~ Craig Nakken
Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health by Vivek H. Murthy, M.D., M.B.A. U.S. Public Health Service, Surgeon General 2016
In 2015, over 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs, and over 66 million people (nearly a quarter of the adult and adolescent population) reported binge drinking in the past month. Alcohol and drug misuse and related disorders are major public health challenges that are taking an enormous toll on individuals, families, and society.
Neighborhoods and communities as a whole are also suffering as a result of alcohol- and drug-related crime and violence, abuse and neglect of children, and the increased costs of health care associated with substance misuse.
It is estimated that the yearly economic impact of substance misuse and substance use disorders is $249 billion for alcohol misuse and alcohol use disorders and $193 billion for illicit drug use and drug use disorders. Annual Total: $442 billion
Welcome to Addiction Trends where we share a few highlights related to ongoing conversations and theories about addiction. Over the past two decades research in neuroscience has led to new theories and also supported existing ideas. Popularity of some interventions has waned while new ones are being carefully considered.
Our Addiction coursework, textbooks and public domain materials present various positions and address process addictions (behaviors) such as sexual addiction or gambling as well as substances. We believe it is important for our courses to provide several ways of thinking about a very complex human condition that crosses all social classes, age groups, genders, cultures, and continents.
Theories of Addiction impact the choice of Treatment and Counselling approaches. Is addiction a moral issue, psychological issue, developmental issue or legal issue? Theories determine the level of Stigma and Compassion that impacts the heart and soul of our friends, family, and communities. Theories affect whether the focus is on shame and punishment or hope and help.
Although there is overlap and interaction of factors, theories of addiction tend to fall into one of the following categories as the LEADING cause of addiction (and determines the focus of treatment):
✔ Compulsive Process/Experience: abused substance/s or addictive behaviors (gambling, pornography), etc.
✔ Person: physiological, emotional, genetics, brain disease, ADHD, Trauma, Triggers, Emotional Intelligence, intuition, spirituality
✔ Societal /Context: family, neighborhood, community, crime and legal climate, faith community, ethnicity, access to housing, food, education, jobs, healthcare, treatment services, legal services
For many years addiction counselors with clinical training have referred to addiction as a bio-psycho-social-spiritual disorder or disease. Many clinicians also understand that developmental factors can be a significant factor in the onset and recovery from addiction.
Findings from an initial face to face assessment of how a person is affected in these five areas typically becomes the basis for prioritizing treatment objectives to help the individual client or patient to address their substance use disorder.
There is ample evidence on the direct physical damage to the human body from substance misuse. But advances in neuroscience and understanding of brain structure and chemistry have led to medical experts now referring to addiction as “a brain disease” based on the effects of substances on the brain.
Technology now exists to take brain scans showing diminished blood flow caused by various substances, injury and other neurofunctions.
Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury. Neuroplasticity offers real hope to everyone including people dealing with addiction as they begin to understand why early recovery can be so challenging from a biological perspective.
Pharmaceutical research has led to new drug therapies to help people deal with a range of substances, from alcohol to heroin and other opiates. Psychotropic drugs for conditions like depression or anxiety are part of treatment for a person with a co-occurring mental illness and a substance use disorder.
The biological dimension of addiction is the focus of the American Society of Addiction Medicine (ASAM) which defines addiction as follows:
- 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.
This ASAM definition found here: asam.org/resources/definition-of-addiction
In his book, In the Realm of Hungry Ghosts, Dr. Gabor Mate writes, “We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meaning we’ve created. Unwittingly, we write the story of our future from narratives based on the past.”
Dr. Mate defines addiction as “any behavior that a person finds pleasure or relief in and craves but suffers negative consequences and can’t give up.” (He includes substances and behaviors such as pornography, overeating, gambling, over working, etc. )
In an interview with John Lavitt posted on “the fix”, Dr. Mate explains how childhood trauma leads to the creation of a harmful personal mythology where the resulting meaning of that mythology becomes a weapon of the addicted person’s own self-destruction.
