Addiction as a Medical Illness - Part 1

There are many serious questions that are raised when you or someone you love might be suffering from an addiction and seeking help.

Many of these questions can only be answered by medical professionals who have treated those recovering from addiction.

In this two-part series, we sat down with Walker Center’s Director of Clinical Services, Carmalin Resz, MS, ICADC Director of Clinical Services and Dr. Reid Lofgran, Medical Director and Certified Addictionologist, for their professional opinions on treating addiction as a medical illness, and many frequently asked questions regarding addiction treatment & recovery.

What qualifies someone as an addict?

If a person is wondering if they, or someone they love, is an addict, the best place to start is by getting an assessment from a qualified professional. Many areas are assessed, such as use history, medical, behavioral conditions, motivation for change, situations around repeated use, and environmental risk factors.

Addiction presents itself around compulsion to use, preoccupation, tolerance and loss of control. This is why facilities like Pacific Ridge in Portland, OR, are a lifeline to those finding the urge to use so uncontrollably.

Is addiction considered a disease?

According to American Society of Addiction Medicine (www.asam.org) “Addiction is 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.”

What causes addiction in the brain?

Addiction in the brain is caused by the continual process of intoxication, which creates withdrawals and negative effects, which then leads to preoccupation and anticipation (or craving) of the substance. Users continually repeat the cycle to seek relief.

How is addiction classified medically?

The American Society of Addiction Medicine defines addiction as a chronic brain disorder, rather than a behavioral problem involving too much alcohol or drugs.

Addiction is a primary, chronic disease of brain reward, and 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.

How is addiction treated medically?

Addiction is treated medically by managing the withdrawal symptoms to avoid medical complications that can be life-threatening, including high blood pressure and seizures.

This process of withdrawal management is also referred to as detoxification. In addition, the goal of withdrawal management is to provide support for the person to assist them to manage their condition and allow the person to remain motivated to stay in treatment.

For example, joint pain and constipation can be significant issues when withdrawing from opioids, and medical treatment can provide supportive medication to address these issues. The other physical health and mental health issues associated with use will be evaluated and treated as needed.

Medical treatment can also be directed at helping minimize or eliminate cravings, thus helping reduce the risk of relapse.

What factors contribute to the likelihood an individual will develop an addiction?

Science continues to look at gene mapping and there is some promise to finding vulnerable dopamine receptor sites that could help us understand predictions for addiction.

There are a growing number of studies that show possible biological pre-dispositions, showing likelihood increases when parents or grandparents have addiction. Research also shows us environment and social groups play a role in the development of addiction.

When does recreational use become addiction?

Recreational use can show signs of being an addiction when, despite negative consequences, a person continues to use. When a person begins to show inability to consistently abstain from drug or alcohol use, they are showing signs of compulsion.

A person with addiction shows impairment in controlling their behavior and their cravings. They struggle with recognizing problems associated with the consumption.

Do addicts engage with drugs on a voluntary basis?

The initial use of alcohol or any drug is voluntary, the continued use begins to weaken brain regions involved in executive functions and essentially the brain becomes “hijacked”. Addicts continue to reach out for a drugs or alcohol in order to feel good, feel better and in progression, feel normal.

Research in neuroscience continues to support the brain disease model of addiction, indicating that the continued use of alcohol or drug begins to cause desensitization of reward circuits. This type of research is helpful in understanding treatment.

Teaching about craving reduction and how to resist compulsion is a critical part of a good treatment program and voluntary behavioral control.Reference: "Neurobiologic Advances from the Brain Disease Model of Addiction" by Nora D. Volkow, M.D., Director, National Institute on Drug Abuse, George F. Koob, Ph.D., Director, National Institute on Alcohol Abuse and Alcoholism, and A.

Thomas McLellan, Ph.D., Co-founder, Treatment Research Institute, published online January 28, 2016 in The New England Journal of Medicine.

What tends to happen in order for people to realize they have an addiction and seek treatment?

People who love and care for a person who is struggling with addiction are vital in helping a person realize that they need to seek treatment. Loved ones need to realize the person using is not to blame for the addiction, but can be encouraged to speak up in truth and love, rather than feeling unheard and go into silence.

The progression of addiction is fatal. The social systems around a person can work together to help and encourage the person to get an assessment and engage in the appropriate level of care.

If you are struggling with a person’s addiction, we’d recommend go to Alanon (self-help 12 step support group) and gain understanding of how to take care of yourself through this process. You could also look online for a rehab centre for expert advice and support to help a loved one seek action and be addiction free.

The Walker Center is a resource and treatment center to help those suffering from addiction, and their loved ones as well. Addiction is real, but so is the treatment, and we are here to help. If you feel like anyone you know might be suffering from the problems we’ve discussed above, do not hesitate to contact us for a confidential assessment.

If you're struggling with behavioral addictions such as porn addiction, it might be helpful to check out pornaddiction.com. They have useful articles on how to better manage urges.Stay tuned for the next part in this series, where Addictionologist Dr. Lofgran and Director of Clinical Services, Carmalin Resz discuss addiction relapses and recovery.

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