E-Book on Disease of Addiction by Hamrah Co.

Contents 1- Introduction ________________________________________________________________ 1 2- What Is Addiction ___________________________________________________________ 3 Addiction is not a moral issue____________________________________________________________ 3 Definition of addiction __________________________________________________________________ 3 Types of addiction ____________________________________________________________________ 4 Difference between habit and addiction ____________________________________________________ 5

3- Mental Disease _____________________________________________________________ 6 Addiction is a recognized disease ________________________________________________________ 6 Who is a chronic addict ________________________________________________________________ 6 Mental symptoms of addiction ___________________________________________________________ 7 Ways to come out of denial ____________________________________________________________ 10

4- Physical Disease___________________________________________________________ 12 Brainâ&#x20AC;&#x2122;s reward circuit is over stimulated ___________________________________________________ 12 Brainâ&#x20AC;&#x2122;s natural chemical messengers are disrupted _________________________________________ 13

5- Nature of Addiction ________________________________________________________ 14 Factors contributing to addiction ________________________________________________________ 14 Characteristics of addiction ____________________________________________________________ 15

6- Signs of Addiction _________________________________________________________ 17 Symptoms of addiction ________________________________________________________________ 17 Signs of addiction ____________________________________________________________________ 17

7- Chronic addicts____________________________________________________________ 20 Normal Types _______________________________________________________________________ 20 Heavy Types________________________________________________________________________ 20 Chronic Types ______________________________________________________________________ 21

8- Addiction cycle ____________________________________________________________ 22 Obsession develops __________________________________________________________________ 22 Insanity develops ____________________________________________________________________ 23 Cravings develops ___________________________________________________________________ 23 Tolerance develops __________________________________________________________________ 23 Experience hopelessness _____________________________________________________________ 23 Reach rock bottom ___________________________________________________________________ 24

9- Addiction Test _____________________________________________________________ 25 Figures & Tables _____________________________________________________________ 26

1- Introduction This section describes why substance addiction is scientifically proven to be a disease. It explains the ways in which prolonged drug abuse renders the mind and body abnormal and why once the disease of addiction has developed, the addict looses the power to control or stop taking drugs by self will alone. Though the information provided relates to substance addiction, it can also be helpful to those suffering from behavioural addictions. Our hope is that by providing you with information about various aspects of addiction, you will be able to recognize if you are suffering from this disease and what you can do recover from it. To explain the many facets of the disease of addiction, this section has been divided into the following:

2- What is addiction As Iranian addicts, we suffer in silence due to lack of knowledge about our condition, denial of our problem, or the stigma of being labelled an ―addict.‖ Fear and ignorance have prevented many of us from seeking help for a condition that can be successfully treated.

3- Mental disease This page describes the mental components of the disease of addiction in particular to substance abuse, explaining why addicts are compelled to continue abusing drugs in the face of repeated and severe consequences. Once the disease has developed, an addict’s way of thinking becomes abnormal and they loose the power of choice and control.

4- Physical disease While the previous page dealt with the changes that occur in our mind as people addicted to substances, here the physical symptoms of the disease of addiction are described. The information serves to help in understanding why we lose the power to stop our addiction on our own.

5- Nature of addiction As with other chronic diseases, addiction has characteristics that medically define it. Familiarity with these characteristics can help us understand why addiction is recognized as a medical condition.

6- Signs of addiction The disease of addiction has certain characteristic signs and symptoms. By understanding what these are, we can recognize whether we are suffering from it.

7- Chronic addicts Not everyone who uses drugs is an addict. There are three general types of people who use drugs, but it is only the chronic types who develop the disease of addiction. Review the diagram below to identify whether you possess the characteristics of a chronic addict.

8- Addiction cycle The disease of addiction is a vicious cycle, one that is impossible for the addict to break out of on their own. An illustration on this page demonstrates this cycle to explain why an addict needs help outside himself or herself to recover.

9- Addiction test No one but you can say whether you are an addict or alcoholic. The best way to determine if you have a problem with substances is to find out for yourself. This test can help you do that.

2- What Is Addiction As Iranian addicts, we suffer in silence due to lack of knowledge about our condition, denial of our problem, or the stigma of being labelled an “addict.” Fear and ignorance have prevented many of us from seeking help for a condition that can be successfully treated.    

Addiction is not a moral issue Definition of addiction Types of Addiction Difference between habit and addiction

Addiction is not a moral issue People who become addicted are not weak-willed or morally corrupt. This misconception discourages many of us from seeking help, while fostering shame, which is counterproductive. Because addicts are driven to medicate feelings of shame – along with those of fear, anger, and pain -- they need support rather than another reason to feel bad about themselves. The fact is that addiction is a physically based brain disorder. Addicts and the people who love them, though, are often the last to accept the disease concept -- the result of shame, denial, and a need to prove they are in control.

