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The Natural Medicine Guide to ADDICTION
By Stephanie Marohn
Hampton Roads Publishing Company, Inc.Copyright © 2004 Stephanie Marohn
All rights reserved.
What Is Addiction and Who Suffers from It?
"Addiction is a physical disease."
"Addiction is a misguided search for self-love and spiritual fulfillment.
"We can draw a strong comparison between addiction and cancer."
"Addiction is an active belief in and a commitment to a negative lifestyle."
"Addiction is a disease which, without recovery, ends in jails, institutions, and death."
"Addiction is a continuum; your behavior is more or less addicted."
"In its beginning stages, addiction is an attempt to emotionally fulfill oneself."
"Addiction is a disorder of the brain no different from other forms of mental illness."
"Chemical dependency ... is a chronic disease that has no cure."
As you can see from the above definitions of addiction, all offered by professionals in the field of addiction treatment today, there is a wide range of opinion on what exactly addiction is. Conventional psychiatry and Twelve-Step programs subscribe to the incurable disease model, which holds that "Once an addict, always an addict." The natural medicine approach regards addiction as the consequence of physical, energetic, psychological, and/or spiritual imbalances that can be corrected. Everyone agrees, however, that untreated addiction affects every aspect of life and has far-reaching consequences. It also cuts across all class, race, and gender lines. Addiction is an equal opportunity affliction.
The complexity and scope of the problem of addiction are reflected in the fact that the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition), the American Psychiatric Association's diagnostic bible for psychiatric disorders, devotes over 100 pages to "substance-related disorders" alone, more than is allocated to any of the other so-called mental disorders covered in the text.
Amidst these 100 pages, substance dependence (the clinical term for substance addiction) is defined broadly as "a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems." More specifically, to meet the criteria for a diagnosis of substance dependence, at least three of the following must be operational in the space of a year:
* Tolerance (either a need for more of the substance or reduced effects from the same amount)
* Withdrawal when discontinuing use of the substance, or taking the substance (or one like it) to avoid or relieve withdrawal symptoms
* Taking more of the substance or for longer than intended
* Desire or failed attempts to reduce or control substance use
* Much time dedicated to obtaining, using, or recovering from use of the substance
* Giving up or reducing social, professional, or leisure activities due to substance use
* Continuing to use substance despite physical or psychological problems related to its use
In other words, the person experiences a loss of control and has a compulsion to use despite adverse consequences. The DSM-IV distinguishes between substance dependence and substance abuse. For a diagnosis of substance abuse, at least one of the following must be present in the space of year.
* Failure to meet professional or familial obligations as a result of recurrent substance use
* Recurrent substance use in situations in which it is physically dangerous to use, as when driving or operating machinery
* Recurrent legal problems related to substance use
* Continuing to use substance despite social or interpersonal problems related to Its use
The main difference between substance dependence and abuse, then, according to these definitions, is the physiological component of addiction, as manifested in the points regarding tolerance, withdrawal, loss of control, and the nature of the adverse results. This difference may simply be one of degree or stages of substance use, or it may be due to the presence or absence of factors chat predispose an individual to develop full-blown addiction (see chapter 2). In any case, the line between abuse and dependence is not always clear and need not be to initiate treatment. Many addiction-treatment providers do not make the distinction. The therapeutic approaches discussed in this book have equal application to abuse or dependence (and to substances and behaviors).
While the DSM-IV covers only problems with substances, aside from pathological gambling, which is discussed under "Impulse-Control Disorders," many of those in the addiction treatment field categorize addiction as two types: substance addictions and process addictions. The former includes addictions to alcohol, tobacco, and illegal and prescription drugs, while the latter covers behavioral or activity addictions, such as eating, gambling, spending, working, exercising, and sexual activity addictions.
