1. UNDERSTANDING ADDICTION
YEDEM & Believers Network Club GHANA

2. What is Addiction
Definition by ISAM & ASAM – it is a “DISEASE characterized by CONTINUOUS or PERIODIC: IMPAIRED CONTROL over drinking/using drugs, PREOCCUPATION with drug/alcohol, use of alcohol/drugs despite ADVSERSE CONSEQUENCES, and distortions of thinking most notably DENIAL.”

3. Dictionary Definition: (Latin)
Addictus:
Devoting or surrendering one’s life, giving self to some habit or substance, losing one’s soul, being caught or hooked.
Narcomania: In some languages (French, Russia and Scandinavian languages) indicate madness about drugs.
Alcoholism: Identifies the whole person with his/her attachment to alcohol.

4. The Addiction/Dependence Debate
Official scientific name has become DEPENDENCE rather than ADDICTION in both:
The World Health Organization (WHO), classification of diseases ICD 10 and American Psychiatric Association (APA) Diagnostic and Statistical Manual
DSMIV
The term ADDICTION is thought by to be derogatory

5. b. ASAM and ISAM still use the term addiction
b. ASAM and ISAM still use the term addiction. Some very prestigious journals and institutions still hold to the term e.g. The British Journal ADDICTION, The National Institute of ADDICTION etc
c. Some say that is not less derogatory than addiction.

6. DSM-IV ICD-10 Any 3 of the following Criteria
4. DSMIV/ICD10 CRITERIA FOR DIAGNOSIS OF SUBSTANCE DEPENDENC
Any 3 of the following Criteria
DSM-IV
ICD-10
1. Tolerance: needs more for the same effect
Same (4)
2. Withdrawal syndrome
Same (3)
3. Taken in larger amounts or over longer time than planned
Difficulty in controlling use onset, level or end (2)
4. Persistent desire/compulsive use, unsuccessful control of use.
Strong desire or compulsion to use (1)
5. Much time is spent in obtaining, using or recovering from use
No similar criteria
6. Important social, occupational, recreational activities given up
Neglect alternative pleasures or interests (5)
7. Continual use despite adverse physical and psychological problems
Persistent use despite clear harmful consequences

7. 1. not accurate in describing the phenomenon.
12-step approach (AA, NA.. Etc) advocate argue that the term substance dependence is
1. not accurate in describing the phenomenon.
2. it is bound to make us miss the issue of cross-addiction
(cross-addiction is moving from one type of addiction to another e.g. moving from dependence on drugs to dependence alcohol or sex. With the same criteria of losing control, preoccupation and use despite knowledge of adverse consequences)
3. It tends to make us focus on different substances of abuse e.g. heroin, alcohol.. Etc rather than focusing on a common process underlying all these “addictions” which is the disease of addiction itself. (Miller 1995).

8. USE AND ABUSE/HARMFUL USE AND DEPEDNCE
Abuse in the DSM-IV is defined as:
Use of substance:
Leading to failure to fulfill work, education, home obligations etc.
Exposure to physically hazardous e.g. situations e.g. drive drinking
Legal problems
Interpersonal problem.

9. This is also closely related to the ICD 10 definition of Harmful sue
DSM-IV Criteria for substance abuse
A. – A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12 months period:
1. Recurrent substance use resulting in a failure to fulfill major obligations at work (repeated absences or poor work performances), school – (absences, suspensions, or expulsions), or home – (neglect of children or household).

10. 2.Recuurent substance use in situations in which it is physically hazardous; (driving a car or operating a machine when impaired by substance use).
3. Recurrent substance-related legal problems (DUI, arrest, reckless driving)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance; (arguments with spouse, physical fights).
B.- The symptoms have never met the criteria for “SUBSTANCE DEPENDCE”

11. SUBSTANCE DEPENDCE
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 or more of the following, occurring at any time in the same 12 months period:
TOLERANCE: as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect,
b. Markedly diminished effect with continued use of the same amount of substance.

12. 2. WITHDRAWAL, as manifested by either of the following:
a. The characteristics withdrawal syndrome for the substance (refer to criteria A and B of the criteria sets for withdrawal from specific substances)
b. The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than was intended.

13. 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of the substance.
7. The substance use is continued despite knowledge of having persistent or recurrent physical or psychological problems.

