Archive for July, 2014

Chicken or the EggIf only life was a true reflection of the fairy tales our mothers read to us as small children.  There was a problem, with courage and determination it was overcome, and everyone could then live happily ever after.  The illusion was that there was only one problem, and that if it was resolved, everything else would be perfect.  Unfortunately, the myth does not mirror reality, and it certainly does not describe recovery from addiction.

It is often appropriate to ask whether addiction is the problem, or the symptom of something else.  This question does not discount the fact that addiction is a chronic disease, but acknowledges how other issues are often the triggers for drinking and using.  If these “co-occurring conditions” are not recognized and addressed, recovery is hard to achieve.  It is for this reason that St. Joseph Institute believes that “treating” addiction without an equal or greater emphasis on addressing these other issues in a person’s life is poor healthcare practice.  It is like placing a Band-Aid on a wound that has not been cleaned and medicated.  In the end, the patient does not get better and the condition may get far worse.

Not every issue that triggers the desire to use drugs and alcohol is a mental health condition that can be diagnosed and classified.  That is not what is important.  What matters is that something is causing pain or distress – both of which become invitations to self-medicate.

Listed below are some of the common “companions” to addiction that need to find resolution, so that recovery can become easier, and the temptation to use again lose some of its power.

Depression. Escaping feelings of sadness are a common reason to drink and use. Ironically, drugs like alcohol only make depression worse.

Anxiety. Studies on university campuses show the strong link between the social anxiety that accompanies modern life and the use of drugs and alcohol.

Pain.  Human nature drives us to escape pain with all possible haste, rather than learn ways of reducing pain through lifestyle changes or natural means.  Our aversion to pain has made the United States the world’s largest consumer of opiate medications.

Relationships. Nothing creates more emotional distress than relationships that are not working well. Rather than learning to build better boundaries, communicate effectively, or resolve conflict, many people simply medicate their relationships.

Bipolar. Some mental health conditions cause distress and the best medications are still imperfect.  Millions of America’s use their drug of choice to self-medicate their mental health issues.

Stress. Managing the stress of daily living should never be an optional activity.  However, all too often we let it build to unhealthy levels, and allow stress to feed addiction.

Boredom. A surprising number of people use drugs and alcohol to cope with boredom, rather than find activities, hobbies and other outlets for their pent up energy and frustrations.

Sex. For many addicts and alcoholics, their drug of choice has been an integral part of their sex lives.  Concerns about the impact of sobriety on inhibitions, performance, and the quality of the experience need to be resolved.

Self-worth. Guilt, shame, a lack of validation, rejection, are issues that can drive addiction in the hope that using will fill the mental void.

Trauma.  The deep “psychic” pain that comes with abuse, PTSD, and other forms of trauma become fertile ground for addiction.  Without resolution, these hurts often become the “justification” for using drugs and alcohol.

We must realize that addiction does not live in a vacuum.  It is fed by the events in life.  If the issues that have a powerful impact on our lives are not addressed, they become the constant “siren’s call” to use again.  Attempting to treat addiction in isolation is often a futile exercise.  Is it the “problem” or the “symptom?”  I suggest the answer doesn’t matter.  To find wellness the addicted person must deal with both the chicken and the egg.


Addiction treatment can be discouraging.  As a healthcare professional you can invest huge amounts of energy and passion into helping someone enter into recovery, only to see them fall back into the old patterns of using.  The addict or alcoholic comes to understand their disease, learning techniques to manage their urges, triggers and weaknesses. You help them build a support network and emphasize how important it is to reach out to others in times of trial.  Yet, even though they have the tools, they often fail to use them in times of crisis, or resist making the changes necessary to create a life where it is easier not to use.

There are many reasons why people relapse and the outcome of treatment is not under the control of the provider.  However, that does not exempt the rehab program from ensuring that it is doing its best to lay the foundation for a strong recovery.  In this regard, there is a need for addiction treatment to be holistic, focusing on the whole person and the many reasons why they use drugs and alcohol.  There are times when it is not inappropriate to view addiction as the symptom, a means by which the underlying problem is being medicated. If treatment does not address these deeper issues, recovery from addiction is significantly impeded.

The co-occurring conditions must be addressed.

It is estimated that more than two thirds of the people with an addiction have a diagnosable co-occurring condition.  Our experience at St. Joseph Institute would confirm that statistic, and encourage the search for other underlying conditions which might not merit a diagnosis, but nonetheless are important issues that must be addressed. Listed below are ten of the “companions” to addiction that we frequently encounter.

  1. Anxiety. Studies of drug and alcohol use on university campuses highlight how often addiction grows out of a desire to lower anxiety.  Treatment must recognize the importance of equipping the individual with techniques and strategies to manage anxiety without self-medication.
  2. Depression. Sadness is a feeling that we want to avoid and too often drugs or alcohol become the answer.  Depression must be treated if the cycle of addictive behavior is to be broken.
  3. Bipolar Disorder.  Many people affected with bi-polar dislike the way they feel when taking prescription medications for their condition.  Drugs may offer relief from the symptoms, but lead them down a destructive pathway.
  4. Pain.  Addiction is all too often the result of pain medications that were prescribed by a physician.  Natural ways of managing pain must be taught if the dependence on narcotics is to be broken.
  5. Relationship problems.  Nothing creates more “psychic pain” than relationships that are not working well.  Learning to build better boundaries, resolve conflict, and establish trust are important for everyone, especially those who are tempted to self-medicate when relationships become hard.
  6. Stress. Too often managing stress is considered an optional activity.  For people with addiction, finding ways to keep their stress at a low level is a mandatory part of recovery.
  7. Boredom.  A surprising number of people use drugs and alcohol to cope with boredom.  For this group, finding new hobbies, outlets, and ways to get involved is an important part of the healing process.
  8. Sex. Many addicts have used drugs or alcohol as part of their sex lives for as long as they can remember.  They are afraid of the impact of sobriety on their sex lives, because of inhibitions, or because they fear the performance or the experience will change.
  9. Self-worth.  Some many people treat their feelings with drugs and alcohol.  When they have been hurt by others, or are unable to forgive themselves, addiction becomes a place of safety.
  10. Trauma, abuse, PTSD. It is estimated that 1 in 4 women addicts has been sexually abused.  Addictive behavior has become a way of coping, and recovery demands that these underlying issues find resolution.

These are but some of the reasons why people become attached to their drug of choice and are reluctant to let go.  If we are to treat these people, and help them break free from their addiction, we must help them address these driving reasons and adopt new behaviors.  If we treat the addiction, but ignore the co-occurring conditions that provide its fuel, we will almost always witness failure.  Recovery demands that the whole person find healing.  As healthcare professionals, we can offer nothing less.

 Michael Campbell is Co-founder and President of St. Joseph Institute for Addiction, a rehab center located near State College.