Carlton K. Erickson. The Science of Addiction: From Neurobiology to Treatment. New York: W.W. Norton & Co., 2007.
The word “addiction” is not a scientific term, although the author recognizes it as a term the public comprehends. Most scientific studies instead refer to “dependence syndrome”. The term “addiction” is not a precise term.
It is impossible to determine changes in brain chemistry.
The public has stigmatized terms like “addiction” and “alcoholism”. An “alcohol dependence” or “chemical dependence” is what the scientific literature recognizes. “Addiction”, when expressed by different people, could refer to being in a disease state or the more general popular definition. The author notes there is a difference between “chemical addiction”, which is a brain disease, and “drug abuse”, which is not a disease.
“Drug misuse”, which notes that a person should be responsible for one’s actions, is the term found in British journals and is a better description than “drug abuse”.
The stigmatized words are used to indicate that the people being described are different from the person using the words. The stigmatized words indicate the person using the words believes they deserve bad things for a problem that is their fault. Terms that stigmatize include “drunks”, “alcoholics”, “addicts”, “junkies”, etc.
“Drug abuse” is the misuse of a drug and is not a disease. “Chemical dependence” when pathological is a brain disease where the brain is impaired from controlling use of the drug.
The American Medical Association labeled “alcoholism” as an addiction in 1967. The U.S. Supreme Court disagreed in 1988 when it legally found alcoholism as “willful conduct”.
Genetic, neurobiology, and pharmacology research over the past two decades found “chemical dependence is a chronic, medical brain disease, driven significantly by genetic vulnerability.” The mesolimbic dopamine system of the brain works improperly during chemical dependence. This is a disease because it is biologically based, has unique indentifiable symptoms, has an anticipatable results, and a person cannot control the cause of the disease.
Insurance companies fight labeling “addiction” as a disease. They don’t want to pay the costs of handling the disease.
Alcoholics Anonymous contributes to the misunderstanding of alcoholism. It tells its members their problem is behavioral. The author argues it really is a complex issue of biology, genetics, physiological, and behavioral. New data from research shows it is a brain disease.
Physicians have found there are people are people with drug related difficulties are able to cease using drugs on their own will. The drug use is voluntary and intentional. There are also people with drug related difficulties who have a chemical dependence and they can’t stop using drugs. This drug dependency is “pathological and unintended”.
Withdrawal results occur after prolonged drug use that allowed a body to adjust to the depressed functions caused by the drugs. The withdrawal affects occur as the body begins returning to normal functions when the drug use stops. The process of returning to normal functions creates hyperexcitability.
There are no observable physical withdrawal symptoms from stopping the use of drugs that affect the central nervous system, such as cocaine, amphetamines, and LSD.
The rehabilitation “treatment” for chemical dependency could consist of anti-craving medicine when appropriate, detoxification, counseling, and guidance of abstaining, nutrition, exercise, etc. The goal is to achieve a psychological and emotional stability.
There are degrees of severity of chemical dependence. A mild dependence seeks to use drugs “a lot”, a moderate dependency seeks the drug “even more”, and a severe dependency seeks the drug “all the time”.
Scientific studies have never concluded there is an “addictive personality” where a person addicted to a drug is inclined to become addicted to other drugs. There have been studies that show some conduct disorders or antisocial personality disorder may be more inclined to alcohol dependency.
Epidemiology studies indicate there is a higher chance for adolescents, especially young adolescents, to develop alcohol dependency if they begin drinking alcohol during adolescence. It is believe adolescents may be more prone to developing dependency when using other dependency producing substances.
A third of heavy alcohol or drug users become dependent on their use. Many people “do not have the genetic” disposition to become dependent.
There has not been much research into becoming “instantly addicted” on first use of a substance. It is theorized it may be more an infatuation than an actual addiction. Still, the instances are plentiful enough to warrant further study.
