We don’t do ourselves any favors by letting some old ideas drift into the mists of history
Editor’s note: This post is reprinted with permission from one of TreatmentMagazine.com’s go-to blogs about addiction, treatment and recovery: Recovery Review.
By Brian Coon
I have been thinking about “psychological dependence” and “physical dependence” a lot lately. It seems to me our field is losing these concepts.
Psychological Dependence
Back in the late 1980s counselors and patients alike would bring up “psychological dependence” from time to time. But over the last 20 years this concept seems to have slowly gone away. I can’t remember the last time I heard someone bring it up.
When is the last time you heard anyone talk about identifying “psychological dependence” as a feature of someone suffering from addiction illness (alcoholism, or a moderate to severe substance use disorder, etc.)?
I was taught that when psychological dependence is present it indicates further progression. I was taught that psychological dependence is also a concern all on its own, given its particular association with relapse potential. For example, back then, patients with cocaine addiction would say, “It’s a mental thing.”
Back in the ’80s, psychological dependence was taught to me by university academics, clinical professionals, and patients too. They all taught me that psychological dependence can be a feature of addiction illness. It was also taught to me as a developmental milestone in one’s progression in addiction illness. I was taught that when psychological dependence is present it indicates further progression. I was taught that psychological dependence is also a concern all on its own, given its particular association with relapse potential. For example, back then, patients with cocaine addiction would say, “It’s a mental thing.”
I paid particular attention because all three sources taught me about it. They all agreed. Over the last 20 years it seems this topic has been largely lost by academics, researchers, and clinicians trained more recently.
I wonder why.
Physical Dependence
Likewise, back in the late 1980s, I was also taught about “physical dependence” by academics, clinicians, and patients. They all used this term and used it to mean the same thing: physiological adaptation to a drug such that if the drug was not taken withdrawal would begin. Moreover, physical dependence was taught to me as a developmental milestone in addiction illness. How so? I was taught (by university academics, clinical professionals, and patients) to determine if a patient is physically dependent, and if so then to find out how many weeks, months, or years the person has continuously taken the substance to avoid withdrawal.
The longer someone successfully maintained physical dependence without being “sick” or going into withdrawal, the worse their condition, and the more concerned we should be.
The idea was that both the presence of dependence, and the length of dependence, are each related to disease progression of addiction illness. The longer someone successfully maintained physical dependence without being “sick” or going into withdrawal, the worse their condition, and the more concerned we should be.
I paid particular attention to this information because all three sources taught me about it. They all agreed. But over the last 20 years this concept seems to have slowly gone away. I can’t remember the last time I heard someone bring it up. Over the last 20 years it seems this topic has been largely lost by both university academics and by more recently trained clinical professionals.
I wonder why.
Lessons From Frank Lloyd Wright
I recently came across a portion of an interview Frank Lloyd Wright gave. The film footage of this exchange was less than three minutes long (an excerpt from the full interview) but I found it fascinating. I have written out the exchange below. The questions are from the interviewer, and the answers are from Frank Lloyd Wright. To me this gives us a window into the topics above. And this exchange has captivated me.
How many companion students do you have?
There are about 60. They come from all over the world.
Do they. …Some of them have training?
Some have training.
But it doesn’t matter if they don’t?
And some don’t have training and are quite ready to develop without it.
Well, now what’s the minimum thing? They surely have to know some engineering.
No, because an engineer is only a rudimentary, undeveloped architect. They have to get the sense of the thing. The sense of structure. The sense of materials. They have to get the nature of the thing, which very few engineers know. An engineer is a “book man” as a rule. He gets everything out of books and formulas. And puts things together and takes them apart. Without ever knowing. Well, you know these characters who know all about everything and understand nothing. And you can say that of an engineer where architecture is concerned. He knows all about the architecture and knows nothing about it.
To me, Frank Lloyd Wright is showing us the value of understanding the whole thing from a qualitative standpoint, rather than only relying on knowledge of certain facts.
Where do you think they should get their roots from?
Nature study.
Terrain?
Not necessarily terrain. Nature with a capital “N.” The nature of this hand—what is it? The nature of the nail on the thumb. The nature of this. The nature of this little thing here. What’s the nature of that? That’s nature, in that sense, that he studies. And from that he develops by way of experience. Trying this. Trying that. Seeing it tried. Out of our failures—they tell us. And when we make a bad thing, we have to take it down or do it over, he learns. And he learns more, as I have done in my lifetime, from my mistakes—than I have ever learned from my successes.
And from a professor?
Well, I don’t know why professors are, any more than I know why the profession is.
To me, Frank Lloyd Wright is showing us the value of understanding the whole thing from a qualitative standpoint, rather than only relying on knowledge of certain facts.
This Recovery Review post is by Brian Coon, MA, who has been working full time in residential addiction treatment programs starting with his graduate internship in 1988. Since 2008 he has worked in a freestanding multidisciplinary program that includes specialized services for public safety sensitive professionals. Find more of his writing, as well as a thought-provoking range of articles, insights and expert opinions on treatment and addiction, at RecoveryReview.com.blog.
Photo: Dave Hoefler
