UNDERSTANDING
ADDICTION
YEDEM & Believers Network Club
GHANA
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.”
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.
The Addiction/Dependence Debate
a.




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
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.
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

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).
USE AND ABUSE/HARMFUL USE
AND DEPEDNCE


1.
2.
3.
4.
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.
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).

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”
SUBSTANCE DEPENDCE

1.
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.
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.
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.
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).
THE DISEASE CONCEPT VRS
THE SELF MEDICATION
THEORY
The disease concept defines addiction as a primary
disease implying that:
1.
All other manifestations e.g. depression, lack of
responsibility, anger, aggression, lack of balanced
life are consequences of the disease.
2.
Trying t find a reason behind the addictive behavior
is futile. And may be harmful.
3.
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.
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.
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:
1.
Hurts of the past are thought to be the cause of addictive
behavior
2.
Inability to balance the inner world and the outer world
(Khantzian)
3.
Family problems
4.
Problem in childhood development
5.
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
Definition of Addiction in the
Therapeutic Community Approach
Mellnick and DeLeon (1999) defines drug abuse in the
TC approach as: a deviant behavior, reflecting :
(i)
Impeded personality development
(ii)
Chronic deficits in social, educational and
economic skills
Its antecedent lie in,
(i)
Socioeconomic disadvantage
(ii)
Poor family effectiveness
(iii)
And in psychological factors
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.
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
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.
1.
2. Addicts as mush “Normal” people are:
(i)
Created in the image of GOD Gen 1:26,27
(ii)
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.
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