Addiction, whether to psychoactive substances such as drugs or alcohol, or to behaviours such as gambling, sex, or pornography, is growing in our society. As healthcare professionals, we need to recognise the relevance of addiction to our practice. As Christians seeking to reach a lost and broken world, an awareness and understanding of addiction is vital.

The factors underpinning addiction are numerous and often complex and while treatment outcomes are often disappointing, there are two simple messages to remember:

• Addiction is most often a response to deep-seated emotional pain
• Lasting freedom from addiction is available and can be found by engaging in the truth of God's word.

The good news of the gospel is not simply salvation from sin and the promise of eternal life: Jesus also paid the necessary price to make it possible for us to live lives free from the entrapment of sin - and that includes addiction. If we choose to 'walk' or 'live by the Spirit', we can live free from the compulsion to gratify the desires of the flesh. (1) God has given us an attainable goal (2) - but we must apply it to our lives.

The extent of addiction

• Substance addiction. Nearly ten per cent of adults in the UK are physically dependent upon alcohol. This means physical withdrawal symptoms are experienced when not consuming the usual amount. A further 15% of the adult population use alcohol in other hazardous ways such as episodic bingeing, or by regularly drinking above the recommended safe limits.

Addiction or misuse of other chemicals is also high. In the UK, 17% of the population smoke cigarettes and nearly 7% of the population regularly use illicit psychoactive substances including cannabis, heroin, cocaine, and amphetamines. On top of all this, a large group of people are addicted to drugs that have been legally prescribed by their own doctor for pain or anxiety.

• Behavioural addiction. With the help of the internet, pornography and masturbation has skyrocketed. In one recent survey, 63% of men and 21% of women aged between 18 to 30 said they used pornography multiple times a week. Addictions to gambling, shopping, gaming, and internet usage are also on the increase.

What is addiction?

It might be helpful to consider what is meant by an addiction. According to the International Classification of Diseases and Health Problems (ICD), a clinical diagnosis of dependence syndrome, is made when three of a cluster of clinical phenomena are present. These phenomena include: compulsion, difficulty in controlling the behaviour, withdrawal symptoms, and tolerance and persistence in the use/behaviour despite clear evidence of harmful consequences.

Addiction and pain

There are often many factors that underlie addiction. But at the root of nearly all addiction, is deep pain resulting from loss, rejection, abuse, separation and other trauma.

To understand emotional pain further as an important driving force behind addiction, it might be helpful to consider what happens in the area of the brain called the limbic system. The limbic system is a set of brain structures below the cerebrum where both emotional pain and general well-being are meditated. Pleasure and the sense of 'well-being' is heightened by the stimulation of brain receptors that subsequently result in the release of certain chemicals, or neurotransmitters, most notably dopamine and serotonin. Conversely, low levels of these 'brain amines' are known to be associated with depression. The role of medically prescribed antidepressant drugs is to effect a raise in the levels particularly of dopamine and / or serotonin.

Misused substances do the same. Whether alcohol or other sedating drugs such as heroin or cannabis, or whether a stimulant drug such as cocaine, the net result is the stimulation of brain receptors in the limbic system. The same is true of hallucogenic and dissociative substances such as ketamine.

This same rise of dopamine is also brought about by pleasurable activities such as eating and sex and also by all the potentially addictive behaviours such as gambling, shopping, gaming etc.

It is important to understand that it is not abnormal to seek pleasurable activities in a controlled and balanced way. Addiction, on the other hand, is when the pleasurable activity is sought in an uncontrolled manner, often at the expense of normal activities and well-being.

The bottom line is that the pleasurable activity becomes an obsession and is repeatedly sought because it brings relief, albeit temporarily, from the pain. This is equally true for all addictions be they to substances or behaviours.

Many patients who attend drug clinics identify with a painful root to their addiction. Those struggling with addiction who do not readily identify with a major emotional trauma will, at the very least, be able to identify with a lack of contentment or general dissatisfaction. It is this 'ache' that is dulled by the addictive behaviour.

There is a way out

Hopelessness in this area is common. I have come across many people, including patients and even colleagues who have no expectation of recovery. The saying 'once an addict, always an addict' is a widely held belief and sadly, many people in treatment services see addiction as a 'chronic, relapsing condition', rather than a state that can be changed. But the good news, the wonderful news, is that there is a way out of the seemingly hopeless cycle of addiction.

If we truly believe the word of God, we have absolutely no right to see any situation as hopeless. When Paul encourages his readers to 'be transformed by the renewing of their minds,' (3) he does so, certain that total transformation is entirely possible with a changed mindset. Likewise, Jesus says to his listeners: '"you will know the truth and the truth will set you free," ' (4) with the expectation that we will experience true freedom by adherence to his word.

