If you ask an addict why he takes drugs, he is likely to say that he likes, or enjoys them. To someone who has witnessed an addict's behavior that may seem astounding, even impossible, but it's true. In The Essentials of Chemical Dependency, the McAuliffes have examined and isolated the essential factors of addiction-those characteristics which all addictive behaviors have in common. The most amazing characteristic of all is that addiction is a love relationship. Robert and Mary McAuliffe have defined it this way: "Chemical dependency is essentially a committed pathological love relationship to a mood altering chemical substance."
The first edition of The Essentials of Chemical Dependency grew out of materials assembled for a college course that trained specialists in chemical dependency treatment. This book is the second edition, expanded and improved. It examines in detail the nature of chemical dependency, its pathology, its causes, and its diagnosis.
The McAuliffes conclude that chemical dependency is a disease. Some would say it is a choice, but choice does not apply to the addict. It applies only before addiction. Once the love commitment is made, reason and choice are not available. The shift is made to emotional compulsion. The addict is now in the grip of an emotional commitment that warps reason and restricts freedom of choice. A rigid defense system is also produced, warding off any interference with the addict's behavior. And the seal is set to the situation by delusion. The addict's perception of reality is distorted, which further impairs his reason and judgment. If these elements were mildly present in a love relationship between a man and a woman, it would be normal, even comical. But in a love relationship to a chemical it is disastrous, producing a debilitating downward spiral, toward both personal and social disorder and destruction.
"We know that things are when we perceive them directly in their existential reality," The authors write. "But our minds do not rest with knowing that things are; we are not mentally comfortable until we come to know why things are." Along with providing the specifics of chemical dependency, the McAuliffes have inadvertently supplied an excellent view into how the mind works. In the process of describing chemical dependency we are also shown an excellent model of mental processes: intellect and emotion, reason and will, freedom and dependence. The truth of the principles discovered in examining chemical dependency is shown by their application to other domains. Though the book is specifically about drug addiction, the value of these insights into psychological processes is considerable.
The Essentials of Chemical Dependency is not a self-help book designed for popular entertainment. It is scientific in its thorough approach, and to the average reader may seem a bit redundant as it examines every facet of the addict's attitudes and behaviors. However, those who are willing to make the effort can gain a deep understanding of these baffling, aberrant behaviors. This would be an excellent choice for a college text.
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The Essentials of Chemical Dependency Toward a Unified Theory of Addiction
By Robert M. McAuliffe Mary Boesen McAuliffe AuthorHouse Copyright © 2007 Mary Boesen McAuliffe
All right reserved.
Chapter One The Essentials Approach
Chemical dependency is a complex disease in the way it affects the whole person and every aspect of his or her life and being. It is no wonder then that when people speak or write about alcoholism and the other drug dependencies, they display a tendency to address themselves to unknowns and to focus attention on uncertainties. Even a matter as basic as defining the nature of addiction, as we have seen, raises a cloud of questions and concerns. This leaves readers and listeners with the impression that little of value or use has been discovered in the field and that what is known is highly uncertain, mere guesswork, doubtful assumption, and subjective opinion.
The opposite, of course, is true. Much has been discovered about addiction by experts in the field. The fact that there is more to be learned does not diminish in any way either the amount or the value of what is already known. It seems to us that the body of knowledge that exists should be shared with a wider audience. This knowledge should become the common property of the general public, while exploration of unknowns and uncertainties remains a responsibility and a proper task of experts.
A major purpose of this book is to present an orderly summary and synthesis of essential matters that are known about alcoholism and the other drug dependencies. What do we mean by an "essentials approach" to chemical dependency?
By an essentials approach, we mean the following:
A rational, inductive, reality-based method of dealing with chemical dependency, both conceptually and practically. A method that focuses directly and primarily on the specific nature and characteristics of personal drug relationships, that is, on those key constant aspects that are always and necessarily present in every individual case of chemical dependency.
Existential reality is the starting place for this approach. The reality is that there are millions of people who actually ingest mood-altering chemicals and who are personally related to them in some way. There are millions more who are negatively affected by such personal drug relationships.
