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Monday, November 5, 2012

Addiction as Spectrum

One of the revelations I've come back with is that we, those raised in the West with long exposure to AA and 12-Steps, think of addiction as a 'stand alone.'  When we speak of it as a disease, a disease is always singular: you either have cancer, or you don't.  There is a distinct line.  Tests for diseases come back 'positive or negative.

But, when we are talking about mental disorders, the lines start to get a little blurry.  We can talk about individual symptoms, and perhaps even general tendencies or even 'onset' of a disorder, but you will see doctors step back before jumping to a diagnosis.

Now, let's throw in addiction.  When is someone 'addicted?'  Well, AA teaches that you are 'qualified' to call yourself an alcoholic when you say so, but that's not exactly clinical.  Chances are we can see plenty of people around us who are plainly addicted and won't acknowledge it at all.

We can also go back and look at the events which an addict will usually blame for the onset of the disease, yet the person did not become instantly addicted as a direct result.  Usually, the addiction arises sometime later.

Some addicts can point to a particular moment when they had the drug or drink that set the wheels in motion, but they will also readily admit that the wheels were there long before that 'first drink.'  The disease just became more obvious, but even that first experience isn't enough to make a diagnosis.  I know plenty of people who've had euphoria and it does not mean they are hooked.

It is precisely this blurry, indistinct line that gives us trouble when explaining the 'disease concept' to those who do not take AA and the 12 Steps for granted.  I was raised around it, having a number of sober relatives.  There was nothing revolutionary about it for me.  But, I'm in the minority.

In Romania, teaching about the disease model is frustrated by the simple fact that the Romanians pick up on the disjunctive situation, where a precise 'disease model' does not line up with an imprecise diagnostic model.  One is specific, while the other is ambiguous.

Sure, most of psychology operates in this blurry world, but psychology and psychiatry are a lot less controversial because they usually are the only path available to people with mental illness.  When it comes to addiction, there are a number of choices people can take in order to 'treat' the problem.  Not that they work, but people usually perceive that they have choices.

To effectively explain addiction, the only thing that has worked for me is to explain the whole spectrum of human experience and suffering.  Explaining addiction as its own thing isn't working.  However, when I can explain how the 'spectrum' of addiction takes hold in the spectrum of human existence, people seem to grasp it quicker.

My sense is that it is time to start looking at addiction through the lens of the 'big picture.'  We need to stop isolating addiction, and address the greater issue of human suffering.

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