Discover Recovery: A Comprehensive Addiction Recovery Workbook

ADDICTION AND ITS MANIFESTATIONS

What Is Addiction?

Exactly what is meant by the term, addiction? The approach of this workbook is that addiction is one disease with many manifestations. Addiction can take many different forms and includes activities, as well as substances. All forms of the disease of addiction share certain universal characteristics, as well as progressive and predictable negative consequences.

Previously, the fields of research and treatment have divided addiction into separate categories for substance addiction and process (activity) addiction. Substance addiction has been subdivided according to specific drugs—alcohol, heroin/opiates/opioids, cocaine, methamphetamine, marijuana, tranquilizers, sedatives, etc.—while process addiction has been subdivided based on the particular activity involved—gambling, eating, sex, pornography, shopping/spending, Internet use, video gaming, etc.

This traditional perspective makes it seem as though there are many different types of addiction and suggests that one person can potentially have a variety of addictions. It downplays similarities and focuses on differences, even though the underlying similarities far outweigh any surface differences.

Because these various manifestations of addiction are so intimately connected, it is much more useful to address addiction as one illness. As a result, when using is referred to in this workbook, it means the use of any substance or activity. For example, if your addiction manifests in gambling, then playing blackjack, poker, roulette, or slots is considered using.

ADDICTION IS ONE DISEASE WITH MANY MANIFESTATIONS

All of these forms (manifestations) of the disease of addiction change how the brain works in similar ways. They all share the same facilitating factors and active dynamics, as well as predictable negative consequences.

I. CORE CHARACTERISTICS

•Internal Emptiness: This is a sense or feeling of being empty, hollow, or missing something. The specific manifestation(s) of addiction—be it a substance or an activity—is an attempt to fill this hole.

•Sense of Self as Different or as Not Fitting In: This is a deep-seated experience of oneself as being separate from or unlike others; of feeling alone no matter how many people are around; of being on the outside looking in. Using becomes a way to temporarily block out or soften this sense of being different and creates a connection with others who use.

•Emotional Hypersensitivity/Inability to Tolerate Uncomfortable, Painful Feelings: This is a heightened sensitivity where emotions are felt more deeply and rapidly than in most other people. As a result, distressing emotions, including anxiety, fear, anger, sadness, depression, as well as physical pain are not only felt with pronounced intensity, they are often experienced as overwhelming, almost suffocating. Using becomes a way to turn down the volume of such feelings and to numb them in order to endure them.

These core characteristics create a vulnerability to addiction for people before they ever come in contact with alcohol and/or other drugs, gambling, sex, pornography, Internet use, video gaming, or any other potential object of addiction. Whenever this personal predisposition to addiction is combined with mood-altering substances and/or activities, it is the equivalent of lighting an old-style fuse on a stick of dynamite.

II. ACTIVE DYNAMICS

•Discomfort/Pain Avoidance: This is characterized by attempts to avoid distressing thoughts, feelings, memories, physical sensations, and other internal experiences, through the use of substances and/or activities. Because avoidance through using achieves short-term relief of discomfort, using behavior is reinforced and continues.

•Obsession: This is a persistent preoccupation with, thinking about, and desire for the specific manifestation(s) of addiction. Obsession is one of the mental/emotional components of addiction.

•Compulsion: This is an irresistible impulse to act on the obsession for the specific manifestation(s) of addiction. Compulsion is one of the physical/behavioral components of addiction.

•Self-Centeredness: This is a self-absorbed pursuit of the manifestation(s) of addiction that focuses on one’s own desires, feelings, and perceived needs to the neglect of consideration of consequences and the needs of others. Self-centeredness is one of the spiritual components of addiction.

•Withdrawal: This is the experience of mental, emotional, and/or physical distress or discomfort when use of the specific manifestation(s) of addiction is discontinued activating the drive for discomfort/pain avoidance.

If the core characteristics mixed with one or more of the objects of addiction ignite the fuse, then these active dynamics are what propel the spark along the fuse toward the dynamite; sometimes the fuse is long and takes more time to burn until the dynamite explodes, and sometimes it’s short and takes little time until it all blows up.

