My Personal Philosophy of Addiction

Addiction Counseling
Derek Joyce 7/10/2012

Joyce, 1 As with all things, in the world of counseling, addictions concerns are best considered with a multi-faceted approach. I believe that everything ranging from addiction development to treatment should be approached with multiple perspectives. I also believe that addiction can be described in a developmental perspective where each stage has distinct characteristics and effective treatments. As with any mental disorder or trauma, addictions begin with a single source. Every addictions case begins with a single moment leads to when the alcohol or drug creates an association of pleasure, which then may eventually become an addiction. Examples may include a troubled childhood, abuse, feelings of inadequacy, peer pressure, and experiences with another addict. This could be seen as a Pre-conceptualization Stage, before the individual has their first drink or use of drugs. During this stage, standard talk counseling would be a good start to treatment. By treating the cognitive source of the clients inner turmoil, I believe that the client would not feel the need to use drug, alcohol, or activities such as gambling or sex in order to compensate. I also believe that proper psychoeducation would be effective in helping younger individuals learn how to drink and to do potentially addictive activities without losing control or getting in trouble. Based on my experiences in the local bars and clubs, most people do not know where their limit is, the point where the drug or alcohol is affecting the individual and the point where they need to stop in order to get home. Proper education in finance may help the client learn when to stop gambling before emptying their wallet. Lessons in impulse control may prevent the development or pyromania or kleptomania. In this sense, I am supporting the use of the Harm Reduction Model as a preventative measure against the development of addiction, while still permitting the individual to engage in the activities.

Joyce, 2 The second stage in addictions development is where the client has already begun using their drug or activity of choice, but is still in control of their usage. An example of this includes a recreational drinker or drug user who still uses spontaneously and can go for periods of weeks at a time without wanting to drink or use. At this stage, use of the drug, alcohol, or activity is associated with fun, pleasure, and/or relief. The user may also experiment with how much of their drug or activity that they can handle on a single occasion or compete or play games centered on use of the drug or activity. The occasional hangover or overuse of the drug of choice may occur at this stage due to the experimental nature of this stage. The psychoeducation that was described above may still be of benefit to the client. I would consider this to be the last safe stage for use of alcohol and gambling, though for legal purposes this is already a dangerous stage for drug use and certain activity addictions or compulsions. At this stage withdrawal and legal ramifications are usually nonexistent or minimal. The third stage of addiction is characterized by the onset of the characteristics that traditionally define addiction: tolerance, withdrawal, and use of the drug or activity has taken regular, consistent frequency. Use has become more prominent in the life of the user and without immediate care, the condition will quickly develop into the fourth stage of addiction. During this time, the user is developing a dependency on their drug or activity, needing it in order to feel like the day or week has been fulfilled or to satisfy cravings. A biological dependency may also be developing depending on the drug or drugs that the individual is using, thus making withdrawal progressively symptomatic and increasing the difficulty of quitting. During this stage, behavior modification may be an effective way of reducing the behavior, which may then be coupled with talk therapy.

Joyce, 3 The fourth and final stage of addiction is when the users life is completely dependent on the drug or activity. Interactions with others are reduced or altered in favor of drug use, alcohol or drugs may be frequently used at the workplace, and the user has great difficulty stopping use. A great deal of time is used for the drug, alcohol, or activity. If usage stops, withdrawal symptoms are often severe, including irritation, preoccupation of thought, and physical effects depending on the drug. At this point, detox is the first step necessary for recovery, though the user may never be without a craving for it. The desire for use may be likened as a disease, incurable, deceptive, and deadly. Therefore, a 12 step program or other support group would be greatly beneficial to maintaining sobriety. As with the previous stage, behavior modification and avoidance of any triggers would be necessary to preventing relapse. By this time the user has likely had legal ramifications for their use and is likely to see a problem with their behavior. Regardless of the stage of addiction, recovery is possible. However, the severity of treatment and the consequences of sobriety would elevate with each subsequent stage. Therefore, the most effective treatment is preventative. Failing that, it is best to treat the patient during early onset. The irony is that during these stages, individuals will likely see no need to change their behavior, nor heed any warning of escalation. As I have seen in the Alcoholics Anonymous meetings, it is not until they have lost their license or witnessed the dead of another due to alcohol or drug use that they considered treatment. Additionally, the meetings at AA have shown me that the third and fourth stages of addiction are characterized by a lot of pain and regret. The people who testified said that they frequently looked back at their past and deeply regretted their use. They also frequently mentioned suicidal ideation as a way out of their addiction. Therefore counseling may be required to help the client cope with these strong emotions.

Joyce, 4 Of course, not all users will go through all four stages of addiction. Not all addicts will seek help either. I look towards the biopsychosocial model of counseling when I consider precipitating factors that would suggest the extent and onset of addiction. For example, Americans begin binge drinking fairly early in life, typically around age 17. Most Americans who enter stages three and four of addiction tend to have trouble with the law in their mid to late twenties, based on my experiences working with addictions and DUI groups. Additionally, the social perspectives on the appropriateness of binge use and acceptable frequencies of use may affect how or if treatment is sought. For instance, if one is in a society where after work binge drinking is considered normal, then it may be unlikely that it would be seen as a legal or clinical problem and treatment would not be sought. However, is one is in a culture where shame is associated with alcohol or drug use, then the individual may seek treatment after or before the first use. Conversely, as is shown in My Name is Bill W, when Bill uses alcohol as a way to get information or conduct business, he developed a tolerance and developed the mentality that alcohol was necessary to conduct business. Biological dispositions may also have a contributing factor in the strength of the initial impact of alcohol, drug, or activity use, the development of tolerance and withdrawal symptoms, and modes of treatment. Psychological factors contribute to the underlying factors for the desire for alcohol, drug, or activity use, some of the effects of the use, as is suggested in the Alcohol Expectancy Theory, and vulnerability to progression of the disease. Furthermore, the social environment may help or hinder the recovery of a user. Of course, when an individual becomes a user or an addict, they are not the only individuals who are affected. Family, friends, and significant others are also impacted. There is the possibility of self-blame for the progression or failed treatment of the disease. Additionally, the family may suffer from trauma or distrust due to the actions of the addict. Therefore, it is

Joyce, 5 important that the affected persons seek treatment as well. Talk and family counseling may be helpful for uncovering the feelings and thoughts that are withheld by the affected persons, helping the user understand the impact that they have on the significant others, and rebuilding healthy relationships between them. It is also probable that if the addiction has been long term that the affected persons have arranged their lives to accommodate for the users addiction, as is described in class. Therefore, it is especially important that everybody is involved in treatment to reestablish healthy and functional relationships and roles. The above framework is derived from my experiences working with alcohol and drug users, the film My Name is Bill W, attendance to AA and Al-Anon meetings, and class discussions. The stage framework for the progression of addiction is my personal framework, where if preventative treatment and early intervention strategies are implemented, alcohol and activity use could be a normal part of life and not progress into addiction. I hesitate to say that this would be appropriate for drug use and certain activities such as kleptomania, due to their illegal natures. However, I believe that the aforementioned strategies are appropriate for predicting progression and treatment for the disease of addiction.