The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, changed the criteria for evaluating substance abuse problems and problems involving compulsive behavior, such as gambling. The DSM-5 includes the word "addiction" for the first time, in reference to pathological gambling, which the manual lists as a "behavioral addiction."

An old saying, often dubiously attributed to Martin Luther, warns: "Who loves not wine, women and song/remains a fool his whole life long." The phrase has hedonistic implications (which is why I find the Luther attribution puzzling) and its modern equivalent is "sex, drugs and rock-and-roll." Whether it really was Luther who said it, or whether it was Johann Heinrich Voss, as Bartlett's Familiar Quotations has it, the hendiatris is an old one. Even if Bartlett made it up himself, it would still date to at least 1855.  That means that for a long, long time, people have lumped substances, sex and music into the same category of mood-altering temptations. Reflecting on this fact made me wonder, is there a difference between addiction to mind-altering substances and mind-altering behaviors or experiences?

I got sober in a rigorous outpatient treatment program based on confrontational therapy and geared toward adolescents. At nearly 22, I was the oldest client. The program is unorthodox and its founder is a somewhat controversial figure in the mental health treatment community. I have mixed feelings about his methods, but something in that program did get, and keep, me sober where others had failed.  

One of my biggest regrets from my drinking days is that I wasn't a support for my grandfather when he was dying.  We were very close throughout my childhood and adolescence, but when he experienced a recurrence of cancer I was totally immersed in my alcoholism. My mother and I lived with my grandparents for some of his last months, but I was more harm than help. He died a few months before I got sober and for years, my wreaking havoc on my family during this difficult time pained me. For the last seven years I have experienced troubling recurring dreams involving my grandparents and their home, which was a happy and magical place for me growing up.

A few days ago a good friend of mine, Leah, asked for my opinion on a situation she was having with a friend of hers, Sarah. Leah was struggling to stay clean and sober, but recently, she recommitted to substance abuse recovery. Leah wanted to help her friend with a history of drug abuse, who is on methadone, so she has been driving Sarah to the methadone clinic three days a week. Unfortunately, Sarah recently started using drugs again and is pressuring Leah for drug contacts and even to drive her to drug deals. Leah decided she needed space from Sarah and asked if I thought seeking temporary distance was okay. My response -- of course! As long as Sarah is overwhelmed by her drug-seeking behavior, she is not capable of being a good friend.

People with substance abuse issues are at higher risk for suicide than those who do not abuse substances. Research suggests that individuals with substance use disorder are nearly six times more likely than others to report having attempted suicide at some time.

I took my last drink of alcohol (hopefully for good) on February 19, 2007. I smoked my last cigarette (also hopefully for good) on December 31, 2010. In contrast, my friend quit street drugs and alcohol years ago, but she doesn't know the exact dates. 12-step programs emphasize dates. Alcoholics Anonymous, Narcotics Anonymous and Overeaters Anonymous all celebrate sobriety dates, clean dates and abstinence dates, respectively. For me, my sobriety date is extremely important. It commemorates a miraculous day when I was given another chance to live. The day I quit smoking is important to me too, but I might not remember it if it didn't coincide with New Year's. Perhaps I care more about my sobriety date because my struggle with alcohol was much harder. Even so, for the clean and sober folks I know who do not commemorate a specific clean date, (mind you, this is the minority of clean and sober folks I know) it is not because their sobriety isn't important to them.

I never saw my alcoholism coming. I grew up in a supportive, loving family and was always a bright and high-achieving child. I also had obsessive compulsive disorder (OCD, an anxiety disorder) from a young age, although I didn’t know what that was for some time. In high school I was very active in my OCD and restricted eating. I didn’t have time or energy for dating or drinking. I had relatives in rural Oregon who were methamphetamine users and I vowed I would never touch that stuff - but alcohol, I figured, was innocuous. After all, I thought, everybody drinks. I had my first drink of alcohol toward the end of my freshman year of college, and it was a nightmare pretty much right out of the gate.

We are, on a whole, a society of addicts. Have you ever seen the AT&T commercial with the little kids and the girl states, “We just want more!”? This is the battle cry for our addiction-consumed society. Whether it is drugs in the form of alcohol or cocaine or in such behaviors like overeating, gambling, pornography or shopping, we just can’t seem to get enough.

Why is it so hard for me to stop using ________? This question has been asked by probably millions upon millions of people over time.  There has been research done on addiction for decades.  While there have been many advances made in the understanding of addictive disorders like drug addiction, alcoholism , and sex addiction, to name but a few, many people still struggle to quit.