SECTION III. ADDICTIONS

 

This section covers several addictions. Chapter 14 deals with alcoholism, chapter 15 with drugs, and chapter 16 with pornography. All these addictions can be seen as diseases or illnesses. It is a common belief among many people that those who become addicted lack willpower or moral fortitude. They have trouble seeing addiction as a disease. This situation is not helped by the ambiguous nature of the disease concept itself.

The term disease can be defined in many different ways (Clayton, 1991:46-47). One way is to define it as a pathological syndrome with a group of symptoms occurring at the same time. It can also be an abnormal condition of an organ or part that impairs normal functioning. And it can be seen as a pathological state that has a known etiology, a predictable course, and a definite outcome.

In 1956 the American Medical Association referred to addiction and alcoholism as a disease. It is classified both medically and legally this way. In a sense, the addictions are diseases according to any of these definitions. But, certainly unlike most physical diseases, people who have addiction diseases tend to deny that they have a disease. There are many defense mechanisms addicts use to escape the consequences or meaning of their disease (Clayton, 1991:Chapter five). Among these defense mechanisms are denial of the problem, projection of emotional pain to another person, minimization of the importance of the addiction itself or the consequences of the addiction, displacement of one's anger and frustration on an innocent party or parties, blaming an innocent person for one's own behavior, repression of one's feelings, free expression of anger, memory blackouts accompanied by fictitious stories covering the missing time period, and rigid thinking that avoids new ways of thought.

There are many types of addictions, including drugs, alcohol, and pornography, just to name a few. There are so many because people can become dependent upon almost anything to which the body strongly responds. Even stress can become an addiction in some people. In short, we can get high on our own brain chemicals (Restak 1984:168; Carnes 1991:30). The drug of choice can be either external or internal. Thus, alcohol addiction is an external drug addiction, while pornography can become an internal drug addiction.

The origin of addiction may be the evolutionary process for the brain makes it pleasurable to engage in those activities necessary for life itself, such as eating and procreation. The brain also has built-in avoidance mechanisms that employ internal sensations in order to avoid danger. Humans can misuse these internal drug systems for pleasurable sensations and in the process become addicted. External drugs work precisely because they take advantage of these internal reward/punishment systems. In summary, we can say that addiction involves the misuse of the internal go-stop systems necessary for human motivation.

The big breakthrough in understanding addiction came with the discovery of receptor sites for stimulant drugs and opiate-like chemicals in the human body. The areas of the brain that elicit self-stimulation behavior are especially concentrated in the most frequently used medial forebrain bundle (MFB) along with the ventral tegmental area (VTA) (Kornetsky and Porrino, 1992:60). Opiate receptors in the nucleus accumbens may be the critical area affected by external opiates (Koob, 1992:80).

Drugs work by acting on the same receptors used by the body's own neurotransmitters (Winger 1986:39). Because a drug can resemble a neurotransmitter, it can also act like one. And just like a neurotransmitter, the drug can activate a nerve system (just as if the body had internally send a nerve-activation message).

There seems to be genetic predispositions at work in the form of inherited genetic structure. This in turn affects a person's neurochemical vulnerability to drug addiction. The choice of the drug depends on whether one want to increase reward or reduce pain. Using the drug often results in neurochemical changes in that prolonged abuse of excessive "highs" alter neurochemical balances. Therefore, tolerance starts to build. The addiction then may lead to permanent imbalances as the addict tries to preserve the imbalance in order to feel normal.

The drug addiction process is a long and involved one. Part of this process is the build-up of tolerance. There is a definite body chemistry to the phenomenon known as tolerance (Zorkin, 1986:98). When a person takes a drug such as heroin or morphine, the receptor sites become overwhelmed by a flood of excess endorphins. The pituitary gland, which manufactures most endorphins, then gets the message to lessen endorphin production. Constant abuse of drugs can cause the pituitary gland to shut down endorphin production for a long time and prevent it from resuming normal functioning. Then the addict has to use more drugs to compensate for the lessening of endorphin production by the pituitary gland, thereby creating a vicious cycle.

There are many reasons why a person becomes a drug addict. And there are many factors affecting this process. Although there are many reasons why people become addicts, these motivations can be classified as to whether the addicts want more reward (through using stimulant drugs) or less pain (through using depressant drugs). In a sense, both motivations are attempts to overcome depression, but the body chemistry probably differs between these two groups of drug addicts. The use of stimulating drugs probably comes from a desire or a need to seek excitement in order to overcome depression or extreme boredom. A way to avoid depressive feelings is to strive for pleasurable ones. The pursuit of dangers and thrills that characterize the lives of some drug users may be their way of reaching out for excitement. Or drugs such as heroin may numb the feeling of pointlessness (Zorkin, 1986:89-91). The use of depressive drugs may flow from the desire to reduce stimulation and stress. The person may want a depressant in order to slow down this stress.