This same existential reality is the ongoing checkpoint and the ultimate testing ground for verifying, confirming, and validating (or invalidating) any conclusions that are drawn. Whatever the approach employed in examining drug involvement, the existential base must remain the same: actual drug relationships in real live persons. And the ultimate objective, too, remains the same: to clarify our understanding of the essential nature and characteristics of drug involvement.
Content, Structure, and Process
In this book, we are concerned with content, structure, and process. An essentials approach necessarily involves all three. But above all, our concern is to present a chemical dependency content. This content can be modified as to structure and process by educators, trainers, researchers, and therapists to meet the needs of their specialized disciplines and the particular clientele they serve.
We believe the content of this book provides a sound base for defining the essential nature, characteristics, and causes of chemical dependency as a phenomenon in itself. This may close the door, partially at least, to misconceptions of it as merely a result or symptom of "some other" problem. In other words, chemical dependency is a primary disorder in and of itself.
The most common misconception about alcoholism and the other drug dependencies is that these conditions are results or symptoms caused by some other preexisting problem.
Theories about what that "other problem" is differ widely and even contradict each other. Some popular labels are "psychological," "psychiatric," "medical," "social," "behavioral," etc. The consequences of this error are many and grave. Two of them are especially harmful.
First, persons who are chemically dependent, and their families and associates, are harmed when the focus of diagnosis and therapy is directed to some other problem. The chemical dependency problem remains undiagnosed and unattended. Clients are left to pursue their drug involvement, and they grow progressively worse.
Second, dependents whose drug problems have been identified and treated, and who are enjoying good recoveries, sometimes find themselves under continuing clouds of suspicion because both they and others keep looking for some mysterious "other problem" to suddenly show up. It is a waiting-for-the-other-shoe-to-drop anxiety that is founded in fantasy, not in reality.
Most of the so-called other problems that accompany and are alleged to cause chemical dependency are in fact caused by chemical dependency itself. Rarely do they continue unresolved once chemical dependency is properly treated and recovery is under way.
Granted, other problems may precede, accompany, and follow drug involvement. But there exists no present evidence to demonstrate causation. The most that can be validly affirmed is correlation. Failure to pinpoint exactly what chemical dependency is and what its essential causes are leaves the way open for erroneous assumptions about other preexisting or underlying problems as its cause.
Toward Early Diagnosis, Intervention, and Treatment
Many people are still diagnosed as chemically dependent on the basis of social, physical, psychological, and moral problems. These diagnostic criteria are actually late-stage complications of a drug involvement that has existed for some time, perhaps for years. Such complications are accidentals, not essentials. They may or may not appear in individual cases, and they are often present in the lives of persons who never ingest mood-altering chemicals at all. In other words, there is no essential cause-and-effect relationship between such complications and chemical dependency.
Essential characteristics, on the other hand, are present from the beginning and continue with increasing intensity throughout the entire progression of the drug involvement. These characteristics include essential symptoms and pathology. Essential symptoms involve direct cause-and-effect relationships, which are the proper criteria for chemical dependency diagnosis. They are the basis for the early identification, evaluation, and diagnosis of chemical dependency that opens the way to the development of effective intervention and therapeutic strategies to assist chemically dependent persons and their family members before their lives are in shambles.
Toward Preventive Education
By focusing on essentials, it is possible to lay a firm foundation for preventive education. Without a clear understanding of the essential nature of chemical dependency, there is no definite target for prevention. Lack of a target reduces efforts to scattershot approaches with the hope of accidentally hitting on something relevant to prevention.
The goal of preventive chemical dependency and drug abuse education is to help individuals develop a sense of personal responsibility for their own relationships to mood-altering chemicals. This applies first to those whose purpose is to offer preventive education. In other words, the first responsibility of drug educators is for their own drug relationships.
The common denominator of many such programs appears to be that they do not focus direct attention on the essential nature and characteristics of chemical dependency or of drug use, misuse, and abuse. In stead, they focus on something else: on drugs themselves; on scare tactics; on law and law enforcement; on environmental factors; on socio-cultural conditions and influences; on effecting change in society or in some of its institutions; on personal and social values and their clarification; on personal growth and development; on interpersonal relations and communication; on alternative highs or life styles; on human health and well-being as such; on skills for living. In short, the focus is anywhere except on the central problem of the personal relationship to mood-altering chemicals and its direct effects on a person and his or her close associates.
