By William D. Tumin, M.D.
In the past few decades, we have come a very long way in recognizing addiction as a disease. It has all the characteristics of most disease states. We can compare it to hypertension or diabetes, for instance. All three diseases have a basis in inheritance and are lifelong in nature. Biochemical changes can be identified for all three. Long-term outcomes and disease progression are well known in each case.
I’ve never known alcoholics or addicts who intended to become addicted when they started the substance. Most addicts are functioning citizens trying to support themselves and their families. They are from all professions and all trades. Some are educated, some are not. Poverty has been shown to increase the likelihood of addiction. Surprisingly, higher intelligence is also associated with a greater chance of developing addiction, but a higher educational level is associated with less chance of addiction and with greater rate of recovery when treated.
Nevertheless, most of my patients express some family or societal shame when others become aware of their condition. Even some medical professionals seem to share these negative responses.
There should be no shame in having a disease. However, a large part of the problem is that the addict commits illegal or immoral acts to secure drugs. This includes lying, stealing, pawning household items (whether owned by the addict or not), and even dealing drugs to support the “habit.” Because denial and minimization are almost always involved, patients have difficulty admitting the severity of their disease.
Addicts and alcoholics may be predisposed by inheritance, (50 percent in most studies). They may be self-treating an underlying condition such as PTSD, bipolar disorder, chronic anxiety, panic attacks, depression, or schizophrenia. The rates of addiction associated with major mental disorders are much higher than those of the general population.
Addiction is a chronic disease in which neuronal transmission has been altered. Messaging between neurons is accomplished chemically by substances called neurotransmitters. The main ones within addiction are dopamine, GABA, norepinephrine, and serotonin. When addiction is established, neurotransmitter patterns are altered, sometimes permanently. This accounts for the increased tolerance and drug cravings, as well as the ease of relapse after treatment.
Addiction has definite causation, definite progression when untreated, and ends in death, disability, or detention. Once the addiction has developed, patients try in vain to control their intake, generally to no avail. The compulsion to use is overwhelming, even after detoxification is complete. Even though addicts and alcoholics may realize the substance is destroying their lives and sometimes that of their family as well, they may be unable to abstain. Trying to stop by “willpower” alone usually ends in frustration. Addiction can rarely be overcome without help. This disorder is lifelong and must be treated as such. Nevertheless, patients can have sane, sober, and happy lives when their disease is properly treated.
However, I want to make one thing clear. Chemical addiction is not the same as simple physical dependence. After continuous use of a narcotic for greater than 11 days, anyone can have physical withdrawal. In this case, the patient’s thought has not been centered around drug use. There has been no need to secure from another source or to go buy drugs on the street. Withdrawal is short-lived, but may be quite uncomfortable. Repeat craving is generally not a problem.
We see that addiction is not a “bad habit,” but a brain disorder and is certainly a disease state. If all of us treat it as such, perhaps the stigma will decrease. Addicts who understand that they are sick, rather than “bad,” are much more likely to seek treatment. Families are more likely to be supportive. We already see that most members of the medical community understand this, and most industries offer supportive therapy or allow time for treatment.
We can increase our understanding of this disease in primary education by using scientific data, as would be done in any science or health class. Properly educated young people may develop different attitudes toward recreational drug and alcohol use.