Addictions: An Overview

Robert L. Smith

Student Learning Outcomes

At the conclusion of this chapter students will

1. Be able to define addictions
2. Identify the criteria used when defining addictions
3. Distinguish between substance and process addictions
4. Identify the etiology and prevalence of addictions
5. Identify addiction treatment strategies, interventions, and programs
6. Identify practitioner characteristics considered essential when working with addictions

Case and Case Discussion

Individuals who directly or indirectly experience the chaos associated with addictions come from all sectors of society. The case of Angie, a 34-year-old Caucasian woman, represents the vast number of individuals who have struggled with and lost their lives to co-occurring addictions. The particulars of this case resemble those of family members, friends, neighbors, colleagues, supervisors, doctors, homeless individuals, and others across the globe who have been, or currently are, severely impacted by multiple addictions.

Angie, a 34-year-old Caucasian woman, experienced a high-risk lifestyle. As a bright, attractive, and entertaining young person she enjoyed the attention of others, and as an impulsive risk taker she exhibited minimal restraint in satisfying her personal needs. Angie had been a popular and smart, capricious adolescent. Her energy and athleticism were assets that had helped her gain recognition as a cheerleader and member of the debate team. She craved the attention of others and took pleasure in being recognized. She also enjoyed the excitement and the high from using alcohol, marijuana, cocaine, and mixed drugs. Her obsession with weight and her personal appearance led to bulimic episodes that were preceded by negative self-talk. Body image and weight were life-long concerns.

Family stressors existed throughout Angie's adolescent years that had affected her development. Angie's father, a gifted athlete, introduced her to golf when she was 12 years old. Angie initially enjoyed the attention provided by her father and her success as a young golfer. She enjoyed the high of being recognized as an up-and-coming athlete within her age group. She was victorious in several tournaments. She worked hard and participated in several golf seminars and intense practice sessions. However, the attention given to Angie by her father and family expectations led her to withdraw from both her family and golf.

The stress placed on Angie by her family and the competition was overwhelming. An additional family stressor, however, was more significant. After practice sessions, Angie would sit with her father, often on his lap, discussing golf and how she was growing up so fast. This time together led to fondling and inappropriate touching by her father. Angie at first was confused but soon realized that something was wrong. She eventually quit golf and distanced herself from her father. She soon withdrew from all of her family members, including her mother, who she felt was aware of but did nothing to stop her husband's behavior.

With excellent grades and a record of leadership, Angie was offered several college scholarships. She selected a university known for its communications department, theatrical productions, and social life. Both students and professors immediately noticed Angie as an attractive, radiant, and fun individual. During her first semester, she was invited to audition for acting roles in the department's theatrical productions. For Angie, it was exciting to be viewed on campus and within the community as a future entertainer.

While in college, Angie misused substances, mainly alcohol and marijuana. Her exposure in local productions, along with some nude modeling, attracted Hollywood associates. These contacts led to auditions for television commercials. Angie's new lifestyle provided access to cocaine, methamphetamines, and designer drugs. Angie also frequently mixed alcohol with other drugs that had initially been prescribed to relieve anxiety.

Angie was popular and met influential executives in the entertainment field. Her contacts led to additional commercials and minor roles in television. She craved recognition and imagined herself in movies.

After years of drug abuse and violent relationships, Angie experienced health issues, career disappointment, and financial problems. Following the stress of an abortion, she became depressed and viewed herself as a failure. Angie lost hope for the future she once imagined. Her severed relationships from family and friends further contributed to her depression. Feelings of being used by others led to distrust and withdrawal from society. Angie continued abusing alcohol and prescription medications, even when receiving help from psychiatrists, psychologists, substance abuse counselors, and family therapists. Angie was hospitalized following a suicide attempt. She attended, but was reluctant to participate in, a mandated inpatient program for substance dependence. Resenting these treatment attempts, Angie withdrew further from others and continued to self-medicate with alcohol and other drugs.

Angie spent most of her time alone and craving drugs. Her health deteriorated, leading to a loss of appetite, weight loss, muscle loss, loss of strength, liver failure, internal bleeding, and kidney failure. The 15-plus years of drug abuse had taken its toll on Angie's body and hijacked her brain. While in hospice care, she began to go in and out of consciousness. Angie died at the age of 34.

Angie's story provides a brief look at someone whose life ended as the result of co-occurring addictions. Her body broke down because of her habitual abuse of substances. Her brain was hijacked by the pleasure she craved as the result of substance and process addictions. The continuous mixing of drugs caused permanent harm to her brain and body. She craved substances and the high obtained from a repeated behavior pattern. Angie's drug addiction and the behavior pattern used to gain personal recognition became her top priority, despite physical, psychological, career, and social consequences.

Both substance and process addictions are presented in the case of Angie. Co-occurring addictions are frequent, as process and substance addictions work together, influencing the continuation of the self-defeating behavior and substance misuse. Treatment therefore takes more time and is complex.

After reviewing this case, one might conclude that the professionals and treatment programs failed Angie. Treatment attempts, whether individual, group, or multidimensional, seemed to have little or no effect on her misuse of drugs or her self-defeating behaviors. Interventions also failed to provide Angie with a sense of hope or relief from her depression. Coping strategies, if learned, were not enacted. This case thus emphasizes the complex nature of addictions.

In this chapter, I first review genetic influences, environmental influences, family factors, stress/trauma factors, and other factors that play a role in the addictions process, with a focus on the brain. Then I address the practitioner characteristics considered necessary when working with clients who have addictions. I conclude the chapter by discussing evidence-based practices and treatment strategies/interventions.

Addiction Defined

The term addiction is derived from the Latin addc meaning "enslaved by" or "bound to," and for many individuals like Angie, this derivative has meaning. The term addiction is frequently attached to a substance and viewed as dependence. Opium and morphine were two of the first addictive substances identified because of misuse of prescriptions. Society today often also characterizes individuals who participate in repetitive behaviors as being addicted. Thus, the term addiction currently applies to the misuse of alcohol, other drugs, and substances and to a large number of behavior patterns. It is safe to say that a large number of individuals can be viewed as being addicted to something. Perhaps someone you know has been accused of having a food addiction, such as to chocolate, ice cream, coffee, or a certain brand of soda. Maybe you know someone who is addicted to golf or to a special series on television. The conversational use of the term addiction has convoluted its meaning and definition.

Scientifically speaking, individuals are considered addicted when they relentlessly pursue a sensation or activity, whether it is a substance such as alcohol or a behavior like gambling, despite consequences to their health or well-being (W. R. Miller, Forcehimes, & Zweben, 2011). Similarly, addiction has been defined as the condition of being habitually or compulsively occupied with or involved in something. W. R. Miller et al. (2011) identified three kinds of actions that define an addiction: (a) an action that is habitual, done regularly, and repeated; (b) an action that appears to be compulsive in nature and at least partially outside of one's conscious control; and (c) an action that does not necessarily involve a drug.

The American Society of Addiction Medicine (ASAM; 2011) refers to addiction as follows:

Addiction is a primary, chronic disease involving brain reward, motivation, memory and related circuitry; it can lead to relapse, progressive development, and the potential for fatality if not treated. While pathological use of alcohol and, more recently, psychoactive substances have been accepted as addictive diseases,...