Unquestionably, the "something elses" deserve attention in and of themselves. No one doubts the desirability of any or all of them. Moreover, they may be useful supplements not only to prevention but also to treatment programs, and they are indispensable elements in recovery and rehabilitation programs. But in and of themselves, they are not chemical dependency or drug abuse prevention because they are without a specific chemical dependency focus and content. To assume that they are prevention is to misread or to mislabel the particular phenomenon of chemical dependency.
The Importance of Clear Definitions
The hit-and-miss prevention efforts that we have witnessed over many years in the field provide clear evidence of a lack of focus on the part of many educators. This lack of focus demonstrates a want of understanding or a misunderstanding about what chemical dependency is.
Enormous expenditures of time and money are poured into ambitious prevention programs without the organizers first defining what they mean to prevent. Elaborate structures and processes are set up, experts from various disciplines are brought in, participants are enrolled, and programs are carried out. Although the programs may be well planned and skillfully implemented, results are often poor. Unless the objective of preventing drug abuse and chemical dependency is focused on the essential nature of the disease, these programs run the risk of being counterproductive.
In making application of content, drug educators, like other helping professionals, must be aware of and sensitive to where their clients are. They must not only know what it is they are educating to prevent, they must also organize their material and adapt their processes to the existential condition and needs of their clients.
It is unrealistic to assume, for example, that typical groups of preschool or early elementary school children are not seriously affected by the drug involvements of their parents, siblings, peers, and teachers. It is even less realistic to assume that other, older groups of children are unaffected by personal drug involvement and/or the involvement of their family members, friends, and peers.
Although they themselves may not be using drugs, they are nevertheless often suffering drug-related disabilities: hurt and bewilderment; preoccupation; negative attitudes of fear, resentment, anger, hatred, loneliness, rejection, and feelings of parental abandonment; a steady build-up of defenses; low self-image; and deep feelings of guilt, shame, insecurity, and inadequacy. They are also drawn into the manipulation and counter-manipulation that always go along with drug abuse and chemical dependency. In other words, they are being forced into the enabler role and are already in the process of developing the sick attitudes and behaviors of a corelative dependency that characterize the enabler role.
Chemical dependency and drug abuse are always more than individual affairs. They are family and group matters, with all members inevitably involved. The codependent enabler role - and the sickness that goes with it - is every bit as essential to this illness as any other aspect of it. Education to prevent it must take this into account. Therefore, educators cannot ignore the harmful effects chemical dependency is likely having here and now on those who are being educated. To do so is to launch preventive education into a vacuum.
This is not to minimize in any way the possibility or need of preventive education, but only to emphasize that its focus and objectives must be clear, its contents well defined and organized, and its audiences realistically perceived. Finally, there is a critical need for everyone engaged in preventive drug education to have a firm grasp of the categories of causation.
Drug educators familiar with previous editions of this book have found its focus, content, and structure helpful in designing both special courses and programs and more generalized preventive education. And the book it self, in the hands of those being educated, provides for them a ready means of continuing self-education on this vital subject.
Chapter Two Drug Ingestion, Use, Misuse, and Abuse
We have all felt the frustration of not having the proper tools with which to do a job or of trying to do a precision job with dull, crude tools. We all know, too, how frustrated we feel when we do not have the proper words to express our ideas exactly or when we struggle to express them with crude or clumsy words. And we have all found ourselves confused when words are shifting about in their meaning. I use words in one sense, you use them in another sense, and others use them in still other senses. We may all end up not knowing what the conversation is about.
Words are meant to express ideas. To be useful, they must have agreed-upon meanings. When key words are not defined, all parties to discussions come away frustrated and confused. There are few places, perhaps, where we find a clearer case of this than in the field of alcohol and other drug problems.
Defining Terms to Avoid Confusion
For example, many reports and studies have been publicized about "drug use" among high school students. In a typical report, we might learn that the number of eighth graders who used marijuana doubled from one in ten to one in five between 1991 and 2001. The increase in marijuana use may be read to mean that there is a growing "drug problem" among these students. In a very general way, this would probably be true simply be cause increased marijuana smoking usually leads to more marijuana-related problems.
