Over the last two decades, addiction professionals have learned a great deal about the progressive symptoms of alcohol and drug addiction. Up until this time, the Jellinek Chart, had been a useful graphic representation of the symptoms of Gamma Alcoholism developed by Dr. Glatt and originally published in the British Journal of Addiction. Although much of the recent research supports the Jellinek symptoms of addiction, the new biopsychosocial research gives us a new perspective on the progressive symptoms of addiction. This new perspective is useful in prevention, the treatment of adolescents, and early identification programs for adults.
Given the advances made in understanding addiction as a brain disease with biopsychosocial symptoms, we have the opportunity to create a new and improved symptom list for teaching our clients and family members to understand and recognize the symptoms of addiction. The following symptoms support the science-based understanding that addiction is a biopsychosocial brain disease. The symptom list, however, is presented in clear and easy-to-understand language so it can easily be used as a teaching or recovery tool.
The symptom list below was developed from two sources: (1) a comprehensive review of published neuropsychological symptoms of addiction; and (2) informal focus groups with recovering alcoholics and addicts who helped provide simplified language to describe these new symptoms. I hope these symptoms will prove to be a useful tool in teaching recovering people and their families about the progressive symptoms of addiction to alcohol and other drugs.
To use these symptoms to better understand you addiction read each paragraph and check that symptoms that you have experienced in the course of you life. Then discuss the symptoms and both the pleasant and pleasant consequences they produced. Remember that symptoms since as the Low-Grade Agitated Depression may appear before substance use and the substance of choice may act as medication in normalizing the symptom and cause a pleasant state of euphoria.
1. Chronic Low-Grade Agitated Depression: Many people are predisposed to addiction because they have abnormally low levels of brain reward chemicals that stabilize their mood, regulate anxiety and depression, and increase the potential for feeling satisfied and content. People with this brain chemistry imbalance experience chronic states of low-grade agitated depression and a tendency toward mood swings triggered by relative minor events. This makes the person chronically uncomfortable and creates a strong need for relief. They feel the urge to find something, anything that will relieve this state. This low-grade agitated depression can vary from mild to severe.
2. Biological Reinforcement: Most people in the American culture begin to experiment with alcohol and other drugs as a normal part of custom and cultural pressure. Those experiencing the predisposing agitated depression find a drug that activates a massive release of brain reward chemicals causing an intense feeling of euphoria and personal well-being. For the first time, the person’s mood normalizes and they feel good. They can experience pleasure. Whatever feelings they are experiencing prior to using this particular drug, which we will call a drug of choice, become normalized. As a result, the drug of choice can be used as a medication for managing feelings, emotions, and bad moods.
3. Euphoric Recall: The biological reinforcement creates a positive emotional and neurological experience. The memory of this experience is stored in sensory memory as a positive experience of euphoria. People then distort the pleasant memory by using an irrational thought process called euphoric recall which exaggerates the memory of how good the experience felt while blocking out or minimizing any negative aspects of the memory. This sensory memory of the euphoric experience stimulates the limbic system to develop an emotional urge to repeat the experience. This emotional urge, as it grows strong, can activate a primitive tissue hunger for the drug which is called craving.
4. Positive Expectancy: We begin to create idealized fantasies about how good it will feel to use the drug of choice. We begin to imagine the details of how this state of euphoria will feel. We have a strong expectancy that the drug of choice will change our mood in a positive way. This expectation causes craving (an overwhelming and intense desire for the drug of choice). The craving motivates us to begin seeking out the drug of choice.
5. Awfulizing Abstinence: We notice how uncomfortable we feel and how little pleasure we’re able to experience when not using the drug of choice. We also find that our agitated depression comes back when we’re not using our drug of choice and that we have difficulty thinking clearly, managing our feelings, and remembering things. The longer we stay away from our drug of choice our stress increases until we can’t relax and we have trouble sleeping. We also begin to Awfulize Abstinence being away from our drug of choice by exaggerating how bad it feels and blocking out or minimizing any positive experiences we have when we’re not using. As a result, we develop a negative expectancy of what abstinence from our drug of choice will be like and attempt to avoid abstinence whenever possible.
6. Regular Use: We begin to use our drug of choice on a regular and frequent basis in order to experience euphoria and to avoid the discomfort of being without our drug of choice.
7. High Tolerance: It takes more of our drug of choice to create the desired feeling of euphoria. We’re also able to use larger amounts of our drug of choice without becoming intoxicated or impaired. As a result we can use frequently and heavily without apparent adverse consequences8. Hangover Resistance: We experience minimal sickness the morning after using alcohol and other drugs. This rapid recovery allows us to use our drug of choice frequently. It also creates the illusion that it’s safe to use our drug of choice and that there will be no adverse consequences.9. Addictive Beliefs: We develop three firmly held beliefs as a result of our reactions to using or not using our drug of choice:
(1) Using my drug of choice is good for me and will magically fix me and solve my problems. This belief develops because the biological reinforcement makes us feel so good, our high tolerance protects us from problems caused by intoxication, and hangover resistance let’s us feel good the next morning.
