Re: Addiction/Dependence

[Guest guest]

Hi Ron & all,

Perhaps it's a trap to get into strict definitions, but I did learn

of a basic model that seems to work as well as any, and kind of

agrees with your reading:

The idea being that everyone that uses mood-altering substances will

go to one of three basic levels -

(1) " User " - e.g., social drinker, occasional pot smoker; quite

unlikely to be considered a problem.

(2) " Abuser " - e.g., regular heavy drinker, possibly a binge-user;

uses on more-or-less appropriate occasions, but does so to excess;

could easily be a serious problem but not necessarily.

(3) " Dependant " - e.g., makes using a top priority, living to use -

unable/unwilling to stop, sacrificing self and others.

I've certainly known people in each category. I figure those in (2)

are likely those who may seek help, but could drink/use again in

moderation. I find myself solidly in (3), and abstinence is a

question of survival, and recovery is more about getting at the

underlying personality issues.

[Guest guest]

Hi,

> Hi Ron & all,

>

> Perhaps it's a trap to get into strict definitions, but I did learn

> of a basic model that seems to work as well as any, and kind of

> agrees with your reading:

>

> The idea being that everyone that uses mood-altering substances will

> go to one of three basic levels -

> (1) " User " - e.g., social drinker, occasional pot smoker; quite

> unlikely to be considered a problem.

> (2) " Abuser " - e.g., regular heavy drinker, possibly a binge-user;

> uses on more-or-less appropriate occasions, but does so to excess;

> could easily be a serious problem but not necessarily.

> (3) " Dependant " - e.g., makes using a top priority, living to use -

> unable/unwilling to stop, sacrificing self and others.

I think the model I put out there varies from this usage, especially

in the " dependent " area. Instead, it is using a continuum of

dependence. Some drug dependence is not thought to be problem at all

in terms of negative consequences, eg., daily coffee or (more and

more) meds for long term intractable pain--and there are many other

examples.

That is not to say that there aren't problems associated with alcohol!

Text makes a convincing case that it is THE most harmful drug in many

ways in America.

And, it has been shown that people do vary in their responses, even

over the life of an individual. The social context seems to be an

overlooked factor, according to some studies (those that dared).

Many theories/explanations rely on perceived negatives by the drinker.

That can't be the whole story either! I'm finding that the model I

put out here is good for describing for me what it isn't, but not

necessarily what it is. :^) Complex, to say the least.

[Guest guest]

> Trimpey has a good point about addiction, though, when he points

> out that only the person in question can know whether or not

> addiction exists.

AAers use this line, too. They say something to the effect that only

you can decide if you are an alcoholic.

Of course, they also believe, following Bill W., that the alcoholic

has a special ability to spot other alcoholics and " potential "

alcoholics.

[Guest guest]

> When I think of " addiction " I think of severe, intense craving, so

intense

> that it is pretty much impossible to ignore it.

>

I've been away for a few days, but I have gone back and read through

this thread. The above statement is interesting to me. I realize that

the further away I get from the addictive behavior I used to be

involved in, the more I seem to forget what it felt like to have

those " intense cravings " . I felt one the other day, and it surprised

me. To me, that is the heart of addiction. I am removed from it for

the most part these days, except for smoking. But every once in a

while I get one about food, and I remember, " Whoa, that's what

addiction is. "

I am trying to figure out how/if the whole concept of ambivelence

fits into this. On the one hand, it makes sense to me that one would

not experience such cravings if there did not exist some level of

ambivelence - " I want x, but I really shouldn't... " . If I want a

drink of water, for intance, I usually just go get one. I satisfy the

desire or the need without it escallating to a " craving " .

On the other hand, I know I have experienced craving to engage in

behavior that I have had no paticular desire to stop. If physical

circumstances prevent me from smoking for a long period of time, I

will begin to crave a cigartette after a while, even if I am not

experiencing any desire to quit all together at that particular time.

I guess the same could be said for water, if I were physically

prevented from drinking it when I needed it. Of course it would be

silly to say I was addicted to water. But still, if a person can

experience cravings because they are physically unable at a

particular time to engage in their addictive behavior, even if they

have no desire to stop at all, would it be correct to say that they

are not addicted just because they don't have ambivelence?

