For me, addiction is a multi-layered disease in accordance with the American Society of Addiction Medicine’s definition, “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

The pathological pursuit involved in using substances is evidenced in the three “C”’s of addiction:

  • Continued use despite adverse Consequences
  • Lack of Control when using substances
  • Compulsive seeking and using of substances

The key component, and in my opinion, the most difficult to understand aspect about addiction is Compulsion.  A good definition of compulsion is, “An uncontrollable impulse to perform an act, often repetitively, as an unconscious mechanism (sic) to avoid unacceptable ideas and desires which, by themselves, arouse anxiety” (2007, American Heritage Medical Dictionary).  I added the bolded font to emphasize that a compulsive behavior is an unconscious mechanism

An unconscious mechanism is one that affects, “the part of the mental function in which thoughts, ideas, emotions, or memories are beyond awareness and rarely subject to ready recall” (2009, Mosby’s Medical Dictionary).  Therefore, if we work our way backwards from our three formal definitions, a person caught in the throngs of addiction is suffering with a brain disorder of which they are unaware that is impacting them upon every facet of their life.   Physical, financial, emotional, and spiritual health are all adversely impacted as a result of a behavior performed without awareness.   The brain of an addict is rutted towards using a substance and becomes ingrained and automatic.

If we look closer at the source of compulsion, anxiety, it becomes apparent that compulsion is protective.  It “feels better” to use than to experience the anxiety caused when not using.  Therefore, the automatic nature of using a substance must be disrupted before there is even a chance that the behavior can change.  That is, someone has to become aware of the compulsion to use, then has to feel the adverse consequences of using, and then has to see not using as a preferred path.  If we do not strip the veil off of the compulsion, we cannot elicit change.

Further, in substances that contain a physical component such as alcohol or opiates, the fear of withdrawal is sometimes so strong that just thinking about withdrawal causes such anxiety that even if the user is not physically ill, they need to use.  Really, addiction is complex and layered and I do not foresee a “magic bullet” from which a simple solution will emerge.  Recovery from an addiction requires patience, commitment, support, and emphasis of strengths rather than amplification of deficits.