While people may start using a substance or activity to feel good, addiction progresses to the point that they must use to keep from feeling bad. "Addicts become addicted not because of the high, but because they need their substance to satisfy their physiological hunger, to relieve the symptoms of depression, and to stave off withdrawal symptoms," states Janice Keller Phelps, M.D., a specialist in the treatment of addiction since 1977.
Withdrawal symptoms vary according to the nature of the addiction, from mood disturbances such as anxiety, depression, agitation, mood swings, irritability, and restlessness to physical symptoms such as chills, shaking, profuse sweating, and abdominal pain. Withdrawal is not necessarily over after conventional detoxification is complete. Post-acute withdrawal syndrome (PAWS), which can include the mood disturbances above as well as insomnia, listlessness, malaise, and/or headaches, can occur as long as a year and a half after "detoxification."
The term "detoxification" as it is employed conventionally does not entail an active detoxification protocol, but simply refers to the process of detoxification or withdrawal that the body does on its own when the formerly abused substance is withheld.
In part 2, you will learn about the biochemistry of withdrawal and how the nightmare of symptoms associated with it can be avoided with amino acids and other nutrients, among other natural medicine therapies. Rebalancing the biochemistry makes it possible for the individual to have the mental and physical wherewithal to proceed to addressing the behavioral, emotional, and spiritual aspects of their addiction as well. A lack of understanding of the multifaceted nature of addiction is what typically makes addiction recovery difficult.
Types of Addiction
There are two main categories of addiction high: arousal and satiation. The arousal high is about temporarily feeling omnipotent. The satiation high is about numbing pain. Substances and activities that produce the arousal high include speed, cocaine, ecstasy (MDMA), Ritalin (used by adults), alcohol during the first few drinks, gambling, and sex addiction activities. Those that produce the satiation high include heroin, alcohol, marijuana, tranquilizers, and food addiction behaviors.
Another way to describe the categories is: substances and behaviors that stimulate nervous system activity and substances and behaviors that depress nervous system activity. Substances can be further broken down into specific drug categories, such as stimulants, depressants, opioids, hallucinogens, cannabinoids, and steroids. Although different substances produce different problems in association with addiction, many practitioners believe that addiction is addiction and all "types" must be treated in the same basic way. Not acknowledging this fact promotes the substitution of one addiction for another. For example, using Valium (diazepam) to help people quit drinking often results in a Valium addiction.
Information about the various categories of addiction and substance abuse is helpful in understanding addiction, however. Here we look at alcohol, street drugs, prescription drugs, tobacco, and common addictive behaviors/activities.
Abuse of alcohol is rampant: 18 million Americans have alcohol problems and 53 percent of American adults have a family history of alcoholism or problem drinking.
Alcoholism varies crossculturally, however. Research has found that Native Americans and the Irish have very high rates of alcoholism, while Chinese, Greeks, Italians, and Jews have very low rates. Some researchers suggest that this is due to differences in how the cultures view alcohol.
For example, the Irish tend to view drinking in all-or-nothing terms while Mediterranean cultures exhibit a more moderate attitude. In the latter, drinking takes place within the family and "doesn't carry the emotional baggage that drinking does for groups with a greater susceptibility to alcoholism," states Stanton Peele, Ph.D., a psychologist, researcher, and specialist in the field of addiction.
In addiction treatment, the term alcoholism has come to refer to both alcohol abuse and dependence, a reflection of the fine line that separates them. The prevailing medical model holds that alcoholism is a physical disease that when untreated results in bio-psychosocial damage, meaning that the body, mind, and interpersonal relationships are affected. Social damage encompasses family, friends, career, and community.
Alcohol is slightly unusual in that it can act as both a stimulant and depressant. For the first few drinks, it is a stimulant; with further drinking, it becomes a depressant. As with drugs, alcohol produces its effects by acting on the brain's neurotransmitters (chemical messengers). Its pleasurable effects are likely the result of its action on endorphins, the body's natural painkillers and the source of "runner's high." Alcohol's sedative effects are likely due to its action on GABA (gamma-aminobutyric acid), which has a calming effect on the brain.