Of users of substances who become addicted, a 1994 study found the percentages at 32% for nicotine, 23% for heroin, 17% for cocaine, 15% for alcohol, 11% for stimulants, 9% for cannabis, 9% for sedatives, 5% for psychedelics, and 4% for inhalants.
A person can become reliant on antidepressants yet they are not addicting. They have no effect on the mesolimbic dopamine system in the brain. People using medication for a disease are reliant on the medication for their health. A diabetic is reliant on insulin. A depressed person is reliant on antidepressants.
Pathological gambling may be a “chronic and progressive mental illness.” Most overcome this without treatment. Consistent pathological gambling may be treated with naltrexone (sometimes in combination with an antidepressant) and, if bipolar disease is also present, lithium. Some new studies indicated that nalmefene is just as effective and has a lower liver toxicity than does naltrexone.
Alcohol and drugs change the human nervous system and alters how cells communicate with other cells. This results in a person feeling intoxication. This can create permanent changes that create a chemical dependency to maintain the changed state. The author argues this is a brain chemistry disease. He disagrees with people who consider people with this disease as having a mental weakness or a moral weakness. He argues that step programs that teach a person they are powerless to overcome their dependency may prevent an awareness of how the dependency can be treated.
Every disease disrupts cell activity.
The release of endorphins and serotonins produce pleasurable feelings. Heroin mimics this release but at a higher does.
The incentive sensitization theory is backed by some strong research. This theory is there is a decrease in a drug’s effective over time of use. This and other theories indicate drugs affect the brain’s mesolimbic dopamine system by turning it into a disease state.
Studies since the 1970s indicate there is a genetic connection to some alcoholism. There is no such thing as an inherited chemical dependency gene. Yet a defect in a gene may make someone susceptible to a disease. A combination of polymorphic genes and environmental factors may lead to alcoholism.
It is a myth that a drug with the most “high” effect is the most addictive. The most addictive drug, nicotine, has a low euphoric value.
Caffeine research is lacking, but so far caffeine does not create a chemical dependence in the brain.
OxyContin is an effective pain control drug and is more effective than other opiods. It is no more likely to create a chemical dependency than morphine. People have died from OxyContin but more deaths occur from other opiods.
Most scientists agree alcohol is a drug.
Alcohol can permanently damage the nervous system.
Long term heavy alcoholic drinking can lead to chronic pancreatitis, which is hard to treat, esophageal varicas, which requires one to stop drinking alcohol to treat, and liver deterioration.
Liver cirrhosis happens in about one fifth of heavy alcohol drinkers. Alcohol can contribute to cancer, immune system, weakening, and poor nutrition. More deaths attributed to drinking are due to accidents and suicides.
No hangover remedy had been found effective. The best way to prevent a hangover is never to let one’s blood go above 0.05% (with this number varying due to body size and other factors).
Alcohol can increase the effects of some other drugs. Alcohol and methamphetamine can increase or decrease the reactions of each depending on how much of each is taken.
A woman drinking alcohol during pregnancy can lead to the body having fetal alcohol spectrum disorder. This can reduce the brain size, lower IQ, and cause missing finger, toes, or kidneys of the baby. This does not occur to every pregnant woman who drinks heavily.
Alcohol in moderation of one or two drinks a day has a mild antioxidant effect of keeping free oxygen radicals from body tissue, which thus reduces risks of cancer and heart disease.
Nicotine is used as an animal tranquilizer.
Babies of mothers who smoke during pregnancy are more apt to be born with smaller lung capacities. They are more apt to die from sudden infant syndrome.
Marijuana is not lethal and is thus the safest drug. In large amounts of use it can create impairment (one should not drive when under its influence), short term memory loss, and create a loss of motivation.
The author believes marijuana is not likely to become addictive although greater euphoria of stronger cannabis can lead to continued use.
Marijuana can produce pain relief, reduce nausea, decrease the eye pressure of glaucoma, reduce lung and trachea pressure to help with asthma, and help with nervous system and spinal cords to assist people with multiple sclerosis.
