Understanding Addiction: The Understanding Series

Introduction

One of the most traumatic times of my life was when I stood up in an Alcoholics Anonymous meeting and said:

Hi, I'm Belinda, and I am an addict.

While yes, there was an initial sense of relief at admitting the truth, at the same time, it was like all the shame, guilt, fear, and anger I felt came tumbling down upon me. Instead of being liberated by the admission, I was suffocated by my distress. Hearing repeatedly about what other people had lost added more rubble on top of my hurting heart, and there was no doubt about it: I was trapped in a deep, dark cave.

It has taken me many years to crawl out of what felt like a hopeless prison and see the light. Thanks to some very patient loved ones and some insightful and compassionate guides, I have learnt so much through this process. This book is here to share this knowledge with you, for understanding gives us the power to take wise and effective action. It also gives us the chance to come to a place of deep and true love for ourselves and for others.

Understanding is love's other name. If you don’t understand, you can’t love. ~ Thich Nhat Hahn

My research and reflections have resulted in a model of addiction called The Addiction Healing Pathway. This model explains the fundamental cause of addiction, its flow-on effects, and, more importantly, the process of healing. However, it is not just a model based on my ideas. It comes from a combination of ancient wisdom, such as spiritual teachings and philosophies, and modern science, including neurobiology and psychology. It shows how we need both approaches to deal with the disease of addiction at its source.

As you will see, the Addiction Healing Pathway's fundamental premise is that it is the separation from our unique and life-sustaining spirits that causes addiction. This disconnect creates an internal conflict that fuels distressing emotions, harmful thoughts, beliefs and behaviours. What begins as a spiritual crisis ends as a war on the body and mind, and there are many casualties. Throughout the pages of this book, this pathway will be presented. I hope that it may help you understand what causes people to undertake such extreme self-harm, but also the steps required to move towards a place of healing and hope.

Throughout Understanding Addiction, you will notice that I use the word healing instead of recovery. I know for some, the difference may be minimal. Still, for me, it is an important distinction to make. I have chosen healing instead of recovery because I believe you never really 'recover' from addiction. It is not just something you get over, like a chest infection, and then move on with life. The wounds go deep. Like soldiers never forget the harrows of war, I don't think someone with an addiction can ever recapture the person they once were. They have seen too much, felt and caused too much pain to 'get back to normal'. Besides, as you will see, it is likely that trying to be 'normal' caused so much of the suffering in the first place.

The one thing I have learnt from my experience is that the horror of addiction never leaves. But you do have a choice - to let the shame suck you down into the dark and keep you stuck or to find the courage to show yourself compassion. We can care for the wounds, nurse the scars and use the wisdom we have gained to help others.

For those of you who are suffering from addiction or are caring for someone who is, please remember:

You deserve to lead a healthy and happy life. Let this book be your guide.

Section 1 - Understanding the Cause of Addiction

More Advancement = More Addiction

Technological progress has merely provided us with more efficient means for going backwards. ~ Aldous Huxley

Addiction is a growing global concern, affecting millions of individuals across various demographics. According to the World Health Organization (WHO), 283 million people worldwide suffer from alcohol use disorder, and 1.3 billion are addicted to tobacco. Additionally, 35 million people are affected by drug use disorders, with approximately ten million individuals seeking assistance for gambling addiction in the last year alone​[1].

Expanding Scope of Addictions

Recent trends indicate that the range of addictive behaviours is broadening beyond traditional substances. In 2017, it was estimated that 18 million people, or more than six per cent of those aged 12 and older, misused prescription medications, including opioids, sedatives, and stimulants​[2]. Furthermore, emerging reports highlight increasing addictions to behaviours such as excessive eating and compulsive sexual activity.

Recent studies reveal that eating addictions, including binge eating disorder, are on the rise globally. This type of addiction often manifests as a compulsive need to consume large amounts of food despite negative consequences, such as obesity, diabetes, and cardiovascular disease. In the United States alone, it is estimated that around 2.8 per cent of adults experience binge eating disorder during their lifetime. This prevalence underscores the significant mental and physical health impacts, with many cases co-occurring with other addictions, such as alcoholism or substance abuse, highlighting the intertwined nature of behavioural and chemical dependencies.

Restrictive eating disorders, such as anorexia nervosa, can also be understood through the lens of addiction, where individuals develop a compulsive need to control and restrict their food intake. Anorexia nervosa affects approximately 0.9 per cent of women and 0.3 per cent of men in their lifetime. A global study revealed that the prevalence of eating disorders increased significantly over the last three decades, with adolescent populations being particularly affected. In Australia, recent estimates suggest that up to 12 per cent of adolescents aged 15 to 19 experienced an eating disorder in 2023, reflecting an upward trend in diagnoses within this age group.  