Definition of addiction  

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Addiction is a primary, progressive, and fatal illness. It is a pathological relationship with a mood- or mind-altering substance or behaviour that renders us powerless in the face of overwhelming cravings. Addiction has been defined as ―a state in which the body relies on a substance or behaviour for normal functioning.‖ When the substance is cut off or the behaviour curtailed, the result is withdrawal symptoms. Addiction can be described as a compulsion to engage in an activity despite significant consequences. Addicts are often the last to accept the disease concept. But even parents, spouses, and others close to the addict are slow in identifying this condition as an illness. This is because they, too, are involved emotionally with the disease process. Though the word ―addiction‖ is most often used to refer to drug or alcohol dependence – and termed Substance addiction -- we can be addicted to activities such as gambling, compulsive overeating, sex, pornography, or shopping. These kinds of addictions are called Behaviour addictions. According to the American Society of Addiction Medicine, addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other destructive behaviours. The addiction is characterized by impairment in behavioural control, craving, inability to consistently abstain, and diminished recognition of significant problems with our behaviours and interpersonal relationships. As with other chronic diseases, addiction can involve cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and may result in disability or death.

Types of addiction Addictions can be divided into two general categories: Figure 1 : Types of addiction

1. Substance addictions (such as those involving drugs and alcohol) Substance addiction is usually characterized by withdrawal symptoms when the substance is suddenly discontinued. Physical addiction also means the body builds a tolerance to the substance, so that we need a larger and larger dose to get the same effect. Common withdrawal symptoms include shaking, diarrhea, and nausea. The speed at which we become addicted to various substances varies with the substance, the frequency of use, the means of ingestion, and our genetic and psychological susceptibility.

2. Behaviour addictions (such as eating disorders, sex, work, co-dependency, love addiction, and self-harm/mutilation) Behavioural or Process addictions are patterns of behaviour that follow a cycle similar to that of substance addiction. To begin with, we experience pleasure in association with a behaviour, and then adopt that behaviour as a way of enhancing our experience of life, and later, as a way of coping with stress. The process of seeking out and engaging in the behaviour becomes more frequent and ritualized, until it becomes a significant part of our daily life. When addicted, we experience urges or cravings to engage in the behaviour despite consequences. These addictions are real and result in problems in many areas of our life. The addiction has similar effects on relationships, which are often neglected in favor of the addictive behaviour, undermining trust and creating havoc in the lives of partners, family members, and friends. There is increasing evidence that addiction to these behaviours involves similar brain mechanisms to substance-based addictions, although more research is needed to confirm and clarify how this happens. Fortunately for those of us suffering from behavioural addictions, there are 12 Step programs and Fellowships that are effective in recovery.

Difference between habit and addiction Many of us acquire the habit of using a substance or becoming engaged in an activity â&#x20AC;&#x201C; and suffer no consequences. We can stop if we choose. What sets an addiction apart is that we continue with the substance or behaviour despite consequences that are predictable and increasingly serious.

1. Habit - it is done by choice. The person with the habit can choose to stop, and be able to do so using free will.

2. Addiction - there is a psychological and physical component. The person continues to abuse a substance or engage in a behaviour despite obvious and repeated harmful consequences because he or she has lost the power of choice and has developed the disease of addiction.

3- Mental Disease This page describes the mental components of the disease of addiction in particular to substance abuse, explaining why addicts are compelled to continue abusing drugs in the face of repeated and severe consequences. Once the disease has developed, an addict’s way of thinking becomes abnormal and they loose the power of choice and control.    

Addiction is a recognized disease Who is a chronic addict Mental symptoms of addiction Ways to come out of denial

Addiction is a recognized disease 

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In order to understand how addiction has been proven to be a disease, we first need to understand the meaning of the word. A disease causes an organ, structure or system in the body to fail or function abnormally. In the case of substance addiction, the prolonged abuse of drugs adversely affects the brain’s structure, impairing its normal functions and making it dependent on drugs to function normally. Depending on the drug and the method used to ingest it, the result may be euphoria, a boost in energy, or improved sleep patterns. Drugs can initially produce these effects because they affect our brain’s communication system. But prolonged use leads to the development of the disease of addiction, making us into chronic addicts as the brain adapts to the repeated use of drugs and ceases to function normally. Although there is increasing evidence that a similar process happens in the brain’s communication system with those suffering from behavioral addictions, more research is needed to confirm and clarify this.

Who is a chronic addict 

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Chronic addicts are people who abuse drugs persistently despite harmful consequences. Because the disease of addiction impairs the brain’s pleasure, reward, motivation and memory circuits, chronic addicts lose the power to stop – or even to control -- their drug use. We then use drugs again and again to reexperience that initial euphoria, but eventually need them just to feel normal. Not everyone who abuses drugs or alcohol develops the disease of addiction. The majority of people who have abused drugs or alcohol can stop on their own; they are still able to exercise will power. Why some of us become addicted and some do not despite the quantity or the length of time we use drugs is unclear. But those of us who develop the disease exhibit common symptoms, including an inability to stop by free will alone.

