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
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?
About Tom Matlack
I am always perplexed when folks don’t want to change established definitions of illness because treatment will cause more money. Don’t we realize it costs money when people have to treated in emergency rooms, when children have to be placed in foster care, when we lose productive and creative individuals, when law enforcement has to become involved, when we incarcerate people because of their addictions and so on.
And that is just the monetary costs.We haven’t factored in the social and humanitarian costs of not treating folks.
Congrats on 15 years of sobriety Tom.
Totally agree Shawn. Thanks.
Well said, Shawn.
Tom, thanks for writing your courageous & heartfelt piece about the terrible price that is paid when ‘addiction’ is only treated in the more advanced stages of the disease, rather than earlier in the process. I work with many clients who are struggling with various aspects of addiction to alcohol & drugs, disordered patterns of eating (including anorexia & bulimia), and sexual addiction. Without a doubt, society often minimizes and even trivializes the reality of addiction. Although there may be other problems with the proposed revisions in the DSM 5 (some of which may have the potential to be confusing and even detrimental), as an experienced psychotherapist I stand firm in supporting these revisions regarding what constitutes addiction. I remain hopeful that more people will be able to get professional help much earlier with their maladaptive patterns, and that this will alleviate the worst kind of suffering that swallows up peoples’ lives when addiction inevitably progresses.
Thank you Cherylynne. Can you enlighten us on what parts of the revision have the potential to be confusing or detrimental from a clinician’s perspective?
One part of this is the addiction. 2nd another part is healthcare to treat the addiction. 3rd part coverage to pay for the care and the last part is “managed care.” Most mental health benefits are very limited and accordingly, the treatment for the addiction is very limited and the outcomes suck at best. Now let’s add “managed care” to the equation and things don’t look good at all.
About a year ago, the state of Illinois introduced managed which in and of itself is limiting, they used a medical model managed care component. Medical model focuses on detox and medical need. Our 6 to 9 month program (adolescent residential) changed to 15 to 30 days at best. Our average senses went from 38 to 12. 98% of the kids we get are through the court system and come to us directly from lock up. With managed care, the criteria required that the patient actively used within the past week. When a kid has been locked up for at least one week to 3 months, patients who once qualified, no longer qualified unless they used while being incarcerated.
My company closed two adult units and one of the few residential adolescent girls facilities in the state. Several others closed in the state as well. After considerable campaigning from the mental health industry, the state pulled back managed care for the moment. Our senses has gone back up but the program is still 30 to 90 days. It’s clear the responders so far as well as the writer understand addiction and more then likely know that adolescent addiction, if not rectified before adulthood, run a much higher chance of being and addict as an adult.
When I moved into my current career 13 years ago, majority of the kids came to us who started using in their mid teens. Things have changed. We now have 7 kids that are 14 years of age and admit using as early as 8 years of age. And I would like to add that addictions is an all-inclusive behavior. Part of the addiction is the activities surrounding the use of drugs. A lot of these kids as just as addicted to the dangers as the drugs themselves. (dangers meaning buying /selling drugs, breaking into cars and homes, robbing people as well as running from the police … it’s all part of the high they get when using)
Tom, thank you for sharing and writing this. Addictions is a BIG problem and one that isn’t being addressed. Worse yet, treatment as we know it will soon be under the thumb of government control and in some cases, already is limited.
Thanks Tom. I am painfully aware of the issues regarding teenage addiction of all kinds from drugs to bolimia/anorexia to sex trade. My understanding, though I don’t know first hand, is that Minnesota has always been the gold standard in terms of state policy on this issue. Maybe we should try to figure out what they are doing right? Clearly we can all pay now or pay a hellofalot more later. In money and in lost souls.
How brutally honest this is…! You are so right about addicts testing the boundaries (constantly!)….I was in love with an alcoholic, who lied constantly….even as he was driving drunk (after a too much red wine) and smacking into a taxi… and then another car….and then getting spit in the face by the second driver…he laughed hysterically as I looked on in horror….(why I didn’t just get out of the car and take the train home that night…I will constantly torture myself with that question)….Even after all that, he promised he wouldn’t ever do that again…How empty such words are from an alcoholic (I was so young and gullible then…)….
Long story short…he had to give up everything before he could progress in life….In retrospect, he had so many addictions….how terrible that he wasted all that time going in circles…
Not all the proposed edits are good; for instance, it has been proposed that grief, a very private and individual emotion, should be considered a pathological problem if it lasts longer than two weeks. (!!!) A similar proposed edit is to make a pathological problem out of normal human sexual desire, also a very private and individual issue. By whose standards will this pathological problem be measured? Some people need years to process grief; some people have naturally more active libidos than others. We cannot suggest it is pathology to need more than two weeks to grieve a profound loss. Doctors, medical and mental, can and do make mistakes. See this article for some of the information I’ve cited: http://my.psychologytoday.com/blog/side-effects/201204/american-sex-and-american-psychiatry
Here is another source on the DSM edit concerning grief: http://ajnoffthecharts.com/2012/03/28/grief-the-proposed-dsm-5-gets-it-wrong/