John Lavitt: How can a person escape such a self-defeating prophecy? Once ingrained, how hard is it to fully overcome such a storyline?
When that doesn’t happen, when we’re hurt for whatever reason, when we’re simply not seen or understood or nurtured emotionally in the way that we need, then we immediately come to believe, and this belief becomes ingrained in our psyches, that’s there’s something wrong with us. We believe we should be ashamed of who we actually are, and that’s because children take everything personally.
Children are narcissists, not in a negative sense, but in the developmental sense that they think it’s all about them. When things don’t go well, they develop a deficient sense of themselves. They also develop a view of the world that is rather fearful in which they have to hide or defend themselves or run or escape how they feel. All of that is the basis of addiction.
However, it’s not human nature to develop in that manner. Human nature is to be connected and loving, open and social, and compassionate. Not being able to be true to our nature is one of the reasons why we suffer. That true nature is still working for us and is still inside us. The very suffering itself helps to wake us up. That very suffering helps to guide us in the right direction if we are open to receiving the guidance.
In the addiction movement, people talk about recovery. What does it mean to recover something — it means to find it. When you recover something, you get it back. In other words, what we get back is ourselves. That self is never actually lost. If we can identify how we lost the way and how we “lost” ourselves, we can find a way back to ourselves, which is the essence of all healing.
John Lavitt: When commenting on the neurobiology of addiction, you write how, “addiction is related psychologically, in terms of both emotional pain relief and neurobiological development, to early adversity.” If the neurobiological development of a child is affected by trauma, how can such physical changes set in place long ago be reversed? Is it possible for an adult to “renew” their brain, and if so, how long would such a process of renewal take? What tools would be required?
Other problematic systems include the stress regulation circuitry, the impulse regulation circuitry, and especially the dopamine-driven incentive motivation circuitry. As a result, doctors often conclude that because these brain circuits aren’t working well, there has to be a brain disease and that addiction is that disease.
The actual truth is that these circuitries are shaped by early experience. From countless studies and from the overall consensus in brain developmental science today, we know these essential brain circuits develop through the interaction of genetics and experiences. Experiences turn genes on and off. What we are seeing in the adult is not the result of some inborn genetic disorder, but the result of childhood experience. That’s the first point.
The second point is that addictive behaviors, particularly substance use disorder, further distorts the structure of the brain. Certain neural changes can be seen in the majority of substance addicts. The longer they use, the more significant those changes are. However, the brain also has a remarkable capacity to change, which is called neuroplasticity. Neuroplasticity is the brain’s innate ability to develop new circuits, even later on in life, in response to new experiences.
With any developmental question, it’s a matter of what conditions do you provide. If you are growing plants, you have to set the right condition for the plants to blossom. This is the same for any organic creature. Whether in childhood or adulthood, the healthy development or the healthy redevelopment requires the right conditions.
From the outside, those conditions include a compassionate environment where you are seen and understood and not unduly criticized, attacked, stigmatized, or criminalized. It also includes, of course, nutrition. It includes contact with nature. It includes getting real help to process the childhood difficulties, adversities, and traumas that influenced your development in negative ways. It also involves mindful awareness practices that help to develop new circuits in the brain.
In other words, in response to this comprehensive question, it takes time to heal. The longer you have been addicted, the longer you used, the longer it may take, but it’s entirely possible. Indeed, the brain can change in positive ways at almost any age.
John Lavatt: In "BEYOND DRUGS: The Universal Experience of Addiction," you quote trauma pioneer Peter Levine, “Trauma has become so commonplace, that most people don’t even recognize its presence.” Do you believe that the widespread experience of trauma is behind this current opioid epidemic? Given the warm bubble of pleasure that opioid use brings about where a user barely can be touched by anything outside the addictive cycle, did prescription painkillers and heroin become the easy choice for a wounded generation? Lacking awareness of their trauma and access to treatment options, did opioids become the most straightforward available option to medicate the experience of latent pain?