Mental symptoms of addiction There are two symptoms prevalent to the mind of those who have developed the disease of addiction. They are: Figure 2 : Mental symptoms of addiction

1. Obsession 

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Obsession is an unwelcome, uncontrollable and persistent thought, image or emotion that takes over a person’s thinking. In our case, the obsession is with drugs, which we abuse despite the harm done to ourselves and those around us. This is because the feelings of euphoria created by drugs are intense – and we seek endlessly to recreate those first highs. As addicts, we become obsessed with finding and using drugs because the effect of drugs on the brain is -- though unnatural -- very powerful. Drugs produce the illusion that we are powerful and in control. We take drugs and suddenly find ourselves capable of doing things we normally fear. We feel ecstatic, carefree and confident to overcome any problem – and the brain likes these feelings, even though they are unnatural. It is this cycle that leads to our obsession. One of our biggest obsessions as chronic addicts is our determination to prove we can manage our drug use and that we are normal. Very likely, the fact that we are powerless over our drug use is too hard for us to acknowledge. So we try all sorts of ways and means to prove we are in control of our drug use. If you are a chronic addict still fighting against admitting to your disease, ask yourself how many times you have tried using drugs in moderation and have failed. How many times have you promised yourself you would not use drugs, only to find yourself days later in a blackout or at the end of another run?

2. Insanity 

The second symptom prevalent to our minds is insanity. Insanity can be defined as thinking that is not whole, rational, logical, or based in reality. Our thinking becomes abnormal due to the powerful and unnatural ways in which drugs disrupt how our brains send, receive and process information. We therefore lose the ability to make sane decisions and judgments.

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Our insane way of thinking leads us to harmful behaviours and actions that ultimately make our life chaotic. How many times have we fooled ourselves into doing drugs again, believing that this time we can manage them and that the results will be different? How many times have we abused drugs despite all the evidence we have of the destruction to our families and ourselves. Those around us see our behaviour as crazy, but to us it seems normal.

There are certain insane thinking patterns and character traits common to most chronic addicts. Below is a description of some of them: A. Denial Denial is a defence mechanism we use to convince ourselves and others that we do not have a problem with drugs. We may not even be aware we are in denial because drug abuse has impaired our ability to think rationally. But being in denial keeps us in our addiction despite all the harm our drug use causes us and others. Those in 12 Step programs say that ―addiction is the only disease that tells the sufferer that the disease doesn’t exist‖. Denial is our way of avoiding the painful reality of our addiction. Because we are too frightened to admit we have become addicts, we simply deny that there is a problem. Ultimately, denial enables us to live in a fantasy, a place that is familiar to us and where we feel safe despite how much pain we may be experiencing. Yet it is our denial that keeps us a prisoner to addiction. So long as this defence mechanism has us in its grip, we are like slaves to drugs. The list of the types of defence mechanisms we use to stay in denial is long. Here are some of the defences we use to keep our drug abuse safe: I. Justification: Justifying to others or ourselves why we abuse drugs. ―If you had a life like mine, you would use drugs too‖. II. Rationalization: Giving illogical reasons for why we abuse drugs. ―I need drugs to have fun and feel confident‖. III. Blaming/Playing the Victim: transferring responsibility for our drug abuse and behaviour to other people as an excuse to use drugs. ―My husband treats me badly; I need to use drugs to put up with him‖. IV. Minimization: Refusing to admit how much and how often we are doing drugs. ―I only use drugs occasionally; I can manage it‖. V. Intellectualization: Using faulty logic to convince ourselves and others that there isn’t a problem. ―I need to take drugs to feel creative and do a better job‖. VI. Dishonesty: the truth about our drug abuse is a reality too hard for us to face, so we lie, distort the truth or leave out important details. ―I don’t take drugs for pleasure; I need them for medical purposes‖. ―I don't do drugs everyday -only on weekends‖. VII. Manipulation: We argue, tease, mock, con, etc. when confronted with our drug abuse. ―I don’t use that much, and I can stop anytime I want‖. ―I don’t have a problem; you are the one with the problem‖. VIII. Isolation: Keeping ourselves isolated from others so we can continue drugging.

