CHUV-UNIL professor Jean-Bernard Daeppen wrote his book La Maladie du désir, which came out in March, based on his experience with his patients suffering from addiction. In Vivo dedicated a major interview to the subject. An opportunity to better understand how addiction develops, why some people succumb to it more than others, and what friends and family can do.

in vivo / You entitled your book La Maladie du désir (The Disease of Desire). Is addiction now considered a disease?

Jean-Bernard Daeppen / Addiction is a neurological disease, caused by the deregulation of the brain’s reward system. One particular aspect is that it integrates a degree of responsibility on the part of the person suffering from it. Addictions cause strong reactions, often to the point of caricature. On one side, you have people who fear them, for themselves and for their loved ones, and on the other, those who suffer from them and are often riddled with shame and guilt. For healthcare workers who deal with it every day, addictions are a real challenge. Some patients are restless; some do not do what they are asked to. They end up having more complications and are sometimes suspected of not wanting to be treated.

iv How can we explain why some people develop an addiction to alcohol, while others can handle maintaining occasional, non-addictive drinking?

jbd / The primary addiction in humans is dependence on another person. That concerns all of us. Another great characteristic of being human is our extraordinary appetite for drugs, and alcohol is the most obvious example. Addiction becomes a problem when it involves taking dangerous substances in excessive amounts. Most people who develop an addiction, whether to tobacco, alcohol, cocaine or marijuana, live like that for several years before finding – once the disadvantages outweigh the advantages – the solutions to control it without seeing a doctor. However, for a small group of people, addictions are more problematic, and their efforts to recover are futile. Genetic factors and personality traits can make someone more vulnerable to addictions. People with the most severe cases almost always suffer from attachment disorders linked to relational insecurity. Addiction has to do with one’s ability to connect with others. That is why adolescence is a prime period for the emergence of substance use and addiction, because it is a life stage of emancipation and when people start exploring in their love life. Psychotropic drugs make it easier to feel confident. The risk of developing an addiction is therefore closely linked to the ability to connect in a relationship. When a person is in a stimulating environment and leads an interesting life, the risk of addiction is significantly reduced.

iv / The title of your book also associates it with the question of desire. How is desire related to addiction?

jbd / I built my book around notes from my consultations, times when I felt particularly moved and thoughts provoked by the experience of my patients. I comment on these stories with explanations based on current medical knowledge about addiction, but also with insights from my special interest in psychology and philosophy. “Desire is the essence of a man,” the philosopher Baruch Spinoza said when he spoke of conatus, that extraordinary energy that makes us strive to persevere.

Addictions disrupt the chemistry of desire by interfering with the reward circuit in deep areas of the brain.

Addictions raise existential questions about the meaning of life or perhaps the meaning that we try to give life any way we can.

iv / What population segment do you see in your consultations?

jbd / We receive an extraordinary variety of patients: young people, senior citizens, men, women, people from all walks of life. It’s more the personality traits that have in common than characteristics such as age, gender and social class. Our patients are often extremely sensitive people who have difficulty managing their emotions. They often use drugs to regulate them. We treat all types of addiction, with and without substances, such as pathological gambling and video gaming. But the majority of our patients are tackling addictions to alcohol and opioids, which wreak a lot of havoc on their physical and mental health.

iv / What drives people to come for help?

jbd / Most of our patients come for help when they can no longer cope on their own, when the addiction takes over too much of their lives and causes problems in their family life, job, health, or socially.

xiv ( What does therapy to help someone people with an addiction involve?

jbd / We offer a variety of treatments, for individuals and in groups, that combine medication and psychotherapy with cognitive, behavioural and motivational approaches. We aim to encourage patients to change their behaviour by helping them to act independently. I also address this in my book in a section about how people can help themselves. In particular, I emphasise that addiction is not an unchangeable fate, that it is possible to get out of it. The people in their lives also play an important role in the therapy.

iv / What should loved ones do?

jbd / Friends and family need to understand what is going on with the individual struggling with addiction. Ambivalence is a key symptom of addiction. The person experiences a conflict between reasons to continue using and the realisation that they must do something or risk losing everything. The most problematic attitude from those close to the patient when they want to convince the person and give advice.

To recover from an addiction, the individual has to convince themselves to quit using.

If family and friends meddle with this negotiation, the individual suffering from addiction may feel stripped or deprived of their freedom of choice. In short, the mistake is wanting to act in the place of the other person. Loved ones need to avoid judging, pressuring, patronising or constantly talking about substance use. They can of course express their feelings, in quiet times when dialogue is possible, but should avoid telling the person what to do. Most importantly, they should display patience, trust and empathy, as much as possible.

iv / What can we do to prevent addiction?

jbd / Despite it being a major public health problem, people are generally poorly informed about the substances that can lead to addiction. For example, schools rarely address the subject. This suggests that people are actually fairly naive and tend to over-generalise about alcohol and drug use. We need to explain more about what these products are, which are both attractive and dangerous when consumed in excess. And they can lead to real slavery. That’s why I felt it was important to write a book that would address a broad population. It is crucial for us to better understand addictions, for ourselves and for our loved ones, to better protect ourselves from them and manage them better. /