Drug and alcohol abuse is a huge problem for adults and young people in the UK today; with an estimated 268,251 adults in treatment for substance misuse in England alone addiction is a real concern for the healthcare sector. Types of addiction vary from alcohol to drugs, gambling, sex, shopping, eating disorders, video games and many more.
Of course, these are only the main types of addiction at play in the world, and this macro view doesn’t take into consideration the individual struggles of those fighting addiction. That is what rehabilitation and detox centres, as well as sobriety support groups, do. If you think that you or someone you love could be struggling with addiction it’s important that you seek help.
What is Addiction?
The textbook definition of an addiction is “the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming.” Of course, the reality of addiction is too complex to be summed up in one sentence in a textbook or dictionary.
In real-world terms, addiction is defined as the inability to give up a habit or substance despite the desire or need to do so. This can include substances like alcohol and narcotics or activities such as gambling, shopping, sex, or working.
Understanding Drug Addiction
While addiction comes in many forms, drug addictions are the most common in the UK today. This is why it is important to understand how drugs affect the brain and why they are so addictive.
While all types of addiction take root, to some extent, because of the ‘rush’ that the activity (shopping, sex, gambling) brings as a result of a dopamine surge, those who are fighting drug addictions also have to deal with the physical changes that drugs cause within the brain.
Studies of the neurochemical changes which occur in the brain of drug-addicted subjects found a number of physical changes and effects which explain why narcotic addictions are so hard to beat. First and foremost, taking drugs, whether they be opioids or psychoactive substances, releases a surge of chemicals like dopamine, creating feelings of euphoria, as well as other side effects.
This has been known for many years, what is now coming to light, however, is the way in which long-term drug use physically alters the function of the brain. Intense or prolonged drug abuse not only creates a strong physical and psychological dependence on the substance but alters the brains’ ability to take pleasure in other ‘normal’ activities like sex, reading, exercise, etc.
More than this, an in-depth study has shown that drug abuse affects multiple brain circuits including the pleasure/reward centre, the motivation/drive circuit, and the circuits connected to memory and learning.
In some cases, this damage can be reversed either fully or in part after cessation of use, but for those who have struggled with long-term, sustained, or incredibly severe drug abuse the damage may be permanent. As a result, many people seeking sobriety may also need to be treated for depression, anxiety, or other mental health issues which have been instigated or exacerbated by drug use.
What Causes Addiction?
This is a simple question with a complex and non-definitive answer; research has shown than many things, including genetics, socialisation, and mental health, influence addiction. Despite this, there is no way to reliably predict who will develop any type of addiction.
Neuroscientific studies, however, have found evidence that addiction is a chronic brain disorder or disease which is moulded by biological as well as social factors. While our understanding of addiction is constantly evolving, there are several factors which we currently believe contribute to the likelihood of developing a type of addiction. They are:
Estimates on the level of influence genetics have very, but scientists agree that there is a genetic element to addiction for many people
While this varies, there are some indications that men are more likely to develop substance abuse disorders. Whether this is biological, social, or a result of combined factors is not yet certain
3. Physiological Factors
Some studies suggest that physical factors such as variations in liver enzymes contribute to the development of alcohol dependency and addiction
4. Psychological Factors
Things like personality, trauma, abuse, and mental health contribute to the likelihood of an individual developing an addiction
5. Environmental Factors
Environmental factors such as family history, ease of access to alcohol and drugs, employment status, and the peer group a person has also influence addiction development
Can Addiction be ‘Cured’?
For those who find themselves struggling with a type of addiction, the desire to be ‘cured’ is often incredibly strong. However, addiction is classed as a ‘chronic’ brain disease. This term, ‘chronic’, has become a point of contention for many in the medical field (especially academics.)
But can be defined as meaning ‘a disease which is long-lasting, slow to progress, and has associated functional impairments, conditions, or disabilities as well as a complex causality.’ To put it simply, there is no ‘cure’ for addiction, but like many long-term chronic diseases (for example diabetes) it can be effectively managed and need never be fatal.
