People with addiction as well as their friends and families often struggle with determining whether addiction is a personal choice or a complex brain disease.
For addiction expert Kevin McCauley, M.D.—himself in recovery from opioid use disorder—that is the most fundamental question about addiction: is it really is a disease? As he explains he himself was skeptical at first when people told him addiction was a disease. Don’t addicted people make the deliberate choice to harm themselves?
But the more McCauley learned about addiction, including his own, the better he understood that it’s not a choice-versus-disease dichotomy but that addiction is a disease of choice. “It’s a disorder of the very parts of the brain we need to make proper decisions,” he says.
It is very important for everybody involved to understand this basic concept of addiction because it is also a family disease: the family of the addicted person needs to heal, too. In the family program of the Farley Center, concerned family members have the opportunity to understand addiction as a multidimensional disease with biological, psychological, social, and spiritual aspects affecting the entire family system, explains Garry Spain, Farley’s director of business development and clinical services.
There are biological factors: genetic predisposition and individual high-versus-low response to addictive substances can make a big difference. Medical issues can also be contributing factors and there are medical consequences reinforcing the addiction, for example, when certain parts of the brain go “offline” due to the overstimulation and reprogramming of the reward cycle.
Frequent psychological factors are underlying mental health issues such as anxiety, depression, personality disorders, and trauma. Although addicted individuals may intend to self-medicate the symptoms of these conditions, they end up actually intensifying them. This feedback loop needs to be addressed in treatment.
The social dimension of addiction includes a tendency to isolate from others and to violate social norms leading to severe relationship problems, something family members are usually acutely aware of but don’t know how to fix.
Finally, there is a spiritual dimension of addiction. People with a substance use discord often feel hopeless and perceive their life as meaningless. They feel lost and are unable to connect to something bigger than themselves.
It helps the recovery process enormously if family members understand these aspects of addiction correctly because it is the foundation on which they can build support for their addicted loved one. The family system as a whole can only heal if everybody understands what’s going on and acts accordingly.
Due to the COVID-19 pandemic, Farley’s in-person family program had to be temporarily suspended. The Farley Center is now offering an online program to assist family members in learning about addiction and coping with its consequences.