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I can't get no...

April 26, 2011
by Arthur S. Trotzky, PhD
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Does 'persistent dissatisfaction disorder' more accurately describe the illness?

A man is taken into an emergency room in a large metropolitan hospital. He has a history of diabetes and is dizzy and feels faint. Upon examining him, the doctor says to the patient, “You’re in your disease.”
A woman who has undergone three angioplasties arrives at her cardiologist’s office complaining of shortness of breath and pressure in her chest. The doctor orders an EKG and says to his nurse, “Let’s see if the patient is in her disease.”
A young male athlete who has a history of panic attacks is taken by ambulance to the ER in his small town and the MD on call who knows his situation well says to him, “You’re in your disease.”
Sounds ridiculous? This admonition is a rather commonplace expression often heard in addiction rehabilitation centers. It is understood to mean that one’s addictive disease is becoming active in one form or another. It does not describe the disease or the emotional components, but refers usually to the patient’s behaviors.
Treatment centers address chemical as well as behavioral addictions, and there appears to be a tendency for addicts to move from one to the other. Insurance companies do not reimburse for “addiction” per se and rely on the clinical definitions of alcohol, opiate, sedative and amphetamine dependence that are described in the DSM-IV. Food and eating addictions, sex addiction and gambling addictions are usually classified as eating disorders and impulse control disorders, and yet treatment professionals most often use the addiction terminology and call these conditions “the disease.”
Oftentimes we hear from those in 12-Step fellowships that addiction is a “hole in the soul,” a description well beyond the realm of medicine. Addicts often describe their addiction as “feeling empty,” when in reality they are quite full of a number of human emotions: guilt, shame, fear, sadness, resentments, anger and rage.
With the new technology that allows for examination of neurochemical structure and functioning, addiction is currently viewed as a brain disease and the genetic relationship and predispositions are being mapped as in the example of the relationship between gambling and Parkinson’s disease. The etiological factor may be related to the neurochemical dopamine.

There does not appear to be a need to treat broccoli addiction because this green does not alter mood in the way glazed donuts, alcohol, sex and gambling do. Most addiction specialists would agree that we are treating some sort of “lack” that produces a need to fill that deficiency, perhaps in the limbic system, with a substance or a mood-altering behavior. Still, we are left with no description to communicate in understandable terms what the addict is actually experiencing, and therefore there may be a need to find an appropriate terminology that would explain the “felt need” created by the proposed neurochemical deficiency.

Suggested terminology

In order to communicate to patients the feelings associated with, or generated by, the chemical imbalance and to help them to understand the tendency to cross addictions, a helpful reference to a “persistent dissatisfaction disorder” (PDD) might well have some practical as well as theoretical benefits.
PDD is the existing DSM classification for “pervasive developmental disorder,” and my purpose here is not to replace or create another DSM item but rather to facilitate the subjective understanding of addiction.
The terminology presented here might also suggest the potential role and benefits of the spiritual elements advocated at this time in our approaches using 12-Sstep principles. The medications commonly prescribed, and at increasingly alarming rates, may be providing a temporary feeling of satisfaction, and traditional psychotherapies may do the same. In order to help addicts effectively, personnel involved in their treatment need to know what the problem is that they are treating and to communicate this to patients.
Father Joseph Martin would present this interesting analogy:
Alcohol ————► Alcoholism
Penicillin ————► Penicillinism He would go on to say that this is the only disease he knew of that is named after the medication.

Professionals involved in the treatment of this “ism” called addiction could benefit by examining the cognitive and affective dynamics within a framework that analyzes and suggests solutions to a persistent dissatisfaction disorder. The principles and non-chemical approach to dissatisfaction have been well addressed by the 12-Step fellowships, and their wisdom might offer a path to cognitive restructuring that would lead to feelings of serenity, acceptance and an overall higher degree of satisfaction. Arthur S. Trotzky, PhD, is an internationally known addiction treatment specialist and lecturer who facilitates an online group therapy website that serves recovering addicts ( www.onlinegrouptherapy.com). For the past six years, Trotzky was Case Manager of Ridgeview Institute’s Recovering Professionals’ Program in Atlanta. His e-mail address is dr@onlinegrouptherapy.com.

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