The Addiction & Recovery Continuum

I.D.E.A.L. Recovery Coaching views substance abuse and dependency as a treatable condition rather than as a character failing.  However, a knowing refusal to address the issue and its consequences in our own lives raises concerns about our honesty and integrity.

I.D.E.A.L. Recovery Coaching recognizes there are multiple pathways to recovery and offers the following resources to help you determine both your place and your direction on the path.

I.     THE ADDICTION CONTINUUM:  One Man’s Meat is Another’s Poison

“Experimenting” suggests we try something a few times and then don’t come back to it.  Beyond that, we are probably “using.”  The line between “using” and “abusing” is then largely circumstantial.  One person’s pattern of casual or recreational use may be become progressively harmful enough to constitute “abuse.”  However, even one who “abuses” alcohol or other drugs is not necessarily an “addict” who is “chemically dependent.”

The 4th Edition of the Diagnostic & Statistical Manual of Disorders (“DSM-IV”) offers the following definitions of substance abuse and dependence:

A.     SUBSTANCE ABUSE:   A MALADAPTIVE PATTERN OF SUBSTANCE USE LEADING TO CLINICALLY SIGNIFICANT IMPAIRMENT OR DISTRESS IS MANIFESTED BY ONE OR MORE OF THE FOLLOWING, OCCURRING WITHIN A 12-MONTH PERIOD:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g. repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household).

2. Recurrent substance use in situations in which it is physically hazardous (e.g. driving an automobile or operating a machine when impaired).

3. Recurrent substance-related legal problems (e.g. arrests for substance-related disorderly conduct).

4. Continued substance use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g. arguments with spouse about consequences of intoxication, physical fights)

B.     SUBSTANCE DEPENDENCE:   A MALADAPTIVE PATTERN OF SUBSTANCE USE LEADING TO CLINICALLY SIGNIFICANT IMPAIRMENT OR DISTRESS IS MANIFESTED BY THREE OR MORE OF THE FOLLOWING, OCCURRING AT ANY TIME IN THE SAME 12-MONTH PERIOD:

1. Tolerance, as defined by either of the following:

a. need for markedly increased amounts of the substance to achieve intoxication or desired effect;

b. a markedly diminished effect with continued use of the same amount of the substance.

2. Withdrawal, as manifested by either of the following:

a. the characteristic withdrawal syndrome for the substance; or

b. taking the same (or a closely related) substance to relieve or avoid withdrawal symptoms.

3. Taking the substance often in larger amounts or over a longer period than was intended.

4. Having a persistent desire or unsuccessful efforts to cut down or control substance use.

The DSM-V now combines substance abuse and substance dependence into a single condition that can be measured on a scale of mild to severe.

C.    THE DISEASE CONCEPT OF ADDICTION 

THE AMERICAN SOCIETY OF ADDICTION MEDICINE DEFINES ADDICTION AS A:

“…a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

D. RECOVERY: WHAT IT IS AND CAN BE

1.   William Anthony, Executive Director of the Boston Center for Psychiatric Rehabilitation, calls recovery: “a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness…” 

2. In 2005, the SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) offered a working definition of Recovery from alcohol or drug problems as: “…a process of change through which an individual achieves abstinence and improved health, wellness and quality of life.”

3. In 2011, SAMHSA revised its working definition of recovery as follows: Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.”

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