III. PREDICTABLE RESULTS

•Progression: This refers to the escalation of the disease of addiction as it increases in intensity, frequency, and severity. Over time, active addiction consumes a greater percentage of time, attention, and energy. It always leads to problems in different areas of life, and those problems will become more and more serious.

•Loss of Control: This is characterized by the inability to limit the amount and frequency of use of the specific manifestation(s) of addiction.

•Continuing Use Despite Increasingly Serious Negative Consequences: These consequences include, but are not limited to problems and losses related to family, relationships, health, employment, finances, and other interests.

These negative consequences are the predictable results of the spark reaching the dynamite and exploding. The explosion usually leaves serious wreckage in its wake, affecting the lives of not only the individual struggling with addiction, but all those who are close to him or her.

Denial and other defense mechanisms are interwoven with all of the above-mentioned aspects of addiction. Denial is both an active dynamic of addiction and a predictable result of it. Denial convinces addicts that they do not have the disease of addiction and enables them to continue to use despite worsening problems. It is a natural and unconscious form of self-protection that clouds a person’s ability to accurately identify obsession, compulsion, and self-centeredness, and thus admit addiction. An addict may deny his or her addiction, the extent of his or her use, and the problems it creates because the reality is too uncomfortable and painful. In this way, denial functions as another layer of distress avoidance.

Describe your experience with the Core Characteristics of addiction.

Internal Emptiness

Sense of Self as Different or as Not Fitting In

Emotional Hypersensitivity/Inability to Tolerate Uncomfortable, Painful Feelings

To paraphrase the definition by the American Society of Addiction Medicine (ASAM)*:

Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

This brain dysfunction leads to characteristic biological, psychological, social, and spiritual effects that include impairments in emotional response and behavioral control, craving, and inability to consistently abstain, along with diminished recognition of significant problems with one’s behaviors and interpersonal relationships.

Addiction evolves from an unhealthy and mood-altering relationship between a person and the manifestation(s) of his or her addiction, whether substances—drugs that can be used to change how a person feels, regardless of whether these drugs come from the street (cocaine/crack, heroin/opiates, meth/speed, marijuana, hallucinogens) or are prescribed by a doctor (painkillers, tranquilizers, sedatives) or are bought at a store (alcohol, over-the-counter medications, and other substances, such as inhalants)—or activities (gambling, eating, shopping/spending, sex, pornography, Internet use, video gaming, love/relationships, etc.) to the point where using the substance or engaging in the activity becomes beyond voluntary control and continues regardless of increasingly negative consequences.

From this perspective, codependency is one of the many manifestations of the disease of addiction. The feeling that people struggling with addiction experience of not being able to survive without cocaine, alcohol, opiates, or pot is the same feeling someone who is codependent experiences related to another person. It is essentially the same process as the addict who must gamble, must have sex, must shop/spend money, must eat more, must play video games or go online, must be in a primary relationship, or must take care of others.

WHAT CAUSES ADDICTION?

While research indicates there is a genetic predisposition toward addiction, a predisposition is not the same as a predetermination. A predisposition increases the risk of something occurring, but it cannot by itself cause it to happen. Another key factor is the environment. Genes are activated or turned off by the environment. Whether a person becomes addicted is often influenced by a variety of factors including genetics/biology, family history of addiction, quality of family relationships, childhood experiences, mental health, exposure to physical or sexual abuse or other kinds of trauma, or the degree of drug use/addiction in one’s social circles, neighborhood, and community.

In active addiction, the need to use substances or engage in other activities becomes so strong that it overrides most all other needs and creates problems that only get worse over time. The object of addiction, regardless of whether it is a substance or an activity, becomes the highest priority and assumes greater importance than family, friends, health, and work.

The object of addiction, regardless of whether it is a substance or an activity, becomes the highest priority and assumes more importance than family, friends, health, and work.

It becomes the organizing focus in the lives of addicts, taking over their attention, time, and energy. As a result, addicts are often driven to sacrifice what they previously cherished most in order to preserve and continue to live in their active addiction.