Before we can draw any more definite conclusions, we have to ask some basic questions. A first question has to be: What is meant by marijuana "use"? Does it mean taking an occasional puff ? Does it mean one joint a week? Or three or four or more? Does it mean getting a slight high or totally spaced out? Is the marijuana used with alcohol or other drugs? Actually, we have no way of knowing whether there is any student drug problem at all unless the term "use" is clearly defined.
We would have to ask, too, what is meant by a "drug problem." Does it mean trouble with schoolwork or teachers or other students? Does it mean legal troubles? Does it mean loss of interest in activities or sports? Or apathy to life in general? We have no way of knowing anything very definite about a "drug problem" until the term "problem" has been defined.
In an effort to avoid any confusion here, we begin by defining our terms. Our definitions are largely those found in any standard dictionary of the English language. You may wish to define these terms in other ways, of course, or to use other words to describe the same realities. But at least you will know what we mean when we use these terms.
The first word to be defined is "ingestion." It is the physical act of taking a substance into one's body. Eating food is ingestion. Drinking liquids is ingestion. Inhaling tobacco smoke is ingestion.
Drug ingestion is the physical act of taking a drug into one's body. Alcohol and pills are usually ingested orally, that is, by mouth. Marijuana and some other drugs are ordinarily ingested by inhaling or "sniffing." Heroin and certain other drugs are commonly ingested by injection, or "shooting." However it is accomplished, ingestion always refers to drug intake, to any physical act of getting the drug into one's body.
When the terms "drug-taking" or "drug use" are employed, they usually mean drug ingestion - but not always. In lectures and literature about drug problems, for instance, it is not always clear how these terms are being used, and they are seldom defined for us. The burden of giving meanings to the terms is placed on the audience, which means, practically, that it is left to guesswork or conjecture. This is clearly unsatisfactory, although it does point up the need for developing critical listening skills.
Beyond drug ingestion is drug use. While these two terms are often used interchangeably, there is considerable difference in their meanings.
"Use" means to put into service or to employ for a purpose, as soap is used for washing. "Drug use," therefore, means to ingest drugs for a purpose. Note that the mere act of taking drugs - ingestion - refers only to the physical act, whereas use implies an action of the total person for a purpose. Drug use involves a personal decision and a personal choice; it is a fully human act, not just the physical act of drug-taking.
Excerpted from The Essentials of Chemical Dependency by Robert M. McAuliffe Mary Boesen McAuliffe Copyright © 2007 by Mary Boesen McAuliffe. Excerpted by permission.
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Table of ContentsContents Foreword: Toward a Unified Theory of Addiction....................ix
Introduction: What Is Addiction? My Search for an Answer....................xvii
PART ONE The Essential Nature of Chemical Dependency 1. The Essentials Approach....................3
2. Drug Ingestion, Use, Misuse, and Abuse....................8
3. Chemical Dependency in Focus....................13
4. Essential Definition of Chemical Dependency....................24
5. Essential Progression of Chemical Dependency....................43
PART TWO The Essential Pathology of Chemical Dependency Introduction: Locating Elements of Pathology....................55
6. Chemically Dependent Whole Person Psychological Dependency....................58
7. Chemically Dependent Whole Person Powerlessness....................71
8. Chemically Dependent Mental Obsession....................97
9. Chemically Dependent Emotional Compulsion....................116
10. Chemically Dependent Low Self-Image....................138
11. Chemically Dependent Rigid Negative Attitudes....................156
12. Chemically Dependent Rigid Defense System....................172
13. Chemically Dependent Delusion....................190
14. Physical Pathology of Chemical Dependency....................206
PART THREE The Essential Causes of Chemical Dependency 15. The Problem of Causes....................221
16. Causal Input of Contributing Factors....................228
17. Causes in the Essential Definition....................231
PART FOUR Chemical Dependency Diagnosis and Evaluation 18. An Overview of Chemical Dependency Diagnosis and Evaluation....................237
19.Diagnosis by Essential Symptoms....................241
20. Target of Diagnosis and Evaluation....................246
21. Qualifications for Diagnosticians....................252
22. Some Obstacles to Diagnosis....................255
Afterword: Some Final Thoughts....................260