I also believe there are addicts who create rather elaborate schemes

to protect their addictive behavior. They have tremendous motivation

to do this, precisely because they don't want to stop. I did this

with bulimia for many years. I was hospitalized for over three months

in a facility where the staff insisted they knew and understood my

every move, and I was binging and purging the entire time I was there

(something they certainly would have taken steps to prevent, had they

been aware). I don't think it would be correct to say that I wasn't

addicted to the behavior, just because I didn't have any desire to

stop.

I also have a very good friend who I expect to find dead any day now.

He doesn't care that he drinks far too much. He isn't ambivelent. I

don't think I'm *not* allowed to aknowledge that there is something

seriously wrong just because he does not wish to define it as such.

He looks really unhealthy, and his every day life is starting to

reveal his destructive behavior. I just don't believe it would be

correct to say that he is not addicted just because he obviously

doesn't care whether he is or not.

Just some thoughts.

Joan

> says, " I always thought that addiction necessarily implied a

directly

> mood-altering substance (or possibly activity?). "

>

> I'm glad you said, " activity " as well as " substance " . My first

husband was

> a compulsive spender, and life with his " addiction " or " compulsion "

was a

> nightmare, as nightmarish as with any drunk or drug addict.

>

> I've been hearing here on this forum that " addiction " is not a very

useful

> word. I can't find the post where someone stated that

professionals of some

> sort don't use that word.

>

> I do see mood-alteration as having something to do with it. Or

maybe

> " mood-alteration " is not quite adequate. Lots of things alter my

mood. My

> mood gets altered all the time. When my cat comes over and invites

me to

> pet and cuddle him, my mood alters. When I look out and see the

sunshine,

> my mood alters. When I take a nice hot bath with pleasant smelling

soap, my

> mood alters. When I sit outside under the tree and watch the

traffic go by,

> my mood alters.

>

> Maybe the mood-alteration is more specific. Perhaps the mood is

some sort

> of pleasure. mentioned pizza with various kinds of peppers

on

> it...mmmmm....I could get into that, and I could easily come over to

> 's house and over-eat her wonderful pizza, especially if she

put lots

> of hot peppers on it...

>

> But what about situations that are not pleasurable?

>

> For me it was not pleasurable to smoke. I'd started smoking as a

teenager

> because I thought it was really cool to do what the adults did. It

made me

> sick as hell, but I did it because I wanted to imitate the grown

ups. I can

> never say it gave me pleasure. I got to where I could smoke

without getting

> sick to my stomach, or at least not excessively sick. And then I

was

> smoking because the craving was so miserable and so severe. What I

was

> getting was not so much pleasure as relief from misery.

>

> When I quit, it wasn't with white knuckles. I'd tried repeatedly

to quit,

> but I'd not been able to hold out against the intense misery of

nicotine

> withdrawal. But then I reached a point where smoking was making me

so sick

> that my body just kind of rebelled. And I just stopped. Just

stopped.

> Period. Without any sort of withdrawal. That was in 1982, and I

haven't

> smoked since.

>

> When I think of " addiction " I think of severe, intense craving, so

intense

> that it is pretty much impossible to ignore it.

>

> And yes, I'm well aware that there is nothing scientific about my

> definition.

>

> Cheers,

>

> nz

[Guest guest]

> I've been hearing here on this forum that " addiction " is not a very

useful

> word. I can't find the post where someone stated that professionals

of some

> sort don't use that word.

The words " addiction, " addict " , " alcoholism " , and " alcoholic " are not

used anywhere in the American Psychiatric Association's Diagnostic and

Statistical Manul of Mental Disorders, 4th Ed., (DSM IV).

The two relevant diagnoses are Alcohol/Substance Abuse and

Alcohol/Substance Dependence. The latter is usually claimed by

disease model supporters to be " Real Alcoholism/Addiction " . However,

contrary to the often expressed views of actual practioners, it is not

necessary to be abstinent in order to be in Full Remission from this

disorder. The fact that some many practitioners are mistaken on this

is, imo, rather alarming.