And of course, there are many addiction-inducing social factors such as availability, peer pressure, social learning, social controls, and setting (Zorkin, 1986). The purpose of this book, however, is to focus on the biological causes, not the equally valid sociological ones.

There also can be psychological addiction. The addictive personality concept is very nebulous, but indicates a person with overpowering needs; people who have obsessions and who never really end their addictions but only switch from one addiction to another. The problem is that this whole approach is not grounded in physiology, and therefore will remain obscure until researchers correct this shortcoming. Nevertheless, it helps distinguish between real physical addiction, and mere psychological dependence.

Related to the search for excitement is the theory that addicts are born with too low of a production of endorphins. Another theory claims that addicts somehow develop endorphin problems before using opiates. Either way, addiction may become a real bodily need because it works to correct a bodily deficiency. Some addicts may become addicted to pleasure itself (Zorkin, 1986:98). In other words, drug-induced euphoria may establish thresholds of pleasure that are so high that the addict loses interest in more everyday satisfactions.

CHAPTER 16. ALCOHOLISM

Definition

Alcoholism is the name for a variety of disorders accompanying the regular intake of alcohol. There are four common definitions of or criteria for alcoholism (Schuckit, 1985:5). First, the criterion of quantity and frequency of alcohol consumed stresses that alcoholics are individuals who drink a substantial quantity of alcohol over a certain period of time. Second, psychological dependence stresses that someone is an alcoholic if he or she "needs" alcohol psychologically, cannot function without it, or suffers extreme discomfort and anxiety if deprived of it under specific circumstances. Third, physical dependence: someone is an alcoholic to the extent that he or she would suffer withdrawal symptoms upon discontinuation of drinking. And fourth, the life problems definition: whoever drinks and incurs "serious life difficulties," such as divorce, being fired from a job, being arrested, facing community censure, and harming one's health, but continues to drink in spite of it (Goode, 1990:137).

The reason why alcoholism is a progressively debilitating disease is due to the chemistry of the alcohol metabolism in the human body. In normal drinkers alcohol is broken down into acetaldehyde in the liver along with carbon dioxide and water. But in the alcoholic, who has a genetic predisposition, the liver produces so much acetaldehyde that the organ cannot produce enough enzyme to eliminate it. The excess acetaldehyde travels to the brain where it forms THIQ (a morphine-like substance). THIQ is a suppressor chemical that suppresses endorphin. The more an addict uses, the more THIQ is produced.

The CAT scan reveals other damage to the alcoholic. The alcoholic's brain has a loss of cortical tissue, particularly in the frontal areas.

Occurrence

Roughly one-third of all Americans are more or less total abstainers. In spite of this, Americans age 15 or older consume about 2.58 gallons of absolute alcohol per person per year (Lender and Martin, 1987:206). This works out to just under one ounce of absolute alcohol per person age 15 or older per day. This represents two and a half 12-ounce bottles or cans of beer or three 4-ounce glasses of wine or one 3- or 4-ounce drink of hard liquor per day for every drinking adolescent and adult in the country (Goode, 1990:131).

Kandel (1992) estimates that 12 percent of the population are heavy drinkers in that they drink nearly everyday. She also estimates the number of alcoholics in the nation is somewhere between 10 and 13 million. Neugebauer, et. al. (1980:65-66) estimates the proportion of alcoholics in the United States at 4 percent.

In the 1980s there has actually been a decline in the consumption of alcohol. Fewer people appear to be drinking, and, among those who drink, a higher proportion is drinking less when they drink, and less frequently as well (Goode, 1990:132). This may be related to the increased understanding of the health- damaging consequences of alcohol consumption.

Moralism

We are all familiar with the moralism of the American public concerning various behavior problems due to chemical imbalances. Many, however, are not as familiar with the moralism of social scientists. Vogler and Bartz (1985) provide an example of this moralism applied to alcoholism. They argue that alcoholism should not be treated as a disease. They argue social scientifically that alcoholism is really a learned pattern of behavior and not a disease. The two psychologists reject the disease concept by arguing in a very unsophisticated way that it is not like a physical disease, such as measles. The disease concept is really just "part of a movement to consider problems in living as mental illness (1985:217)." They argue that alcoholism is more like a bad habit than a disease.

These psychologists argue like social conservatives that if the public accepts the disease concept, they weaken the concept of free will and, thereby, encourage drinkers and others to take no responsibility for their own behaviors. The disease concept also discourages alcoholics and others from seeking help until their situation is out of control, for few people will admit that they are "sick."