B. Self-centredness / Selfishness Another mental feature of the disease of addiction is what it does to us as people. Those around us may call us selfish, because it seems our only priority is ourselves, and all we seem to do is chase after drugs. They think we have a choice or are just doing it to experience pleasure. But when suffering from this disease, we have no choice but to be ―selfish‖, for we need drugs to survive and will put them before everyone and everything. C. Grandiosity The great two-edged sword with us addicts is our grandiosity, our exaggerated sense of self-importance. When we first use drugs, we experience a sense of power and control. We believe in the illusion the drug creates and think ourselves better, smarter, special and more important than others. We are not content, nor take pleasure, in normal life, but want more and more. We believe we can succeed where so many others have failed; we strive for more money, more power, more and more prestige. We buy into the fantasy the drug creates of ourselves. Ironically it is this grandiosity that can prevent us from seeking help to recover. We may believe we are different from others, too far gone down the ladder, or that a 12 Step program may help others but not us because we are different -- or special! This feeling about ourselves is referred to as ―terminal uniqueness‖ in 12 Step programs. It is also said in 12 Step programs that low self-esteem and grandiosity are two sides of the same coin. D. Radical change in personality when intoxicated Another feature of how the disease of addiction distorts our way of thinking is how our personality radically changes when we abuse drugs. We may be the kindest people on earth, but when we put drugs into our system we suddenly become monsters. We lose our sense of morality and act in undignified ways. We resort to crime or unbecoming activities because the need to use drugs dominates our actions. We never know how we are going to react, what character we are going to become once we use drugs. The tragedy is that the disease of addiction has distorted our thinking. We believe the lies we tell others to protect our drug abuse. Dishonesty becomes second nature, making it difficult for us to face the reality of our disease. Many of us have to reach rock bottom before we can finally accept our disease. The pain caused by our addiction becomes so great that it breaks through our defence mechanisms. Sadly, many die before reaching this point because the truth is too hard to face. Drugs damage our mind, so relying on our thinking is of no use if we want to stop. As chronic addicts, we don’t have the mental ability to help ourselves. Abuse of drugs has taken that power away. We need the help of a Power greater than ourselves if we want to recover. It is the belief and reliance on this Power that can bring forth a solution for our disease of addiction.

Ways to come out of denial Breaking through denial is one of the biggest challenges any of us can face in seeking help and finding recovery. The thought of stopping our drug use may seem impossible to many of us, for by now our brains need drugs to function normally. But there is hope. Many of us have been able to break through this destructive defence mechanism by using the tools of this program, and are now in recovery. Suggestions to help you come out of denial: 1. The most important first step towards recovery is admitting that we have a problem. There is absolutely no way we can seek help if we are still under the delusion that we have the power to control or stop our drug use. Would you want to fix something that you believe is not broken? Your experience with your drug use and the damage it has done to your life usually show you if you have a problem. All you need to do is gather the courage to see your life for what it has become. Even if it’s too painful to acknowledge the full extent of your problem, a simple honest admission is enough to start the process of coming out of denial. 2. If you think you may have a problem with drugs but cannot see it for the problem it is, ask your God – a Higher Power of your understanding -- to help you recognize the truth. We have lied for so long to others and ourselves about the extent of our addiction, that now we believe our own lies and cannot tell them from reality. But a sincere call for help to any Power outside yourself shows you have reached a place of humility, a place where you have become ready and willing to want a way out. 3. Working Step 1 (―We admitted we were powerless over our addiction – that our lives had become unmanageable‖) can help us break through our denial. The strength we gain from understanding that our addiction is a disease and not a moral weakness can help us face the reality of our condition, rather than hiding from it. 4. Unfortunately, many of us have to reach rock bottom before we are confronted with the truth about our addiction. Rock bottom is the lowest and most desperate place a person can reach, and each person’s bottom is different. Some of us reach this dark and hopeless place when we have lost everything, and may even welcome death as a way out. Some of us experience rock bottom when we lose our home, our family, our job, or our health. Whatever the circumstances, rock bottom is marked by reaching a place where we are woken up to the reality of how our addiction is destroying our lives. But we don't necessarily need to hit rock bottom to come out of denial. There are many of us in recovery who have seen where the drugs were taking us and stopped before losing everything. 5. 12 Step Fellowship meetings are great places for confronting and overcoming denial. Being among people who suffer the same disease helps alleviate the shame and guilt we may feel about ourselves. Seeing others who have recovered from addiction can bring hope into our hearts and make it easier for us to overcome denial and admit we are suffering from a disease over which we have no power.

6. As difficult as it may be, try to challenge your thinking about your drug use. Try to drop the excuses you make to yourself and take a hard look at the reality of your addiction. Ask yourself: what has happened every time I have used drugs? Where have I ended up? Simply recognizing â&#x20AC;&#x201C; and admitting to yourself -- the damage and destruction drugs have done in your life is a huge breakthrough. Above all don't forget you are not alone. The 12 Steps offer a solution for our disease. You can recover. With your God and the others in the program providing help and support, you can start your journey towards a new and free life. 7. Bear in mind that coming out of denial is a process. There is a saying in 12 Step fellowships that we did not become addicts overnight, so we should not expect to recover in a day either. Addiction is a complicated and complex disease, and recovery from it is a long-term process. Some of our insanities and defence mechanisms stay with us long after we have stopped using drugs. It takes time and working the program for the layers of denial to peel off, as move forward in our recovery.

