I just had a long term former substance disorder patient turned warrior and full fledged citizen of llife and family and work. She spent years on crack cocaine and it destroyed her life, her job options, her home, her family, and her health. Her once bright appearance became unrecognizable. The good news is that three years ago now, with prompting by her parents who had not yet given up on her, offered her a place to live in exchange for getting help. You know what, she got that help and three years later she is independent, has her own apartment, and her own job and comes into my office smiling with make up on. It is amazing to witness.

it really got me to thinking a lot about addiction and substance abuse disorder. I thought about all the misconceptions that I have heard about it and all the judgement that I have heard about it. Let me take a minute to explain what it really is.

Sadly I have a lot of personal experience with this with patients and I make it a point to listen to their stories in detail, always hoping that I can grab something from one of them that could be used to inspire another patient in trouble.

Let’s first define addiction. The definition of addiction is the fact or conditions of being addicted to a particular substance, thing, or activity. I know, using a word to define itself right? An addiction can also be referred to as a dependence, craving, habit, weakness, compulsion, fixation, or enslavement to a particular substance, thing, or activity. You get the point though, correct? It implies an unhealthy deep attachment to anything.
Now let’s talk about substance abuse disorder. the definition of substance use disorder is the persistent use of drugs despite substantial harm and adverse consequences to oneself and or others. This often described in laymen’s terms as drug or alcohol abuse.

So, you see they both go together. They can’t really exist without each other, but yet they are not the same thing.

Theses are devious bad buddies people. When people often think of addiction, they get either judgy or uncomfortable. They tend to be afraid of or look down on those patients and people, either because they just don’t understand it or they have had some personal bad experience.

I get it, if you have been the victim of a crime perpetrated by someone under the influence of drugs or alcohol, it can be both terrifying and very serious and something that it hard to get. Short of that, most of the judging or condescending toward addiction patients is just a lack of understanding,

This is not me saying that there are basic codes of conduct that should be followed by any human being. No. Not at all. I am just trying to make sure that this particular disease is better understood.

Wait? Did I say disease? Yep I did. Addiction is truly a form of disease with multiple components not unlike diabetes or hypertension. You could tell yourself, there is no way that someone made a choice to be diabetic or hypertensive and an addicted person did! Well, actually, in a way, genetics aside, sometimes people have made choices to gain weight or make other unhealthy decisions that led them to those diagnoses in the first place and once the anatomical changes are in place, serious measures have to be taken to attempt to correct them and ensure a longer life.

Well, whaddya know. The same kind of principles apply to addiction. Addiction has multiple components. There may in fact be a genetic susctibility. There may be environmental factors. There may be stimulating traumas that lead people to try to find a mental way out and they pick the worst one. Last time I checked, no addicts that I have come to know just sat down one day and decided to shoot up heroin out of nowhere. That initial terrible decision came from a variety of different sources and triggers the majority of the time.

Like with any disease, once addiction has rooted itself in the brain, it literally changes the brain anatomy, It literally causes the formation of a whole new shortcut pathway of dopamine to the nucleus accumbens in the brain. This decreases and intensifies the perception of the pleasure response, while also shortening the duration at which it lasts. This is a terrible double-edged sword and even for those who maintain recovery status, there is a risk of that new path always being there, hence the forever fight against cravings and temptation.

Like with any disease, it requires a certain level of readiness before recovery can even become an entertainable option, just like hypertension and diabetes. I have patients every day that are not ready to actualize that they have these conditions and it is incredibly difficult to help them until they are ready. Unfortunately, addiction carries the extra weight of ruining all the patient’s relationships and job opportunities all around them so many people suffer, not just the patient. That is a way that addiction is definitely worse and potentially more powerful.

My whole point and the most important bottom line is to offer a least a slight pause of understanding for the addicted patient. They do need help and hopefully they are willing to receive it. They have to understand going in that it will require a lifetime of strength, resistance and fortitude. It is not a job or a task that is completed in a day. There are multiple steps every single day to keep the train on track so to speak. It is no easy task, but it can potentially save their lives.

Have a great day everyone. There are potential heros at heart everywhere.

Dr. Katz