Addiction: Frequently Asked Questions (Advanced)

  • ranks with cancer, heart disease and stroke as a major disease
  • reduces the life expectancy of its victim by 10 to 12 years
  • is related to 1/3rd of all deaths reported as suicides
  • is related to 1/3rd of all fatal automobile accidents
  • destroys marriages and careers of 3/4th of its victims

What is denial?

When a person takes alcohol or drugs excessively, several problems arise which are clearly visible to others. Yet the person continues to say that he has no problems at all. This is called ‘denial’. Addicts deny their problem in order to protect themselves from feeling hurt, sad or guilty and also to continue with their drinking or drug-taking.

Denial can be observed in various forms:

  1. Simple denial: The addict says he has no problem with drinking or drug-taking
  2. Blaming: Claiming that others are the cause of his addiction
  3. Minimising: Accepting the problem of addiction but claiming it’s only a small problem
  4. Rationalising: Producing ‘intelligent’ excuses for addiction
  5. Diverting: Avoiding any talk about his addiction
  6. Aggression: Initiating fights and quarrels, which provides an excuse to drink or take drugs

What are the physiological facets of addiction?

Physical dependence as characterised by tolerance is defined by either of the following:

  • Need for increased amounts of the substance to achieve intoxication or desired effect
  • Markedly diminished effect with continued use of the same amount of substance

Withdrawal is manifested as either of the following:

  1. Development of a substance-specific syndrome due to the cessation of or reduction in the intake of a substance that the person previously used regularly. In case of alcohol: increased hand tremors, insomnia, nausea or vomiting, anxiety, rum-fits, irritability. In case of drugs: dysphoric mood (excessive restlessness and impatience), muscle aches, pupilary dilation, piloerection (goose bumps) or sweating, diarrhoea, yawning, fever, delirium tremens, hallucinations etc.
  2. Clinically significant distress or impairment in social, occupational and other important areas of functioning.

Medical complications caused by substance abuse are as follows:

  • Liver Diseases: Fatty liver, Alcoholic hepatitis, Liver Cirrhosis
  • Gastrointestinal Disorders: Ulcers, Pancreatitis
  • Nutritional Disorders: Malnutrition, Anaemia, Peripheral neuropathy
  • Heart Disease: Cardiomyopathy, Hypertension, Ischaemic Heart Disease (IHD)

What are the emotional aspects of addiction?

It is argued that addiction is essentially an emotional problem. We at Muktangan are not interested in analysing whether the emotional problems are the root causes of addiction or not. But here we would like to present some of our observations.

  • Depression — in some cases leads to addiction. Some depressed persons use the substance to cope with depressive thoughts.
  • Generalised Anxiety Disorder (GAD) — It is very difficult to identify whether GAD is the cause or the effect of addiction. However, a negligible percent of patients were earlier found to be treated for GAD.
  • Personality Disorders (PD) — Diagnosing PD is quite a difficult task. However, in a few cases if history is properly provided & clinical tests are carried out, personality factors can be identified.

What are the emotional problems caused by addiction?

As stated earlier, addiction has definite emotional consequences. We have observed the following emotional consequences:

  • Emotions of an addict are usually “inappropriate”. Consequently his behavior is irrational. He ignores his material & emotional goals, he cannot think of alternatives, invites unnecessary conflicts with others and at the extreme state harms himself.
  • ‘Hate’ is at the top of the list of most commonly experienced negative feelings at the onset.

After cessation of addiction following feelings are most often experienced – disgusted, resentful, bitter, detested, fed-up, frustrated, sad, depressed, sick, dissatisfied, fatigued, worn-out, useless, weak, hopeless, rejected, guilty, embarrassed, inhibited, bewildered, frightened, anxious, dismayed, apprehensive, disturbed, antagonistic, vengeful, indignant, mad, torn.

Now here is the list of extreme emotions experienced by the addicts. All the following feelings are intense and “inappropriate”: Hate, unloved, abhorrence, despised, angry, hurt, miserable, pain, lonely, cynical, worthless, impotent, futile, accursed, abandoned, degraded, humiliated, shocked, panicky, trapped, horrified, afraid, scared, terrified, threatened, infuriated, furious, exhausted.

What is addictive thinking?

