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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 an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.  (ASAM, 2011)

The "Stages of Change" model was identified and developed during a study of smoking cessation (Prochaska & DiClemente, 1983), the model has been applied to and studied with numerous bio-psycho-social problems, including substance use/dependence, domestic violence, HIV prevention, and child abuse (Prochaska & Prochaska, 2009)  This model recognizes that different people are in different stages of readiness for change. It is important not to assume that people are ready for or want to make an immediate or permanent behavior change. By identifying a person's position in the change process, a worker can more appropriately match the intervention to the person's stage of readiness for change.

During the change process of Pre-contemplation (not ready), Contemplation (Getting Ready), Preparation (Ready), Action, Maintenance, most people will experience relapse. Relapses can be important for learning and helping the person to become stronger in their resolve to change. Alternatively relapses can be a trigger for giving up in the quest for change. The key to recovering from a relapse is to review the quit attempt up to that point, identify personal strengths and weaknesses, and develop a plan to resolve those weaknesses to solve similar problems the next time they occur.

The factors that keep people from seeking treatment are denial, shame, and fear.  What pushes someone past these elements to seek treatment are the “short window of opportunity” where they have a willingness to change and a desire for a better life.  Often the “window” opens up because of negative consequences referred to as hitting bottom (losing, or threat of losing, a job, a significant relationship, living situation, or legal/health factors).  All change is contingent on the possibility of moving to cessation of use and the development of supportive community and tools to stay abstinent.

Legal penalties can be a motivator for change initially.  The only problem is if the penalties are so harsh that they leave the person in a state of fear and/or shame sending them deeper into their use/addiction.  If legal consequences for use don’t include the opportunity for rehabilitation, the user is moved deeper into the core of what is causing them to use.

George Comiskey, Psy.D., LCDC, ICPS
Associate Director, External Relations

Center for Collegiate Recovery Communities
Instructor, Addictive Disorders Recovery Sciences
Communities Families and Addiction Sciences
Advisor-Association of Students About Service
Texas Tech University


Addiction is a biopsychosocial disease that manifests as a loss of control over the substance (i.e., alcohol or drugs)  or behavior (e.g., gambling) to the point that the individual uses the substance or engages in the behavior despite negative consequences (e.g., arrest, loss of family, job, finances).

Relapse, or use of the substance or engagement in the behavior after a period of abstinence such that the individual’s symptoms return.  Addiction is a “relapsing-remitting” disease.  This means that the norm is for individuals to abstain, then relapse, then have another period of abstinence, and so on.  Research demonstrates that following treatment for alcohol use disorder (“alcoholism”), about 80% of individuals relapse within one year.

A majority of people with problem drinking or drug use are able to quit without treatment.  However, around 10% of alcohol and drug abusers need psychological rehabilitation to attain abstinence, and these individuals typically have a host of issues, both psychological problems (e.g., psychiatric illness) and problems of living (e.g., criminal justice involvement, lost job), which make their addiction more severe and impairing.  Unfortunately, a majority of those individuals do not receive treatment.  A primary motivator for treatment is some sort of negative consequence.  This can be legal (e.g., arrest), social (e.g., loss of job or loss of relationship), or physical (e.g., injury or illness related to the addiction).  We often see people present for treatment who have NOT had a legal consequence.

I work with the McLennan County DWI Drug Court.  This program admits participants with misdemeanor DWI and/or violations of probation for failing a drug or alcohol test.  This particular program requires completion of an intensive outpatient substance abuse treatment program, aftercare as recommended by the treatment program, cognitive education for DWI offenders, and a required number of AA or other addiction treatment groups each week.  Participants give weekly drug and alcohol tests.  If a participant fails a drug test, miss a meeting, or violate some other condition of the program, s/he is sanctioned with either more treatment or a weekend in jail.  Participants in this program have lower rates of recidivism, and they cost the county much less financially than matched offenders who do not participate in our Drug Court.

This program demonstrates that mandated treatment, rather than a harsh criminal penalty, results in better outcomes for persons with substance use disorders.

Sara Dolan, PhD
Associate Professor and Graduate Program Director (Clinical Psychology PsyD Program)
Department of Psychology and Neuroscience
Baylor University