Last month, I began to share with you the educational journey I embarked upon when I started in the New Life Program of the Springs Rescue Mission. I came into my position without much of an in-depth understanding of addiction, and set out to fill in the gaps I knew I had.I began by learning about the brain chemistry associated with addiction. I came to understand that when someone suffers from addiction, they have two very different parts of their brain working against each other, and eventually completely reversing their roles. This chemical breakdown and reversal helped me understand some of the behavior patterns I was seeing in the men I was working with, but it didn’t quite paint the entire picture. I saw an explanation of what was going on mechanically, but there seemed to be so much more to the picture that was missing. Where were the broken relationships? The legal troubles? The lost jobs? These all seemed to be missing from the medical explanation of addiction.So my search continued. I suddenly remembered, I was a counselor. I had a master’s degree in counseling. I had just spent almost three years learning about psychology and psychotherapy - I should be able to find a good definition in the world descended from Mr. Freud.

The psychology behind addiction

The great thing was, all I had to do is pick up one book. I found my grey copy of the Diagnostic and Statistical Manual of Mental Disorders; fourth addition: text revision - or as it is known in the industry DSM-IV-TR. For those of you who don’t know, this is the psychologist’s bible. It contains the very scientific agreed upon definitions of all mental disorders. If it’s not in the DSM, you’re not crazy.The section in the DSM –IV that deals with addiction is just over 100 pages (191 – 297 if you are keeping score at home) and it is very thorough. There are definitions for substance dependence, for substance abuse and substance withdrawal. It classifies “early partial remission”, “sustained partial remission” or even “remission in a controlled environment.” It deals with Alcohol disorders, Amphetamine disorders, Opioid disorders, and yes, even caffeine related disorders. I wonder what the majority of Americans would say if they knew they fully qualified for a mental health diagnosis based on their daily coffee intake?I thought for sure I had found my definition of addiction. With all this classification and dissection, there must be a clear category for everyone. It is all logically laid out. Over 100 pages of definition, how could anything be missed? Emotional aspects, social problems, it was all there. This has to be it.

Clinical definition vs real life experiences

Then I found a very interesting phrase. At the beginning of every section, where the foundation for a diagnosis of each type of disorder is being explained, the following text is found: The symptoms must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Hmmmm…Clinically significant distress, what does that mean? Social impairment, how am I going to measure that? And these two criteria are important; without them we don’t even get to look at all the other diagnostic tools that follow. Without significant distress or social impairment, it’s case closed. We stop the investigation and go home.These criteria are each to be assessed from the point of view of the person dealing with the symptoms. What I call significant distress, they may call normal life. What is social impairment when everyone you know drinks or uses just as much as you do? When your friends and family already move from job to job, are involved with the court system and have no money for bills that is not impairment, that’s just life.I began to see, in a lot of cases, that using and abusing drugs and alcohol was such a common part of the culture, it would be almost impossible for individuals to identify their situation and behavior as distressful or impaired. I had to impose my definition of “normal” on them to continue with the DSM-IV diagnostic criterion.Or, I found the opposite end of the spectrum. There were men in the program who had been functional alcoholics or addicts for years. They could perform just fine at work when they had a bottle (yes, a whole bottle) of wine over lunch. They carried on life for years with an active addiction, all while going to soccer games, getting promoted at work and attending church. Distress and impairment? Where?So once again, I was faced with a partial definition and understanding. Yes, the psychological definition brings a scientific classification to addiction, and it addresses some of the social and emotional consequences that the medical/biological definition leaves out. But it falls short because it asks people to identify distress and impairment, and for a number of reasons both cultural and physical, they may not be able to.So once again, I had a piece of what addiction looked like, but I still needed more. My search continues...The staff and volunteers at Springs Rescue Mission have been serving our neighbors experiencing homelessness, poverty and addiction since 1996. We are powered by the generosity of our community. Discover how you can get involved.https://www.springsrescuemission.org/ways-to-help/