By Todd Valentine, LCSW

The Disease of Addiction

Addiction is a chronic, progressive, and deadly disease. It’s a disease that constantly demands more but is never satisfied. In seeking more of the substance, the addict creates a lot of disruption for everyone he or she comes into contact with, particularly within the family system.

The swirling chaos surrounding the addict is the result of trying to feed an emptiness that cannot be filled. The only way to stop this process is the radical shift in perspective and priorities that come through long-term recovery. To help facilitate that shift, the most loving thing that family members can do for their addicted loved one is simple: get out of the way. I should clarify that it’s simple to describe but often feels very difficult to do.

The best antidote to the family disease is setting healthy boundaries. By taking themselves out of the equation, families can stop providing fuel for the chaos. This is the most helpful action a family member can take because it gives the addict an opportunity to confront the reality of his or her disease.

The Effect on the Family

When we think about the miscommunication, constant emergencies, half-truths, outright lies, and continual stress circling around the addict, it’s helpful to use the analogy of a whirlpool. In addition, the brain is thoroughly “rewired” so that the addict is unable to tell the difference many times between self-preservation and self-destruction. Left untreated, the addict’s disease will progress further along in this process.

The change in the addict’s brain chemistry also changes his or her social interactions, centering them around supporting the addiction. This happens in even long-standing and committed relationships.  Consciously or unconsciously, the addict’s relationships will eventually become less important than the substance he or she is dependent on, which will in time become the highest priority.

Don’t Get Pulled In

Another way to put this is that the disease of addiction as it manifests in the addict is a disease of “more.” It demands more of the substance, and to support that overarching need, the addict will demand more money, more emotional support, more time, more of whatever’s available. Everything around the addict gets pulled toward supporting their addiction or getting them out of situations that their addiction has created.

Family members direct their money, energy, attention, and resources toward the addict and their day-to-day emergencies. Sometimes these actions may even seem to help, at least temporarily. But often these resources are not moving the addict toward treatment or a context that allows them to confront the reality of their disease. Rather the family members are helping them move further away from recovery by allowing them to deny the reality and consequences of their addiction.

To return to our analogy, the family members are pulled into the whirlpool of the disease. The entire family system becomes swirling chaos circling an emptiness inside of the addict that everyone is desperately trying to fill. As mentioned earlier, the emptiness can only be treated when the addict enters into recovery. If you don’t understand this process, it makes sense that you would attempt to pull your loved one out of the whirlpool and back on to the shore. But when family members attempt to enable rescue or control, they are venturing into waters that are too strong to go into alone.

By Kirsty D., MARR Alumnus

On August 25, 2008, I walked through the doors of MARR a broken twenty-two-year-old. After witnessing someone close to me die of an overdose and being arrested, my mom bailed me out of jail with a contract that read “I will go to treatment or go back to jail”. I quickly signed the contract and was immediately taken to detox. While in detox, my mom researched long-term treatment options.

I remember trying to persuade my mom to let me go to a 30-day treatment center after she had told me about MARR. 90 days seemed like an eternity! I had my life I needed to get back to. I was facing multiple court charges in several counties, had just been kicked out of my apartment and was in the depths of my disease. Alcohol and drugs were a necessity in order for me to function on a day-to-day basis.

I only agreed to come to MARR to get my mom off of my back and to get my court cases dismissed. I really had no intentions on staying sober. Thankfully, God had a different plan. I completed MARR’s halfway program and decided to stay in their three-quarters sober living. That was one of the best decisions I ever made. I ended up staying at MARR for a total of 13 months (even though 90 days was an eternity). At some point along the way at my time at MARR, I surrendered and decided to give recovery a shot. The little bit of willingness I had helped God work through me and changed my life forever.

Throughout my time at MARR I was given so many gifts. I learned about my disease and was introduced to a 12-Step program that offered a solution. I learned how to feel and sort through the feelings I had been stuffing for years and years. I learned how to have integrity and most importantly, how to have fun without drugs and alcohol. I learned how to love myself and how to be a good friend. My life isn’t controlled by when or how I’m going to get my next fix and that’s a miracle! MARR helped me grow up to become a healthier and happier woman.