(2) Not using my drug of choice is bad for me. This belief develops because of how badly I feel and how poorly I am able to function and relate to other people when I’m not using my drug of choice.
(3) People who support my alcohol and drug use are my friends. This belief develops because I like and need to use my drug of choice. Anyone who supports me in getting and using the drug that makes me feel so good and magically fixes my problems must be my friend.
(4) People who don’t support my alcohol and drug use are my enemies. This belief develops because I feel so bad and function so poorly when I can’t get my drug of choice I start to believe anyone who would take this magical drug away from me, limit my use, or make it hard for me to get must be my enemy.
10. Obsession & Compulsion: We begin to spend a large amount of time thinking about how good it is to use our drug of choice and how bad we feel when we’re not using it. These thoughts become obsessive and begin to intrude into moments when we would be better off thinking about other things. These obsessive thoughts cause us to feel a compulsion or a strong urge to use our drug of choice. Eventually our brain chemistry is altered by our addiction to our drug of choice and our obsession (thinking about our drug of choice constantly) and our compulsion (wanting to use our drug of choice as often as possible) escalates into a craving (our brain tells us we need to use our drug of choice in order to survive.
11. A Pattern of Heavy and Regular Use: We begin to use our drug of choice regularly and heavily. We develop a strong habit pattern of drug-seeking behavior that becomes routine rituals of getting our drug of choice, preparing to use it, using it, and recovering from its use.
12. Addictive Lifestyle: We start to attract and feel attracted to other people who share our strong positive beliefs about using alcohol and other drugs. We begin to change the routines of our lifestyle so we can spend more time around people, places, and things that support the use of our drug of choice. As a result, we become immersed in an addiction-centered subculture and social network that supports our strong positive attitudes toward alcohol and drug use and reinforces our dislike for anyone who criticizes our drug use or tries to make us stop.
13. Addictive Lifestyle Losses: We distance ourselves from people who support sober and responsible living. We surround ourselves with people who support drinking, drug use, irresponsibility, and criminal activities. As we get totally involved in our addictive lifestyle, we begin to lose the important people and activities that used to be important to us and give our lives meaning and purpose. We give up our relationships with family and long-term friends. We avoid positive activities that we used to enjoy and value.
14. Loss of Behavioral Control: We begin to use larger amounts of our drug of choice with greater frequency. We start having problems with our judgment, impulse control, problem solving, and ability to think rationally and effectively. We start making stupid mistakes that gets us into trouble. We also start to have physical, psychological, and social problems that keep getting worse.
15. Denial: We become unable to recognize the pattern of problems related to our use of alcohol and other drugs. We begin to lie and con other people and then we start believing our own lies. We develop an unconscious denial mechanism that protects us from experiencing the pain of facing the progressive pattern of severe problems we are experiencing. We avoid thinking and talking about our alcohol and drug use and the problems they are causing. When questioned about our alcohol and drug use we absolutely deny that we are worried or that there are any problems. When confronted with alcohol and drug-related problems, we minimize how serious the problems are and convince ourselves that the problems are being blown out of proportion. We rationalize by developing good reasons for drinking and drugging, good reasons for having the problems, and good reasons for not trying to stop. We also start blaming other people by believing that they are responsible for causing our problems
16. Progressive Neuropsychological Impairment: The progressive damage of alcohol and drugs to the brain creates growing problems with judgment and impulse control. As a result our behavior begins to spiral out of control. Our cognitive abilities that we need to think clearly and solve problems become impaired. We get locked into a repetitive pattern of behavior marked by denial, circular reasoning, blaming, and more frequent and heavy use of alcohol and other drugs.
17. Degeneration: We begin to experience physical, psychological, and social deterioration. Unless we have sudden insight into how bad our problems are, or somebody confronts us with our problems, we are likely to continue until we have serious damage to our health and our lives.
18. Inability to Abstain: The problems get so bad that we decide to stop but no matter how hard we try we can’t stay stopped. When we try to abstain, we go into serious acute alcohol and drug withdrawal. If we get through that, we find that we are suffering from long-term post acute withdrawal caused by the damage chronic alcohol and drug use has done to our brains. In addiction, the low-grade agitated depression and the inability to experience pleasure from normally pleasurable experiences return. This combination of problems causes impaired judgment and impulse control. When coupled with the addictive belief system and the deeply ingrained pattern of obsession, compulsion, and craving we find ourselves unable to maintain abstinence and we relapse. (Terence T. Gorski)
At the Gorski Relapse Prevention Certification School, Part of the first day is used to show participants how to use a check-list of Biopsychosocial Symptoms to identify the active symptoms of addiction that may follow them into recovery. They are also give an assessment tool that allows the concurrent evaluation of The CAGES questionnaire, The DSM-IV-TR, and the DSM 5. This allows for both a comprehensive integrated assessment of addiction symptoms, cross-verification of the addition and its severity, and a clinical self assessment tool designed to surface symptoms that could linger to become early relapse warning signs.