The problem with the above argument is that it is deliberately unsophisticated about the "disease" concept. Health professionals and scientists are now using more sophisticated terms, such as chemical "dependencies," to refer to alcoholism and drug addiction. Furthermore, the disease concept does not undermine the concept of free will, but rather simply restricts its application. And, if alcoholism and drug dependency are more like bad habits than diseases, then where is the urgency to seek treatment?

Role of Genetics

Genetics plays a major role in alcoholism. Family, twin, and adoption studies all support this conclusion (Schuckit, 1992:94). The sons of alcoholic fathers, even those who have been separated from their fathers at birth, are at high risk for developing alcoholism themselves. Studies of boys who have been adopted reveal that it is the biological rather than the adoptive parent who is predictive of later drinking problems. Even being raised by an alcoholic adoptive parent does not appear to add to the alcoholism risk (Schuckit, 1992:94). Studies of identical twins compared to fraternal twins have shown that alcohol abuse in identical twins is almost double that for fraternal twins (Restak 1988:120-121). If one twin drinks heavily, it is likely the other will also overindulge. Family studies have consistently revealed that close relatives of alcoholics have a twofold to fourfold increased risk for severe alcohol-related life problems (Cotton, 1979; Goodwin, 1988).

Possible Genetic Markers

To spot a potential susceptibility to alcoholism, possible genetic markers are being sought. Event related potentials (ERPs) for individuals with a family history of alcoholism tend to manifest different wave forms from normals . Schuckit (1992) has done comparisons between subjects who have a family history of alcoholism and subjects without such a history on electro-physiological measures. The positive voltage brain wave observed approximately 300 milli-seconds following a rare but anticipated sensory stimulus (the P3 wave of the event related potential or ERP) has a smaller amplitude in alcoholics than in controls. Studies have repeatedly demonstrated that a substantial minority (perhaps one third) of sons of alcoholics have evidence of a diminished P3 amplitude (Schuckit, 1992:98). The size of this wave is related to the overall ability of an individual to recognize and properly interpret subtle stimuli in the environment. In other words, many sons of alcoholics may have a reduced or slowed capacity to respond to events such as the first subtle effects of alcohol.

There is some evidence that there are important blood proteins that can be used as markers of an elevated alcoholism risk. Alcoholics and their offspring are likely to show at least a trend for lower levels of monoamine oxidase (MAO) (Schuckit, 1992:99). A second blood protein is adenylate cyclase. Alcoholics have decreased platelet activity for this enzyme after stimulation with several chemicals (but adequate data have not yet been generated on children of alcoholics).

Types of Alcoholism

The first type of alcoholism involves those with a family history of alcoholism. Studies show that about 40 percent of the sons of relatively severely alcoholic fathers have a decreased intensity of responses to three to five drinks of alcoholic beverages (Schuckit, 1992:105). Those with a family history of alcoholism have less intense subjective feelings of intoxication and less intense reactions on motor performance tasks following modest doses of alcohol.

The second type of alcoholism is the alcoholism that develops later in life. This type of alcoholism is due more to the lack of endorphins secreted by the body. In addition, a person suffering from hypoglycemia often has a biological predisposition for alcoholism since there is an underproduction of sugars in the body. A ingestion of sugar can lead to a sugar rush in the body followed by a subsequent crash leading to the sugar blues. These types of alcoholics are often overeaters. Interestingly, compulsive overeating and alcoholism run in the same families (Winger, 1986:28).

There is a possible third type of alcoholism. This is the alcoholic who suffers from antisocial personality disorder. Studies have been conducted at the University of Connecticut Alcohol Research Center on the association between ASP and alcohol-related problems (Hesselbrock, et al. 1992:179 & 181). While a high prevalence of substance use disorders has been noted among patients in the general mental illness treatment system, ASP is the most prevalent coexisting psychiatric disorder among males with substance use disorders. Subjects with ASP have an earlier onset of drinking and a more rapid development of alcohol dependence once drinking has begun than nonASP subjects.

A Note on Gambling

According to the DSM-III, compulsive gambling is a disorder of impulse control, along with kleptomania and pyromania. There are some physiological similarities between compulsive gamblers and alcoholics (Carnes, 1991:30). Compulsive gamblers have been found to have abnormally low beta-endorphin levels, and like alcoholics, compulsive gamblers manufacture a state of excitement in order to make up for the opiate-like deficiency. Gamblers get high on their own body's reaction to fear. The actor Walter Matthau noted that he only got a physical high when he bet enough money that the possible economic loss could hurt him financially. In other words, there had to be an element of fear involved in order to produce the desired physical rush. In severe cases, prolonged gambling can build up tolerance, but it does not produce "real" physiologically addictive states.

Activities such as gambling, skydiving, and shoplifting share the fear emotions of high risk. Zuckerman (1983) has found many studies showing the existence of low levels of monoamine oxidase (MAO) in those addicted to high risk.

 

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