Cosmetic surgery addiction, also known as body dysmorphic disorder-related addiction, is a growing concern as procedures become more accessible and normalized. This condition often involves an obsessive need for physical alterations, despite prior surgeries, fueled by dissatisfaction with appearance and underlying mental health issues like anxiety or low self-esteem. Statistics on addiction to cosmetic surgery are challenging to quantify precisely, as this behavior often stems from conditions like body dysmorphic disorder (BDD). However, it is estimated that between 4% and 15% of individuals seeking cosmetic surgery may suffer from BDD, a condition strongly linked to an obsessive desire for repeated surgical procedures.

Similarly, sex and pornography addictions are becoming increasingly recognized as pervasive issues in the modern era. Studies estimate that 3-6 per cent of the population may struggle with compulsive sexual behavior, with a significant proportion of these cases involving addiction to pornography. In 2021, one survey suggested that 10-15 per cent of internet users frequent pornographic websites regularly, with some developing patterns of dependency that disrupt personal relationships, professional life, and mental health. These figures reveal a growing need for awareness and resources to address the broader scope of behavioural addictions.

In 2019, the WHO recognised gaming disorder as an official addiction, reflecting the growing concern over behavioural addictions. In response, several countries, including the United Kingdom and the United States, established clinics dedicated to treating internet addiction. In the United States alone, it is estimated that eight per cent of the population, or over 26 million people, are addicted to the internet, struggling to balance real-world activities with online interactions such as social media, internet shopping, and gaming.

There is also a concerning trend in the decreasing age of individuals affected by internet addiction. In South Korea, at least 160,000 children aged five to nine are reported to be addicted to the Internet. In Japan, approximately 500,000 children aged 12 to 18 meet the criteria for internet addiction. Similarly, in China, about ten per cent of teenagers, equating to 14.5 million individuals, are classified as internet addicts​[3].

The rise of vaping and e-cigarettes represents a new frontier in addictive behaviours, especially for adolescents. It is estimated that there are over 55 million vape users globally, with a significant proportion being teenagers. The National Institute on Drug Abuse notes that one-third of these users transition to traditional tobacco products within six months, a phenomenon known as the 'gateway effect', which highlights the potential risks associated with vaping. No longer are vapes seen as an effective way to help smokers quit the toxic substances within cigarettes. They have now become a source of self-harm within themselves.

Defining Addiction

Traditionally, addiction has been narrowly defined as physical and mental dependence on a substance​[4]. However, the evolving landscape of addictions demands a more comprehensive definition. It's no longer just about substances like alcohol, tobacco, opioids, and illicit drugs. It's also about everyday activities like eating, sexual behaviour, internet use, and even cosmetic surgery. This broader understanding of addiction is essential for a more effective approach to prevention and treatment.

Dr Gabor Maté offers a more inclusive definition of addiction:

Any behaviour that gives you temporary relief, temporary pleasure, but in the long term causes harm, has some negative consequences, and you can't give it up, despite those negative consequences.​[5]

This perspective underscores the multifaceted nature of addiction, extending beyond substance dependence to include behavioural patterns that provide temporary relief but lead to long-term detriment.

The Paradox of Progress

The proliferation of addictive behaviours raises important questions about the relationship between human advancement and addiction. As societies make strides in scientific, medical, and technological fields, there appears to be a concurrent increase in the prevalence of addiction. Everything we invent to remove pain, bring enjoyment or to make our lives easier is being twisted to become a source of powerlessness and distress. This paradox shows that current approaches to understanding and treating addiction are incomplete and that we need to dig deeper into the underlying causes of addiction. For it seems somewhere amongst all this complexity, technology, entertainment and excess, we are losing the link to an essential life-sustaining source.

Current Viewpoints on Addiction

A lot of people think that addiction is a choice. A lot of people think it's a matter of will. That has not been my experience. I don't find it to have anything to do with strength. ~ Matthew Perry

For as long as there has been addiction, there have been people who have sought to understand it, and to develop models to drive its treatment. While working through these different theories may seem tedious, understanding the differing viewpoints is important, for they all provide part of the picture of what addiction is, and therefore, how it can be overcome. For those seeking or currently undergoing treatment, it is also helpful to recognise the perspectives held by the healthcare providers you are working with, as their beliefs about addiction will shape the treatment programs they recommend. In this way, familiarising oneself with these different approaches towards addiction can help you make informed choices about services and treatment options.

Addiction as a Choice

One viewpoint is that addiction is fundamentally a choice. Choice is defined as:

An act of choosing between two or more possibilities​[6].

From an outsider’s perspective, it may appear that individuals do have the power to choose