Thursday, 15 May 2008

The nature of addiction: chronic or not?

I had an interesting and thoughtful comment about the Wired In 'Way Forward' from Ian Sherwood, with both criticisms and positive remarks. Just the sort of comment needed to provoke further thought and discussion. I'd like to quote one paragraph:

The use of the word "chronic" is unattractive to me and at odds with the idea of recovery, the word has strong connotations of hopelessness and failure. It is technically correct for long term medical conditions such as diabetes which may be cited as comparison cases but no one uses the term "chronically diabetic" because it is a tautology. I feel that the word needs to be replaced in such a statement because it is important to win people over and language is a very important resource."

This really is a difficult one. It's an issue I have been addressing in my recent DDN Background Briefings, the third which I have just this moment sent off to Claire. In my mind, there is no doubt that addiction is a chronic condition, at least for many people. It does not always mean that it is an everlasting condition though. I was seriously addicted to nicotine (and had what I felt were awful withdrawal symptoms - I was a wimp) for over 20 years, but I have had no inclination to smoke for many years now.  

If we do not accept that addiction is a chronic condition, then we have more difficulty in justifying the potentially greater resources required to develop chronic, versus, acute models of care.

I agree with Ian we have to be very careful how we communicate the message about the (chronic) nature of addiction. That is in fact the focus of this upcoming Briefing in DDN. Would be great to see some comments on this issue.

3 comments:

tim1leg said...

chronic
Persisting over a long period of time.

Origin: L. Chronicus, Gr. Chronos = time

from the Dictionary of Cell and Molecular Biology.

(11 Mar 2008)
I rest my case.

can I just say that the it is easy for people to misunderstand The central idea of the Wired in Way forward recovery movement is not that "addiction is a disease" or that "treatment works" but that addiction recovery is a living reality for hundreds of thousands of individuals, families, and communities. Yes that right we do recover.

Also to those who offer a pessimistic, its about cost cutting or a "one way" view of recovery, this new movement is on the contary saying that there are many pathways to recovery. A reminder and a challenge if you will that recovery flourishes in supportive communities. A contrast to the increasingly coercive nature of addiction treatment, this movement is reminding us all that ultimately recovery is a voluntary process.

The way forward is offering living proof that recovery gives back what addiction has taken from individuals, families, and communities and that recovering and recovered people are part of the solution (to alcohol and other drug problems).

Essentially turning a community's previous "problems" into assets through the vehicles of social action and community service. Attitudes and policies toward addiction and recovery are changeing because faces of addiction and recovery are being brought into the consciousness of our communities, professional helpers, and policy makers.

The timing is critical, the time is now. Either you will participate and embrace the shift to recovery or be a witnesses of the change taking place in the field.

Addiction "treatment" and recovery will be determined by either your resistance to change or your embracement of this shift.

I suggest that if you choose to be passive or silient then you should seriously consider a new are of work.

Challenging the attitudes and policies that are seeking to once again transfer people with alcohol and or drug problems from systems of care to systems of control and punishment in our current climate is more important now than at any time ever in history.

I would go as far to suggest that If you are not willing to step beyond the demands of your paid role, remember your wealth is there beacause people continue to suffer "IMHO unnessecarily" to volunteer your time, your skills and talents, and even our personal financial resources to shape the way forward then again I would ask you to reconsider what real service you are to the people and their families all over the uk presently still suffering.
The time is now.

opiferum said...

I disagree with the qualification of a state of addiction by way of attaching an adjective to it, e.g. "chronic addiction".

It only encourage a determinist attitude towards a situation that is not nearly as hopeless as contemporary addiction treatments suggest.

To suggest addiction has an altruistic nature is also giving more power to the term addiction, and encourages a sense of powerlessness in the individual in a state of addiction.

Paul du Buf said...

The nature of addiction

Questioning now what addiction actually is is a great question and it comes at a good time where it seems that we have come to the realisation that the map we have created and use to relate to the reality of addiction, is no longer satisfactory any more, it does not deliver on the results we’re after.

This realisation creates a chance to find and draw a better, more accurate map and find a perspective that acknowledges and includes what we already know yet also enables us to see our efforts from a higher, more inclusive level.

My belief is that the integral theory of Ken Wilber provides that inclusive perspective which enables us to create a more accurate and complete map that can help us to navigate and find out how to deal more effectively with the complex challenge of addiction. Integral’ means ‘inclusive, balanced, comprehensive.’ It is a bringing together. (see www.integralinstitute.org)

This model acknowledges the truth in the view that addiction is a chronic disorder and an emotional fixation (professor Nils Bejerot) and possibly a genetic predisposition to certain behaviors and influenced by process described in the opponent-process model (Richard Soloman) and that culture is a strong determinant of whether or not individuals fall prey to certain addictions and that addiction might be a metaphor and that the only reason to make the distinction between habit and addiction "might be to persecute somebody” (Thomas Szasz) etc., etc. etc.

There is truth in all these perspectives yet it is a partial truth.

The integral model allows us to show the relevant truth of every perspective in the dimensions: self / consciousness – brain and organism – social system and environment – culture and worldview.

To call addiction a chronic disorder is to emphasise the physical, measurable expressions of addiction (as acknowledged in the “brain and organism” dimension) yet the name does not reflect the truth of the other 3 dimensions.

For example: an eye-opener for me in my intuitive quest how to understand addiction as an expression of a developmental process and part of the ‘human condition’ has come to me through reading the book ‘Integral Coaching’ by Martin Shervington.

In this book he uses Robert Kegan’s work:
‘Robert Kegan is a compassionate writer and academic who sees that at each stage of our development we construct meaning in the world differently – we make meaning different. He begins, “If you want to understand another person in some fundamental way you must know where the person is in his or her evolution” and he continues that the first goal in this understanding is “how the other person composes his or her private reality.” And it is the levels to this reality, or making of meaning, not just the thoughts and feelings that could be at a given level, that we next turn our attention.’

He then describes different levels of development including stages of adaptation, which - of course - is not a linear trajectory but a more dynamic, erratic process going from levels of consciousness: 'Pre-as if' to 'As if' to 'What if? Full What if?' to 'What what if?' with the corresponding adaptations.

Using this model, addictive behaviour can be understood as an expression of one or more adaptations (particular in the levels 'pre-as if' and 'as if'), which are informed by a particular level of consciousness.

Through this model the partial truth of the relationship between addiction and consciousness is expressed in the “self and consciousness” dimension.

Therefore it is more accurate to speak about the model we use to understand addiction, then to limit addiction to the model we use. And the integral model is the most comprehensive model I know that does most justice to the complexity addiction expresses.

Paul du Buf

Nurse, Coach and Author of the forthcoming book ‘The promis of Integral Recovery Coaching.’