4- Physical Disease While the previous page dealt with the changes that occur in our mind as people addicted to substances, this section explains the physical symptoms of the disease of addiction. The information serves to help in understanding why we lose the power to stop our addiction on our own.  

Brain’s reward circuit is over stimulated Brain’s natural chemical messengers are disrupted

There are two changes that happen in the brain’s function and structure as a result of prolonged drug abuse. They are: Figure 3 : Drugs change the brain's structure

1- Brain’s reward circuit is over stimulated Prolonged abuse of drugs changes the function and structure of the brain. When this occurs, the disease of addiction can be said to have developed, because the brain is now dependant on drugs to function normally. Dopamine, a naturally occurring chemical in the brain, produces a sense of pleasure and reward. Vigorous exercise, for instance, boosts dopamine levels and results in a feeling of well being. Drugs, though, cause unnaturally large amounts of this chemical to be manufactured by the body, which is why the person feels euphoric and ―high‖. But because the brain is being given external chemicals (drugs) to feel pleasure or reward, it slowly loses the ability to produce its own natural feel-good chemicals – dopamine. The brain’s reward circuit is impacted in two ways through drug abuse:

1st impact: After repeated drug-induced ―highs,‖ the brain loses its ability to gain pleasure from normal activities. For example, normal people may enjoy going to the movies, but addicts -- having experienced intense states of euphoria -- lose the ability to enjoy the simple pleasures of life.

2nd impact: as the brain constantly adapts to increasing external chemicals, it requires more and more drugs to function normally.

2- Brain’s natural chemical messengers are disrupted The second physical effect of drug abuse on the brain is the disruption of its communication system, which can be seen in two symptoms:

1st symptom: Cravings 

A craving occurs when the brain is physically activated to produce a powerful urge or impulse to use drugs. Cravings are like strong memories that are linked to the effect of drugs on the brain's neurochemistry. For example, if we see others using drugs, our brain gets physically activated or carves to use drugs. If we then don't supply our body with the drug, it reacts through physical withdrawal symptoms.  Withdrawal is the body’s way of broadcasting that it is dependent on drugs. It is as if our body inflicts punishment on us to supply it with drugs. Withdrawals can be both physical and psychological.  Psychological withdrawal symptoms include: anxiety, irritability, restlessness, insomnia, headaches, difficulty concentrating, and depression.  Physical withdrawal symptoms include: heavy sweating, palpitations, diarrhoea, laboured breathing, shaking, nausea, vomiting, muscle aches and chest tightness.  Facing withdrawals is a frightening prospect for us and can be a deterrent to seeking treatment.  Bear in mind: Withdrawal symptoms vary -- and can be dangerous, leading to seizures, strokes or heart attacks. It is important to seek medical help when dealing with withdrawals.

2nd symptom: Tolerance 

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Another feature of the disease of addiction is the development of tolerance, which results in gradually needing more and more of a drug to experience the same effect. This can lead us to reach the point where our regular dose of drugs would put the life of a non-addict in danger. In the language of 12 Steps, tolerance is commonly referred to as our Allergy toward drugs, setting off a craving that would not occur in the non-addict. Our allergy toward drugs is shown in our compulsion to use a drug more and more despite its harmful consequences. This is considered an allergy because our reaction is abnormal – instead of stopping we continue using drugs. The phenomenon of an allergy to a substance is demonstrated on a big scale with alcohol. For example, many non-alcoholics in the world are able to sip a glass of whiskey for what seems like ages – and then stop. With the alcoholic, though, the first drink very often sets off the allergy, leading to a binge. The alcoholic, like the addict, has lost control over the substance. The drink or the drug is in charge, leaving us powerless in the face of our disease.

5- Nature of Addiction As with other chronic diseases, addiction has characteristics that medically define it. Familiarity with these characteristics can help us understand why addiction is recognized as a medical condition.  

Factors contributing to addiction Characteristics of addiction

Factors contributing to addiction Addiction is a complex disease with no single factor accounting to its development. There are amalgamations of characteristics that contribute to its development, ranging from: Figure 4 : Factors contributing to addiction

 Genetics  Social environment  Gender  Ethnicity  Psychology / mental illness  Trauma & abuse  Unstable family relationships  Poor social or coping skills  Peer pressure Medical science has not yet been able to find a cure for the disease of addiction. Experience shows that recovery depends on employing a variety of resources, with 12 Step programs being the most effective. Twelve Step programs -- with the support of the meetings and comradeship that make up these fellowships -- provide the spiritual, cognitive and behavioral tools to best recover from all the elements and effects of this disease. In addition, 12 Step programs offer us as recovering addicts a path to a serene and spiritual life.