The myth that the opioids create the addiction is wrong; it’s the pain that creates the addiction combined with access to the opioids. There are legitimate uses of opioids in the treatment of physical pain. There is no legitimate use in the treatment of emotional pain. The opioid epidemic represents an epidemic of emotional pain that is rooted in the childhood experience of trauma. Such emotional pain is coupled with a troubled society where disconnection, isolation, and increasing amounts of stress have become commonplace. For example, we know that for every percentage point in the increase of the unemployment rate, there is a corresponding increase in opioid use. It’s a question of a very stressed society where people are seeking escape.
Another key factor in the opioid epidemic is the under-education and inadequacy of the medical profession when it comes to learning how to deal with pain. We don’t teach or learn about the complexity of pain. We don’t explain that physical pain is often a result of a combination of both physical and emotional factors.
We don’t learn how to speak to people with pain and how to listen to them. We don’t learn about the roots of chronic physical pain and chronic emotional pain that often lies in childhood experience. We don’t learn about non-pharmacological ways of treating pain. Therefore, it’s much easier and much quicker, and it’s an awful lot cheaper just to write an opioid prescription and move on to your next patient.
All of these other modalities would take more time. Combined with a troubled society and an epidemic of emotional pain caused by unresolved trauma, such medical inadequacy was nothing less than a recipe for such an epidemic. When you consider all of these factors, the opioid epidemic is not that surprising, but the loss of human life remains tragic and so unnecessary. There are ways to break these cycles.
He believes that the idea of addiction being a “brain disease,” as increasingly promoted by neuroscience, is hampering progress in treatment.
He also asserts that the DSM’s focus of the actual substance itself or an addictive behavior like gambling, is also not helpful with labels such as alcohol use disorder or cocaine use disorder, etc., which implies that the substance or behavior IS the problem.
While the label “disease” has helped to lessen the shame associated with addiction, it has helped to promote the “chronic disease” model of addiction which he believes has no validity.
Dr. Dodes, M.D. is supervising analyst at the Boston Psychoanalytic Society, professor of psychiatry at Harvard Medical School and director of the addiction treatment unit at Harvard’s McLean Hospital.
For More: Adverse Childhood Experiences Study – https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_Study
John Lavitt: In your critique of Facing Addiction in America, the Surgeon General’s Report on Alcohol, Drugs, and Health, you write, “In accurately identifying the brain systems implicated in addiction, the report ignores the scientific fact that the brain is a social organ, shaped in its development by the emotional environment in which the developing child grows up.
Thus, the brilliant brain scans that show the dysfunctionality of the addicted cerebrum are not the result of addiction originally, but of the childhood circumstances that predisposed the person towards addictive behaviors. The drugs didn’t cause the addiction—they only provided the most devastating outlet for it.”
John Lavitt: Why did the Surgeon General principally ignore the role of trauma and its relationship to addiction? If he did know about the role of trauma, could Dr. Murthy’s decision to sidestep the issue be related to the lack of treatment services available to address such deep-seated challenges?
However, despite all the research on trauma and despite all the studies that show how childhood adversity predisposes a person towards addiction in significant ways, the role of trauma remains largely ignored. Despite the consensus in brain developmental scientific circles that the brain is a social organ that develops through a child’s ongoing interaction with their environment, these facts are not yet taught in the medical schools. Most physicians don’t actually know how the brain develops. In most medical schools, although this is changing somewhat, although rather slowly…, most students never hear a single lecture on trauma.
It’s not just the medical professional, but society as a whole. We are trauma-phobic at our very core. We are so afraid to look at it because we deny our own experiences. We are so afraid of our own pain. Despite all the research, we are in constant denial of it. This has been going on for a very long time now. We basically will only acknowledge trauma in extreme cases like the PTSD symptomology of combat veterans, but we are less interested in recognizing how many adults suffer from PTSD because they were traumatized in childhood.
