Aidan French
Professor Richman
CORE102
November 7, 2018
Addiction: Why it is an Issue and What Can We Do
There I was, celebrating Christmas with my mother’s family on Christmas Eve like we did most years when I was younger. My younger brother and I were in the living room enjoying ourselves with our new toys and we could hear the family in the kitchen cleaning up and talking, all enjoying the night. “Don’t worry about anything Marc. Go play with the kids, you don’t get to see them very often,” I heard my mom tell my uncle when he was offering to help clean up.
So, he came and talked with my brother and me. He had the idea of us creating secret handshakes. This is my only memory with him, and I can’t even remember the handshake. That was the last time I would ever see him again.
My uncle dealt with addiction to alcohol as well as various other drugs. His use eventually led to his death in his thirties. It took all of us by surprise because it wasn’t as if there were cumulative factors that caused it. It just happened one day. At the time, his death did not affect my brother or I very much, we hardly knew him after all. But, my mom was forever changed by what happened. She put the blame on herself because she thought that if she had done something everything would have been different.
Years later my aunt’s substance use started to get the better of her and we took notice. We tried to help her get control over her addiction, but addiction was something she dealt with for decades, making it even harder to make better. Her problems started before I was born, coming down to an injury she sustained during work as an EMT. She had been prescribed pain killers, so she could recover without feeling so much pain. Eventually she, just like many other people, developed a dependence on these painkillers, as well as some tolerance. After her prescription wasn’t being filled she turned to illicit kinds of painkillers. This marked the beginning of a lifelong struggle with substance addiction. Research is showing that addiction is one disease that has multiple “manifestations,” explaining why people who overcome addiction to one thing very often find themselves addicted to another thing (Richter and Foster 61-62). I could see this clearly in my aunt who gave up painkillers and other opioids for alcohol.
While I was alive I only knew her to be a problem drinker, one that was not necessarily drunk every day but rather once in a while I would hear about it when my parents were talking. But as time went on her habit became more controlling in her life. I remember that peculiar scent that alcoholics carry being on her when I saw her the few times a year that I did.
One day she ended up being hospitalized, the first of many times that she was. This made the situation much realer to me; hearing that my aunt was hospitalized because her organs were failing her. I wanted for her to stop and I could not understand why she couldn’t. I went with my mom to see her in Detroit multiple times, but two days stand out to me and are well-embedded in my memory. One very important memory I have was when my mom took my aunt to buy groceries and my aunt asked if my mom would take her to a liquor store, so she could get something to drink. My mom’s reaction to this was to stop the car to tell my aunt that she would not contribute to her problem. This raised a question in my head that I still ask to this day, how can somebody be so willing to worsen the thing that is bringing them down?
Another day that I remember clearly was when we visited her in the hospital not too long before she died. Seeing her stomach all swollen up and being told that they had to drain so much liquid from her regularly made me feel a hard-to-describe kind of disgust. The swelling of her stomach is called ascites, a condition ultimately caused by cirrhosis of the liver, when healthy liver tissue is replaced with scar tissue (WebMD.com).
Alcohol as a Drug
So why is alcohol commonly not considered a drug by the general public? Merriam-Webster defines a drug as “something and often an illegal substance that causes addiction, habituation, or a marked change in consciousness” (Merriam-Webster). So, would that not mean that many other things that we consume are drugs? Caffeine is one of the most commonly consumed substances, and it elicits a change in consciousness, acting as a stimulant to help people feel more “awake.” However, in most situations caffeine is not regarded as a drug because it is legal, easily obtainable, and highly desirable. In comparison, alcohol is something that is legal, easily obtainable, and by many it is highly desirable. The clear difference between these two is that alcohol is age-restricted, in the United States an individual must be at least twenty-one years of age to purchase alcohol. Similarly, tobacco cigarettes are also age-restricted and are very often not considered drugs.
Classifying alcohol differently depending on the context of the situation may be even more important than simply strictly referring to it as a drug. In diagnosing a person with a dependence disorder, it may be more effective have separate classifications for alcohol and other drugs as the treatment and symptoms can be different. But, it would be effective to refer to alcohol as a drug in most of situations because of the many similarities between illicit drugs and it, possibly creating a deterrent from future development of alcohol dependence. Where should the line be drawn for a substance’s classification as a drug? Ultimately that is for the individual to decide, but education on addiction could serve to change many people’s opinion on alcohol not being a drug.