Characteristics of addiction Addiction is defined by the six characteristics: Figure 5 : Characteristics of addiction

1. Chronic disease •

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Addiction is a chronic brain disease characterized by compulsive abuse of drugs in the face of harmful consequences. Over time, our brain structure and functions become abnormal. These changes can be long lasting, and are characterized by obsessive and deranged thought patterns and physical cravings. There is no cure for the disease of addiction, but as with other chronic diseases, it can be managed successfully and kept in remission on a daily basis. Similar to those who suffer from diabetes, asthma or heart conditions, as recovering addicts we must follow a treatment plan, which in our case usually means working the 12 Steps and attending fellowship meetings and activities.

2. Primary disease •

•

Addiction is a separate entity to itself and not the cause or offshoot of other diseases or conditions. We addicts do not develop the disease of addiction due to social, environmental, or biological conditions, although medical science has proven some factors such as genetics, may attribute to its development. We may start using drugs due to certain circumstances or medical conditions, but once the disease has developed, it becomes an entity of its own. For example, although a person may start using drugs to ease up their depression or chronic pain condition prolonged abuse eventually leads up to the disease of addiction. Bear in mind: that the 12 Steps provide a recovery plan for the disease of addiction only. Although their spiritual principles can be applied to help us deal with other life problems, the Steps are not a treatment plan for other primary diseases. For example, if you are suffering from a heart condition, then medical attention and relevant medication has to be taken regardless if you are in recovery with 12 Step programs.

3. Progressive & fatal o Disease of addiction is progressive in that it gets worse with time, never better. Neither does a period of abstinence make it safe to use drugs again. Experience shows that addicts who use drugs after a period of abstinence pick up exactly where they left off. o The consequences of not treating your addiction can be fatal in that you may suffer damage to the brain, liver, heart, and other organs – all the way to death through overdose. In addition, adverse effects on the addict’s brain and behavior can prompt suicide, homicide, and accidents -- and in general wreak havoc in the lives of users.

4. Obsession & cravings o One phenomenon of the disease of addiction is obsession. This is because drugs produce such intense and euphoric feelings that the addict wants to take more and more of the substance despite harmful consequences to themselves and others. o The addict’s craving to take drugs takes precedence over all other aspects of their lives, including their health, family, job, etc. Ultimately their only priority is how to find and use drugs. This is because of the effects and impact of drugs on the brain.

5. Insanity & denial • • •

• •

Chronic abuse of drugs disrupts the brain’s communication system, leaving us unable to distinguish reality from fantasy. This leads to us suffering from a defense mechanism called denial. Denial is a form of insanity because our way of thinking is neither whole nor logical. This makes it easier for us to continue using drugs because we are oblivious to the truth about our condition. Denial shows itself in many forms, such as rationalizing, intellectualizing, justifying or blaming others in order to use more drugs. Yet denial operates outside our awareness, because drug abuse has distorted our sense of reality and we are unaware that we are lying to ourselves and others. Denial is the number one obstacle preventing us from facing the disease of addiction. Many of us die in denial of the disease, and many must first hit rock bottom before admitting to a problem. Addiction is the only disease that prompts the sufferer to deny its very existence.

6. Unmanageable life The disease of addiction ultimately leads us to suffer many adverse consequences. In 12 Step programs these consequences add up to what is termed an unmanageable life. These adverse consequences can lead us to suffer from: o Mental consequences = psychosis, deliriums, depression, suicidal thoughts, etc. o Physical consequences = medical conditions or accidents, etc. o Interpersonal consequences = marital or family problems, child abuse, etc. o Social consequences = criminal activity, dishonesty, manipulations, etc. o Occupational consequences = loss of job, economic stature, homelessness, etc. o Financial consequences = loss or misuse of income

6- Signs of Addiction The disease of addiction has certain characteristic signs and symptoms. By understanding what these are, we can recognize whether we are suffering from it.  

Symptoms of addiction Signs of addiction

Symptoms of addiction General symptoms common to most addicts are: • • • • • • • • • • • • • • • •

Increase or decrease in appetite Change in eating habits Unexplained weight loss Need for money — or engaging in theft Chronic dishonesty Accidents Excessive desire for privacy, and finding yourself isolating Hyperactivity or compulsive talking A need to hide behaviour from others Depression & paranoia Erratic behaviour or violent temper Nervousness, irritability or mood swings Lack of motivation or discipline Changing friends to accommodate drug use Loss of interest in family, school or work life Failure to look after yourself

Please note — recognizing these symptoms in yourself does not necessarily mean you are an addict. The signs are simply general indications of the disease of addiction.

