Addictive disorders have steadily been on the increase over the last 18 months due to recent events. Even recorded deaths from addiction have reached an all time high in places like the United Kingdom (2021). Resources for dealing with addictive disorders have become severely compromised, meetings have been put on hold and some rehabs closed. These are just the changes within the treatment world that have been severely tampered with, let alone what people have had disrupted in their own personal lives.
Lack of Control
One of the most simple descriptions of addiction is a lack of control, this description was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-VI, 1994). It can be paired up with almost any action to show a disordered relationship with that behaviour or substance. Sex addiction, alcohol addiction, heroin addiction, computer game addiction, work addiction…etc.
Unlike when people might say they’re addicted to crosswords or football, addiction usually refers to that someone has a disordered relationship with that thing. Usually a disordered relationship can be defined as something that causes problems in the following areas:
- Liver (your health)
- Lover (partner/spouse/family)
- Livelihood (job/career/occupation)
- Law (either legal trouble or risk of breaking the law)
The American Society of Addiction Medicine (2020) breaks it down as Bio-Psycho-Social-Spiritual disease, whereby someone must have issues in all four areas in order to have addiction:
- Bio : Physical withdrawals, tiredness, fatigue, itchy, heart problems, nose damage, liver damage, high blood pressure, chewed nails, bad skin, sleep problems, indigestion issues, cough, collapsed lung, chest infections, damage to veins, change of weight….etc.
- Psycho: Mental health issues, depression, mood swings, anger, feelings of hostility towards others, compulsive lying, impulsive behaviours, shame, guilt, flashbacks, anxiety, loss of sleep, lack of self-efficacy, lack of empathy, inability to set goals…etc.
- Social: Presence of deviant sub-culture, criminal record, breakdown of nuclear family, child neglect, divorce, separation, lack of work, lying to people around you, loss of friends, resentments towards others…etc.
- Spiritual: Loss of faith, no plans for future, lack of purpose, anomie (meaningless life), no longer developing, inability to progress, reality distortion, obsession instead of focus…etc
Addiction or Not Addiction?
The term addiction is a rather loaded term in ways, for some it stirs up feelings of deep shame and denial. A more helpful word is Substance Use Disorder, this simply means a person has encountered so level of dysfunction in their life because they use a substance. If the substance wasn’t there in their life they may not have that particular problem.
There are however critics of this, believing that a person must accept that addiction is their primary disorder and they must put that before all else. There is some truth to this matter also, but it can differ from person to person.
For example, if a person were to come to me and tell me that they are very depressed and as a result of this depression they drink alcohol heavily on a regular basis (by heavily I mean 2+ drinks on most nights of the week, or binge drink. UK defines harmful drinking as being in excess of 4units of alcohol). Alcohol in larger amounts is directly linked with poorer mental health, depression and anxiety. Some people might be robust enough to not feel these affects, but on average alcohol does worsen moods and stability of moods for a person. If a person is unable to get full control over their mental health then it would be highly advisable that the person ceases to use alcohol entirely until they can understand what is the underlying cause of their low moods. If a person can identify their alcohol use is directly linked with poorer moods then their relationship with alcohol must be addressed as a primary problem.
It is worth noting that not all people fit the classic definition term of alcoholic, they might be able to refrain from alcohol use entirely for several days, weeks or months. They may not even drink to a level that is out of sorts with their peers. However, the effect of their drinking might have immediate consequences on their life.
As much as we can identify with groups of people, and indeed share some traits with them, we are still individually different.
A quick example of this is that I was working with a lady in a group at a rehab a few years ago, she had her results back from the doctors, they were fairly severe. She was taken back to hospital and a scan showed that she had liver damage in the form of alcoholic hepatitis. When she was back in the community she compared her results with others who had a similar pattern of drinking. She was astounded that she appeared to have been drinking much less than some of her peers but they seemed to be fairly intact. She put it to the group that it wasn’t fair and how could it be right? Unfortunately there are lot of individual factors that govern how a person will react with high levels of drinking. A lot of the information about safe levels or levels of harm are very generalized. There are going to be people who are more susceptible to harms than others, conversely to this there may be people who can tolerate a lot more.
Counseling For Addiction
In order to address addiction effectively, counselling for addiction must be different that usual counseling. One feature that makes it very different is that it often or always orientated around the goal of stopping alcohol/drug use, or in some cases controlling it.
Other fields of psychotherapy invite the client to bring goals to the session themselves, although this is true of addiction counselling also, it is often highlighted by the therapist that those other goals will not be easily accessible without some level of change towards their addiction.
It is worth noting, just as I described that addiction has different effects on individuals, some people want different outcomes also. Within a treatment facility, the outcome is being able to manage a life that is usually addiction free, meaning that the person would never go back to taking a substance that they previously had issues with. Counseling within a community setting can greatly differ, some people may want to sample a life where they wish to have more control over their drinking or using. This all entirely depends on the severity of the addiction.
Addiction counseling is generally focused on behaviour, without addressing behaviour around a substances it is unlikely that a person will make effective changes in their life. Therefore nearly all counselling processes on addiction will include cognitive behaviour therapy (DBT) or a similar behaviour therapy. Changing thinking styles and arresting anxiety alone will not help a person manage their behaviour.
Addiction counseling will also involve a daily process of sorts. As addiction is a powerful process that generally effects a person on a day to day basis it is important that the remedy is also on a day to day basis. In addiction counselling this will usually come in the form of a workbook, app, face to face meetings, check in processes, counseling, groups….etc.
As addiction is a chronic disorder it needs a chronic solution. An acute treatment process of 1-3 months is not sufficient enough to make sustainable changes. If a person chooses to only sample an addiction free life for a period less than 3 months then they may not feel the full benefits of change. Sometimes when a person goes addiction free, for the first couple of months they may actually feel a little worse, they may lose sleep, have a lower mood and encounter more difficulties in anxiety. This is a normal and natural response, the body and brain don’t quite know how to cope with life on life’s terms just yet. It may take longer for the body and brain to adjust with being substance-free. It also takes an individual a little longer to learn new coping skills.
Even the most simple stressors, Friday night. A Friday night at first might feel novel to spend with the family watching a movie and eating a nice meal, but then four weeks pass and that Friday evening in may now feel like a drawn out boring process where urges to use/drink begin to rise. What is one to do? Why should one feel this way? This process can only be answered by experience, by knowing what to put into life and how to manage it effectively. Without the proper guidance or framework a person may chose to act out and use on the back of this experience.
Online Addiction Counseling
Online addiction counseling can be an effective means of helping someone through their substance use disorder or addictive disorder. As online times are generally more flexible than traditional counselling hours (usually 9am – 5pm), it affords people a greater range of times to fit in around their lifestyle. Although addiction is a primary disorder in many cases, people still live in the real world. They have jobs, commitments and other issues to attend with.
Online addiction counseling is also more popular with people who undecided with AA, they may find AA does not give them the personal touch they are looking for. They may feel uncomfortable with talking to a group of people regarding their behaviour, thoughts or addiction. They may also feel uncomfortable with a rituals and praying involved at AA groups if they come from a secular background.
Often peer to peer groups like AA and others lack the expert knowledge to advise on addictive disorders.
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