As a biopsychosocial disease, addiction often requires complex, tiered, and on-going treatment. Thankfully, there are now many different options for those who wish to achieve and maintain sobriety or freedom from their addiction.
Types of Addiction Treatment
Broadly speaking, there are 6 options for treating addiction, though the suitability of certain options changes depending on the nature of the addiction. These types are;
- Inpatient rehabilitation
- Outpatient rehabilitation
- Drug and alcohol detox
- Sober living homes
Each of these treatment ‘types’ encompasses a range of therapies, resources, support groups, and methodologies designed to effectively treat the specific addiction its patients are facing. Not all types are suitable for every type of addiction, and they do have their strengths and weaknesses so be sure to do some research and consult with your doctor before choosing a programme.
A residential addiction treatment programme which offers round the clock support and a schedule of therapeutic classes and pursuits designed to establish sobriety and develop the skills needed to maintain it.
The pros of this type of treatment lie mostly in the round-the-clock support and restriction of temptation and access to drugs and alcohol, etc.
A series of treatments, therapies, and classes much the same as those offered in residential programmes, outpatient rehab instead allows patients to stay in their own homes and continue working/educational pursuits if they are able to.
This is a big pro for many people, but the drawbacks are many and include continued access to the addictive substance or activity and reduced support when tempted to relapse outwith classes and therapies.
Alcohol and drug abuse first require the purging of the addictive substance from the body before rehabilitation can begin.
Detox is often the first part of inpatient rehab where drugs and alcohol are concerned, but it is a necessity for outpatient programmes too.
These homes act as a bridging measure between residential programmes and 'normal' life. By protecting sobriety in a supportive environment during the first months of return to the wider world, many people find that they are able to maintain sobriety with a much lower chance of relapse.
Some detox processes may require medical assistance (this is very common, for example, in heroin detox). Medications may be used to manage withdrawal symptoms, reduce cravings, or treat co-occurring issues such as mental illnesses.
The Treatment Process
While different types of addictions require different therapies and treatments, the general process of treating addiction remains the same. First and foremost, detox is necessary where any alcohol or drugs are concerned.
Following detox, a programme of rehabilitation begins. This will generally include therapy, either individual, group or both, some form of 12-step programme, and classes designed to develop healthier coping mechanisms to prevent relapse in times of stress or upheaval.
At some point in this process, self-help groups will also be introduced to allow those fighting a type of addiction to meet others who are dedicated to sobriety. Peer support and accountability are considered incredibly important to recovery.
Finally, any co-occurring disorders or illness will be medicated; in some cases, like opioid addiction, this may mean being weaned off of the substance in question via a substitute like methadone.
The Pros and Cons of Treatment Options
There are a number of treatment options which you may be offered or recommended, each comes with a set of pros and cons that you should be aware of.
1. Individual Counselling
Meeting with a therapist or counsellor on a one-to-one basis, generally in an office setting. These regular appointments tend to be weekly and focus on your personal circumstances and needs.
- You set the pace and direction of treatment
- Lack of group support
- Requires self-motivation
- Risk of relapse in early recovery (if undertaken on an outpatient basis)
2. Group Counselling
Meeting with a counsellor and a group of peers to discuss shared issues, coping mechanisms, and build connections that encourage and support sobriety.
- Group support networks have been shown to be key to recovery.
- Advice and understanding from people in advanced recovery.
- Practice of group communication skills
- Lack of privacy/ confidentiality not guaranteed
- Can be stressful for anxious individuals
- Risk of relapse in early recovery (if undertaken on an outpatient basis)
3. Recovery Meetings
Peer support groups led by other people fighting addiction rather than counsellors. Good examples of recovery meetings are AA and NA, but there are meetings for almost any addiction now.
- Strong support
- Proven effective
- Sponsor system increases the availability of individual support
- Non-professional (cannot assist with co-occurring disorders)
- Cannot provide medical assistance with detox stage
- Risk of relapse nearly recovery (if undertaken on an outpatient basis)
4. Intensive Outpatient Treatment (IOP)
Counselling groups which generally meet three times per week, lasting roughly three hours per meeting. They may also include individual counselling and are more intensive than regular group counselling.
