Addiction Is an Illness We All Share

Contents

Introduction

The Origin And Trafficking Of Drugs

The Brain And Behavior Of Drugs

Addiction And The Person

Drug Abuse: Self-Medication Or The Result Of Experiences?

Addiction And Its Effects On Family, Children And Teens

Treating Drug Abuse And Quitting

References

Appendix A

About The Author

About The Editor

Endnotes

This book would not be accomplished

without the support of Dr. Ralph Bradley.

Thank you Ralph for everything!

Introduction

What is Addiction?

A DDICTION IS DEFINED as a persistent, compulsive dependence on a behavior or substance. The term has been partially replaced by the word dependence and substance abuse now also includes mood altering behaviors or activities. Some researchers refer to two types of addiction: 1) substance addiction such as alcoholism, drug abuse, and smoking, and 2) process addiction such as gambling, spending, shopping, eating and sexual activity. The social cost for either of these is substantial. Property crime increased 8.6% and violent crime increased 12.6% due to gambling alone. ¹ There is a growing recognition that many addicts are those who are poly-drug abusers—individuals who are addicted to more than one substance or process. Addiction is a disease which can be treated with medications, counseling and support from family and friends.

Addiction is not something that is easily tested for and test results cannot be the sole basis for treatment and decisions-making. Very often patients are the last ones to make any decisions about their own health, such as taking control and responsibility for what they put in their bodies. They may not be true and honest with themselves because they are afraid of the consequences and would rather not take responsibility, accountability, and learn from it. Deception may be second nature to them and a survival mechanism, much like using lies to hide and cover the unpleasant truth. The problem is that one lie creates and leads to another lie.

The Overabundance of Drugs

In the era of a pill for every ill there are abundant drugs and if we do not like what we take, it can be quickly replaced with another drug. Why make the effort to change our lifestyle if swallowing a pill can resolve the problem in a matter of seconds? Pharmacological companies will not go out of business, but they do not consider what drugs do to consumers in the long run. Does the problem we take that pill for really vanish for good? Does the drug guarantee that we will not have another problem in the future? Taking one drug may cause addiction to another drug as we become dependent on the first. There is a danger of taking a pill of unknown origin, which could contain any substance, even a lethal one. Most addictions are life-long disease, which means that to avoid a relapse, a person must remain sober for life. Often making adjustments or modifications to the environment, behaviors, and lifestyle is a much better solution. Many illnesses are a result of a psychosomatic cause and the root of the problem does not disappear with the best drug. Numerous medications and substances can produce false-positive or false-negative results.

Too many people rely on medications to resolve their addiction and to treat drug abuse. A new vaccine that prevents nicotine addiction does so by triggering the production of antibodies that bind nicotine in the blood and keeps it from reaching the brain. Another investigational medication is designed to induce the body’s natural defenses to deactivate cocaine before it reaches the brain. Most of these medications are tested on laboratory animals. It seems to be unethical to administer street drugs to animals, but researchers claim the benefits outweigh the cost, and save human lives. Animal studies determine whether substances have addictive properties. They also guide the development of new treatments and medicines and provide key information about how they produce their curing or addictive properties.

Mental and Medical Health

Though the number of adults smoking in the US has decreased overall, 68% of those who are smoking said they are addicted.² According to Brain the in News³, those who suffer from mental health are more than twice as likely to smoke cigarettes and more than 50 percent more likely to be obese compared to the rest of the population. Heart disease, diabetes, or other physical medical conditions are often major illnesses and compound onto the problems caused by drug addiction. For those who had a heart attack, experiencing depression increases their risk for cardiac-related death three-fold. People with diabetes have double the risk of depression. Severe chronic traumatic encephalopathy (CTE) which is a progressive damage to the brain associated with repeated blows to the head has also been identified as a major cause of depression and dementia.⁴ Due to the dangers of CTE amongst football players, the National Football League has launched a mental health hotline developed and operated with the assistance of specialists in suicide prevention derived from depression.

