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Man in recovery looking for hope overcoming addiction

The Top 10 Things You Need to Know About Addiction

Addiction is such a strange thing when you think about it. I think it intrigues everyone because we know just how much it can destroy life, even though the person it’s affecting hates that they do it.

Addiction is a lure that captivates the vulnerable and haunts people who never planned on a life so controlled by something they don’t want. It’s a mysterious villain who doesn’t have any shape or form, yet finds its power by feeding on the darkness that we all must admit we have inside.

When I do initial assessments on patients with addiction in my psychiatry practice, I usually find that they’ve been operating on bad information. They are people who took advice from well-intentioned helpers, only to find they wasted years of their life by using misguided approaches.

If you understand things accurately, you have a much better chance of doing something productive about it. Below are the top 10 things you need to know about addiction to understand it:

 

1.  There is a debate around whether it is a disease or not.

If it is a disease, then you’d also need to call anger a disease too. Even though there are measurable changes in brain chemistry with addiction, you have to keep in mind that we can measure changes for any mindset or repetitive pattern (whether that’s heroin, riding a bike, or being angry). Research supports the theory that addiction is a learned (trained) behavior, not a true disease.

 

What this means:  Nobody with addiction is doomed. Just as it becomes a learned behavior, it can be unlearned. This more accurate understanding gives honest hope for anyone who gets the right guidance. 

 

2.  Addiction is not just from getting hooked on chemicals.

Dopamine is a reward neurotransmitter that surges with drugs. But did you know we usually release more dopamine in anticipation of using a drug, than from the actual drug itself? We also can get quite addicted to behaviors without chemicals (like porn or gambling). Substances are actually tapping into a very normal mechanism that drives us towards rewarding things (like love, food, shelter, and security). We all have that reward pathway. It takes two to tango… although substances are the object of addiction, it takes a learned behavioral pattern to keep seeking them out. I’ve written more about this here.

 

What this means:  Vices and substances are always going to be available, and we all have an addiction circuit that drives us towards rewarding things. The key is to shift away from the quick, false pleasures towards more deeply satisfying ones we can be proud of.

 

3.  Only one in ten people with addiction accesses treatment.

The barriers are both practical ones (cost, insurance, time away from work or family, etc.) and psychological ones (like shame, guilt, and fear of being found out). Ironically, most people don’t get treatment because the industry is set up for dramatic and high-cost intervention. Rehab isn’t even shown to be better than sustainable outpatient therapy. Studies suggest two reasons for this: outpatient programs allow people to practice new behaviors in their real-life environment, and have a longer duration of treatment to practice changes.

 

What this means:  Getting help doesn’t need to be a traditional 30-day rehab, so think broadly about how to get better. Try to reflect on what’s holding you back from getting help, and troubleshoot how to work through those barriers.

 

4.  76% of people with addiction get better without traditional treatment. 

This data comes from one of the best, largest, unbiased studies. While some people absolutely need a high level of care or risk death, not everyone needs that. The facts show that it’s more than possible to find your own personal tools to get better and that works as well as formal treatment for most people.

 

What this means:  You’re not crazy if you are skeptical about traditional treatment facilities. But you do need to honestly ask yourself how bad things are, what type of help you might need, and figure out what tools you need to improve. I’ve created a pdf guide on treatment options: here

 

5.  Addiction affects everyone.

It doesn’t just hit the poor, homeless, or disadvantaged. That’s because it’s not an issue of intelligence or morals. It’s a what-feels-good issue. And anyone who is human is susceptible to feeling really good with addictive substances and behaviors. For example, 1 in 4 female surgeons and 1 in 4 male lawyers have an alcohol use disorder, and executives have 40% higher rates of drug use than other occupations. I’ve written about addiction in high achievers here.

 

What this means:  Don’t judge people with addiction. It doesn’t reflect how moral or smart a person is, but it does reflect some type of compulsion or inner suffering that a person is going through.

 

6.  Alcoholics Anonymous (AA) / Twelve-Step dominates the addiction treatment world.

About 75% of the industry uses this model, from outpatient counselors to inpatient facilities. But just because it dominates doesn’t mean it’s the only way or the best way. The largest-ever peer-reviewed study of the AA model concluded: “No experimental studies unequivocally demonstrated the effectiveness of AA or Twelve-Step Facilitation approaches for reducing alcohol dependence or problems.” I still recommend certain patients use the strong social support of Twelve-Step but keep in mind it was never intended to be a treatment or replace clinical care.

 

What this means:  If you believe in and want to use the support of Twelve-Step, please do. But don’t let people convince you it’s the best way to get better. Science and psychology remain the most proven tools for recovery.

 

7.  It’s difficult to find a good addiction therapist.

The problem is that most mental health therapists don’t get trained in addiction (I know this because I train them afterward). On the other end, addiction counselors don’t get trained to treat underlying mood issues like depression or anxiety. In fact, there are few standards of care, and many coaches have zero clinical training. That’s why it’s not uncommon for me to meet new patients who have been through decades of “treatment” without any effect. The shame is that patients blame themselves rather than their treatment until they have a chance to recognize the gaps in their care.

 

What this means:  Don’t leave gaps in your progress with under-equipped providers. Look for someone with the training and experience to deal with both addiction and underlying issues together.

 

8.  Addiction is a trained pattern of seeking pleasure to escape intolerable painful emotion.

That’s the definition I created that most accurately and simply describes how addiction works. If you already think of addiction as a way to numb or escape problems, you’re already ahead of the game. Do some people use substances without any underlying pain? Yes… and they are recreational users who can stop when they want without issue (other than a short physical withdrawal). In cases of ongoing psychological dependence, there’s always an underlying pain. More on the cause of addiction here.

 

What this means:  If you’re the kind of person who compulsively uses a substance or behavior to get through hard things, ask yourself what the pain is underneath it all. It can be all kinds of things like a difficult childhood, not being happy with where you are in life, depression, anger, emptiness, or boredom (anything that makes you feel bad).

 

9.  A narrow focus on sobriety isn’t helpful.

Sounds wrong, doesn’t it? While sobriety is a fine goal, this irony happens because it focuses on what not to do (instead of what to do) in order to improve. The usual mindset in addiction is that pain is bad and should be escaped from with a chemical or behavior. The fixation on abstinence pulls us even further in the wrong direction where we superficially measure only that outcome. Studies show long term abstinence is most likely with a focus on emotional well-being instead.

 

What this means:  Sobriety doesn’t necessarily mean you’re well. Instead, trust that your addiction will fade if you live a healthy life you are genuinely proud of. That will keep you focused on the right efforts, and work through natural and expected relapses over the course of your effort. 

 

10.  Willpower isn’t a real thing… science is.

When you have to force behavior, it does indeed feel like an endless test of willpower. But as much as you may have heard that you need to grind your way to sobriety for the rest of your life, science shows us willpower is more of a made-up concept than a true strategy. There are much more effective ways to change behaviors that lead people on a stepwise path to fill in life’s potholes. I’ve written more on willpower here.

 

What this means:  Willpower is an abstract concept and doesn’t provide a reliable way forward. Instead, find more tangible strategies that you can actually name, practice, and implement. 

 

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