I am fond of the definition of addiction which goes, “someone who does something over and over again expecting different results.”
The alcoholic goes on a bender entirely convinced that this time will be different. He’ll be able to control his drinking, he won’t get into bar fights, he won’t drive drunk, he won’t cheat on his wife, he won’t do whatever insanely stupid thing he always does when he ingests alcohol.
Left untreated, addiction is a progressive disease. If the drunk thinks that whatever trouble he got himself into last time won’t happen the next time he drinks, he’s actually right in the sense that not only will he do the same insanely stupid shit that he did last time but he will do stuff that is even more destructive to himself and the people he loves. Drunks and drug addicts don’t end up unemployed and homeless because they were born that way. It’s the addiction that did it to them.
Once addiction is in full swing, nothing—and I mean nothing, not a job, a house, a car, a wife, kids, parents, friends—nothing is as important than getting a fix. That’s where the dishonesty comes in. Addicts lie because all they really want is the booze or the crack or the sex. They will sell their mother to get it. There’s a great scene in The Fighter where Dicky Eckland (played by Christian Bale) is in a crack house and his mother comes looking for him. He jumps out a second story window in a drug induced haze to try to keep his mother from seeing the truth. He lands in a huge pile of trash and he can’t avoid coming face to face with his Ma. But even that doesn’t get him sober.
The final definition for addiction is when the thing you are addicted to is ruining your life. Some people can drink tons of booze or even take lots of coke and their life is honestly unaffected. It doesn’t send them into a downward spiral caused by the phenomenon of craving which blots out anything good in their life. A guy jumping out a window to avoid his mom is most likely an addict.
But the addict’s mind tells the addict that they are not an addict no matter how complete the breakdown of normal life. That’s why most addicts end up in jail, dead or, despite all odds, getting the help they need to get and stay sober. There’s not a lot of gray in the trajectory of continued use.
Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the standard by which mental illness is diagnosed and heath care is provided in the United States. Health Insurance, including Medicare and Medicaid, look to the D.S.M. to define standards of care and to establish medical reimbursement. The New York Times reports that the newest D.S.M. will have a much broader definition of addiction than in prior versions.
In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.
Under the new definition the addictive use of drugs and alcohol will be broadened and the number of activities that can be considered addiction will also be broadened to include such things as gambling for the first time.
Currently only 2 million of 22 million addicts, defined under the old D.S.M., get treatment at least in part because they don’t have health insurance. The new definition may increase the number classified as addicts by as much as an additional 20 million. Insurance companies, and many clinicians, are criticizing the expansion of the definition of addiction as costing hundreds of millions of dollars.
David Carr, the noted media columnist, tells the story about free-basing cocaine with his first wife when her water broke and she went into labor with their twins. He was honest with the doctor when they got to the hospital. The kids got taken away from the drug addict parents. Carr’s wife never got sober. He did and ended up with the kids (who are now in their 20s). In Carr’s case he went to inpatient rehab and then a long term care facility for months before he was well enough to try his life again and eventually to take custody of his kids. In his memoir, The Night of the Gun: A reporter investigates the darkest story of his life. His own, he makes clear how much the treatment he got was responsible for any chance he had at fighting off his addiction.
I wasn’t freebasing when my kids were born, but I was drunk. I did plenty of insane things because of my drinking that cost me the things I valued most in my life. In my case I never went to a facility of any kind. I went to church basements sometimes twice a day and threw in a buck before listening to how to fix my problem. That was fifteen years ago and I am still sober. For a decade the church basements routine was a daily event for me.
My life, like Carr’s, has been turned around and blossomed as a result of sobriety. From darkness there has been light and laughter and lots of love.
The idea that a broader definition of addiction is somehow going to harm us as a country is just as insane as the disease itself. Are we addicted to money, oil, reality tv, celebrity magazines? Yes, but that is not what we are talking about. We are talking about teenaged girls who kill themselves through eating disorders, college students binge drinking, the growing epidemic of ruined lives due to gambling, and sexual obsession so profound it ruins everything else.
Addiction in all of its forms is the most significant public health problem facing our country. Ignoring it or only classifying its most advanced forms as a disease will not make it go away. On the flip side, working to assist addicts to overcome their negative patterns of behavior is an opportunity to unlock massive human resources currently trapped in a cage of dispair.
Who knows how many David Carr’s there are out there if we were just able to treat addiction in a more systematic and effective way?