Signs of addiction According to the American Psychiatric Association, a person has developed the disease of addiction if their use of drugs has led to three or more of the following in a 12-month period: Figure 6 : Signs of addiction

1. Tolerance Tolerance is defined as a need for an increasingly larger dose of drugs to achieve the same effect or when the effect of drugs is markedly diminished with prolonged use.

2. Obsession Addicts become obsessed with repeating the experience of that first high and spend a lot of their time obtaining and using drugs.

3. Increase intake Another sign of addiction is doing drugs in larger quantities or over a longer period to achieve that first high – that feeling of euphoria.

4. Loss of control Addicts usually make unsuccessful efforts to cut down, stop, or control their drug use. They make repeated, genuine promises and resolutions to stop but cannot, because the disease has set in and they have lost the power to control their use of drugs.

5. Abuse despite harmful consequences Finding and using drugs takes dominance over the addict’s life despite harm to themselves and others.

6. Withdrawal symptoms Addicts suffer from withdrawal symptoms because drugs suppress the brain’s production of neurotransmitters, which are responsible for feelings of reward and pleasure. Withdrawal symptoms are painful physical or mental changes that occur when the body is deprived of the drug that it is accustomed to getting. Depending on the type of substance, withdrawal symptoms can appear from within a few hours to several days, and can last from a few days to a few months. Withdrawal symptoms vary with each drug. Some substances -- such as alcohol, opiates, and tranquilizers -- produce severe physical withdrawal symptoms, which can be dangerous and even fatal. Other substances -- such as cocaine, marijuana, and ecstasy -produce psychological withdrawal symptoms, which although very uncomfortable are not life threatening. Each person's withdrawal patterns and symptoms are different, and medical supervision is recommended if you decide to stop your drug or alcohol use.

Figure 7 : Withdrawal symptoms

Psychological Withdrawal Symptoms: o Anxiety o Restlessness o Irritability o Insomnia o Headaches o Poor concentration o Depression o Social isolation Physical Withdrawal Symptoms o Sweating o Heart Palpitations o Muscle tension o Tightness in the chest o Difficulty breathing o Tremors o Nausea o Vomiting, or diarrhea Dangerous withdrawal symptoms: Alcohol and tranquilizers cause the most dangerous physical withdrawals. Suddenly stopping these substances can lead to seizures, strokes, or heart attacks. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications. Dangerous effects of withdrawal are: o Grand mal seizures o Heart attacks o Strokes o Hallucinations o Delirium tremens (DTs)

1- Normal Types    

These types can use drugs occasionally for fun or on social occasions They can take it or leave it Feel the effect and don’t want anymore – Normal reaction Have power to control or stop

2- Heavy Types          

These types use drugs to cope with stress and pressure They use drugs to escape painful feelings After a while they need more and more for the same effect – develop tolerance They feel uneasy when drugs are unavailable They start to experience mental and physical deterioration Experience financial, social or marital problems Experience work or school performance deterioration They lose interest in simple pleasures They have a tendency to isolate themselves Given sufficient reason, have power to control or stop

3- Chronic Types Chronic addicts go through 3 phases as described below:

1st phase       

These types can never go back to Normal or Heavy types They experience intense euphoria and relief from drug use Their brain likes these intense & unnatural feelings and wants more Obsession develops – they want more drugs despite harm They use drugs to escape from or cope with life Drugs help them feel powerful and confidant They lose ability to Inability to enjoy normal activities

2nd phase           

Their brain’s structure and communication system becomes abnormal Insanity develops – they cannot distinguish reality from fantasy They use insane defence mechanisms to use more drugs The exhibit extreme personality traits Slowly their brain adapts to drugs & needs them to function normally – Tolerance They use more drugs despite adverse consequences – Allergy Their brain gets physically activated to want more drugs- Craving They neglect themselves & others They experience financial, legal, work and family problems They lose the power to control or stop their drug use Disease of addiction has developed

3rd phase       

They need drugs to survive Drugs take precedence over everything else in life They experience withdrawal symptoms if drug use is reduced or stopped They lose interest in life & have suicidal thoughts Repeated attempts to stop to no avail Their life in chaos & unmanageability Have lost power to stop or control – Powerless

8- Addiction cycle The diagram below illustrates how the disease of addiction affects both our mind and body. As chronic addicts, we get caught in a vicious cycle and are unable to break free on our own. Understanding this cycle will help us realize how this disease operates and why we need to look outside ourselves for a solution to recover. 1. 2. 3. 4. 5. 6.

Obsession develops Insanity develops Cravings develop Tolerance develops Experience hopelessness Reach rock bottom Figure 9 : Cycle of addiction

Note: this illustrations has used drugs as a way of example, you can replace it with your problematic substance or behaviour to understand the vicious cycle of addiction.

