Addiction is nothing new, as we can see from the above quotation, in which the biblical writer paints a hauntingly accurate picture of the devastation caused by alcohol addiction. Alcoholism, drug addiction, and addictive behaviors affect every group at every level in our society. In the United States, one out of four people has a parent, child, or sibling who is addicted. In 1995 the National Institutes of Health estimated the economic cost of alcohol and drug abuse at over $240 billion. Lost productivity, illness, premature death, and health care expenditures are all part of this picture, as are costs associated with motor vehicle accidents and with crime and incarceration. (Covington, Stephanie and Beckett, p. 42) The emotional and social damage is immeasurable. Abuse of alcohol and drugs disrupts personal development, relationships, and families, corrupting the very fabric of society. Addiction to nicotine is a problem of massive proportions, and the difficulty of shaking that habit is familiar to millions. Behavioral addictions include pathological gambling and sex and compulsive overeating. Most of us are affected, directly or indirectly, by addiction or its consequences on others.
We are familiar with the image of the skid row wino and the strung-out junkie, but addicts don’t usually look or behave like that; they are more likely to resemble your next door neighbor. They are often accomplished people, and many have achieved fame. In recent years, public figures have become more open about their problems with addiction. Betty Ford, the wife of former president Gerald Ford, struggled with alcoholism, then dedicated her life to establishing an addiction treatment center. Golfer John Daly also talked of his problems with alcoholism, as did the baseball hall of famer Mickey Mantle before his death from the physical consequences of addiction.
Our knowledge of the biology of addiction has grown tremendously in recent years. We have learned that the addicted brain does not function normally and that it is impossible to separate the brain’s biological function from a person’s psychology and will. Clinicians who treat addiction know that there is no one perspective or approach that is correct. Recovery for addicted people and their families involves physical healing, behavioral changes, relational reconciliation, and psychological and spiritual growth.
However, how do you know if you have a problem with addiction? How do you know if a loved one does? How much is too much? At what point does social drinking become problem drinking, and when does problem drinking become alcoholism? What about illegal substances? Are you an addict if you use them simply because they’re illegal? I am going to try to provide a useful way to answer these questions, and I’ll also look at why it has been such a problem to come up with a definition of addiction.
A joke that was being told around addiction treatment facilities a while ago went like this: If you want to find out whether somebody is alcoholic, follow him into a bar at happy hour. When he’s not looking, drop a dead fly on top of his beer. If he’s a social drinker, he’ll leave it alone and go on talking. If he’s a problem drinker, he’ll wait till no one is looking, then flick the fly off. But if he’s alcoholic, he’ll wring that sucker out …
Since this method of diagnosis is probably not practical in the general clinical setting, clinicians have developed several questionnaires that are used to determine whether someone is addicted.
The shortest, and one of the most accurate, is the CAGE questionnaire, which applies to alcohol. The CAGE questionnaire consists of four questions featuring key words that start with the letters C, A, G, and E. A positive answer to at least one question suggests a problem with alcohol. The CAGE questionnaire is not standardized for use with other substances or with addictive behaviors, but a positive answer to C, A, or G regarding drugs is a strong indication that there is a problem. (Earle, Ralph, Crow and Osborn, p. 51)
The CAGE Questionnaire
C: Have you ever felt you ought to c ut down on your drinking [drug use]?
A: Have people ever a nnoyed you by criticizing your drinking [drug use]?
G: Have you ever felt bad or g uilty about your drinking [drug use]?
E: Have you ever had a drink (e ye-opener) first thing in the morning to steady your nerves or get rid of a hangover?
Although several other screening questionnaires have been developed, including the Michigan Alcohol Screening Test (MAST), the Substance Abuse Subtle Screening Inventory (SASSI), and the Addiction Severity Index (ASI), the simple common sense approach of asking people if they have ever had any problems associated with their drinking or drug use probably identifies better than 90 percent of those with addiction.
Denial is a psychological defense mechanism that is found almost universally in people with addiction. Denial is a person’s ability to ignore negative consequences in order to be able to continue to use the substance in question. It is ironic that this characteristic sign of addiction is probably what causes the most problems with diagnosis in the day-today clinical setting.
People who are truly addicted can come up with an endless variety of reasons and justifications for the bad consequences of the addiction and also with reasons why the label “addicted” doesn’t apply in their case. So if you are worrying about a family member and show him or her the CAGE questionnaire, don’t expect to get honest answers. But if you wondering if you yourself have a problem with addiction, you probably know the answer deep down. Denial is usually not complete. Most people with addictions are well aware of the feeling of being caught between a rock and a hard place, knowing that the addiction is causing problems but not knowing how to live life without it. (Larsen, p.34)
Before we go any further in your study of this problem, we need to know that there is a way out and how to find it.
Identifying the exact point at which the use of a substance constitutes an addiction ought to be easy, but it is not. Confusion arises because we are limited to observing and describing behaviors, when what we are really trying to define involves a change in the way the brain functions as a result of exposure to an addicting substance. (Schaeffer, p.11) It’s the same problem that appears in the story of the three blind men and the elephant. One man feels the elephant’s ears and concludes that the creature is broad, thin, and waving like a leaf in the wind. Another feels the elephant’s trunk and believes that he is touching something long and sinuous, like a snake. The third feels the elephant’s leg, and notes that it is chunky and sturdy, resembling the trunk of a tree. All three are correct, but none has discovered the true nature of the elephant.
Addiction is a complicated condition, with biological, physiological, psychological, behavioral, and spiritual aspects. For this reason it is best to think of alcoholism and drug addiction as multifaceted disorders, only one of which is the compulsive use of the addicting substance.