P.

[Guest guest]

> > However,

> > contrary to the often expressed views of actual practioners, it is

not

> > necessary to be abstinent in order to be in Full Remission from

this

> > [Alcohol/Substance Dependence] disorder.

>

> Do you mean because once one detoxes one is no longer physically

>dependent?

No - merely that the criteria for Remission does not require it. All

that is required to be considered in Full Remission is to *not meet*

any of the criteria for Abuse or Dependence during the period in

question - since simply drinking/using *at all* doesnt meet any

criterion alone, it follows that one can drink/use and still be in

Full Remission. I have known practitioners dispute this, citing the

" Continued drinking/using despite harm " crieerion. however, if in

order to be in Full Remission one had to be abstinent, why would the

crieteria not say so directly? Why bother with such a roundabout way

of putting it " Did not meet any criterion for Abuse or Dependence "

iif merely " Is Abstinet " would do? The only logical conclusion is

that the compilers intended it to be possible to be in FUll Remission

and not be abstinent. The criterion about Use despite harm must only

apply to to the period in question, not the person's entire

drinking/using history. When I have pointed out the above in

professional forums, it is met with silence, and I am sure that

probably most addiction practioners continue to insist on total

abstinece before they will consider a client to be in Full Remission.

Another cheat that they use with drugs is the " Use despite

repeated Legal Consequences " criterion, arguing that using an illegal

drug is itself a legal consequence, even if the person doesnt get

busted! Again, if this were true the compilers would simply say " Drug

is illegal " , and it is of curse manifestly ridiculous to have a

criterion that *every* use would automatically fill. These are just

modus operandi for the disease folks to demand abstinence as a

condition for recovery.

P.

P.

[Guest guest]

Further on this, the criteria for Alcohol/Substance Dependence Full

Remission is uniusually strict, since epidemiologically ordinarily one

is no longer consoidered to have a disorder when one would no longer

be diagnosed with it on first examination. The DSM criterion for

remission is unusualy strict in this regard. One reason why Robin

room cannot imo be considered an AA proponent is he points out this

anomaly and argued against it when the DSM was formulated. Also, I

believe he agrees with Fred Rotgers when the latter points out that it

is anomalous to demand a higher standard of recovery than one does

ofppl in general - hence so long as a formerly alcohol depepndent

person gets no more drunk no more often than the average, why should

this not too be considered Full Remission, if Jo(e) Citizen isnt

considered Alcohol Dependent when s/he does it?

P.

[Guest guest]

Mona -- the point is what the standards of professional evaluation and

diagnosis are. " Prognosis " is different from " diagnosis. " DSM criteria are for

current diagnoses only. If someone has not experienced any problems from

drinking for over a year, then they cannot currently be diagnosed with Alcohol

Abuse or Alcohol Dependence, whether or not they are totally abstinent.

It may be statistically more likely for formerly alcohol-dependent persons

who take up drinking again than for abstinent people, to have a recurrence of

alcohol dependence, but until such time as they DO again meet the criteria for

Alcohol Dependence, they must be considered to be in full remission.

Also, in your previous post, you appeared to misunderstand " Alcohol

Dependence " to mean physical dependence resulting in withdrawal. The DSM

criteria for alcohol dependence do not require physical symptoms -- they

basically require " continued use of the substance despite knowledge of repeated

(severe) negative consequences " in the past year.

~Rita

> In a message dated 5/29/01 11:06:22 PM Pacific Daylight Time,

> watts_pete@h... writes:

>

>

> > Also, I

> > believe he agrees with Fred Rotgers when the latter points out that it

> > is anomalous to demand a higher standard of recovery than one does

> > ofppl in general - hence so long as a formerly alcohol depepndent

> > person gets no more drunk no more often than the average, why should

> > this not too be considered Full Remission, if Jo(e) Citizen isnt

> > considered Alcohol Dependent when s/he does it?

> >

>

> Well, but people who have become physically dependent may have avastly

> higher likelihood of becoming so again than does the population at large, if

> they resume drinking. Maybe not after one month, or one year, but at some

> point. Does that not have some great significance?

>

> --Mona--