Posted by Elizabeth on October 26, 2001, at 17:34:03
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
> A) What is the differenece between a person who self-medicates a depressive/anxiety disorder and an addict (whom AA refers to as needing alcohol because of a natural tendency to be "irritable, restless, and discontent")?
I wouldn't take the AA definition too seriously. But people taking medication (with or without a doctor's permission) do not necessarily have psychological "cravings" (similar to pressing hunger) for drugs. A person can become addicted to a medication; this is rare when the medication is being supervised by a doctor but probably happens a lot when people try to self-medicate with potentially addictive drugs.
> B) Is there a difference between i) a self-medicater who becomes psychologically attatched to a drug because of the relief it offers, and ii) an addict who becomes "obsessed" (psychologically attatched) to a drug because his/her state is naturally "irritible, restless, and discontent" without it?
Yes. If the condition being medicated goes away, a nonaddicted self-medicating person will no longer feel a need for the drug.
> C) Are the differences between these two sets of people (and the way in which these people are treated) simply semantic, or are there deeper differences?
I think the difference is significant.
> D) There is evidence that both addiction and mood/anxiety disorders are heritable. Could it be that inheritance of an addiction to a particular substance is the same thing as inheritance of a "subset" of mood/anxiety disorder for which the use of that drug is particularly efficacious (for the short-term) in alleviating?
Yes, that is quite possible.
> In the AA group I attend, there is a dichotomy of people. There are the ones who, after getting clean and "working the steps," seem to flourish. They are depressed at first as they withdrawal, but then they glow. On the other hand, there is the group that, after getting clean and "working the steps," continues to struggle and struggle and struggle.
> E) Could it be that one group comprises the "addicts" (getting better once withdrawn) while the other group comprises the "self-medicaters" (declining due to lack of pharmacological treatment)?
I think both sets of people were addicted to begin with, but you may well be right that the people who aren't able to stay off the drug once they detox actually have a chronic condition for which they require the drug (or some other effective treatment). Other factors that could be related to relapsing include the length of time that the person was addicted, psychological resilience, stability of lifestyle (e.g., a job, a home, etc.), and social support (family, friends, etc.).
> a) that I'm just an irritable person with character flaws who used drugs because I was selfish and too ungrateful for the life "God" had given me; and
I'm predisposed to become skeptical when people invoke the supernatural to justify their opinions. :-)
> b) that I suffer from a wholly physiological brain disorder which I attemped to self-medicate with drugs...and that with the proper biological treatment my affinity to illegal drugs and alcohol would become a non-issue.
Well, let me first say that I think the dichotomy between "physiological" and "psychological" conditions is a false one, so the whole question is a bit nonsensical.
But anyway, think about why you started using drugs in the first place. What did they seem to help with, what was their appeal?
I learned when I first took hydrocodone that it made me feel "normal," "okay" -- it was like I'd found something that had been missing all my life. I was lucky enough to be living in Boston, a city where a lot of psychiatric research goes on, so I was able to meet with doctors who had experience treating depression with opioids. I feel lucky; if my circumstances had been different, I might well have gotten into trouble with heroin. As it was, I went through just about all the conventional treatments there are (though not all the possible combinations, of course) before my doctor and I started seriously considering buprenorphine as a potential treatment. If I hadn't had the degree of social support and education that I did, I'm not sure I would have been able to muster up the patience to go through all those trials.
> The first model appeals to my tendency for self loathing, and the second model appeals to my tendency to abdicate responsibility, but both seem completely myopic and inadequate.
Both models are based on a fallacy; IMO, that's the problem. Both models require a black-and-white view of human behaviour and experience.
> I feel like Jackie Chan standing and screaming "who am I??!!" in the extremely cheesy movie by the same name. Or, more philosophically, I want to scream "WHAT am I?"
You're a human being, dude.
Hey, let me know about the results of the SPECT scan -- I'd be interested.