Chemical Dependency: Cause and Effect

When discussing addiction, or chemical dependency, not many people really understand the subject. Don’t feel bad, because many health professionals don’t understand chemical dependency. The most common idea I run across is that addiction is caused by underlying psychological problems. In other words, most people don’t understand chemical dependency as a primary disease. I’ll use CD to refer to chemical dependency or addiction, both terms are used – however, chemical dependency is the clinically preferred term. The term addiction has lost a lot of its meaning through popular use — I’m addicted to ice cream, I’m addicted to a person, I’m addicted to golf, and so forth.

CD refers to dependence on a chemical, a drug. Substance abuse is also used quite often when the person using the term is really referring to CD. Abuse, or misuse, of a drug is not the same as CD. A 22 year old college student might misuse alcohol to fit in or to feel comfortable in social situations, or to impress friends, but that doesn’t mean that CD exists, even if the young person gets in trouble and gets a DUI. Mostly this confusion over terms is based in lack of understanding of CD. Although lack of understanding is the main reason for confusion, there are other reasons people refuse to refer to CD as a chronic brain disease.

Way too many people resist acknowledging CD is a chronic brain disease because they believe it excuses the person from responsibility. In order to accept CD as a disease, they think they have to change their ideas about free will, choice, responsibility, accountability for actions, etc. We’ve all heard such stories as the young kid who killed someone while drinking and driving and was not imprisoned because he was brought up as a privileged kid and wasn’t taught responsibility. This type of situation mixes social, moral and legal issues with biological issues.

Determining why someone starts to drink, or if they should drink at all, does not tell us why the person develops a dependence on alcohol. A moralist might say the person should never have started drinking in the first place, that the act of drinking is a choice and the chooser is accountable for the outcome. True, true, but this doesn’t tell us why one person develops a physical dependence on alcohol while another who drinks doesn’t become dependent. The moralist might say that the person who drinks alcoholically simply didn’t control his/her drinking and thus became dependent. But what about the heavy drinker who never becomes physically dependent on alcohol? The moralist doesn’t have an answer. Science doesn’t have all the answers, but science has learned quite a lot about CD and drinking in general — the moralist can learn if he/she wants to truly understand chemical dependency. The moralist might still say that the person is responsible for his/her condition, and most everyone will agree — this is what recovery is about. Recovery from CD is about taking responsibility for this chronic brain disease and taking actions to remain abstinent. There’s common ground, but first let’s all accept the facts. We’ve learned in the addiction treatment field that blaming or shaming people for their condition, a condition they didn’t choose, is not helpful, but showing someone how to deal with the condition and how to change is helpful.