A serious condition with many faces
As part of our information series, we regularly address topics of medical and social relevance. In this article, Marianne Umaña and Max Kälin discuss the topic of addiction from a professional perspective.
What exactly is an addictive disorder? Which substances or behaviors can be addictive? And how do such disorders develop and progress?
The following Q&A provides well-founded insights into the complex issue of dependency – with a special focus on physical, psychological, and social impacts.
Questions (Q): Marianne Umaña
Answers (A): Max Kälin
- Q: What is addiction?
- A: Addiction is a derailed desire – a need that has spun out of control. The spectrum ranges from occasional use to life-destroying dependence.
- Q: What can one become addicted to?
- A: To a great many things. First, to substances: alcohol, nicotine, and tetrahydrocannabinol (THC) are often visible and sometimes socially accepted. Party drugs such as MDMA or LSD, medications like benzodiazepines, as well as opioids, cocaine, and stimulants such as methylphenidate (MPH) are usually less visible but often far more dangerous. Behind all these substances are powerful industries that promote addiction and exploit those who become dependent.
Beyond that, there are mental or behavioral addictions: work, sex, sports, eating behaviors, beauty ideals, spirituality – practically anything can become an addiction.
- Q: What happens to the body and mind?
- A: Physically: Intravenous use or unprotected sex can lead to infections like HIV, hepatitis B, or hepatitis C, and also parasitic diseases such as scabies or lice. Psychologically and socially: Social withdrawal and isolation, bonding with others in similar situations, and constant pressure to obtain substances foster fear and vulnerability to blackmail. Life becomes a prison.
- Q: How does an addictive disorder begin?
- A: Often gradually, in a social setting, with a positive mood. Sometimes it begins abruptly, as with heroin. The transition from occasional use to dependence often occurs step by step, yet inexorably.
- Q: How does an addictive disorder develop?
- A: Use changes from occasional to regular and compulsory. One’s thoughts and feelings revolve around the addictive substance or behavior. The addiction becomes the “boss” of life. Loss of control: addiction becomes the focus of one’s existence. Tolerance development: one needs more and more. If one falls below the “maintenance dose,” an agonizing craving arises. Obligations are neglected; even harm or guilt does not change this pattern.
- Q: What are the causes?
- A: Often a combination of individual, family, social, and biological factors. There may be genetic predispositions, mental illnesses such as depression, anxiety disorders, eating disorders, early childhood or later trauma. But one thing always applies: without availability, the addiction cannot manifest. Even animals sometimes get intoxicated on fermented fruits. The desire for intoxication could be tied to a biological mechanism.
- Q: What can be done?
- A: Seek help – first from people you trust. True friendship means providing support without judgment, no scolding, no humiliating. The most important remedy: warmth, security, and a sense of safety. However, genuine friendship is rare.
- Q: What role does medicine play?
- A: Medicine can contribute in several ways: Medication-assisted treatment, including substitution. Protection through harm reduction. Achievable, small therapeutic steps; unrealistic expectations and pressure are detrimental.
- Q: How should one approach people with addiction?
- A: With empathy, not judgment. With trust, but recognize that frequently this trust may be broken as part of the disease – people with addiction can’t act otherwise. With control, but only as much as necessary. Physically: relieve pain and withdrawal symptoms. Psychologically: manage despair, foster motivation. Socially: help build a daily structure, find housing and work.
- Q: And you personally?
- A: I have been caring for people with addictions since 1987, back then at the Baylor College of Medicine in Houston: methadone substitution for heroin-dependent patients and withdrawal treatment in newborns. I have always treated marginalized individuals as well. Marginalization and addiction often go hand in hand. People with addictions can develop very complex physical illnesses. Since I have worked for decades, I have treated many of these very complex patients and know how fragile they can be. In addition to broad somatic experience, I hold the SSAM certificate for addiction disorders (recognized by the SIWF).
My goal is to reduce fear and provide protection. Addiction also stresses the immune system. It suffers alongside, and starting at around age forty, people with addictions begin to die off; the immune system gives out. I am glad for every small step forward my patients make – and I know how serious this disease is.