Alcohol’s Role in the World
The National Institue on Alcohol Abuse and Alocholism compiled statistics from studies and surveys to show a condensed list of the negative consequences associated with alcohol consumption. A baseline statistic is provided to give insight as to how common drinking is “86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime” (NIAAA.nih.gov qtd. NSDUH). Seeing that the majority of people have tried drinking alcohol at least once in their life shows the widespread risk for the development on dependence or addiction to it. The NSDUH also reported that and estimated 15.1 million adults age 18 and older had Alcohol Use Disorder. Alcohol Use Disorder is the diagnosis of problem drinking. The Diagnostic and Statistical Manual of Mental Disorders currently states that anyone that meets two of the eleven criteria during the same 12-month period is experiencing AUD. The severity of the Alcohol Use Disorder is determined by the number of criteria met by an individual (NIAAA.nih.gov).
The NIAAA reports, “An estimated 88,000 people (approximately 62,000 men and 26,000 women) die from alcohol-related caused annually, making alcohol the third leading preventable cause of death in the United States” (NIAAA.nih.gov). If so many deaths are attributed directly to alcohol consumption, why do so many people use alcohol in manners that puts them at risk of death?
Addiction Mechanisms
The commonality between these different substances is that they all cause varying degrees of dependence in humans and other animals as well. A research review by Steven E. Meredith explains the concept of caffeine dependence very well,
Caffeine acts as an antagonist at adenosine receptors, thereby blocking endogenous adenosine.25,26 Functionally, caffeine produces a range of effects opposite those of adenosine, including the behavioral stimulant effects associated with the drug.27 Importantly, caffeine has been shown to stimulate dopaminergic activity by removing the negative modulatory effects of adenosine at dopamine receptors.28 Studies suggest that dopamine release in the nucleus accumbens shell may be a specific neuropharmacological mechanism underlying the addictive potential of caffeine. (Meredith et al. 115).
The explanation provided tells us that dopamine release is a large player in the development of addiction to caffeine. This mechanism is present in many other substances that possess addictive properties as well. “Furthermore, alcohol ingestion and even the anticipation that alcohol will be available produce dopamine release in the nucleus accumbens as determined by increased dopamine levels in the fluid outside the nucleus” (Gilpin and Koop 188). This dopamine-driven mechanism of addiction is present even in food consumption, serving as a sort of system for reminding us that certain things are necessary for our survival.
A startling statistic about addiction is mentioned in Caffeine Use Disorder relates pregnant women’s risk of dependence on caffeine to other substances. “Among a group of pregnant women, Svikis et al.22 found that those who received a lifetime diagnosis of caffeine dependence were nearly nine times more likely than those without the diagnosis to report a history of cigarette smoking” (qtd. in Meredith, et al 126). This could suggest a correlation between substance dependencies, although Meredith does state, “more clinical, epidemiological, and genetic research is needed to determine the relationship between Caffeine Use Disorder and other Substance Use Disorders” (126). This data is still alarming seeing that in a study conducted on pregnant women those with diagnosed caffeine dependence were nine times more likely to have a history of cigarette smoking.
Addict as a Label
I had never thought of my aunt or uncle as addicts until after their deaths. Maybe I felt that I didn’t want to put the same label that addict is to most people. “A 2009 national survey of adults underscores the considerable stigma still associated with addiction; words commonly used to describe those with the disease include ‘sinner’, ‘irresponsible’, ‘selfish’, ‘stupid’, ‘loser’, ‘undisciplined’, ‘pathetic’, and ‘weak’” (Richter and Foster 61). To me, my aunt and uncle were none of those things, they were kind, loving, and wonderful people, so why label them with a term that generally paints a negative image.
Most people associate addiction with ‘drug abuse’ or ‘substance abuse,’ but looking at the issue this way ignores that addiction is a disease caused by major changes in the brain. Using ‘abuse’ to describe a person’s affliction creates shame that puts those at risk in a position where they will avoid getting help (Richter and Foster 62). Richter and Foster write in their article, Effectively Addressing Addiction Requires Changing the Language of Addiction, “A national survey of patients in addiction treatment found that the majority (84 per cent) said they would not discuss their use of addictive substances with their primary care physician because they were ashamed” (62-63). Knowing that the current stigma of addiction is accompanied by negative reinforcement it is important to consider how we as a society regard people struggling with addiction.
It is important for everybody to be conscious of how they refer to people dealing with addiction, they are people just like everyone else and many of them resent their addiction(s). If ‘addict’ carried a more positive and uplifting connotation it is possible that more people would be willing to admit their problems and find ways to overcome them.
