Dear Readers:
We are privileged to have as a guest writer for this column Lew Abrams, a pioneer in social work with Jewish youth and chemical dependency. In this column, during the next three months, Lew will share with us what he has learned over the more than 40 years that he has been in practice. Here, in the first of the three articles, we will learn the facts about chemical dependency. In April we will learn about the common myths and misconceptions about chemical abuse/dependency and in May, Lew will discuss the challenges to the family that chemical dependency creates. As always, we welcome your comments and questions about this article.
Chemical Dependency 101: The Basics
By Lew Abrams, ACSW, LCSW, CASAC, CSAT
A most basic tenet of Yiddishkeit states that “Hashem created the world. For every problem, for every challenge, there is a refuah, a healing process because of His kindness.” The kindness comes in the form of recovery from the disease of chemical dependency, not only for those directly afflicted, but for their family members and others effected by this potentially fatal condition.
Allusions to chemical dependency are recorded in the Torah as early as Bereishis Chapter 9 Perek 20-21 “Noach, the man of the earth, debased himself and planted a vineyard. He drank of the wine…” As challenges arise in our culture, solutions are created. It is difficult to keep up with the advent of new, more complex challenges. However, great strides have been made in the field of chemical dependency treatment. The 12 Steps were introduced by two men who came together in Akron, Ohio circa 1935 to support each other in their efforts and ultimate goal to stay stopped from drinking alcohol. Today, these 12 Steps have blossomed into a model for countless varieties of compulsive behaviors. The evolution of a “12-Step culture” is helping millions of those effected directly as well as their family members. This article will present some salient components of chemical dependency, myths and misconceptions that must be exposed and a specific direction for parents of adolescents and young adults who are affected.
Some clarification of terminology is helpful before addressing the practical applications of this phenomenon. Various phrases such as substance abuse and chemical dependency are often used interchangeably with “addiction” and “alcoholism.” For the purpose of this article, the term chemical dependency is used interchangeably with alcoholism, addiction, drug addiction and substance abuse/dependency.
Yet the word addiction has many meanings and contexts:
Physical addiction: When a person experiences withdrawal from a substance, one is said to be physically addicted. Withdrawal involves a physical reaction when the chemical is removed from a person’s body, i.e. when a person suffers symptoms such as sweating, increased pulse rate, increased hand tremors, nausea or vomiting and/or anxiety.
Psychological/mental/emotional addiction: Although subjective, these words imply a need for a “mood changer” that becomes a driving force in a person’s psyche but is not necessarily physiological. Craving, expecting/in the habit of, i.e., various strong drives for a substance that will change a mood and may indeed be habit forming, for example, a person with social anxiety who learns that alcohol may alleviate the anxiety of being in a group of people, allowing that person to relax and socialize. This behavioral change associated with a substance (drinking alcohol) may lead to a psychological addiction.
In recent years, specialists have depicted addiction as pertaining to two subcategories: substance addictions, such as alcoholism and drug addiction, and behavioral or process addictions, such as gambling, sexual, spending money/debt.
Since 1948 when the American Medical Association named alcoholism a “disease” (“illness” is also used), professionals have defined addiction as a primary chronic, progressive, fatal (if left untreated) and treatable disease with a set of diagnosable set criteria and symptoms. Addiction has biological, psychological, social and spiritual variables. Extensive research supports that for some, a genetic predisposition for addiction exists.
As researchers continued this work, it became apparent that various myths and misconceptions existed in the general
public’s perception of alcoholism and other addictions. We must clarify and dispel these erroneous ideas about the topic or those individuals and significant others affected will resist proper pathways to treatment and recovery. Let’s look at some basic principles of “the disease of chemical dependency” and then some common myths and misconceptions of this disease.
Key Concepts of
Chemical Dependency
1. Chemical dependency is best described as an individual’s pattern of consequences that relate directly to their use and abuse of, and eventual dependency on, various mood-altering/habit-forming chemicals. The pattern may be inconsistent with periods of “controlled use.” Episodic use is another pattern. Consequences follow use.
2. Alcohol is the most common of these chemicals and is usually the first chemical individuals experience. In Judaism, alcohol is often introduced by way of religious rituals, holidays and customs. It is referred to as a “holy substance,” which is based on law (Halacha). In theory, children are to be taught there is a responsibility in using “holy substances.” This teaching and healthy role-modeling by adults doesn’t always happen. The child and adolescent may become confused. Most adults who drink do not have problems with alcohol. Studies agree that among the adult population, approximately 10% of individuals drinking do have problems.
