FAQs About Addiction

 

Expanded versions of many of these answers can be found in Lisa’s books, If You Loved Me, You’d Stop! and Loved One In Treatment? Now What!

And for a list of key terms, visit our webpage, KEY TERMS.

1. How is it possible to call addiction (to drugs or alcohol) a disease?

Addiction – whether it is to drugs or alcohol – is a brain disease – a chronic, often relapsing brain disease, and here is why this is true. Everything about our body – what we can see and what we cannot see – is made up of cells.  Diseases change cells in our body — that’s what makes a disease a disease. A disease might change cells in body organs (like the heart or liver or eyes) or in body organ systems (meaning several organs working together), like metabolism or cardiovascular. For example, the disease of breast cancer attacks cells in the breast, and the disease of diabetes attacks cells in the metabolic system.

The diseases of addiction (drug addiction or alcoholism) change cells in the brain, thereby changing how the brain works. Because neural networks in the brain control everything we think, feel, say and do, these brain changes get in the way of a person’s ability to act normally and make good decisions. It can cause that person to do things like: starting fights with friends, yelling at or hitting family members, missing work, carrying on rambling arguments, accusing family members or friends of doing things they haven’t done, driving while under the influence, being super nice, not getting to work on time, not being able to fully concentrate when at work or school, or continuing to use/drink after promising not to. We call these “things” drinking/drugging behaviors. Additionally, alcoholism and/or drug addiction often change cells in several other body organs, as well, such as the liver, heart, and kidney. As true with other diseases, if untreated or during a lapse in management of the disease, a person can die from alcoholism or drug addiction, just as people die from other diseases.

2. Can a person have a problem with drinking and not be an alcoholic?

Yes.

Most people think of drinking as either “normal” or “alcoholic.” What we don’t understand is that there is a whole other “stage” — alcohol abuse (excessive drinking). Alcohol abuse is is when a person repeatedly drinks more alcohol than their brain and body can process and engages in drinking behaviors.  It’s important to know that a person can engage in drinking behaviors and not be an alcoholic or an alcoholic abuser. Drinking behaviors are simply the result of a person drinking more than their brain and body can process. Drinking behaviors include:

• Doing poorly at work or school because of the drinking or recovering from the effects of drinking.
• Fighting with friends or family about the drinking; saying or doing things you don’t remember or regret.
• Binge drinking  (defined as drinking 4 or more standard drinks for women; 5 or more for men).
• Experiencing blackouts – fragmentary or complete; vomiting; passing out.
• Driving while under the influence; getting a DUI; riding in a car driven by someone who has been drinking.
• Having unplanned, unwanted or unprotected sex; committing date rape.
• Being admitted to the emergency room with a high BAC, regardless of the “other” reason.

When a person abuses alcohol — repeatedly drinks more than their brain and body can process — they can actually change the chemical and structural make-up of their brains. These changes can contribute to their developing the disease of alcoholism.

To answer the question, “How can you tell if someone drinks too much,” certainly drinking behaviors is one way. Another is to understand the definition of “normal” or “moderate” drinking:

• for women, it is no more than 7 standard drinks in a week, with no more than 3 of the 7 in a day
• for men, it is no more than 14 standard drinks in a week, with no more than 4 of the 14 in a day

A “standard drink” is defined as:

• a 5 ounce glass of wine
• a 12 ounce beer
• 1.5 ounces (a shot) of 80-proof distilled spirits (scotch, gin, vodka)
• 3.3 ounces of champagne

Note: 4 or more drinks on one occasion for women and 5 or more drinks on one occasion for men is considered binge drinking. Binge drinking is not considered “normal” drinking. Staying within moderate drinking limits allows a person to maintain control of their thinking and thereby their behaviors.

If you are concerned about whether your drinking patterns are a problem, click here to go to NIAAA’s website, “Rethinking Drinking,” where you can anonymously assess your (or someone else’s) drinking patterns and learn tips for how to cut down.