To accept such an idea would demand an entirely different set of social attitudes and social policies as well as economic priorities. We would have to question how we support families and the nature of childcare and maternity leaves and paternity leaves and so on and so forth.
Example: “Every Friday night my dad would come home drunk after work; we could tell how bad it was going to be within a few minutes.” Alcoholism, often referred to as a “family disease,” has been studied through the lenses of Systems Theory which has provided much hope and healing.
For over five millennia human beings have acknowledged and related to the invisible world that exists beyond our five senses. This nonphysical dimension is referred to as the “unseen” or supernatural world. From prophets to priests to gurus and shamans of native peoples there has been an ongoing recognition of a connection or perhaps a lost connection between humans who are earth bound and supernatural forces or entities that are beyond our five senses yet interact with humans through extra sensory means.
Traditionally Humans are viewed as three-part beings with a physical body (skeleton, muscles, and organs); a soul (the mind, will, and emotions), and a spirit (the conscience, the capacity to hold in awe or worship, and the power to love and commune with others and nature). The spirit of man is the transcendent aspect that gives human beings the spiritual ability to know or be aware of God or a deity and to be aware of that which exists beyond our five senses.
William (Bill) White, Recovery historian, writes of Transformational Change that is unplanned, profound, positive and permanent and happens in a brief moment with the result being a dramatic change from a state of desperate addiction to complete and total sobriety with new identity, values and relationships.
Early AA history from the 1930’s is filled with stories of tremendous cures of hopeless drunks along with references to God and Biblical Christianity. Carl Jung and William James attest to such spiritual dynamics in the lives of early AA founding members.
Modern AA reflects contemporary thought of separating spirituality from religion or belief in God to a subjective concept of a Higher Power or perhaps a force for good. Yet phrases in the Big Book still reflect the reality of help from a compassionate God of grace. Well known phrases include: “God did for us what we could not do for ourselves” and “…that God could and would if He were sought.”
Modern AA is still considered a ‘spiritual’ program created to help people who have a desire to quit drinking or drugging. The 12 Step Programs are well respected internationally, especially in the Middle East among Muslims who have a belief in God.
On the other hand, many modern psychologists and psychiatrists believe that human beings are two dimensional, physical and psychological: body and soul (mind, will, and emotions). Since the mid 1700’s, science has been defined as the systematic knowledge of the physical or material world gained through observation and experimentation. These methods cannot observe, prove or disprove the existence of spiritual realities.
Is addiction a spiritual problem? To think about this, we first must define the word, “spirituality.” This turns out to be surprisingly hard to do. A search reveals that up to about 70 years ago, the terms spirituality and religion were almost synonymous.
But since then, “spirituality” has also been used to refer to a feeling or belief in the oneness between an individual and the universe, being in touch with one’s soul or inner self, and even simply a sense of personal well-being. None of these newer meanings has a specific reference to a deity or to religion.
So, is addiction a spiritual problem? If “spiritual” is used in the original sense as “religious” then the answer is certainly no. Addiction is not a failure of religious devotion. There is also no reason to think of addiction as a disconnection between an individual and the universe, or any other “New Age” ideas such as working for social change or channeling contact with spirits.
Since addiction is a psychological symptom, it probably could be loosely described as being out of touch with one’s inner self, in the sense that there are unconscious elements in every emotional symptom.
But calling addiction a spiritual problem on this basis would mean saying that every aspect of emotional distress was a “spiritual” problem. That would add nothing to our understanding or treatment and would actually interfere with trying to figure out the specific emotional factors within people that produce addictive behavior.
Of course, sometimes people, including people with addictions, feel less distressed when they feel “spiritually” at peace—comfortable with themselves and their place in the universe. But plainly that doesn’t mean that addiction is a spiritual problem, or that treatment of addiction has anything to do with becoming more spiritual.
Addiction is not a spiritual problem. Indeed, saying that it is has caused a great deal of pain to many. Addiction is hard enough for people, without having to think they have shallow or tormented souls.