DR. PARI DESHMUKH is a board certified psychiatrist, a certified psychotherapist, and a meditation trainer in both Heartfulness and Mindfulness. He is also an elected fellow of the American Psychiatric Association and the Society of Addiction Medicine. He has a special interest in the common ground of science and spirituality, and their implications on the betterment of our mental health. Here he addresses some basic aspects of addiction, including common misconceptions.
What is addiction?
Addiction is a treatable, chronic medical disease, a complex interaction among brain circuits, genetics, the environment, and an individual’s life experiences. Many think that addiction is not treatable and is some form of moral defect or character defect, which is not true. It’s just like high blood pressure or diabetes. Chronic means long-term; it can be a very long time including over a lifetime, but it is treatable.
The brain is involved in pushing the addiction, and there are certain brain circuits that are more involved. One of them is the reward pathway.
There is also the component of genetics; if our family members have addiction disorders, our chances of addiction are more. Even if their addiction was in some other form, we may still be predisposed to it.
Then there is interaction with the environment. What kind of stimulus, rewards, and punishments is the environment giving us, and how is it guiding our behavior? That has a tremendous impact on our addiction.
Any form of activity can become
an addiction, if it’s spiraling out of
control and leading to
negative consequences in life.
Then there are individual life experiences. How has our life been shaped so far?
So, brain circuits, genetics, individual life experiences, and environment are the ingredients that come together to form a long-term medical disease, which is treatable. Research shows that treating addiction is equally as successful as treating other chronic disorders, like diabetes.
What are the different types of addictions that exist?
There are mostly two types: substance addiction and process addiction.
Substance addiction means we are addicted to a chemical, and the most common is alcohol. There are other addictions like marijuana, cocaine, heroin, opiates. Then there are prescription drugs, like benzodiazepines, or alprazolam. There are also hallucinogens and dissociatives, like LSD, ketamine, and inhalants.
There are various forms of substance addictions, because there are so many substances available. The brain becomes dependent on a particular chemical.
There is also process addiction, which is dependency on some form of act or thinking pattern. For example, gambling and shopping can be addictions. It’s for good reason that Amazon is successful, because shopping is one of the most common addictions. Then we have Internet addiction. On the Internet, we have pornography addiction and sex addiction. We have other co-dependency issues, and eating can also be an addiction. Any form of activity can become an addiction, if it’s spiraling out of control and leading to negative consequences in life.
For example, knowing that alcohol damages your liver and has an impact on your physical health, will you still drink? It could have an impact on your performance at work. You lose your job due to addiction, yet you’re still drinking. Your relationships are affected but you are still doing it. So, despite the negative consequences, your addiction is persisting. You have legal problems, financial problems, but you are still doing it. When it becomes uncontrollable, despite the negative consequences you continue, then it is an addiction.
What are some factors that predispose a person to addiction?
Sometimes addiction serves as an escape from the uncomfortable feeling we are having. It’s easier to just go ahead and look at the mobile or drink a glass of alcohol.
Eventually, over time, we develop a tolerance toward drugs and alcohol the more we consume them. Initially, one glass of alcohol would give us pleasure. Eventually, we would have to drink 10 glasses to get the same pleasure. The tolerance builds up. With time, the pleasure goes away and misery starts.
Then there are co-dependency issues. Relationships are normal, but when dependency affects life performance it also can be an addiction.
Coming to the factors that predispose us, they could be genetic, family, or our lack of ability to cope. Initially we find it pleasurable, and there is a reward pathway in the brain that whenever we find pleasure we want to do it again. Nature has put those reward pathways there for a reason, giving us pleasurable stimuli for certain things. For example, if we did not have any pleasure in eating, we would not eat, and we would suffer from nutritional deficiencies. If we win something, we feel pleasure. We feel like doing more hard work because there are outcomes and we get pleasure from the outcomes. So nature has its way of advancing us and improving our life. But if we are too much involved in work, for example, it can be an addiction.
What does recovery from addiction look like? What does it entail when a person has to go through rehab or treatment?
Treatment options are many. Rehab is when we are admitted to an in-patient facility, where there’s detox followed by learning. Detox is done under supervision, because detox from some substances, like alcohol and benzodiazepines, can be life-threatening. Other detoxes may not be life-threatening, but they are very uncomfortable, and taking medications from a professional during that time can make it easier, tolerable and safe. Detox is the first step.
The second step is learning about addiction, learning about self, and learning about coping skills. I would say there are two ways of approaching this. The first is within, where we are learning about our own psychiatric disorders, treating them, and removing the underlying factors, such as access to the drugs and alcohol, and stimulus triggers, so that we can get away from them. We learn how to say no, and about the underlying emotional states that predispose us to addiction. Then we learn to cope with that. We have to remove those factors and learn about our inside environment and triggers, and work on them.
The second thing is action, and the level of action we take. Some examples are the 12-step meetings, going to peer support groups, sober houses, and ongoing community programs that helps us stay motivated and sober.
So, there is inside work and outside work on the path to recovery. As professionals, we use various tools such as individual psychotherapy, group psychotherapy circles, psycho drama, Rapid Eye Movement Treatment (EMDR), neurofeedback, medication, and then meditation after some time. All these tools are utilized. More and more research is available on how to use what tool for which person. There is no one formula for every person with addiction – we have to choose what is best for them. The good news is there are a lot of tools available, and as the research is growing they are becoming more and more effective. The primary step is to recognize the addiction and to seek help.
Misconceptions and myths people have about addiction
The most common and harmful misconception about addiction is that it’s a moral defect, or a character defect, or a lack of will power. I don’t know who’s spreading that misconception, but it’s so wrong. Addiction is a medical disease and it’s very common. We should all have empathy and compassion toward each other, because it’s all about imbalance. We all have been through some form of imbalance, and if we understand that, then we can have compassion and empathy for each other. That’s the first step toward improvement. It’s a disease and it’s a spectrum. We all fall somewhere along that spectrum.
We should all have empathy
and compassion toward each other,
because
it’s all about imbalance.
We all have been through
some
form of imbalance,
and if we understand that,
then we can
have compassion
and empathy for each other.
The second thing is that it’s treatable. Efforts do bring results. The thought that it’s not treatable puts a block to recovery, to wellness, to our betterment.
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Pari Deshmukh
