According to the American Society of Addiction Medicine (ASAM), addiction is characterized by:
“an inability to consistently abstain, impairment in behavior control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”
The “inability to consistently abstain” is a concept that sometimes confuses loved ones and family members of addicts. They wonder, “How can we ever expect the addict to establish and maintain sobriety if ‘addiction’ means that’s something he can’t do?”
This confusion is understandable. What ASAM really means is that on their own addicts lack the ability to consistently abstain from addictive behaviors. They struggle to establish and maintain sobriety without help. Most addicts would stop their compulsive behaviors on their own if they could, but they can’t.
An addict’s inability to establish and maintain sobriety manifests in many ways. For instance, he might make promises to himself and others (loved ones, employers, the legal system, etc.) that he won’t engage in a particular behavior again, or he might promise himself and others that after a certain date in the future he will significantly cut back or quit altogether. However, these promises are rarely kept, even when the addict feels deep shame about his behavior.
Worse still, the addict’s craving for his “drug of choice” (whether it’s an addictive substance or an addictive behavior) increases over time. The addict experiences an increased tolerance, and this causes his addiction to escalate.
If he’s an alcoholic, he may require more drinks or stronger drinks to get the same level of intoxication. If he’s a drug addict, he might take more of a substance or a stronger substance, or he might ingest a substance in a way that gives him a faster and stronger high (like crushing pills and snorting them instead of swallowing them). If he’s a sex addict, he might spend more time engaged in a certain sexual behavior, or he might engage in increasingly more intense and/or risky sexual behaviors to get the desired high.
Over time, addicts develop chronic feelings of low self-worth. These feelings are caused by a combination of unresolved childhood issues, their inability to quit the addiction, and the secret, consequence-filled double-lives they lead. Typically, their relationships suffer, they have trouble at work or in school, they struggle with money or experience legal problems. And all of these issues tend to increase their shame and diminish their already low self-esteem.
This, of course, drives an addict right back into the emotional escape his addiction provides. This is the cycle of addiction. The addict feels shame, stress, anxiety, or some other form of emotional discomfort; he self-medicates, using his addiction to temporarily escape his feelings; and then he feels even worse because his life is out of control and filled with an escalating series of problems. Then he escapes his emotional discomfort by self-medicating yet again.
This is why it’s so hard for an addict to establish and maintain sobriety without help. It’s also why addiction is considered a lifelong, chronic issue similar to heart disease and diabetes. This means that addicts are never actually cured. Their addiction can, however, be managed with ongoing guidance and support, usually in the form of psychotherapy, addiction-focused counseling, 12-step groups, and, in more serious cases, inpatient treatment.