14. Some scholars are currently applying the same criteria of substance dependence on other kinds of addictive behaviors e.g. gambling, love and sex addiction, co-dependence ( the addiction of being controlled or trying to control life of others), overeating, anorexia (loosing control over dieting and an obsession with loosing weight, bulimia (anorexia alternating with binge eating).

15. THE DISEASE CONCEPT VRS THE SELF MEDICATION THEORY
The disease concept defines addiction as a primary disease implying that:
All other manifestations e.g. depression, lack of responsibility, anger, aggression, lack of balanced life are consequences of the disease.
Trying t find a reason behind the addictive behavior is futile. And may be harmful.
Lifelong abstinence is a must because the disease is seen as controllable but incurable. If an addict resumes drinking or using he or she is bound to relapse to the former state of addiction.

16. 4. The process recovery implies a spiritual lifelong journey
4. The process recovery implies a spiritual lifelong journey. If you are an addict you never be come an “ex-addict” or “recovered addict” you have always to be an addict “recovery” or a “recovering addict”.
5. Addicts need to attend 12-step groups and live the steps for the rest of the lives. If they do not they are increasing the probability of their relapse.

17. Self-Medication Theory
Advocates of this theory claim that addictive behavior is a way the addict is trying to alleviate his/her pain. Pain may be readily identifiable or it might be hidden. Some variations of this theory include:
Hurts of the past are thought to be the cause of addictive behavior
Inability to balance the inner world and the outer world (Khantzian)
Family problems
Problem in childhood development
A desire to destroy one self (Meninger) and dozens of other theories.
A stable recovery is thought to be achievable once the cause of addictive behavior is discovered and dealt with

18. Definition of Addiction in the Therapeutic Community Approach
Mellnick and DeLeon (1999) defines drug abuse in the TC approach as: a deviant behavior, reflecting :
Impeded personality development
Chronic deficits in social, educational and economic skills
Its antecedent lie in,
Socioeconomic disadvantage
Poor family effectiveness
And in psychological factors

19. Some general notes on the development of Addictive Behaviors
Genetic predisposition to certain addictive behaviors is strongly supported by research now. Alcohol and nicotine dependence being substances most commonly studied.
Socio-cultural factors play a major role in the development of addiction
Psycho-dynamic elements may play a role
Behavioral and social learning elements are important.
Religious and spiritual elements are more and more proving to be of utmost importance in the development and treatment of substance abuse and dependence.

20. ADDICTION IS THOUGHT TO BE A BIO PSYCHO SOCIAL DISEASE
If you recognized the SPIRITUAL ROOTS and IMPLICATIONS.
You will call it a Spiritual Bio Psycho Social Disease

21. IMPLICATIONS FROM CHRISTIAN PERSPECTIVE
Many advocate that the addict is as good as any of us. I say yes but it is better put as we are as bad as any addict.
We have all sinned and fell short of the glory of God Rn 3:23. It is essential to understand that “we” normal balanced, respectable people are not different in the core of our being the worse sinner, indeed not any better from any addict.

22. 2. Addicts as mush “Normal” people are:
Created in the image of GOD Gen 1:26,27
Are deeply loved by Him and have an everlasting value in His eyes. Jn 3:16
3. Our separation from God manifest itself in surrendering one life to false gods. Money, fame, sex, success, a “balanced productive life” or just living for one self.
Addiction to alcohol, drugs or non-substance addictions (gambling, food, diet, love/sex, codependence, religion.. Etc)
The disease is what makes people addicts just than normal, balanced successful sinners.
“we have been created for you Lord and our souls will not find rest until it finds in you”. St Augustin.

23. Addiction is a chronic disease, a deceitful enemy and so is the “flesh”, “The old man”, The body of sin”
Addiction will not be cured by a one time experience or mere decision of the will. Not cured by a glimpse of spiritual reality.
Not cured by the right doctrines.
To overcome WE-addicts and non addicts-we need a life long journey.
One day at a time surrender to God and reliance upon Him.
True understanding of addiction brings you closer to the One True God.
The Higher Power has a name and His name is Wonderful, Counselor, Mighty God, Everlasting Father, and Prince of Peace. His name is Jesus.
Knowing this is not enough to live day by day in this knowledge is what we need