Before I leave the Earth, I anticipate saying that fear is the shackle that locks an addiction into place about a million more times. In a conversation I had last night, someone analogized someone addicted to heroin to someone addicted to alcohol. “An addict is an addict,” he said. To me. Of all people. But, the person said that to me from a perspective of fear, as his niece was admitted to the hospital after overdosing on heroin. He is close with her and his fear of losing her was tied to his fear of his father who would become mean when he drank too much. However, the father held a job and supported his family, even if he did abuse alcohol from time to time.
There is no one size of addiction that fits everyone. Two facts about addiction that have to be absorbed before real understanding can occur are: 1) Addiction is a progressive compulsive disease that can be ingestive or process-based; and, 2) Substance abuse occurs along a spectrum that’s measured by function an adverse consequences.
Addiction is based upon compulsion; that is, when someone is addicted to either a process (sex/gambling) or a substance (cocaine, heroin, food), he or she may not be aware of the intense drive towards the object of the addiction. Before any treatment can occur, in my professional opinion, awareness of the behaviors and rituals associated with the addiction must be built. Especially with opiates: Opiates can cause such an intense physical dependence that the drive for the substance becomes as automatic as breathing. Someone addicted to opiates, without treatment, is more than likely not aware of anything other than fixing, once even a hint of withdrawal begins. It’s absolutely true and I will argue the point with anyone, anytime (compulsion works the same way in all addiction, but that’s a topic for another time).
Substance abuse leads to addiction, but is marked by function. In the case of the man who I argued with, his father was functioned and though the man was afraid of his father when the father drank, there wasn’t really too many other adverse consequences that resulted directly from drinking. But, the man thought his father was addicted and held so much fear, that he transferred that fear onto his niece’s situation without realizing that his father’s relationship with alcohol was different that his niece’s relationship with heroin.
Not that either person was better or worse, it’s just the measure of the addiction each faced is clearly different.
So, then before anybody judges all addiction as the same, I recommend that he or she asks three questions:
- What substance is the person using/abusing (different substances have different dependence trajectories)?
- Is the person functional in other areas of his or her life (physical, economic, spiritual)?
- Has the person received past treatment for the addiction (treatment of any kind may help disrupt the addiction, even if it may not appear that it does)?
Really, these three questions can shed a lot of light on the nature of someone’s addiction and must be accounted for when trying to understand an addiction. If those questions aren’t asked, then I’m willing to bet the fear is driving and when it does, anger, hate and shame are sure to follow.