I remember sitting in groups with alumni that had years of sobriety thinking how impossible it felt to get that much time. I wondered how I was going to get through my wedding without alcohol or go to a concert without getting messed up. They shared their experiences and gave me so much hope. I moved out of MARR into a house not far from the Women’s Recovery Center with three of the girls I lived with in three-quarters. Everyone joked and called our house four-quarters. We remained very involved with MARR for years.

Throughout the years, I still try to stay involved with the women in MARR. I have volunteered in the Thursday Spirituality Group up until I had my daughter 8 months ago, and I took a year off after I had my son, too. It was such a big deal for me to see the support the alumni gave me when I was in MARR, I really try to do the same. I want to show the new lady walking in, broken and sad like I was, that recovery is possible and a beautiful life is waiting for her if she is willing to do the work.

I got married in 2011 and had a DRY wedding. It was so much fun, filled with people in recovery. We danced the night away and alcohol wasn’t even a thought in my mind. I have two beautiful kids, who, God-willing, never have to see me drunk or high, as long as I continue to do the things I was taught when I first came in. I’m learning how to balance being a mom, a wife, an employee and a friend and none of that would be possible if it weren’t for MARR. As long as I make my recovery the top priority, my life will continue to be great. It’s like “they” say, my life isn’t always rainbows and butterflies, but I know today that a drink or drug will never make anything better, always worse.

I know, without a shadow of doubt, if it weren’t for MARR and the staff at the Women’s Recovery Center, I wouldn’t be where I am today. MARR saved my life and I will be forever grateful for their program.

Addiction is an isolating disease. Although drug and alcohol use may begin in a social setting, chemical dependency eventually results in isolation. To keep up with the demands of the addiction, a person necessarily detaches from family and friends. Seclusion triggers loneliness and depression, and the addict suppresses these painful feelings with drugs and alcohol. The cycle is relentless.

Clients are brought out of isolation as soon as they come to MARR. Our counseling staff helps the clients learn to facilitate healthy relationships through the use of the community model. Community members share their life stories with one another, assist housemates in developing a contract of personal goals, and attend 12-Step meetings as a group. 

Even seemingly insignificant tasks take on a therapeutic dimension. Grocery shopping, cleaning, or figuring out transportation provide opportunities to practice honest, respectful communication as a way of life. The constant practice the clients receive through navigating daily community life at MARR allows them to carry these skills back to their families, professional settings, places of worship, and any other communities they participate in.

We want our clients to take the relationship skills they learned at MARR into their lives outside of treatment. But that transition is painful and also frightening for the client. The bonds that clients form during treatment are strong. They create a sense of safety.

Fortunately MARR maintains a strong alumni network and clients frequently maintain their relationships with fellow alumni and counselors after completing treatment. But what those relationships look like will change when they are no longer in treatment. Their counselors and community members will still be available to them but will not be the constant presence that they were in treatment.  

Acknowledging that the relationships they have formed are going to look different as they transition out of treatment is a difficult process. But rather than avoiding that pain and allowing clients to slip out unannounced, we emphasize the importance of saying goodbye.

We believe meaningful goodbyes at the end of treatment honor the healthy relationships that have been established. Thoughtful, intentional goodbyes allow for reflection and an appreciation of the importance of connection in their recovery. Goodbyes also provide necessary closure for the recovering addict and community members. Emotional wounds surrounding abandonment are common among addicts and alcoholics; therefore, verbal farewells appropriately acknowledge the relationships and the connections made.

During Goodbye Week, the clients address each person (including volunteers and counselors) in every group throughout the week prior to successfully completing the program. Once the client reflects on what that individual has meant to him or her during treatment, the addressee reciprocates. Both parties feel a sense of loss but also liberation from the meaningful exit.

Life is full of changes. To the recovering addict, change yields fear; fear can lead to relapse. Saying goodbye is an important part of relationships. MARR offers the opportunity for clients to experience healthy relationships and goodbyes, both of which are vital for lasting recovery.

By Jim Seckman, MAC, CACII, CCS

Is addiction a disease? Is addiction a choice?  These are good questions, and ones that require careful attention to the nature of disease in general. We must also look at what the addictive process does to the alcoholic or addict.

