The definition of addiction is closely examined



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Dear Readers:
Over the past few years, I have repeatedly labeled alcoholism, as well as addiction to any other drugs, a “disease” process.

In today’s column, I’m going to try to clarify why I, and most of my colleagues working in the field of addiction medicine, are certain that we are dealing with patients who are victims of an illness which has a strong genetic component, thus deserving of professional care.

First, let me start as I begin my 17th year of writing this column and repeat what I quoted some years ago about the detailed and complete definition of the disease of addiction as offered by The National Council on Alcoholism and Drug Dependence (NCADD):
“Addiction is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.
“The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over usage, preoccupation with alcohol and/or other drugs despite adverse consequences, and distortions in thinking, most notably denial.”

“Primary” refers to the nature of addiction as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it.
It suggests that addiction is not a symptom of an underlying disease state.

“Disease” means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals.
These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.

“Often progressive and fatal” means that the disease persists over time and that physical, emotional, and social changes are often cumulative and may progress as usage continues.

Alcoholism and/or other addictions cause premature death through overdose, organic complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes and other traumatic events.

“Impaired control” means the inability to consistently limit usage on any occasion — the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking/using.

“Preoccupation” in association with usage indicates excessive, focused attention given to alcohol or to other drugs, its effects, and/or its use.
The relative value thus assigned to these drugs by the individual often leads to a diversion of energies away from important life concerns.
“Adverse consequences” are alcohol/other drug-related problems or impairments in such areas as physical health (e.g., withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders), psychological functioning (e.g., impairments in cognition, changes in mood and behavior), interpersonal functioning (e.g., marital problems and child abuse, impaired social relationships), occupational functioning (e.g., scholastic or job problems), and legal, financial, or spiritual problems.

“Denial” is used here not only in the psychoanalytic sense of a single psychological defense mechanism disavowing the significance of events, but more broadly to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol or other drug use is the cause of an individual’s problems rather than a solution to those problems.

Denial becomes an integral part of the disease and a major obstacle to recovery
Yet, many doubters, particularly in the health industry, insist that addiction is not a disease because it “doesn’t act like a disease.”

More about this later.
William C. Van Ost, M.D., is a co-founder of the not-for-profit Van Ost Institute addiction treatment center. Address questions c/o Twin-Boro News, 210 Knickerbocker Road, Cresskill NJ 07626 or e-mail [email protected].

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