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Sunday, January 4, 2009

It's All About Choices

Addiction is a tricky thing. Many people loosely use dependence and addiction interchangeably but they really are not. Even in the standard diagnostic texts only chemicals are included in things that can be addictive.

For example, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) states that their definition of "substance" includes drugs of abuse, alcohol, medications, or toxins. By this definition someone nonchalantly saying they are "addicted to shoes" would not qualify. Flippant remarks such as this cloud the public perception of addiction and make it seem okay.

We live in a society that praises addiction as entertainment. You will see on any given day several shows with teens drinking or having "pill parties" where they collect meds from their relatives and their "dealers", toss them all together in a bowl then take a few to see how f*cked up they can get.

There are even shows like Celebrity Rehab and Intervention that try to show the bad parts of addiction but only come off as schlocky "Jerry Springeresque" entertainment. I don't think these shows even get a message through to the people they are trying to help because most of them end up right back where they started a few months down the road.

Hell, even big money high profile celebrities have photos splattered over every magazine known to man each time they go on a bender and another stint in rehab. This is how they get attention and we glorify it. We then glorify their "return to fabulosity" with another tabloid spread.

The DSM-IV criteria are aimed at substance abuse where "The relationship with the drug becomes primary--it is like a consuming love affair--it becomes the most important relationship for the individual and all decisions made are based on the maintenance of this relationship. The definition has psychological and physiological characteristics. Psychological because the individual has an obsessive preoccupation with the drug and physiological because of the neuro-chemical action taking place in the brain."

Substance Abuse (one or more)
*Failure to fulfill major obligations
*Use when physically hazardous
*Recurrent legal problems
*Recurrent social or interpersonal problems

Substance Dependence (three or more)
*Large amounts over a long period
*Unsuccessful efforts to cut down
*Time spent in obtaining the substance replaces social, occupational or recreational activities
*Continued use despite adverse consequences

How can parents deal with this? Well, there is no right answer. For most cases of drug addiction the abuser is just hooked on a lesser "legal" addictive substance and put through a counseling program. I have never met a "reformed" drug addict that didn't go right back to their favorite substance of abuse at some point in time and I have met several. I also know casual or "recreational" users who have no problem with addiction. Finding a "safe" addiction to replace the "harmful" addiction is half the battle. Maybe something like sculpting, writing, or macrame?

The bottom line is that addicts won't successfully rehabilitate unless they really want to. They chose that substance and the lifestyle or lack thereof associated with it. Parents should not blame themselves. Unless you specifically were seen abusing a substance by your child, gave your child the substance, or physically or psychologically tortured (and I mean secret illegal we don't talk about it military style torture) then you have NO blame in the addiction. A lot of it starts as a psychological need to escape or a need to fit in with peers or "look dangerous" or "popular" and ends up being a physiological need for brain chemical stimulation so it is hard to fight and prevent.

At the end of the day it's all about choices. I don't feel sorry for anyone. We all make choices every day that lead us to where we are. Life is what you make of it. Some people are ambitious and do what they need to do to get what they want and some people choose to be f*cked up all the time. Some people choose to eat donuts, pizza, and ice cream when they know their diabetes and weight are out of control then cry about it later. Some people choose to play video games all hours of the day and barely maintain a job in order to do such. These all qualify as addictions and should be treated as such. I am all for a new expansion of "addiction" and "dependence" to include things that go beyond "obsession" and "compulsion." So choose wisely, Grasshopper, and you will turn out okay.

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