Models of Addiction

Due to the illusion that drugs could give love it was thought that abstinence required spiritual and mental context, which drew some to non-traditional models of curing addiction rather than pharmacological intervention. While the wealthy could afford treatment, others reached to substances, such as methadone, to cease tolerance and relieve their cravings. Methadone intervention helped cut criminal activity, death and HIV and healing seems to improve with heroin addicts.

Addiction used to be categorized as an army disorder, due to the record consumption of cocaine, marijuana, and heroin after the wars. The term cross-addiction was developed and refers to dependence where, as a result of primary addiction, an individual develops a secondary addiction. This was very likely to be presented in cocaine users with alcohol, in alcohol users with marijuana, in heroine users with caffeine or nicotine. All of these addicts are affected by the pleasure part of the brain, the mid brain, the limbic system, which all take part in the dopamine hypothesis. Most crime and violence were found to occur in the context of drugs and alcohol abuse. In order to fix the problem psycho-stimulants were frequently prescribed in addition to a group therapy.

According to Alcoholics Anonymous, those who were addicted stayed addicted due to chemical disease and imbalance in the brain. The disease model implies that the cause, origin, and symptoms are a defect which cannot be changed. Therefore, those who are at risk of relapse will probably be reusing drugs if preventive measurements are not taken.

The basis of the harm reduction model, which was to reduce the harm of unsafe drugs with the main concern being that the individual stayed alive, became controversial. The problem with this model was that patients did not need to come ready to change and abstinence was not a requirement. Nicotine consumption was also on the rise during this time. Physicians offered nicotine gums as part of the harm reduction model to eliminate smoking. At high doses, however, benefits did not meet. Later it was reported that nicotine gums delivered more nicotine to the blood stream.

Therapeutic communities are often a preferred model to the harm reduction model. This is a type of group therapy where every resident has a job: they work in the kitchen, serve, clean, paint and repair; they run the offices to assist professionals who provide medical care, legal services, classroom instructions, and vocational counseling. Members act as staff aids and deputies. They are part of treatment and take a responsibility for its success. Good performance and attitude are rewarded and reinforced with promotions. Poor performance and violations of house regulations are punished. At the top of the hierarchy are members who are former drug abusers themselves, graduated the program and have been trained in the clinical methods. Their experience allows them to relate easily to the experiences of new residents. They function as role models; they encourage self-examination that leads to understanding responsibilities and change. The longer one remains in the community therapy, the better the chance of success and the greater the degree of psychological improvement. The therapeutic community model has many advantages, but is sometimes perceived as brainwash when the goal is not freedom from drugs, but rather allegiance to a religious or a political orthodoxy.

Faith based approaches can be seen in therapeutic communities. Gary Ryan, an inmate, wrote in his book that abusing drugs and alcohol gave him comfort for awhile, but then came the discomfort. Prison was a blessing to him because he did not have access to drugs, and the therapeutic community he was in became his awareness. Alcohol and drugs often mask and numb negative thinking and therefore the network of support groups outside of prison is a key component in reducing recidivism rates. Prison is sometimes perceived as a privilege because it provides a rehab program, free health care, food, shelter, hygiene conditions, and personal time to think, read and develop artistic hobbies (music, painting, or writing) as part of therapy.

The best interventions that are relevant to the community model are directed at risk and protective factors, which play part in the community’s needs, resources and readiness to act. The cost benefit of substance abuse prevention to the community can be up to $36 in savings for every $1 invested. On average, funding for treatment cost is $10,000 for a state, $5,000 for a county, $7,500 for a city. Estimated personnel cost for one year is $16,900, it cost $16-20/hr to hire a coordinator, $6100 for training, community needs, data collection and implementation. Having health insurance can affect the type of treatment used. Employment is an enabling factor because it can provide payable access to health insurance.

The Cost of Addiction

Vast amounts of dollars have been spent on the war on drugs. The cost of illness is complex and covers three main areas of inquiry: what the connection between addiction and various adverse outcomes is (such as medical and social problems), to what degree addiction is directly responsible for its cost, and how the cost is determined.

