CHAPTER 1
Why A Person Can't Stop: Understanding the Science of Addiction
Introduction
Addiction has been one of the more perplexing disorders to treat over the years. No other disorder has created more confusion or controversy, or for that matter, debate as to what needs to be accomplished for someone suffering from an addiction. Fortunately, there continues to be an emergence of research in the field of the neurosciences that is shedding more light on addiction and, especially, on how best to address and to treat this life threatening illness (Koob, G.F. and Volkow, N.D., 2010; Kalivas, P. and Volkow, N.D., 2005; Ting-Kai, L. and Volkow, N.D.,2005).
Although researchers have garnered the necessary information to support and strengthen the side of those proponents of the "disease" concept of addiction, understanding the process of addiction continues to remain unclear, if not confusing, for many (O'Brien, C. P., Volkow, N., & Li, T. K. 2006). Despite the widespread use of the term "addiction," the concept of addiction, itself, still has difficulty being accepted by many as a bona fide medical illness or mental disorder. It has only been recently that the Diagnostic Statistical Manual (DSM), the basic text for mental health and addiction professionals, has referred to the term "addiction." Even still, there are those professionals that argue that the term "addiction" continues to remain too vague and too general.
Contributing to this confusion is the inconsistency to what actually constitutes an addiction. Is the person who is physically dependent on prescribed pain medications as a result of a chronic injury or illness, yet functioning effectively in the environment, considered addicted? Is there a difference between a young adult in college who binge drinks on the weekends and the middle age man who engages in similar behavior on the weekends?
To complicate matters further, there is also a qualitative issue present. Does the person who engages in compulsive gambling, shopping, or sex have the same illness as the person who engages in compulsive drinking or drug taking? Is an "addiction" to chocolate qualitatively different than an "addiction" to heroin? If so, why? If not, why not? The answers to these questions have significant consequences. As our understanding of the addiction process deepens, so will our ability to effectuate a more valuable recovery process.
One of the other challenges that have emerged from this confusion regarding addiction is that there is no consensus on what a person needs to do in order to achieve a successful recovery. Despite the considerable amount of attention devoted to the science of addiction, there is no similar effort devoted to the science of recovery. Clearly, if there is a science of addiction, there must also be a science of recovery.
For the purposes of this book, it cannot be emphasized too strongly that the phenomenon of addiction does, in fact, exist. It is a neurobiological process that can affect anyone, at any time, regardless of a genetic predisposition. It is a further contention that whether a person is addicted to chocolate, or addicted to heroin, the same type of neurobiological brain processes occur. The important ramification of this is that these same neurobiological brain processes need to be considered in the recovery process. Understanding these underlying neurobiological processes can play a crucial role in assisting a person in taking control of their recovery from an addictive disorder.
This book seeks both to explore, and to contribute to, the science of recovery. As previously mentioned, the science of recovery has not been a major source of focus. The limited amount of study has created a significant void regarding those suffering from an addictive disorder. "Just don't pick up" is no longer an acceptable response in light of the wealth of information and research on addiction. The time has come for a deeper and more meaningful exploration of the science of recovery. A science of addiction demands, indeed requires, a science of recovery. This book is designed, in part, to address this deficiency.
Conceptualizing Addiction on a Continuum
For the longest time, the Diagnostic and Statistical Manual (DSM) only recognized abuse and dependency with various substances as mental disorders (American Psychiatric Association, 2000). The problem that these set categories presented was that they were extremely limiting in nature. They either focused on the deleterious effects on a person's psychosocial functioning when abusing a substance or, in the case of dependence, focused on the physiological need for a substance to maintain a sense of normalcy. Either the person was abusing a substance or the person was dependent on a substance.
The problem with this narrow range of focus was it did not incorporate the full scope of behaviors that can contribute to an addictive disorder including what happens when a person simply uses a substance. Additionally, this narrow categorization did not take into consideration that there was a neurobiological process occurring. These limitations, no doubt, contributed to the confusion of what constitutes an addiction.
In order to further develop our understanding of "addiction" as a neurobiological disorder, it will be helpful, first, to examine addiction on a continuum. To accomplish this, it is important to consider how use, abuse, and dependency actually are interrelated and, ultimately, contribute to the development of an addiction.
Use, Abuse, and Dependency
Use would include situations where a person may use a substance or a set of behaviors for recreational, social, or ritual purposes without any negative ramifications. This may include drinks before dinner or at a celebratory function. The main emphasis is that the use of the substance or behaviors has no negative impact on the person nor is it the primary focus for the person.
Abuse is when the substance or set of behaviors has a deleterious effect on the level of functioning areas of a person's life. Although that person may have yet to have develop a dependence, the excessive use has created problems or difficulties that have interfered with daily functioning and responsibilities such as DUI, domestic violence, job difficulties, or physical illness.
With dependence, there is a build up of tolerance or a reliance on particular substances or behaviors whereby a person increasingly needs more of the given substance or the specific behaviors to maintain a...
