Treating Addiction: Why a one-size-fits-all approach is inadvisable

Over the years, the word ‘addiction’ has come to be primarily associated with drug or substance abuse. At its core, addiction is compulsive behaviour engaged to reward oneself financially, physically, emotionally or mentally. It is a neuropsychiatric disorder that induces a recurring desire to consume substances or engage in practices leading to harmful consequences. Hence, behavioural compulsions like gambling, video games, social media/ internet addiction or pornography come under the purview of addiction.

The genesis of addiction

Before we treat addictions, it is important to understand the genesis of an addiction. Research has proven that there is a strong correlation between substance abuse or addiction and loneliness. Addictions are considered the opposite of connections, wherein people with healthy connections have lower chances of addiction and vice versa.

While there may be several reasons, there are at least five primary drivers for addiction:

1. Peer Pressure

The pressure to fit in or emulate popular trends from music videos, television or movies often becomes a recurring behaviour.

2. Inability to manage stress

Often, people are unable to cope with stress in life in a healthy manner, thereby resorting to addictive behaviour.

3. Sleep issues

Irregular sleep patterns or insomnia can also lead people towards dependence on substances or prescription-only medicines to address the issue.

4. Genetic predisposition

People can also acquire addictive behaviour either as a genetic predisposition or from the surrounding environment in the family, where addictions run across generations.

5. Self-esteem issues

Some people also rely on addictions to boost their low self-esteem

Tailored treatment

Because every addiction is different, a ‘one-size-fits-all’ approach to treating it doesn’t work. Treating addiction begins with analysing the type of addiction, whether it is substance-based or behavioural. Secondly, one needs to consider the reason behind the occurrence of an addiction.

A customised or tailored treatment of addiction is based on the principles of the bio-psycho-social model. Under the model, the therapy tries to reduce the perpetuating factors, even focusing on improving the person’s lifestyle. Such a treatment should encourage people to have healthier lifestyles, maintain a routine, and add some form of physical activity such as walking, exercise, or sports.

Tailored treatment of addiction might also require input from a psychologist with sessions around stress management, management of anxiety, confidence, and addressing depression. Typically, around 10-12 sessions are recommended, along with additional efforts to avoid relapse.

In certain cases, the treatment may involve medical intervention, including managing physical health, withdrawals, and management of any other psychiatric comorbidities like depression and anxiety. Such treatment needs to be case-to-case as some people benefit from medicines, even as others crave medications for addictions.

In extreme cases, treatment on an outpatient basis may not suffice for some people who may instead require inpatient treatment. For example, people with extreme abuse of alcohol may first need to be managed in a hospital if they exhibit physical health issues. This is because staying in a rehabilitation facility can help simultaneously promote lifestyle changes, routines, therapy, and medications.

However, care needs to be taken regarding the length of hospital rehabilitation, which may vary depending on the person’s circumstances and the history of addictions. Also, since some people may be wary about rehabilitation, inpatient stay needs to assist people in adopting the treatment and help ‘reset’ or restart their life.

The role of the addict

While significant help is at the disposal of a person in their journey to overcome addictions, the role of the patient is equally crucial in the treatment process. Eventually, the chance of success is directly proportional to a person’s willingness to improve their life.

(Dr Vipul Rastogi is a behavioural neurology and psychiatry consultant at Gurgaon Multispecialty Clinic. A leading voice in neuropsychiatry, dementia and Parkinson’s, Dr. Rastogi is empanelled as a referring doctor with Sukoon. With more than a decade of experience, Dr. Rastogi earned his MSc in Neurology (Merit) from University College London (UCL).)