3. What makes substance abuse different than addiction?

The disease of addiction (whether it’s to alcohol or illegal or prescription drugs) has four primary characteristics that make it different than substance abuse.

These include: cravings, loss of control, tolerance, and physical dependence. An addiction craving, for example, can be five times stronger than our instinctual, hardwired drive to eat food when hungry because of the neural networks that are compromised. These powerful cravings override all other “thought” and are what cause an alcoholic or drug addict to lie and steal and do whatever it takes to drink or use. 

4. Can it be cured?

No. Alcohol dependence (alcoholism) or drug addiction cannot be “cured” in the sense that a person can control their drinking or drug use (consistently avoid drinking or drugging behaviors), but it can most definitely be treated – by the alcoholic or drug addict, not by you. The pdf explains what effective treatment looks like.

Alcohol abuse or drug abuse (excessive drinking or use of legal drugs in accordance with a doctor’s monitoring and prescriptions), on the other hand, can be “cured.” The person needs to change their drinking to fall within normal limits (or stop drinking if they find they cannot control it) or their drug use to fall within that prescribed and monitored by their doctor. The reason alcohol or drug abuse can be “cured” and alcoholism or drug addiction can only be treated is that alcoholism and drug addiction are two of the diseases of addiction. Addiction is a chronic, often relapsing brain disease, that particularly affects areas of the brain involved in judgment, decision making, learning and memory and pleasure. (See #1 and #3).

5. What can someone do to help a loved one who drinks too much?

• Learn as much as you can about the disease of alcoholism and about alcohol abuse and what constitutes normal drinking.
• Learn as much as you can about what happens to you (and other family members) by virtue of growing up with or living with an alcoholic or an alcohol abuser. This will help you to become open to ways to make your life more enjoyable whether your loved one stops drinking or not.
• Learn to talk openly and honestly about what’s going on and thus stop the denial. It really is “that bad” – whether it’s alcohol abuse or alcohol dependence (alcoholism).

6. What makes one person come an alcoholic or drug addict, while another person does not, even though that other person drinks or uses too much?

While both substance abuse and addiction (aka substance dependence) cause chemical and structural changes in the brain and thus changed behaviors, there are five key risk factors that contribute to a person developing the brain disease of addiction. These risk factors include:  genetics (if it runs in the family, genetic predisposition – not an “addiction” gene, rather genetic differences, such as higher or lower levels of neurotransmitters or receptors or the liver enzymes that break down alcohol, as examples); social environment (where heavy drinking or drug use is viewed as “normal,” causing a person to drink or use heavily, which given their brain/genetic make-up, may lead to substance abuse and/or addiction);  childhood trauma (verbal, physical, emotional abuse, which “wires” unhealthy coping skills and brain changes); early use (critical brain development ages 12-early 20s makes the brain especially vulnerable to brain changes caused by substance misuse), and mental illness (e.g., depression, anxiety, ADHD, PTSD, bipolar – which also cause brain changes and often a tendency to “self medicate” with alcohol or drugs). The more risk factors, the more susceptible a person is to the possibility of “crossing the line” from abuse to addiction.

7. Why do you think there are so many problems related to substance abuse and addiction?

Denial. Shame. Lack of knowledge and understanding.

I think the denial comes into play because of society’s inaccurate view of alcoholism or drug addiction as a shameful lack of willpower instead of the brain disease that it is. This view drives the alcoholic and his or her loved ones to continue making one Herculean attempt after another to battle the disease – (and long before the disease — the alcohol abuse or drug addiction) – in isolation.

Additionally, society is even more silent on what is happening to the family members and friends who love the alcoholic, drug addict or alcohol or drug abuser abuser — the people who are on the receiving end of the secondhand drinking/drugging (SHDD) — those who try to cope with the drinking/drugging behaviors.

©LisaFrederiksen, BreakingTheCycles.com, 2008-2011, ALL RIGHTS RESERVED.