At first, most people experience initial positive effects by using drugs or activities to change the way they feel. They experience the reward of feeling good and/or the relief of feeling better. Mind- and mood-altering substances and activities provide a way to temporarily avoid or lessen feelings of emotional or physical discomfort, such as anxiety, depression, anger, physical pain, fear, boredom, and/or stress. Stress can play a major role in beginning involvement with drugs and/or activities, continuing involvement, or for people in recovery, relapse into active addiction.

Those who become addicted almost always believe they can control their using, even after there is plenty of evidence that the use of substances or participation in activities has taken over their lives. In this way, denial and other defense mechanisms that are characteristic of the disease of addiction, such as minimization and rationalization, convince those who suffer from it that they do not have it.

Defense mechanisms are unconscious psychological processes that come into play outside of your awareness to help you cope with painful aspects of reality. This process can happen quickly—sometimes in a matter of days or weeks or unfold gradually over several months or even years. When drug use or participation in the activities previously noted continues over time, other interests that were important and pleasurable, such as recreational activities and hobbies, relationships with family and friends, work, health, etc., become less important and less pleasurable. More and more time and energy are spent thinking about, pursuing, and participating in the manifestations of addiction, as well as facing the aftermath of its consequences, such as withdrawal, hangovers, injuries, missed responsibilities, and financial problems.

Addicts reach a point where they are driven to continue their involvement with the manifestations of their addiction despite the problems it creates for both themselves and their loved ones.

HOW ADDICTION AFFECTS YOUR BRAIN

As both ASAM and National Institute on Drug Abuse (NIDA) have declared, addiction is a brain disease. Neuroscience increasingly demonstrates that repetitive experiences effectively shape the brain. The use of substances and mood-altering activities changes brain structure and functioning, directly altering how it sends and receives information. The brain uses a communication system that sends and receives messages through certain naturally occurring chemicals, called neurotransmitters. The research is crystal clear; substance use effectively hijacks the brain’s reward system by changing the levels of specific neurotransmitters. Think of the reward system on steroids or other performance enhancers.

When the reward system, located deep within a part of the brain known as the limbic system, is activated through messages sent by particular neurotransmitters, people experience pleasure. Research on the brain’s reward system indicates that a reward is a reward, regardless of whether it comes from a drug or an activity.

At one time, people who are addicted made a decision to use; however, they did not make a decision to become addicted.

Activities such as gambling, eating, sex/pornography, shopping/spending, Internet use, and video gaming also stimulate the release of neurotransmitters that activate the reward system in the brain. It is this stimulation of the brain’s reward system that produces the mood-changing effects sought by people through the use of drugs and participation in activities. Basically, you learn through the experience of using how you can give yourself a dose of pleasure.

Your brain is in charge of your body’s basic functions and gives you the ability to interpret and respond to everything you experience. In this way, your brain directs the course of your thoughts, emotions, and behaviors. At one time, people who are addicted made a decision to use; however, they did not make a decision to become addicted. No one intends to become addicted. At first, the decision to use is a conscious choice, but as addiction progressively alters brain functioning and takes over a person’s life, he or she loses more and more of the ability to exercise control over his or her thoughts, impulses, choices, and actions.

Brain imaging studies provide evidence that addicts experience physical changes in the areas of their brains that involve judgment, decision-making, learning and memory, and behavior control. These changes affect how the brain works in important ways. They help to explain the cycle of obsessive thinking, compulsive behaviors, and self-centeredness (including the decreased capacity to consider the consequences of choices and behaviors), in which addiction traps those who struggle with it. Addiction erodes a person’s capacity for self-control as well as the ability to make healthy decisions. This only gets worse over time as addiction drives the need to continue to use more to try to recreate the intense pleasure of the highs and avoid the devastating lows of the crash of withdrawal.

The brain adapts to repetitive experiences by forming memory connections or tracks that are unconscious. These unconscious memory tracks are the foundation of the habits of addiction. Such habits can be difficult to control because they are created by changes in the brain’s operating system, outside of conscious awareness. The powerful desire addicts experience for their drug or activity, sometimes long after they last used, is an example of the strength of these memory tracks.

The brain adapts to repetitive experiences by forming memory connections or tracks that are unconscious.