1st Obsession develops        

We experience intense reward & euphoria from using drugs Drugs help us cope with stress & problems We want to re-experience the first high again and again - obsession We take more & more for to achieve the first high Nothing brings us pleasure and relief except drugs We lose interest in everything except finding and using drugs Drugs become our number one priority in life We neglect ourselves and others

2nd Insanity develops      

   

Drug abuse disrupts our brain’s communication system Our thinking becomes distorted, illogical & abnormal – definition of Insanity We cannot make logical judgments or rational decisions We cannot distinguish between fantasy & reality – Denial We use defence mechanisms to abuse drugs despite harmful consequences – i.e. justifications, rationalizations, manipulations, dishonesty, minimization, intellectualization, etc. We develop extreme character traits such as: o Selfishness – want more & more to feel normal o Self-centredness - don’t care about anyone or anything except drugs o Grandiosity - I am better and smarter, I am different and special, and don’t need any help Our insane ways of thinking leads to destructive behaviours and actions, i.e. crime, violence Our life becomes more chaotic & unmanageable We cannot rely on our thinking to make a right decision over our drug use Self-reliance or our will power cannot help us

3rd Cravings develops     

Drug abuse changes our brain’s function and structure The way our brain nerve cells send, receive, and process information becomes abnormal Our brain becomes physically activated to produce powerful urges to use drugs regardless of consequences – definition of Cravings Slowly our brain becomes dependant on drugs to function normally As a result, we engage in shameful behaviours to use drugs for our survival

4th Tolerance develops       

Our brain adapts and builds tolerance towards unnatural chemicals / drugs We need more drugs to experience feeling normal – definition of Tolerance Our reaction towards drugs becomes abnormal – we take more despite harmful consequences- definition of Allergy Slowly we lose our emotions, feelings and morals Become prone to accidents or suicidal thoughts We experience withdrawal symptoms if stop using drugs We have now lost the power of choice and control over our drug use

5th Experience hopelessness        

We are not aware we suffer from a disease We believe we are bad & weak people We feel shame, guilt and regret over our drug use We are under the illusion we have power to control or stop our drug use - insanity We make sincere resolutions and promises not to use again We are always angry, restless and depressed We don’t know how to cope with life without drugs Our obsession with drugs is overwhelming

   

We are constantly craving more & more dugs Our body needs drugs in order to function normally otherwise will experience withdrawals We exercise will power and can stop for a while, but soon find ourselves using again We cannot understand why we can stop- have no power over our drug use.

6th Reach rock bottom   

This cycle is repeated over and over again until we reach rock bottom Many of us end up in institutions and asylums Many of us kill ourselves or die due to consequences of our addiction

THERE IS A SOLUTION: 12 STEPS         

Accept we are suffering from a disease Accept we have no power over our drug use Accept our life is unmanageable as a result of it Accept defeat, we cannot help ourselves Surrender and look for help outside ourselves Join 12 Step Fellowships to find hope and support Work the 12 Step as the solution for recovery from our addiction Experience a new way of life without drugs Live a life beyond our wildest dreams in freedom, peace and serenity

9- Addiction Test No one but you can say whether you are an addict or alcoholic. The best way to determine if you have a problem with substances is to find out for yourself. This test can help you do that. Answer yes or no to the following questions: Table 1 : Addiction test

If you answer yes to one question, it is a warning for potential addiction. If you answer yes to two questions, it is likely that you are an alcoholic or addict. If you answer yes to three questions, it can be assumed that you are addicted to alcohol and/or drugs.

Figures & Tables Figures Types of addiction ______________________________________________________________ 4 Mental symptoms of addiction ____________________________________________________ 7 Drugs change the brain's structure ________________________________________________ 12 Factors contributing to addiction __________________________________________________ 14 Characteristics of addiction ______________________________________________________ 15 Signs of addiction _____________________________________________________________ 17 Withdrawal symptoms __________________________________________________________ 19 3 types of users_______________________________________________________________ 20 Cycle of addiction _____________________________________________________________ 22

Tables Addiction test ________________________________________________________________ 25

About Hamrah Given that addiction is scientifically proven to be a disease, and the effectiveness of 12 Step programs towards recovery from it, Hamrah has been established to provide information on the disease of addiction, its various manifestations and its effects on family members. Our hope is to empower you with information about 12 Step programs and Fellowships so that you may find the means and the support to recover and live a new way of life free from addiction. The information provided, aims to empower: 1- People suffering from addiction, be it to substances or behaviours. 2- Addicts in recovery wishing to enhance their knowledge of 12 Step programs and Fellowships. 3- Family members and or friends seeking to recover from the effects of a loved oneâ&#x20AC;&#x2122;s addiction on their lives. 4- Community members interested to learn about the disease of addiction and recovery with 12 Step programs. 5- Professionals interested in enhancing their knowledge of 12 Step programs and Fellowships so as to support their addicted clients towards recovery.