When someone asks the question, “which came first, the chicken or the egg?” they want you to put in chronological order two different things: an egg, and one chicken. If you answer by saying, “the egg came first,” you have also answered a second question, which was hidden beneath the first. The hidden question emerges – which caused the other? Your answer implied that the egg caused or produced a chicken.
So, which came first, the panic and anxiety, or the alcoholism? The debilitating bouts of depression or the cocaine use? Alienation and emotional trauma or the daily use of pot? BUT, why does it even matter which came first?
1. Addiction is currently viewed as a specific or separate entity, which is diagnosed by the drug used. For example, if one is addicted to cocaine, the primary diagnosis would be: Cocaine Addiction.
2. The primary diagnosis of a drug problem his often viewed as the main target of treatment. The logic? Cocaine destroyed the person’s life. Remove the cocaine and teach the patient how to live clean and sober. That is the treatment goal.
3. The reason a person became addicted is not necessary and it is never asked. But, what if that addiction was caused by an underlying disorder? And what if the underlying disorder, in turn, produced that drug use? And, what if the person whose life has been crippled by the drug use, is using the drug to cope with a yet undetected psychiatric illness?
These questions then lead into a broader model of addiction. It actually breaks down into two diagnoses. Primary illness: clinical depression. Secondary illness: Drug addiction. This more educated model shows that the destructive power of the undetected depression is being hidden under that person’s use of a drug trying to reduce the despair of that depression.