Treatment
As far as I know my aunt did not go to any treatment centers, but if she did it obviously did not work. If she had found a method that suited her it is possible that she would still be here today. But with so many different options for recovery why is it that countless people don’t find help? Michael Lemanski’s article Addiction: Alternatives for Recovery opens by discussing how the twelve-step process found in groups like Alcoholics Anonymous is a dated method that is faulted because it is based on “religion-spirituality and talk-therapy” (14). Obviously, religion can be a barrier for people seeking recovery if they believe in a religion that is not the religion used in one treatment method, or if they have no belief in religion at all. Talk-therapy may be affective for some people, but many cases require more action taken than talking about their problems.
The Health Recovery Center is one of the treatment centers formed after Alcohols Anonymous that employs a much different method of treatment. The group uses “biochemical repair” and diet to promote recovery. Dr. Joan Mathews-Larson formed the Health Recovery Center after finding that “many alcohol-dependent persons have some kind of biochemical deficiency” (Lemanski 15). When people who first entered her program they were
• 75 percent were hypoglycemic (low blood sugar), which can result in a variety of symptoms including depression (15).
• A majority suffered from malnutrition (deficient in several key vitamins and minerals), as excessive alcohol consumption inhibits the body’s natural ability absorb essential nutrients (15)
• Tobacco, caffeine, refined sugar, simple carbohydrates, and processed low nutrient diets were common among recovering addicts (and often recommended as a substitute for alcohol by AA-model treatment facilities) and can induce physical cravings, cause mood swings, and precipitate depression (15).
These deficiencies create an environment in the body and mind that can lead to higher risk of alcohol use or abuse in the “abstinent addict” (15). Mathews-Larson reported a 74 percent success rate in a three-and-a-half-year follow up period. Nearly three out of every four patients having success shows that this method is possibly very effective.
Various groups that promote secular treatment exist, notably the Alcohol and Drug Abuse Self-Help Network, Inc. and Secular Organizations for Sobriety. The Alcohol and Drug Abuse Self-Help Network, Inc. uses Self Management and Recovery Training (SMART) as a sort of self-regulated road for recovery. Members are encouraged to identify and discuss their self-destructive behaviors to change them to avoid future relapses. Members also create short-term and long-term goals to give a sense of progression. Within the organization, abstinence from alcohol and other addictive substances is the main goal and a mindset is developed to assist the abstinence. No religion is preached to members, making it more widely acceptable and accessible.
Conclusion
Addiction is something that everybody is vulnerable to. It is human nature to exhibit some sort of addictive behavior as dopamine reactions in the brain are naturally occurring in humans, as well as animals. While most people have some sort of non-destructive addiction, there are many people in the world, regardless of demographics like age, race, or gender, that do suffer from addiction. Addiction is unavoidable, and people should support addicts, rather than put them down, so more seek treatment or successfully recover through treatment. It will be impossible to eliminate this issue, but education can help decrease the amount of repercussions incurred from alcohol use and drug addiction.
Works Cited
“Alcohol Facts and Statistics.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics.
“Drug.” Merriam-Webster, Merriam-Webster, www.merriam-webster.com/dictionary/drug.
“What Are Ascites and Paracentesis?” WebMD, WebMD, www.webmd.com/digestive-disorders/ascites-medref.
Gilpin, Nicholas W, and George F. Koob “Neurobiology of Alcohol Dependence: Focus on Motivational Mechanisms.” Alcohol Research & Health, vol. 31, no. 3, 2008, pp 185-195
Lemanski, Michael J. “Addiction: Alternatives for Recovery.” Humanist, vol. 60, no. 1, Winter 2000, pp. 14-17. Humanities Abstracts,
Meredith, Steven E, et al. “Caffeine Use Disorder: A Comprehensive Review and Research Agenda.” Journal of Caffeine Research, vol. 3, no. 3, 2013, pp. 114-130.
Richter, Linda, and Susan E. Foster. “Effectively Addressing Addiction Requires Changing the Language of Addiction.” Journal of Public Health Policy, vol. 35, no. 1, 2014, pp. 60–64. JSTOR, www.jstor.org/stable/43288004.
Weisner, Constance. “The Merging of Alcohol and Drug Treatment: A Policy Review.” Journal of Public Health Policy, vol. 13, no. 1, 1992, pp. 66–80. JSTOR, JSTOR, www.jstor.org/stable/3343059.