Historically, addiction has been defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin, caffeine, and other drugs) that cross the blood-brain barrier, and once ingested, temporarily alter the chemical milieu of the brain. Addiction can also be viewed as a continued involvement with a substance or activity despite the negative consequences associated with it.
Addiction begins as a pursuit of pleasure, enjoyment, or relief from actual or perceived ailments; however, over a period of time more involvement with the substance or activity (such as gambling, eating, or sex) is needed to feel normal. In other words, you start doing it to feel good and then have to continue doing it to keep from feeling bad.
However we define it, humankind has been experimenting with mind-altering substances ever since we first discovered that grapes would ferment into wine. Since then, we’ve used our intellect, imagination, and ability to create myriad new ways to alter our consciousness through the use of addictive drugs and behaviors. Unfortunately, some people develop serious problems when they go down this road. It has often been said that in the beginning of this deterioration, the use of drugs sometimes “gets in the way of the person’s life.” Later on, “life gets in the way of the person’s drug use.”
Forty million Americans ages twelve and older have an addiction involving nicotine, alcohol, or other drugs, making addiction a disease affecting more Americans than heart conditions, diabetes, or cancer, according to a five-year national study released in June of 2012 by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another eighty million people are at-risk substance users—using tobacco, alcohol, and other drugs in ways that threaten health and safety.
The report, Addiction Medicine: Closing the Gap between Science and Practice, reveals that while seven in ten people with diseases such as hypertension, major depression, and diabetes receive treatment, only about one in ten people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.
The CASA Columbia report found that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment, and disease-management tools and practices exist, they are rarely employed. The report exposed the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and that most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills, or credentials necessary to provide the full range of evidence-based services.
Throughout my many years as a physician working in this field, it has been disappointing to observe that so many well-meaning therapists seem to know relatively little about the biological and medical aspects of addiction. The consequences of this lack lead to suboptimal care and treatment for this very vulnerable patient population. I wrote The Therapist’s Guide to Addiction Medicine: A Handbook for Addiction Counselors and Therapists to help improve the integration of the medical and counseling components of addiction treatment. This book provides the essential biological and medical knowledge that a counselor should have if he or she desires to work effectively in helping clients recover from the disease of addiction.