What is a disease?

Before we begin with sorting out whether or not addiction is a disease, it is important that we are clear on how we define the term disease.  From a physiological perspective, a disease is when an organ or a system within the body gets a defect. This defect in turn causes symptoms within the body.

What kind of disease is addiction?

Addiction is a disease of the brain. Using drugs and alcohol will affect every system and organ within the body, but the primary organ affected is the brain. Drugs and alcohol affect the dopamine levels in the limbic system, the brain’s primary home to our emotions and memories. Substance use increases dopamine levels to such a degree that the dopamine channels are flooded in connection with the use of the substance. The overwhelmingly pleasurable memory of use gets permanently locked into the memory of the addict or alcoholic.

This activity makes such a significant impact that the rational part of the brain, the prefrontal cortex, is overwhelmed by the surge of dopamine. It then mistakenly classifies drinking and drug use alongside the survival behaviors, like eating, reproduction, or taking care of one’s children. The brain is “hijacked” to such a degree that when the disease of addiction is active, the craving for alcohol or drugs will supersede the other survival instincts.

But didn’t they choose to drink or use?

Yes and no. At some point there was choice involved, but eventually choice is removed. The fellowship of Alcoholics Anonymous has a long-held saying: the first drink is a choice, and the rest of them aren’t. Science has shown this to be true.

Because of the changes in the brain noted above, at some point, a substance that was formerly a choice so overpowers the brain’s original “wiring” that the brain begins to perceive the substance as a means for survival.

Here’s where it gets a little confusing. A person may be in remission (or recovery) from the disease after abstaining from substance use for a certain period of time. However, once an addict or alcoholic uses again, the disease is reactivated and the “rewired” survival system kicks in. Choice is once again removed from the equation.  

What about “real” diseases like cancer or diabetes?

Simply because addiction is a brain disease and the symptoms may not be readily apparent does not make it less of a disease. An organ in the body (the brain) is damaged by substances. When someone is diagnosed with diabetes we don’t determine whether or not it is a disease by looking back at their diet up to that point. Similarly, a lifelong smoker diagnosed with lung cancer still has the disease of cancer because the lungs have been damaged by a substance.

Does that mean that they cannot be held accountable for their actions?

Absolutely not. In fact, for recovery to be possible it is essential that a person take responsibility for their actions. Even though though they committed these actions while influenced by a chronic and progressive brain disease, responsibility for their actions is the means by which the addict and alcoholic can begin to sort out the true from the false. With the help of their sponsor, the counseling staff, and their community, they can begin to distinguish the difference between their actual survival instincts, which are necessary, and behaviors that their brains have only deceived them into believing are helping them survive, but in actuality are only servicing the fatal impulses of the disease.  

Coming to terms with this accountability while also recognizing the reality of the disease is an emotionally charged and difficult process.  Working the 12 Steps masterfully leads a person through this process. In many cases, our alumni will state that they didn’t realize it at the time, but now believe that they needed the structure of  MARR–which includes the accountability of their process groups, community, as well as the residential, counseling and medical staff–to support them through the process of working the steps.

Addiction is a disease, but recovery is possible. 

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Addiction is a family disease, and one of the most important steps to take in recovery is setting boundaries.

Addiction is a disease of isolation.  It relentlessly crosses boundaries, threatens relationships, and causes chaos. But you do not have to sit idly by and watch destruction happen; there are healthy steps that you can take in your own recovery. Just as an alcoholic or addict must learn to set boundaries, so do the people who love them.

We tend to hope that over time, change will naturally happen for the better, but the truth is that most change requires work. There is a common saying within the counseling profession: “If nothing changes, nothing changes.” If we do not put in work and take action toward the things that we want, we will, for the most part, stay stuck in unhealthy cycles and toxic patterns.

Addiction almost always coexists with codependent relationships. Codependency develops out of a deep desire to care for someone else, and in doing so we end up trying to fix their problems and manage external circumstances. Codependency becomes an unhealthy way to deal with our negative feelings by pouring ourselves into making sure that our love one is “okay.” Creating boundaries helps us find healthy coping skills and teaches us how to care for ourselves.