A 2004 study indicates there could be a connection between marijuana and psychosis, although this remains unclear as to whether it triggers or calms psychosis.
Marijuana can create a dependency. It can have withdrawal symptoms.
Ecstacy can cause death in high doses. Few studies have been done of this drug.
LSD fragments or blurs the ego/self from the external world. This can cause delusions and hallucinations. It is not toxic to organs. It has a low rate of dependency. It does not create hallucinations in all users, but it does distort perception. There is no known legal use of LSD itself. It can cause psychotic episodes or a “bad trip”. A “flashback” can occur to a psychological retrieval of the memory. The flashback does not occur to the drug remaining in one’s system, as it does not remain in the system. The flashback can bring back pleasant, unpleasant, or neutral feelings.
Gamma-hydroxybutyrate or GHB was used to create alertness in a person with narcolepsy. It has high toxicity. It can as it cross the blood-brain barrier, causing an overdose,
Rohypnol, or “roofies”, when combined with alcohol, create a comatose state. It is also known as the “date rape drug”. It has a high risk of lethal overdose.
Inhalants are found in pain solvents, deodorants, cooking sprays, air freshners, glue, gasoline, paints, etc. It reduces oxygen and disrupts the hearth rhythms. Death has occurred in people are young as 10 years old.
Physician supervised prescription drugs are usually not dangerous. Neuroleptics (used for mental illness), antidepressants, membrane stabilizers, anti-epileptics, and lithium do not create a chemical dependency.
There is no single drug that is effective for everyone with the same disease. A choice of medication options, until the correct option is found, is required.
Alcoholics Anonymous has a 5% overall effective rate based on some formal studies and anecdotal estimates. Of members who attend meetings for three years, there is a 50% effective rate.
Interactional and behavioral therapy counseling seeks to address issues related to chemical dependency. The author believes many counseling programs have poor diagnostic intake assessments. Most counseling ignore the disease aspect of chemical dependence.
A good methadone program: 1.) watches the patient take the methadone in the clinic. Methadone taken home could be sold to others. 2.) conducts regular urine drug testing, 3.) requires the patient to achieve economic stability, and 4.) requires counseling for a drug free life.
Some methadone clinic staff do not believe abstinence works. Some other staff do not ask for abstinence for fear of the patient leaving the program and reentering chemical dependency.
Benzodiazepine prevents delirium tremors (DTs), seizures, and hallucinations during withdrawal.
There is no case on record of anyone dying from just acute withdrawal. Medications and acupuncture can reduce withdrawal symptoms.
Disulfiram or antabuse blocks aldehyde dehydrogenase, a liver enzyme, causing a sick feeling when drinking alcohol. It can cause death. A study in Germany found a 50% abstinence rate from antabuse users. Some will continue drinking through the sick feeling.
Medications that may reduce a craving for alcohol, and are not very effective when used alone, are naltrexone (blocks the endorphin high) and acamprosate (shown to decrease alcohol use).
Medicaitons for heroin dependency are methadone (reduces the craving for heroin) and buprenorphine (with trade names of Subutex and Suboxonel), which is less likely to be abused. Different patients find one medication better than the other.
Nicotine dependency can be treated by bupropion or zyban (reduces withdrawal symptoms). When used alone, they have less than a 50% effective rate. They are more effective when used with nicotine replacement therapy (such as patches, gum, and devices that continuously reduce nicotine use over time until abstinence is reached).
A 2006 study found that varenicline is a more effective medication than is bupropion for quitting nicotine.
Rimonabant, or Acomplia, is an endocannabinoid used in England for quitting smoking and fighting obesity. This has potential benefits as some people otherwise tend to gain weight when reducing smoking.
There are no medicines for treating amphetamine addiction. This addiction is treated with counseling and supportive care.
A 1996 study found 33% of bipolar disorder patients also has a drug use disorder.