The annual cost of substance abuse in the United States is estimated as $2.76 billion. This is part of the cost of healthcare, loss of productivity, crime, and motor vehicle accidents. Recovery and treating withdrawal symptoms call for medical and mental interventions which cost tax payer money.

Anything can be abused and can become an addiction if it is used in excess. Even prescriptions of aspirin or Tylenol contribute to healthcare cost. Although we do not become addicted to them as to other drugs prescribed for emotional and psychiatric conditions we may feel psychologically dependent on them. The Drug Abuse Warning Network has warned against fatalities caused by addiction in emergency rooms. Cost of direct healthcare is measured and estimates are made of lost productivity resulting from addiction and other costs associated with crime and accidents, in addition to the cost of medications.

Medications have been used for withdrawal from addictive drugs because withdrawal is associated with a decrease in the brain’s ability to feel pleasure. Medications which have been used to treat addiction and overdose (e.g Maltrexone) reduced relapse. Methadone maintenance treatment has allowed heroin addicts to enter recovery. Among drugs which block cravings and assist in relapse are the antidepressants imipramine and fluoxetine, and the mood stabilizers carbamezepine and valproate. Contingency management is the intention to help counteract the classical conditioning when the addict was exposed to an environment where drugs were being used which resulted in cravings.

Genes play an important role in the addict’s vulnerability to dependence and resilience. The addict may have had a troubled childhood, or suffered from anxiety or depression which was never treated. After years of abstinence, when the craving has been reduced to almost negligible thoughts, a small exposure to the drug is all it takes to restart the abuse and to bring back the intensity of the compelling urge that has been programmed into the brain.

Differences between Abuse and Dependence

The definitions of addictive disorder have ranged widely from a nomenclature based upon the presence or absence of physiological dependence to constructs relying on legal, social, and/or psychological problems associated with substance use. Individuals understand their own behavior and put it into a meaningful context on the basis of their culture, personal history and psychodynamics; family and other object relations; psychopathology, and other specific and nonspecific factors. Physical dependence upon a drug or upon alcohol also produces meaningful relationships between time and/or space, and subjective mood and behavior. Where heavy drinking is normative in certain societies in Europe and Russia, psychopathology appears to be a less significant risk factor for alcoholism. As marijuana use has become wide spread in the US over the past two decades, use per se is no longer limited to deviant or peripheral groups, and psychopathology has become less important as a risk factor of use by veterans.

The criteria for diagnosing abuse or dependence are based on the consequences that have occurred. The prevailing culture is an added factor. A smoker in the 1950s would have less severe addiction than a smoker today, because addiction was not a concern.

Sometimes people go through a period of abusing substances during stressful periods in their lives, but when the crisis is over there is no record of the abuse. Addiction occurs when the continued use of the substance becomes the focal point of life. When that change occurs, even when it is subtle, all other aspects of life (such as relationships, jobs, responsibilities, and goals) become less important than the drug. Incarceration or even death may result before the addict has the chance to realize the severity of the problem and enter treatment.

Addicts may be living in an abusive situation at the time that they choose to experiment and the relief that they get from painful feelings is a powerful reinforcer. The need to conform to a group may be very strong particularly for young people. Especially vulnerable are those with poor impulse control or low stress tolerance, and people who have difficulty learning from negative consequences. If they have relatives with drug dependence they are at a substantially increased risk of becoming addicted to any drug including alcohol.

Type I alcoholics tend to have mothers who are alcoholics; to have the onset of alcoholic drinking in their 30s or 40s; to be anxious, rigid, and emotionally dependent; and to experience loss of control. These alcoholics tend to engage in binge drinking. Type II alcoholics tend to have fathers who are alcoholics; to have the onset of alcoholic drinking before age 25; to have problems with conduct, aggression, and impulsiveness; and inclination for novelty-seeking behaviors. These alcoholics tend to be continuous drinkers.

Those with a genetic risk for alcoholism do not seem to have as much impairment in motor functioning when they drink the same amount of alcohol. If the family history is positive for alcoholism, there is much less body sway apparent than if the family history is negative. At a lower risk are those who lack a certain form of the enzyme alcohol