Of course, my wonderful parents, who showered me with love and encouraged me (and paid for my college and medical school education); my teachers at the State University of New York and Yale University, who inspired me toward academic pursuits; Dr. George Wayne, who first recruited me to work at Edgemont Hospital in Los Angeles; Dr. Anthony Radcliffe, who brought me to SCPMG Kaiser Permanente; Dr. Rochelle Sechooler, who asked me to join the teaching faculty at Los Angeles City College; and more recently, Dr. Krista Gilbert, who invited me to join the treatment team at Michael’s House in Palm Springs, California. I also want to thank Dan Mager of Central Recovery Press and Mike Rounds for their invaluable assistance in putting this book together.
Merriam-Webster defines addiction as “a compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal” or in a broader definition, “the persistent compulsive use of a substance known by the user to be harmful.”1
Historically, addiction has been defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin, caffeine, and other drugs) that cross the blood-brain barrier, and once ingested, temporarily alter the chemical milieu of the brain. Addiction can also be viewed as a continued involvement with a substance or activity despite the negative consequences associated with it.
Addiction begins as a pursuit of pleasure, enjoyment, or relief from actual or perceived ailments; however, over a period of time more involvement with the substance or activity (such as gambling, eating, or sex) is needed to feel normal. In other words, a person starts doing it to feel good and then has to continue doing it to keep from feeling bad.
However we define it, humankind has been experimenting with mind-altering substances ever since we first discovered that grapes would ferment into wine. Since then, we’ve used our intellect, imagination, and ability to create myriad new ways to alter our consciousness through the use of addictive drugs and behaviors. Unfortunately, some people go on to develop serious problems when they go down this road. It has often been said that in the beginning of this deterioration, the use of drugs sometimes “gets in the way of the person’s life.” Later on, “life gets in the way of the person’s drug use.”
This is not a book about counseling or therapy. We already have more than enough books that deal with that subject area. This is a book about the essential biological and medical knowledge that a therapist or counselor should have if he or she desires to work effectively with addicts (including alcoholics). Throughout my many years as a physician working in this field it has been disappointing to observe that so many well-meaning therapists and counselors seem to know relatively little about the biological and medical aspects of addiction. The consequences of this lack of knowledge lead to suboptimal care and treatment for this very vulnerable patient population.
I hope that in some small way this book will lead to improved integration of the medical and counseling fields. The Therapist’s Guide to Addiction Medicine has been written as a basic guide to assist counselors and therapists in helping their clients recover from the disease of addiction. Although The Therapist’s Guide to Addiction Medicine was envisioned as a handbook for addiction counselors and therapists, I have tried to make it easy to understand so that it can be used as an educational and self-awareness resource for anyone who struggles with addiction or is living with or caring for someone who suffers from this disease.
INTRODUCTION NOTES
1 By permission. From Merriam-Webster’s Collegiate® Dictionary, 11th Edition, ©2013 Merriam-Webster. Inc. (www.Merriam-Webster.com).
“I’m Not an Addict; I Can Stop Anytime I Want!”
There are any number of reasons why people use and end up becoming addicted to alcohol and other drugs: to change the way they feel—for euphoria, sedation, and anesthesia; to self-medicate depression, anxiety, insomnia, boredom, and lack of pleasure. To treat addiction, you have to understand what it is, how people become addicted, and work to eliminate the underlying causes. If you don’t, you’re just addressing the symptoms and your treatment process won’t work. First of all, addiction doesn’t just happen—it takes time.
There appears to be a “continuum” of people who use alcohol and other drugs. Let’s start by stating that many people at the beginning of this imaginary continuum never get involved with substances. In fact, there really are many people who never use or even try alcohol or other drugs. It may be against their religion, like Seventh-Day Adventists, or for some other reason they are fearful, or simply uninterested. In other words, a lot of people never touch the stuff.
Having said that, let’s let the medical community weigh in with a definition. The American Society of Addiction Medicine defines addiction as “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.”
But please recognize that not everyone who uses alcohol and other drugs becomes addicted. Going back to the imaginary drug use continuum, we note there are many people who experiment with alcohol and other drugs but never become dependent or addicted to them. Who experiments with these substances? The answer is most people in our society. People experiment, even kids on a playground. You’ll sometimes observe them spinning in circles and going, Woo, I’m getting dizzy! This happens because people seem to have a desire to periodically alter their consciousness and it seems at the time like fun. I’m not saying that experimentation is always harmless because it isn’t. A kid can experiment with LSD and jump off a roof or experiment with cocaine and get arrested. But I am saying that many people do it and don’t run into any problems with it.
As we move on along the continuum we observe people who use drugs recreationally. Recreational drug use means you go to a party and you smoke a little pot or snort a little cocaine. Or you go to a baseball game and have a few beers. Now, again, I’m not saying that recreational drug use is harmless or for that matter, legal. Because you could use cocaine recreationally and have a heart attack or you could be observed smoking marijuana and wind up getting arrested. Or you could get stopped for DUI on the way back from the baseball game.
For these reasons and others, recreational drug use is a big problem in our society. Unfortunately, however, the media always manage to confuse addiction with drug use. Sometimes you’ll see an article in the paper reporting that the police busted a “rave” party, where kids were on ecstasy, and the media talk about what a big problem addiction is. The problem is that the two don’t have much to do with each other, at least not in that context. Kids do drugs, teenagers do drugs, adults do drugs. However, this phenomenon is not necessarily chemical dependency or addiction, but instead should be characterized as recreational drug use.
For that matter, when you see articles in the papers or