program, attending at least one meeting a day, more if possible, they have a good chance of staying clean. Avoiding persons, places and situations that trigger craving, talking to others who understand and accepting suggestions are all part of what allows brain chemistry to change.
By listening to those who have been there, by resisting the old behavior and doing almost everything differently, the urge to use will gradually disappear as the brain heals. Addicts begin to have hope of an ongoing life free from drugs and self-destruction.
Those of us who have some time in recovery should (I rarely ‘should’ on people, but this requires it!) share our own experience, strength and hope. We can safely guarantee that the program works. Besides the evidence from the many hundreds of thousands of recovering men and women, we now have scientific evidence of brain changes resulting from chemical use as well as reversals brought about by abstinence. While there is some variation depending on duration, quantity and specific drug used, the point is that addiction is a brain disease and recovery is possible. We can promise that craving eventually stops, IF one remains abstinent from all mind-altering substances AND does some positive recovery work: Ahem…that means Steps!
More on the addict brain next time.
Happy New Year!!