Why family members need boundaries

If you are a family member who feels ready to sacrifice everything in an attempt to save your addicted loved one, you are not alone. The power of love and compassion that lives inside of you is real and it is important, but you must first take care of yourself by establishing and enforcing boundaries.

Boundaries help us define who we are, what we value, and what kind of future we are working towards. They regulate our emotional, physical, and spiritual health. They help us express what is acceptable and what is not acceptable, and they help us define what we need within our relationships.

Think about the instructions that you are given about oxygen masks on airplanes. If cabin pressure changes, masks will drop down from the compartments above; make sure to secure your own mask before helping others. You have to take care of yourself in order to effectively help the people you love. Living in a constant state of self-sacrifice will lead us to continue repeating unhealthy cycles of behavior.

If you’re a family member of a person with an addiction, you don’t have to wait for your loved one to hit rock bottom or go to treatment before you set boundaries. Although it may seem counterintuitive, creating boundaries may be the best thing you can do for your loved one. It may frustrate them or cause them to be angry at you for a time, but a lack of boundaries is what enables an addict or alcoholic to continue down the same path.

Why the addict needs boundaries

It takes two people to make a codependent relationship. For this reason, boundaries are a two-way street.  Just as the family member becomes consumed by the addict’s emotional ups and downs, the addict also learns to hyper-focus on their loved one’s emotional state, even if their actions may seem to indicate otherwise.

The addict can become so wrapped up in hiding their addiction from their loved ones or reacting to them, that they lose sight of what is going on for them in this moment and finding a healthy way forward.

Once the substance is removed, these difficult feelings about their relationships with loved ones often intensify and the need for boundaries becomes even more apparent.

People struggling with substance abuse often find themselves overwhelmed with shame. Yes, their actions in addiction have negatively affected their loved ones. Healthy remorse about these actions can certainly help bring change, but shame is crippling and undermines recovery.  Addiction has a way of writing a shame-based story and trapping the person within it.

Boundaries It often leads to hyper-focusing on what the person believes others perceptions of them to be, rather on what the person in recovery actually needs. Boundaries serve as a healthy tool for redirecting the person’s attention to what they can control.

Boundaries are building blocks

This is not a quick fix. You cannot set a boundary today and expect your loved one to stop drinking or using tomorrow. Boundaries are a foundation for a healthy relationship, and they take time and practice. Each time we honor our boundaries, we are laying a brick in this foundation, and over time it becomes more sturdy and substantial.

It is important to know that boundaries are not about changing someone else’s behavior – that is impossible. Rather, they are about creating healthier versions of ourselves, because healthy relationships are the best thing we can offer to our addicted loved ones.

Communicate your boundaries effectively by stating your feelings, needs, and actions.

• “When you [behavior], I feel [emotion].
• “I prefer/want/need [specific action].
• “If you continue [specific behavior], I will [specific action.]

Maintaining fierce boundaries does not mean you stop loving someone or that you are not compassionate. It is actually an act of love.

You may need to set boundaries if:

• You are doing things for your alcoholic/addict that they are able to do for themselves.
• You are doing things for your alcoholic/addict that they did not ask you to do.
• You think that you may be in a codependent relationship

So, what boundaries should we set? There is no formula for boundaries; they are different for each person and each relationship. Although this may seem frustrating, it may also be hopeful. There is no other relationship in the world that is exactly like yours, and boundaries are something to be explored and discovered. They may take some experimenting, some trial & error, and some patience.

But you are not alone. Find the kind of support that you need while you are making these changes. Look into local family support groups, and know that addiction does not have to be a point of shame. Find a counselor or therapist that you trust. Take time and space to do something that brings you peace and joy.

Additional resources on boundaries:

• Setting Boundaries with Your Adult Children: Six Steps to Hope and Healing for Struggling Parents – Allison Bottke
• Codependence and the Power of Detachment: How to Set Boundaries and Make Your Life Your Own – Karen Casey
• Boundaries: When to Say Yes, How to Say No to Take Control of Your Life – Dr. Henry Cloud and Dr. John Townsend
• Boundaries in Marriage – Dr. Henry Cloud and Dr. John Townsend
• https://al-anon.org/
• https://www.nar-anon.org/