Why Addiction is So Challenging
Addiction is a cunning and self-destructive disease. It is difficult to understand because it ranges in the apparentness, from the well-groomed, high-functioning and employed individual to the stereotyped homeless and haggard individual on the street. Individuals affected with addiction can appear “normal” yet they often and reliably make bad decisions that harms themselves the most. They may be rude and belligerent at times which is often uncharacteristic of the true individual, but in displaying such behavior, they drive away loved ones, good Samaritans, and everyone else in between. It is important to both understand addiction to not take personal affront by the behavior of an addict yet not contribute to enabling addicts who are often lying and stealing, largely beyond their control. A minority of addicts can achieve recovery easily with the sense that grit is all that’s needed whereas others struggle for years to achieve recovery. The disease of addiction can continue to evolve and what may resonate or work today will simply not work tomorrow. Many people have failed medication assisted therapy and have relapsed after countless rounds of detox and rehabs. The disease of addiction has a different intensity and characteristic of grip on each person. The degree to which addiction can co-exist with an appearance of a normal life is also variable. The ease of sustaining recovery is different for everyone with many personal and external factors. Support is critical to success for most people. Overall, as a disadvantaged and highly stigmatized population in society, these people need our (addict and non-addict) support more than ever.
Successful recovery is defined as long-term sobriety with societal reintegration as productive and happy individuals. Successful sobriety (being “clean”) is defined here as either complete drug abstinence or with medication assistance that does not impair the person’s cognitive function and emotional well-being. Relapse is a part of recovery for most people affected with substance use disorders and should not be assumed as failure to achieve or sustain recovery. The disease of addiction affects each person differently and the solutions to recovery can vary as widely too. Effective solutions for a person today may be less effective for the same person later. Persons achieving sustainable recovery require a strong desire for sobriety and most require emotional and spiritual support. Use of medication assistance can significantly reduce the symptoms of withdrawal and cravings and should be considered on an individualized basis with each affected person assessed by a qualified physician who may be a primary care physician, psychiatrist, or when available, a substance use disorder specialist. Complete abstinence can be especially difficult to maintain in the first few months of sobriety but offers physiologic independence of replacement medications and its potential side effects. Side effects of medication replacement may include unintentional euphoria, agitation, more severe withdrawal symptoms acutely and persistent withdrawal symptoms longitudinally for many months, blunting of senses and motivation, changes in personality, physiologic hormonal imbalance, and social withdrawal from others.