Substance Use Isn’t the Problem. Addiction is the Problem.
Substance use is a symptom of addiction disease. And therein lies the actual focus of recovery support.
Substance use disorder is not addiction disease.
When we talk about people who use alcohol and/or other drugs and what they need, the focus has traditionally been more on ending substance use. This is the wrong focus because the resulting treatment places emphasis ont the symptom (substance use) and not the solving the actual problem: addiction. I’ll repeat it again: Substance use disorder is not addiction disease. Substance use is just one symptom of the complex disease that is addiction.
“If substances truly were the problem, we should expect to see way more people with addiction problems. And yet, we don’t. Because the definition of addiction disease is wrong. And therefore, our addiction treatment models set people up to fail.”
Even the APA has it wrong.
Their definition of addiction disease states that:
Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.
The APA has inextricably interwoven addiction disease with substance use disorder. The problem is, addiction isn’t just seeking out substances. Addiction also manifests in symptoms of gambling, sex, porn, and other behaviors. And, if it was so interconnected with substances, why is it that only a tenth of the population has an addiction disease related to substance use? It is estimated that about two-thirds of the American population regularly use alcohol and other drugs, but roughly just 7% of them would be classified as having a substance dependence problem needing treatment. If substances truly were the problem, we should expect to see way more people with addiction problems. And yet, we don't. Because the definition of addiction disease is wrong. And therefore, our treatment models set people up to fail.
So what is the root of addiction disease?
Addiction would more accurately be defined as a brain disease in which biopsychosocial factors have contributed to a learned behavioral coping response to ease negative feelings like stress, anxiety, and depression. The behavior is a quick fix and does not address the problem adequately. The result is a vicious feedback loop in the brain.
That feedback loop releases all the feel good chemicals in the brain when the behavior is acted out. When the behavior stops and the effects diminish, the loop creates a more powerful negative experience mixed with withdrawal symptoms. This reinforces the behavior even more because now engaging in the behavior eliminates the withdrawal symptoms plus gets the negative feelings that caused a person to need the behavior in the first place. Over time, the person becomes tolerant to the “high”. The result is more and more engagement in the behavior to get the high feeling. Eventually, the behavior just helps a person to feel normal because they are so reliant on the behavior to cope with negative experiences.
This is why addiction disease is so insidious; it creates this perfectly destructive loop in which each part reinforces the other. This is why it is so hard to stop the spiral, especially when the focus of treatment is solely on the symptoms, like substance use, and not on the actual disease.
Our way forward.
This new definition is the way we need to think about addiction and substance use moving forward. It untangles substance use and addiction, allowing appropriately tailored recovery support interventions. We can provide the right support for the different symptoms of addiction that come in the form of substances or behaviors like gambling.
Supporting addiction recovery effectively requires the addition of supportive resources that help people more effectively cope with the stressors in their lives. Subtracting substance use alone does nothing to actually combat the addiction disease. People need to feel safe, secure, and supported. They need to have hope. When society and treatment professionals begin to accept this definition of addiction disease, we can get more people the help they need and deserve.