- Group therapy is effective
- Social support from people in advanced recovery
- Increased effectiveness over a less intensive group or individual therapy
- No guarantee of confidentiality
- Lack of privacy
- Risk of relapse nearly recovery (if undertaken on an outpatient basis)
5. Partial Hospitalization Programme
A programme of rehabilitation including daily group counselling and weekly individual counselling, lasting 5 to 8 hours per day. Far more intensive than IOP or group counselling.
- Most effective non-inpatient treatment
- Supportive group environment
- Help from those in advanced recovery
- Increased support
- Confidentiality cannot be guaranteed
- The group environment can be daunting for anxious people
- Continuing to live at home increases the risk of relapse where a persons peer group is unsupportive of sobriet
6. Medication-Assisted Treatment (MAT)
A harm reduction treatment includes medication like suboxone or methadone as a replacement for a substance which one is physically addicted to.
- Allows for physical stabilisation
- Makes working on long-term issues possible
- Merely a replacement addiction if other work is not undertaken.
- A long-term treatment taking years to complete.
- Prone to abuse
7. Inpatient Treatment
A 24hr residential programme which includes group therapy, individual therapy, and recreational activities as well as recovery meetings. These programmes tend to last from 14 to 90 days, but can be much longer.
- Lowest risk of relapse
- Intensive treatment which also allows for treatment of co-occurring issues
- Removal from a toxic environment can allow individuals to learn healthy coping mechanisms.
- Many struggle with being removed from friends and family
The Stages and Rules of Recovery
Addiction recovery has 5 stages. The first is becoming aware of an acknowledging that there is an issue, and the second is shifting from awareness to actively seeking recovery. The third stage is exploring recovery through moderation, abstinence, or the decision to seek treatment.
Early recovery is the fourth stage where someone fighting a type of addiction has achieved sobriety and is learning to maintain it; relapse is common during this stage. Finally, the fifth stage is active recovery and maintenance which is when sobriety is advanced and the person fighting addiction has recognised that recovery will require lifelong awareness and effort from them.
This process is underpinned by 5 recovery rules which show those seeking sobriety how to make it a reality and maintain it indefinitely:
1. New Life
The first rule is to create a new life where it is easier to not use than to relapse. This means avoiding high-risk people and situations. Cutting dealers out of your life, or even ceasing contact with friends and family who encourage relapse may be necessary.
2. Ask For Help
Rule two is to develop a support network and ask for help; addiction isolates us, by connecting with peers in recovery you can benefit from their experience and guidance. As you become more experienced you can also offer support.
The third rule is to be completely honest with this support network. So much of addiction includes lying, deflection, or obscuring the true situation. Being honest about mistakes, relapses, bad thoughts, or temptations takes the shame and guilt off of your shoulders and opens up opportunities for positive change.
Practising self-care is the fourth rule. Finding new ways to relax, escape, and reward yourself is key to long-term recovery. Learning to meditate or practise mindfulness, finding new hobbies, and taking care of yourself is hugely helpful in recovery.
The final rule is perhaps the most difficult; do not try to negotiate the terms of your recovery. Accepting and embracing the process of recovery is hard; it requires self-awareness, work, and determination, but doing so can lead to a greater understanding of self and happiness in the long-term.
Intervening for a Loved One
If you are concerned that someone you love is fighting a type of addiction, it can be hard to know what to do. It is not easy to stage a successful intervention, but when done properly they can be crucial to helping someone begin recovery.
First and foremost, you should always consult with a doctor when considering an intervention; ask for their help and support if possible. In any case, they will have resources that can help you. Secondly, be prepared for the long-haul; these conversations can be long and gruelling. You should also be prepared for it to be unsuccessful. You must lay out the consequences of refusing treatment and follow-through, no matter how hard it seems.
Finally, and most importantly, be prepared for success. Have a list of appropriate treatments ready beforehand and encourage immediate action if you succeed in breaking through to them.
Addiction is a horrible disease, but it can be combated and managed.