Addictions always originate in unhappiness, even if hidden…They are emotional anesthetics; they numb pain. The first question — always — is not “Why the addiction?” but “Why the pain?” The answer, ever the same, is scrawled with crude eloquence on the wall of my patient Anna’s room at the Portland Hotel in the heart of Vancouver’s Downtown Eastside: “Any place I went to, I wasn’t wanted. And that bites large.
Gabor Mate, M.D. – physician & author
Addiction reflects suffering. It represents our disconnection from ourselves, our feelings, and the people we love. Untreated, addiction may destroy our health, our relationships, our families, our very lives. Unlike the suffering associated with other states of ill health, the addict is frequently judged as somehow defective, weak or immoral. Furthermore, the effect of substances on the brain of the addicted individual impairs the functional capacity of the same organ on which the person must rely to make the autonomous choice to change the addicted behaviors. Complex family systems and processes, such as the tendency of many families to nominate a “black sheep,” can perpetuate the kinds of problems fundamental to the development of addiction, while twelve step programs, among the most widely implemented approaches to the treatment of addiction, have at times taken such a strong stance against all “substances” that potentially beneficial medications for the treatment of addiction have been deemed a form of “relapse.” Hence, the treatment of addictions is often complicated by these unique challenges.
Fortunately, many rapid changes in our understanding of the complex underpinnings of addictions, their pathophysiology, and their treatment are unfolding at an accelerated pace.
The treatment of addiction begins with a thorough assessment to identify the biological and psychological antecedents to the pain and suffering of the individual in whom the addiction has developed. The familial, generational and societal context must be considered. Treatment must target the psychological and behavioral underpinnings, the nutritional and physiologic aspects of the addiction (including the risk of potentially dangerous withdrawal from certain substances), and efforts to reduce the potential harms associated with the addiction. When all of these aspects of the context in which the addiction arose are considered and folded into the development of a treatment plan, outcomes can and do improve.