3. Chemicals come in a variety of forms. Examples include those sold in stores (alcohol), medication prescribed by a healthcare professional, over-the-counter substances in pharmacies and groceries or those chemicals sold “on the street.” mood-altering/habit-forming chemicals may be drunk (alcohol), smoked (marijuana), ingested by swallowing (pills), injected (heroin which may also be smoked or snorted) or used intranasally or snorted (cocaine). Some prescription drugs used to treat psychiatric illness are highly abusable, e.g., benzodiazepines such as Xanax.
4. Chemical dependency is a primary disease. Naming chemical dependency as a “primary disease” means it is not simply a symptom of a deeper problem, of an underlying physical or mental health disorder. This clarifies that when someone has chemical dependency, it has become a problem in and of itself. There are many situations that constitute a co-morbid diagnoses, where a person has a combination of chemical dependency and mental health issues. Sometimes it’s clear which challenge appeared first. Other times, it is uncertain until an assessment reveals the order in which diseases were contracted.
5. Chemical dependency may have obsessive and compulsive characteristics. This does not mean it is the same as obsessive-compulsive disorder, a psychiatric anxiety diagnosis. When a person becomes dependent on a mood-altering/habit-forming chemical there is a loss of controlling the use of that substance. The idea of using these chemicals begins to dominate the person’s thinking (obsessions) and the actual use takes on a compulsive behavior style.
6. Chemical dependency is a progressive disease. Once a person has contracted the disease, there is a predictable, “natural history.” This does not mean everyone goes through the same timeline of consequences (loss). The progress rarely reverses itself. This is why individuals who realize they have a problem and become abstinent from using drugs and/or alcohol, and then return to use, eventually discover they are back in the same syndrome of suffering consequences from their use.
7. Chemical dependency has stages of progression: early, middle and late stages. In the early stage, the signs are subtle and often hidden. Individuals may be functioning in a school or employment capacity and they do not display overt, noticeable symptoms of the disease. Early-stage symptoms may include loss of self-respect, respect and trust of others and value violations, i.e., lying. As the disease progresses to the middle and late stages, defensiveness increases as do concerns from the family and social systems. Signs become more apparent, more concrete. Consequences are tangible Examples include various types of loss, e.g., relationships, driving issues, problems at work. In the late stages, health is deteriorating, legal problems may arise and the various types of loss are difficult to hide. A child can tell when someone is in the late stages of chemical dependency.
8. Chemical dependency is a chronic disease. Once a person becomes addicted to chemicals, they can no longer use drugs/alcohol safely. There are some exceptions, but these are few and far between. Many individuals who are in the beginning of coming face to face with a problem wish to be an exception, e.g., “I never had a problem with alcohol. It was opiates or marijuana that I abused. Why must I stop drinking as well?” The disease rarely goes away. It can, however, be arrested or put in remission.
9. Chemical Dependency is a fatal disease. Left untreated, the chemically dependent person usually dies prematurely. How long that process takes depends on the individual. AA speaks of three ends to active, untreated alcoholism: “jails, institutions or death.” Attempting to learn how to drink and/or drug safely seems to eventually lead to more and continued consequences with problem use.
10. Chemical Dependency is a treatable disease. It can be treated and arrested, and a person can be restored to a healthy and productive life. For many, a major part of recovery becomes the incorporation of spiritual components, sometimes in the beginning of the process and sometimes down the road. This may include but is not limited to new components of gratitude,
connecting with people and helping others in need. There are various approaches and treatment models but if people follow through, there can be a new life for those who participate.
Lew Abrams has over 40 years of experience in the fields of substance abuse and mental health treatment. He has created and directed programs at all levels of care including traditional outpatient, partial hospitalization, intensive outpatient and residential services throughout New York, New Jersey and Pennsylvania, including the well-known Yatzken Center for teens with addictions, sponsored by the FEFS/Jewish Federation of New York. Lew has specialized training in clinical supervision, group therapy, psychodrama, family therapy and experiential techniques including anger discharge and grief work. He currently is in private practice, with offices in New York and New Jersey. Lew received his BA in psychology from the State University of New York at Buffalo (1978) and his master’s degree in social work from Columbia University (1980). He has written numerous articles regarding substance abuse and mental health topics. Lew can be reached at 201-725-3627 or [email protected].
