A Spo-fan asked me to talk about addiction.

The treatment of addiction is in transition. Once upon a time we didn’t know much about the etiology and physiology of addiction, and there were no treatments other than spiritual types based on psychodynamic theories.  Addiction treatment is slowly becoming more ‘neurological’ and pharmaceutical.

The treatment of addiction remains challenged – thwarted? – by old beliefs about addiction and people with such. Addiction is a medical disorder, not unlike diabetes. Indeed, the two illnesses have a lot in common. Many people, including medical folk who should know better, see addiction as the result of weakness, wages of sin, or at least bad behavior. Although people can intellectually see the many parallels between diabetics and addicts, few physicians have negative emotions to diabetics. Yet, addicts are considered ‘not quality’.

Treatments like Alcoholics Anonymous or Narcotics Anonymous will always be useful as any illness involves improving one’s habits and behaviors. Medicine (with a capitol “M”) has never relied on merely medication. No doctor would just prescribe insulin without telling a diabetic to watch sugar, change diet, get exercise etc.

There are medications now to curtail drinking, they don’t work well without the behavioral component.

Ironically, I run into patients who tell me traditional AA groups frown upon or even disallow prescriptions for the treatment of alcoholism.

It is all rather complex. The next 5-10 years will see some interesting developments. I wonder how the culture of America will react to it all. Americans like to make things black and white; there remains the mentality addiction is the result of lifestyle choices. (Rather than this approach going away, it seems to be increasing in these frustrating times)

For interest, here is a summary of the dynamic theory of addiction. (Keep in mind I am summarizing a very old theory into a few take home sentences. I feel like Anna Russell summarizing the Ring Cycle)

Addiction is a failure of the will to coordinate the mind and the heart.  The mind says “Drugs/alcohol/smoking etc. is bad and I need to quit” but the heart says “no you don’t, you love this stuff, it gives pleasure and makes you feel good – normal even’.  By forgoing a harmonious mind-will-soul energy flow, a person abandons responsibility to an outside substance. The treatment of addiction is about connecting the mind and heart to disallow further use of the substance.

By the way, the dynamic theory of addiction incorporates physical substances like alcohol, drugs, tobacco, and foodstuffs, but other things like fear, power, worry, work, gambling, or any emotion or behavior that can consume a person.

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