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Letter to the editor: Craving is most salient sign of addiction

I am writing in response to a Dec. 29 editorial "Addiction science needs new terms" from the Detroit Lakes Tribune suggesting a need to create new language used in talking about addiction. I have a couple thoughts to add to the conversation.

First the most important symptom of an addictive disorder isn't drinking, smoking, snorting or injecting. While that behavior may be the most obvious sign of addiction and tends to be awful and destructive, the consistent and most salient symptom of addictive disorder is craving. "The behavior is (not) the disease". Individuals with addictive disorders who in spite of potential consequences from consumption including jail, prison, loss of jobs, loss of relationships and even loss of life will still experience cravings. These cravings are not willful or chosen. They are unwanted but still exist.

The goal of any treatment or recovery support effort is to support, empower and prepare persons with addictive disorders to cope with and resist those cravings. And many people do. While arguably there are other common challenges for persons with Substance Use Disorder, in my experience craving is the most important. It may be useful to understand that those cravings stem from the brain disease of an addictive disorder that has at least in part been caused by the repeated use of toxic drugs. The risk for an individual of early alcohol and/or other drug use to progress in this way seems to be due to a combination of genetics, stress and other personal risk factors, though each person seems to have a very remarkable and unique set of risk factors.

I would also add that the language used to talk about this concern has and will continue to evolve. Most importantly in the recent Diagnostic and Statistical Manual 5th Edition the use of "abuse" and "dependence" when talking about one's status with alcohol or other drugs of abuse has been replaced by Substance Use Disorder and is qualified as mild, moderate or severe. Gambling Disorder has also been added to the manual, and is included in the same section as Substance Use Disorders, Gambling Disorder is also characterized by cravings. The science and study of addictive disorders, this huge societal problem continues to confirm the disease model of addictive disorders. Most importantly, the treatment for these disorders are proven to benefit and are available to the person suffering with addictive disorders and their families.

Lynn Kistler, Bemidji, is a licensed alcohol drug counselor

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