We at Muktangan believe that it is largely the patients’ self-defeating thoughts and resulting feelings and actions that sabotage their lives. Many of our recovering patients share that it is their “thinking” rather than “using” that leads towards or away from the “first drink”. Therefore AA slogans like “One day at a time”, “Easy does it but do it” are the guiding thoughts that keep patients away from the first drink. Thousands of fellow members of AA & NA admit that these slogans have been helping them to stay sober.

We have listed below some characteristic features of addictive thoughts and general beliefs leading to self-sabotaging behavior.

Qualitative descriptions of addictive thinking:

  • Autonomous and non-conscious
  • Rigid and inflexible
  • Dichotomous, all or nothing quality
  • Over-generalised and illogical
  • Jumping to conclusions
  • Negative opinion about oneself
  • Self-criticism and self-blame
  • Negative interpretations of the event
  • Ignoring the positive

Common content or theme of addictive thinking:

  • Denial: Alcohol and/or drugs are not the problem
  • Low frustration tolerance and/or self defined needs for high levels of stimulation, gratification and or excitement
  • Substance is the only way to solve emotional problems
  • Discomfort anxiety: all negative emotions are to be avoided at all costs
  • Change is too difficult, therefore one is hopeless, helpless and worthless
  • Self-blame, guilt and shame for being an addict

What are the interpersonal problems caused by addiction?

Addiction directly affects the interpersonal relationships of the person. The wife and/or mother of the person are the first victims of addiction followed by other family members. We have observed that in almost all cases, the interpersonal relationships are shattered in one way or other.

The most common problems faced by an addict are related to love:

  • Rarely receives loving and confiding behaviour from the parents & siblings
  • Diminishing love, respect and trust of the spouse
  • Hatred, fear, anxiety and distress expressed by the children

How is the behavior during active addiction?

Behavior is marked by the following:

  • Arrogant or conceited: for example, boastful, self-important, self-centered, jealous or envious
  • Attention-seeking or theatrical: for example, always tries to be the center of attention, dramatises, displays theatrical and exaggerated expressions of emotion
  • Intolerant or cruel: for example, unkind, mean, merciless, brutal etc.
  • Lying or cheating: for example, malicious gossip, secret extramarital affairs
  • Domineering or dictatorial: for example, bossy, over aggressive, disrespectful, over-controlling, authoritarian behaviour
  • Criminal and/or violent: for example, destroys property, physically assaults others etc.

Can an addict have a productive life?

Addiction results in diminishing capacity to work and/or have a productive life. Based on our experience following responses are observed towards productive work during addiction:

  • Poor concentration or attention
  • Fidgeting, pacing or hyperactivity
  • Loss of initiative, interest and motivation
  • Lack of spontaneity and slowed reactions
  • Procrastination and avoiding responsibilities
  • Rationalisations, justifications and blaming others at the work place
  • Poor memory and learning ability
  • Frequent errors in decisions and work
  • Overly dependent behavior
  • Disorientation

What about disorganised social life and financial problems?

During active substance abuse, the person faces several social and financial problems. The indicative symptoms are given below.

Social problems:

  • Unstable and intense social relationships: for example, goes from crisis to crisis, loves someone one day and hates them the next
  • Lack of loving and confiding with friends
  • Avoidance of social gatherings, functions etc.
  • Detached from organised social group(s)
  • Phobia: for example, fear of public speaking, staying in a group, travelling etc.
  • Prefers to be with other addict friends
  • Avoids religious activities
  • Mistrust or suspicion: for example, belief that others are always exploiting, harming or deceiving
  • Prolonged anxiety

Financial problems:

  • Loss of work or job typically leads to scarcity of money
  • Spends whatever money is available on substance
  • Spends money extravagantly, on material goods, gambling etc.
  • Owes money to people
  • Lives without income which causes further depression

What is REBT?

Created in 1955 by Dr. Albert Ellis, Rational Emotive Behavior Therapy (REBT) is an action-oriented therapeutic approach that stimulates emotional growth by teaching people to replace their self-defeating thoughts, feelings and actions with new and more effective ones. REBT teaches individuals to be responsible for their own emotions and gives them the power to change and overcome their unhealthy behaviors that interfere with their ability to function and enjoy life.