Addiction- An Illness or Just A Bad Choice : Article

Addiction- An Illness or Just A Bad Choice : Article

Addiction Illness or Just A Bad Choice

If you have ever known anyone with an addiction you may have wondered "why can't they stop". It is not infrequent to encounter a person with a heroin or crack addiction who spends their last dollar to get one more fix, even though at some level they are aware they need that money to feed themselves or their children. Addiction will often drive young men and women to violate the sanctity of their bodies through acts of prostitution just to pay for one high.

Therefore, although there may be very significant consequences from addiction, they are insufficient to stop extremely destructive behaviours. Having said the above you might be wondering - illness or choice. Well the answer is both. In early addiction, drug use is more often guided by choice, with those who are addicted trying to regulate or numb difficult emotions such as anger or anxiety.

In some cases of addiction the choice to use illicit drugs occurs just because drugs make us feel really, really good. If one grows up within the "wrong" area such as for example Regent Park in Toronto where being "cool" can be all about using or selling drugs then it is much more likely that "choice" will be influenced by this paradigm. So in early addiction, "choice" rules the behaviour and societal norms, media , culture, difficult emotions etc. become the underlying drivers of the unhealthy choices to engage in drug abuse.

So what's up with the "addiction is an illness" piece. Well addictive drugs such as heroin, OxyContin, cocaine, crack can lead to addiction because they stimulate the pleasure center in our brain. This stimulation causes the release of a chemical called dopamine. Dopamine makes us feel really good, so the more dopamine released the more pleasure we experience and the more likely we are to get hooked into addiction.

Normally, we must engage in some effort to stimulate the release of dopamine. For example, if I work very hard I can then give myself pleasure by taking my earnings and rewarding myself by purchasing a nice meal or nice clothes. Another example is exercising and then feeling good after I exercise. Both exercise and the eating a nice meal will stimulate dopamine release leading to a sense of pleasure. Both these examples demonstrate a balance between effort / work and reward. I cannot just give myself pleasure /
dopamine at will, I must do something to earn it.

A healthy person achieves a balance between self care, work and activities done purely for the purpose of "feeling good". Drugs such as cocaine, crack, OxyContin, heroin, morphine and marijuana lead to addiction by hijacking our brain and directly stimulating the release of dopamine. As a result, at least in the short term I can stimulate and stimulate and stimulate the release of dopamine and seemingly create boundless degrees of pleasure for myself with the use of drugs. In simplistic biological terms it the compulsive behaviour which directly stimulate our pleasure center which underlies addiction.

Well, this true in the short term but definitely not in the long term. The reason for this is that there is a limited supply of dopamine, and if I drain my dopamine supply, then I will experience the symptoms associated with insufficient dopamine. The term commonly used to describe the symptoms associated with a sudden drop in dopamine levels after drug use is "withdrawal" from addiction.

The slang term often used to describe this is "jonesing". The symptoms associated with withdrawal ( due to a lack of dopamine) can lead to craving and recurrent addictive behaviour. Often those with addiction who continue to use over the longer term will tell you that they no longer got "high" but continued to engage in the addictive behaviour just to feel "normal". Over time a phenomena referred to as tolerance develops and those with addiction will need increasingly larger amounts of the illicit drug to achieve the same effect or any effect.

The saying ; " Round and round and round he /she goes and where he / she stops nobody knows" , is quite applicable to addiction. Drug addiction arises because we find that the use of a particular drug gives us the ability to directly stimulate our pleasure centers at will in an unregulated manner. This stimulation can be so powerful that it leads to addiction. From a behavioural perspective drug addiction might be thought of as the compulsive / impulsive behaviour which an individual repetitively engages in as he or she attempts to re-experience the "feel good" experience, they achieved through using the drug initially.

In a normal brain what is called our "executive function" interacts with the pleasure part of our brain. The executive brain is the logical part of our brain and regulates our behaviours so that I may delay a desire for immediate gratification. For example I might want to take the day off and go to the beach but my executive function tells me I committed to going to work so I must delay going to the beach.

As addiction progresses, the brain actually becomes diseased and the neural connections that normally allow the executive brain to regulate our behaviour becomes diseased. What makes sense to you or me who migh not have an addiction problem, with regards to logical or reasoned behaviour, may have a significantly lesser influence on he / she who has the illness of addiction.

It was not long ago when I cared for an addiction client who had an alcohol addiction. The client had an incident related to drinking and driving and was charged with driving under the influence. I testified as an expert witness in this addiction case and supported the client throughout a one year period of court proceedings. The client managed to cope and remained sober throughout this year. Ultimately, after a one year period of court proceedings and legal wrangling the court allowed him to retain his drivers license which he needed and wanted desperately to keep. He needed to be able to drive inorder to continue to work and employ himself. Within days of having his license returned to him, he relapsed and continued to drink alcohol, lose his license and his ability to work. After years of working with those who struggle with addiction the line between choice vs addiction as an illness remains blurred.

From and addiction perspective it is important to address both the illness component of addiction and the "choice" component of addiction. Various medications such as ReVia, Campral and Disulfiram can assist with treatment. Campral and Disulfiram are predominantly helpful for alcohol abuse / addiction and Revia can play a role in opiate addiction and alcohol addiction / abuse. Identifying underlying concurrent disorders such as anxiety disorders or depression and treating these disorders can also improve recovery rates.

Most importantly, addiction counselling and psychotherapy which focuses on addiction can be enormously helpful. Addiction Treatment can provide clients with counselling to help them recognize addiction triggers and develop strategies to cope with these addiction triggers. Teaching clients to recognize difficult emotions and counselling them as to the ways in which they might respond to these difficult emotions in non destructive ways is also a core component of addiction treatment.

Residential Addiction Treatment Centres in Canada can provide periods of symptom interruption . Residential Addiction Treatment within Canada can provide clients with a safe place to stay while allowing the brain time to heal. As the brain heals the ability of the brain's executive function to regulate behaviour returns and clients become better able to process the counselling and psychotherapy that they will engage in as part of their addiction treatment.

Stay tune for part 2!

Dr. Mark Weiss, providing addiction treatment and addiction counselling in Toronto, Ontario Canada.

The Centre of Addiction and Mental Health is a publicly funded tertiary care mental health and addiction treatment centre in Toronto. There are numerous addiction treatment programs within the Toronto are offered through The Centre of Addiction and Mental Health. Programs consist of both outpatient addiction counselling in Toronto. There is also a residential addiction treatment program within the Toronto area offering 21 day residential programs. CAMH also runs the only pubically funded medical detox in Toronto. Amongst the addiction programs, there is an opiate treatment centre which provides Methadone, suboxone and Revia as potential treatment options.