Substance Dependence - Brief Overview

Brief Overview

Doug Sellman at the National Addiction Center offers what he calls "The 10 most important things to know about addiction". He offers the following points, before explaining them in more detail (although even his full paper does not presume to be able to discuss all the important facts about addiction). First, Sellman says that the most important thing to know about addiction may be that addiction is "fundamentally about compulsive behavior". Second of all, such habits originate outside of consciousness (i.e. from the unconscious mind). The compulsive sequence of behaviors are so practiced that they can be extremely difficult to avoid initiating, and even harder to interrupt. Sellman maintains, thirdly, that addiction is 50% heritable. In other words, family background and genetics play a large role (see also Nature versus Nurture).

The fourth most important thing is that people with addictions often have other psychiatric problems (e.g. psychiatric disorders), which can complicate matters. Next, fifth, Sellman explains that addiction is characterized by frequent relapse, and that one should not expect to overcome addiction on the first try. The sixth point he makes is that the different forms of psychotherapy all produce similar results that may be based on what is common between them (i.e. a strong bond with a trusted friend). Sellman's seventh most important thing about addiction is that ‘come back when you're motivated’ is an inappropriate approach to addiction. Individuals have very specific problems, and so it is important to find ways to engage the addicted individual (Sellman describes how empathy is crucial, for example). His next, eighth point expands on this idea: Sellman says that doctors should apply as broad an approach to the individual as possible. This means combining various rejuvenating approaches, including prescription drugs, family therapy, social and legal support, providing accommodations, and more. The ninth important thing about addiction is that epiphanies are rare - even though they are the most popular kind of story to spread.

The tenth, and final important thing that Sellman explains is that change takes time (months or years of failing and trying again). He advocates for the importance of patience and persistence in practicing new behaviors over long periods of time. He concludes by appealing to all professionals involved in combating addiction; he asks that they all work together - because the combined knowledge of all fields is what is required.