Posted by: dopaminedialogue | 01/23/2010

When can we call it an addiction?

WHEN CAN WE CALL IT AN ADDICTION?

In the article “Is There Such a Thing as Sex Addiction?” (see link below) and many other recent news articles just like this one (most of them mention Tiger Woods), the question comes up: is sex addiction real, or is it really just that the person is capitalizing on opportunity?

I would like to argue that this discussion isn’t helpful for those who are struggling with sex addiction (or to those trying to understand sex addiction) because it serves to further denial and deepen shame. Shame then leads to an increase in a person’s motivation to hide the problem instead of dealing with it head-on. Not dealing with the problem means the problem continues. So if we are going to make headway with regard to treating addictive disorders, we are going to have to change how we talk about it. That change is only going to come about through education about how the disease of addiction works in the brain.

To clarify, the same conversation about choice versus true compulsion can be had with regard to any addiction – not just sex addiction – and it is the same struggle we’ve had many times before with other addictive disorders. Case in point: the same questions are posed in the Big Book of Alcoholics Anonymous (written in the 1930s) and there are straight-forward suggestions for how to determine if one is a “real alcoholic” versus a “heavy drinker”. The Big Book even conjures up a make-believe example of a jaywalker who loves the thrill of jaywalking and can’t stop even when he becomes crippled due to repeated, near-fatal run-ins with cars and buses (this example can be found starting on pg. 37 of the 4th addition).

So, when or how do you determine when something is simply over-indulgence and when it is a real addiction problem? That determination comes when the painful consequences don’t stop the behavior. When pain doesn’t stop it, then it is a compulsion (like a reflex). For example, if a person has gotten more than 1 DUI and they still drink and drive, this is an indication of a drinking problem. If a person has had multiple major health complications due to their uncontrolled diabetes and they still don’t make the necessary changes to their eating habits to better manage their illness, this may be an indication of a food addiction. Each person’s threshold for “pain” or consequences is different, but you get the idea.

I’ve dealt with many people with drug and alcohol disorders who say to me, “I drank because I wanted to drink. I liked the feeling.” or “I used because of what it did for me. I was able to work longer hours and get so much more done.”  “I got the pills from my doctor, he didn’t force me to take them.” With food addiction, it is common for people to shame and blame the food addict and label the behavior as “gluttony” or “overindulgence”.  This is the same thing we are hearing now about Tiger Woods, “He was merely taking advantage if his opportunities.”

These are also the types of justifications any addicted person might use to shame and blame themselves for the problem. But this line of thinking ignores the compulsion – or the reflex – that is a result of the brain disease. In the long run, this self-blame does nothing to help them deal with the problem because it leads to low self-esteem, hopelessness, shame/guilt, less motivation to try to work on the problem – and ultimately relapse. It leads the person to pull-away from positive support or isolate themselves to hide their shame when instead what they need to do is to learn as much about their disorder as they can through help from other people who understand how the disorder works. When people with addictive disorders develop an understanding of how the disease works in the brain (and how that translates to abnormal behavior) – that chemical reactions in the brain lead to an inability to stop doing something extremely harmful to them and others – then that shame/guilt, hopelessness and lack of motivation decreases and they can begin to treat their illness like a true disorder instead of a character flaw or moral weakness. Education about the brain takes the shame out of the equation and allows the person to come out of hiding, get the proper information/education and exposure to healthy coping skills, and treat their illness in the proper ways on a daily basis. It leads to long-term success instead of short-term abstinence and chronic relapse.

Education about addiction is the answer to so many of our society’s woes that are a result of addictive disorders (obesity, bankruptcy due to shopping, gambling, or other addictions, crime related to addictive disorders, and medical care that ignores addictive disorders all-together – to name a few), and articles like this one do more damage than good.

The article, “Is There Such a Thing as Sex Addiction” can be found here:

http://www.chicagotribune.com/health/sns-health-such-thing-as-sex-addiction,0,2552894.story

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