A while back, I posted the Stages of Addiction. I received some feedback that I can sum up like this: “Mr. Blea, you poor misguided soul, you clearly don’t understand Addiction. You see, Addiction is complex and unique to the person who’s addicted. The stages you present are a huge oversimplification that shows just how little you understand…” and on and on.
The thing is that, while I agree that Addiction is layered and complex, it has a clear and measurable progression, especially when it comes to substances. If Addiction was a “case-by-case” basis, there would be no way to measure and predict its worsening or treatment. It would be chaos to try and treat Addiction.
Now, before you say, “It is chaotic and nearly impossible to treat Addiction; therefore, it cannot be generalized and studied;” please understand that Addiction does have a measurable progression that can be examined. However, it’s in treatment and recovery that individuality takes center stage. Untreated Addiction (as I’ve said fifty two (52) million times) will lead to prison, death, or both.
Recovery is the tricky part and I think that there is no single approach that works for everyone. I think that those who’ve shared with me that they believe Addiction is too complex to generalize are confusing Addiction with its treatment. For example, I will present two (2) cases as a way to illustrate that, while each one’s treatment may be different, their Addiction is quite similar (all names are fictitious).
Jim is a thirty (30) year old single Hispanic male who has been abusing opiates for six (6) years. He became acquainted with Oxycodone after injuring his back in a work-related accident. At first, he used the Oxys as prescribed, but after a few months, he needed more and more until his doctor discontinued his prescription. At that point, Jim began hustling for his Oxys on the street, but soon found them to be too expensive and switched to heroin. Along the way, Jim’s financial situation began to deteriorate and he found himself lying more and more to acquire the money to purchase his drugs. When he was first injured, Jim had a girlfriend, a decent job, an apartment of his own, and had hopes of becoming a journeyman-licensed plumber. Six (6) years later, he’s physically dependent upon heroin, spends his waking hours acquiring the drug, has no stable relationships, and has to find places to sleep and usually crashes out under any available bridge. He is seeking treatment because he has become fearful for life.
Betsy is a forty-four (44) year old married Hispanic female who finds herself drinking more and doing so more frequently than she ever has. She has been waking up too hungover to go to work and has been warned that if she continues to come in late, she will be fired. Her husband is also growing more and more tired of her behavior and has also warned her that if she doesn’t get help, he will leave her. However, in spite of both warnings, Betsy cannot stop drinking; she can no longer function without it and lies to both her husband and her boss to cover up her growing dependence upon alcohol. She is seeking treatment because she cannot stop on her own and fears she will lose her job and marriage if she doesn’t get help.
Now, while Jim and Betsy couldn’t be more different as people, their addictions are quite similar: Both are progressing towards death and along the way, there are accumulating more and more losses. Addiction is present in both cases and, although Jim is further along in his, Betsy isn’t really all that far behind. Someone may challenge the similarities and say that alcohol isn’t as bad as heroin or that they are different because one is homeless and one still has a job, but those differences are circumstantial. The reality is that each Addiction is consistent with a progressive disease that has discernable characteristics and mechanics. I can say with one hundred percent (100%) professional confidence that each one is Addicted to the substance of choice and both are headed towards more suffering and death, if they do not get treatment.
It’s in the treatment where the differences emerge. Twelve-step purists would argue that Jim should head to NA meetings and Betsy should get herself to AA meetings as soon as possible. And perhaps I would agree, but I would also add that both require an examination consistent with the BRENDA model because each one’s body may need specific care. For example, Jim is at high risk of getting or having Hep C, while Betsy may be at risk for cirrhosis and diabetes. I’m willing to bet that each one will require nutritional education and some form of emotional therapy to help sort out the grief from the losses that each has acquired, but because Jim is single and Betsy is married, the approach would have to account for those variables, as well.
Also, and here’s the thing: Each one should also seek medical care, not only for their bodies, but also, there are meds that may be useful in each one’s recovery. For Jim, Suboxone can replace the heroin and because it’s a controlled substance, can be tapered in time. Betsy may respond to either Naloxone or Acamprosate as a pharmacological aid within her recovery.
Regardless of the path, I think it’s clear that, while Addiction is diagnosable within each case, its treatment is different for each. So, while I appreciate the recognition that Addiction is multi-layered and complex, it is measurable and definable and holds true to various models of progression and mechanics. The most important thing to remember though is that there is hope and that Addiction does not ever have to be fatal.