Positive reinforcement, the desired outcome that results from using, for example, feeling good or better, is one form of this process. And each time using results in the desired outcome, the memory track between the manifestation(s) of addiction and the result becomes stronger. This positive reinforcement teaches you to repeat the same behaviors in order to get the same results. The more you repeat it, the greater the chances are that you will continue to repeat it, as the vicious circle of addiction intensifies.

Conditioning is another example of how the brain adapts to repeated experiences. Certain emotional states (anger, depression, anxiety, fear, etc.) and situations, including specific people and places, become connected with the experience of using and can light the fire of obsessive thoughts, compulsive behaviors, and self-centered tunnel-vision. This unconscious learned response is strong enough that it can occur even after years of abstinence. As a result, these memory tracks tend to pull people back toward the experiences and behaviors with which they are familiar and comfortable, making it more difficult to stop such behaviors and stay stopped.

Over time, your brain also adjusts to these changes so it takes more and more of a drug or activity to get the same effect. This is known as tolerance. Sooner or later, tolerance develops, and because of it, the object of addiction becomes less and less effective in giving you the results you are seeking. All addicts eventually reach a point where using is no longer fun, it has become work,something you have to do. You rarely get high anymore, and use solely to try to feel normal or what has become normal for you.

ADDICTION IS ADDICTION

As previously described, addiction in all its manifestations begins with mood-changing effects that initially help to make people feel good or better, and can seem to temporarily ease, numb, or block out life’s problems. However, when using turns into an ongoing way to cope with life’s stresses and challenges, and becomes a primary coping strategy, it is no longer voluntary—addiction has taken control. In other words, the relationship with the object of addiction has progressed to the point where it is beyond a person’s ability to control it and their life becomes increasingly unmanageable.

Addiction has certain characteristics that separate the addict from the nonaddict. The obsessive thinking combined with compulsive behaviors and self-centeredness that come to control an addict’s life create powerful habits. In fact, potentially addictive medications have warnings that they may be habit-forming. Habits—patterns of behavior that develop through repetition—are both a cause, as well as a result of changes in the brain.

Habits—patterns of behavior that develop through repetition—are both a cause, as well as a result of changes in the brain.

Any repetitive behavior or experience, but especially those with mood-changing effects such as alcohol or other drug use and participation in certain activities, can create new unconscious memory tracks. The formation of these memory tracks in the brain is like the grading and paving of a roadway that allows traffic to travel easily and efficiently. Over time, repetitive use of drugs or activities can turn an unpaved one-lane road into a multi-lane freeway.

Because addiction is addiction, once you are addicted to any drug, including alcohol, you are automatically at much greater risk of your addiction shifting to another drug or activity, such as gambling, eating, sex, shopping/spending, Internet use, and video gaming. This is true even if you are in recovery.

When you are addicted to any substance, crack cocaine for example, you are at an extremely high risk for your addiction to cross over to alcohol or prescription pain medications or marijuana or any other substance you use. You may think, I’ve never had a problem with alcohol, so I can have a drink, or that Pot is no big deal, or that Percocet/Vicodin/Lortab/Xanax/etc. must be okay for me to take because a doctor prescribed it.

Place a C next to those you use currently; an R next to those you used most recently; and a P next to those you have used in the past.

_____ Heroin/opiates

_____ Methamphetamine

_____ Tobacco

_____ Inhalants

_____ Prescription pain meds

_____ Alcohol

_____ Sedatives (sleeping meds)

_____ Tranquilizers (Xanax, Valium, Klonopin)

_____ Cocaine/crack

_____ Marijuana

_____ Hallucinogens

Others (please list) __________________________________________________________

______________________________________________________________________________

In the same way, your inner voice may say, I know I can’t use, but I can go spend a bunch of money shopping, or Go gambling, because there’s no harm in those activities. Substituting one manifestation of addiction for another is similar to switching where you are sitting on a boat that is sinking—you may be able to stay dry for a little longer, but you will still end up in the water, with all of the potential dangers that go with it.

When experienced in moderation (in a balanced way), many of the activities listed below are simply part of life and can even be healthy up to a point. However, people can get caught