Know the truth - a relationship

When Jesus spoke of knowing the truth, he was talking about a deep, intimate relationship with truth and not just a cerebral knowledge of the words. The New Testament word used in John 8:32 for 'know' is the Greek word ginosko, the same word used for Mary's response to Gabriel: '"how shall this be when I know (ginosko) not a man?"' (5) Jesus is saying that it is intimacy with the truth that sets us free.

So, to be transformed and set free by biblical truth, something is required which is much more than the memorising of Scripture: it is the rejection of false underlying beliefs and total adherence and commitment to the word of God as truth, regardless of circumstances and feelings.

For most of us, achieving this degree of transformation and freedom requires commitment to a process often with the help of those who have gone before, but it is possible and achievable. I write as one who has personally experienced this journey of transformation by the renewal of my mind. I have also seen many others who have known freedom by seriously applying biblical truth to their lives.

Biblical keys to freedom

If we acknowledge, that most addiction is rooted in pain, it is very important to realise that emotional pain is most often - if not always - due to beliefs and perceptions that have been learned, rather than actual events and circumstances. The long-lasting emotional trauma of sexual abuse, for example, probably has much more to do with the subsequent belief by the victim that they are 'dirty' and perhaps 'worthless', than it does to the event itself. This can be hard to understand but it is vital to achieving healing and freedom. The pain for someone having experienced rejection is usually perpetuated by the resulting belief that they are in some way unlovable, and that they will always be rejected by others.

We need to realise too, that the beliefs so often holding people in pain and hopelessness, and thereby to addiction, are always contrary to the word of God.

Let us look at some keys that offer freedom from addiction, which are rooted in biblical truth. There is, however, nowhere near enough space to discuss these keys properly in this article, as each one warrants its own serious consideration!

1. Identity as a child of God

So often the hopelessness and pain of someone ensnared by an addiction relates to their core identity. 'I'm an addict or an alcoholic. This is who I am and there is no way out.' But seriously identifying with the truth of being a child of God (6) or the realisation that we have become a 'new creation' when we accepted Jesus and that God has made us righteous is liberating. (7) I have seen people set free from addiction by grasping this one truth alone!

2. Forgiveness

I cannot overstate the importance of forgiveness for any of us, but for those caught up in addiction it is vital, and for that matter, for any form of mental unrest such as anxiety or depression. Not being able to forgive, regardless of whether the perpetrator of a wrong deserves forgiveness, holds so very many people in torment. In fact, unforgiveness holds us in a prison (8) but the only way out is to forgive.

Many people choose the oblivion of drugs and alcohol. This creates another challenge, considering the terrible traumas that many people have already experienced prior to their addiction. Forgiving is not forgetting and it does not condone wrongs that have been done, but it is an essential key to freedom.

3. Truth and lies

Recognising that not every thought and feeling we have is to be trusted is of great importance. Not only do we easily find ourselves believing lies about our identity, but similarly many thoughts and feelings have their basis in our experiences rather than in reality. For example, someone might well feel rejected and unloved as a result of their father leaving the family home during their childhood. This sort of thing commonly underpins addiction.

But rejecting the lie that they are unloved and choosing to believe that they are passionately loved by their heavenly Father can be very healing, especially when combined with forgiveness - in this case forgiveness for the earthly father that left them. To be effective, the truth will need to be repeatedly 'rehearsed' for some time - and often with help to replace a long-held lie.

4. Recognise the spiritual battle

The key to lasting freedom from addiction, and for that matter all forms of mental anguish, is to recognise that we are in a spiritual battle. 'Our battle is not against flesh and blood', says Paul, 'but against ...the spiritual forces of evil.' (9) Most often that battle is fought in our minds. When we learn our position of authority over the enemy, (10) we can effectively resist our foe and choose hope, joy and peace.

This process of understanding and applying biblical truth to overcome addiction is most often learnt with the help of others. For that reason, I recommend courses such as Freedom In Christ (www.ficm.org.uk) which have been instrumental in setting many free.

Nevertheless, any of us can begin now and be transformed by the renewing of our minds. (11) We must take Paul's lead and 'destroy arguments and every lofty opinion raised against the knowledge of God, and take every thought captive to obey Christ'. (12)

This all arguably amounts to Cognitive Behavioural Therapy (CBT) - a process that was in the Bible long before it was described by psychologists!

Steve Smith is a GP Specialist in Substance Misuse based in Brighton. He was previously involved in addiction work in Pakistan.