Responses to addiction

How should we respond to drug and alcohol addiction? There are three accepted general models: legal, medical and social.

The legal model is based on trying to prevent addiction and the damage it can cause by a combination of legislation, education, control, deterrence and the use of the criminal justice system. Some substances such as alcohol and prescription drugs are controlled; others are illegal. While this model disrupts the production and supply of drugs to addicts it has proved ineffective in preventing access to drugs or their continued misuse. Criminalising the use of these drugs has natural consequences which may, or may not, help in dealing with those who are addicted.

The medical model assumes that the addict has a clinical problem that can be addressed by the application of appropriate treatment and medication. This assumes that addicts first recognise their problem and want to be cured. While this can be effective, in most cases what results is seldom a cure but more often a regime that allows the addict to cope with their addiction through alternative medication or other coping mechanisms such as avoidance (eg avoidance “once an alcoholic always an alcoholic.”).

The social model treats the addiction in the contextual environment of the addict. Here the addiction is treated alongside addressing those wider circumstances eg housing, mental illness, criminality and family relationships rather than simply the addictive behaviour. The various problems in an addict’s life often have multiple causes and effects and can only be properly addressed holistically. Addicts often need considerable support if they are to be helped to change their environment to one where the temptation to turn back to their addiction is minimised.

Stephen Morse, Professor of Psychology and Law in Psychiatry at the University of Pennsylvania presents a very clear description of the three models in his paper entitled Hooked on Hype: addiction and responsibility.
All three models have their part to play in overcoming addiction. For many the move to seek help comes first from the individual addict recognising their problem; others require the intervention of another agency, most often, the justice system.
All people are individuals and thus require different approaches. Thus whatever strategies, policies, initiatives and interventions are used must be person centred and provide holistic care for the individual. We recognise that poverty makes a considerable contribution to the difficulties in overcoming addiction. In the end, however, we remain in no doubt that positive and supportive relationships are what carry people through and enable the most effective recovery.

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What is an addiction?

Defining addiction is not a simple task though we all have a sense of what it is. In this posting most of the examples are coming from alcohol addiction. The clinical definition, commonly used, is based on the International Classification of Disease (ICD-10) (World Health Organisation, 1992). This pertains to alcohol, but is also appropriate for other substances that induce physical or psychological dependence. A diagnosis of dependence (ie addiction) requires the presence of three or more of the following:

1. a strong desire or sense of compulsion to take alcohol
2. impaired capacity to control alcohol taking behaviour
3. a physiological withdrawal state (eg tremor, nausea, rapid pulse rate when alcohol intake is abruptly stopped)
4. evidence of tolerance to the effects of alcohol (ie the need to increase the amount consumed to gain the same effects)
5. preoccupation with alcohol use (to the detriment of alternative pleasures or interests)
6. persistent alcohol use despite clear evidence of harmful consequences

Those who are addicted often speak of it being hell, like a prison but paradoxically also like a love affair. Addicts are sufferers but only seek treatment when they realise the nightmare that they have been in. When asked why they took drugs addicts often spoke of the enjoyment frequently describing heroin as “magic”. For some in a life where there appears to be no hope, no future; the offer of something that will bring great pleasure has a predictable, though not inevitable, outcome. The same applies to the question of relapse. For addicts it will only be tolerable to come off if one retains the idea that one can go back. Addicts will always love it, and feel that if they want they can go back to it.

The reasons that addicts get into the positions that they do are complex but it is clear that often the substance that leads to addiction provides a relief from pain or deep seated need of one sort or another. To use a parallel example: research with those who survive serious attempts at suicide has shown that they do not wish to die but they do want the pain to go away. They know that their death will be hurtful to those around but see that pain as less than the pain or distress with which they are faced. Addiction often provides a route out of pain or satisfies a deep seated need.

Credits

The p[icture of the bottles was taken by Chris_J.

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Hello world

This is the first posting