Another neurotransmitter involved is dopamine. Known as one of the "feel good" neurotransmitters, meaning that it is their presence and function that enable us to be in a good mood, its release in the brain is connected to the sensations of satisfaction and euphoria. Later in the chapter dopamine is discussed in more depth because research indicates that it is the primary neurotransmitter involved in all forms of addiction.
A further effect of alcohol on normal neurotransmitter function is that it impedes the supply of tryptophan (the amino acid precursor to the neurotransmitter serotonin) to the brain and thus reduces serotonin formation. Serotonin is involved in mood regulation, and disturbances in its levels or function have been linked to depression and anxiety, which offers an explanation for why these two mood states often coexist with alcohol abuse.
In addition to anxiety and depression, symptoms of alcohol abuse include facial puffiness, spider-like capillary formations on the face, flushing, sweating, dyspepsia, sleep problems, tremors, and chronic fatigue. The symptoms depend upon the severity of the drinking problem.
Withdrawal symptoms likewise depend upon the degree of abuse and can include increased heart rate, elevated blood pressure, anxiety, nausea, vomiting, headache, sweating, tremors, seizures, confusion, disorientation, hallucinations, and anxiety ranging from mild agitation in less severe cases to panic in more severe cases. The most severe withdrawal is termed "delirium tremens," or DTs.
The consequences of alcohol abuse are far-reaching. It can potentially damage every system of the body. Organ damage, cirrhosis of the liver, high blood pressure, heart problems, nutritional deficiencies, gastrointestinal problems (ulcers and gastritis), immune suppression, hormonal dysfunction, neurological damage, organic brain syndrome (permanent memory impairment), and possibly increased risk of certain types of cancer can all result from excess drinking.
Alcoholism is the third leading cause of death in the United States. More than 100,000 deaths annually are related to alcohol. One-third of all suicides, over 50 percent of homicides and domestic violence incidents, and 25 percent of emergency room admissions are related to alcohol."
The recovery rate with conventional treatment of alcoholism is low, ranging from 15 to 30 percent, depending on the source. The relapse rate among alcoholics is high, with half of those who go through treatment relapsing at least once.
Like alcohol, the use of illegal drugs is woven into the fabric of American society. An estimated 14.8 million Americans use illegal drugs and five to six million Americans have drug problems. One to two million use methamphetamine (speed) regularly" and 1.8 percent of Americans over the age of 12 use cocaine monthly. Five percent of those over 12 years old report using marijuana every month. Eight percent of high school seniors report that they have tried ecstasy (MDMA, methylenedioxymethamphetamine) at least once. Nearly 80 percent of Americans have tried illegal drugs by the time they are in their midtwenties.
The stimulant drugs speed (amphetamine, methamphetamine, and dextroamphetamine), cocaine, and crack; the opioids heroin, opium, and morphine; the cannabinoids marijuana and hashish; the hallucinogens LSD, mescaline, and psilocybin mushrooms; and phencyclidine (PCP, angel dust) can all be the source of substance abuse. While not technically drugs, substances inhaled for intoxification purposes include paint thinner, glue, gasoline, nitrous oxide (laughing gas), propane gas, and amyl and butyl nitrate (poppers).
As with alcohol, all of these drugs are thought to affect the dopamine neurotransmitter system, among other neurotransmitters. Speed, for example, floods the brain with dopamine, and scientists have found that even low levels of methamphetamine over time can damage up to 50 percent of the dopamine-producing cells in the brain. One study found that the level of dopamine in methamphetamine addicts was 24 percent lower than in normal subjects.
Heroin and marijuana also trigger dopamine release. Cocaine and crack block the absorption of dopamine, resulting in more dopamine in circulation in the brain. Chronic use damages dopamine receptors and disturbs the regulation of pleasure. (Receptors are the components of nerve cells that receive the neurotransmitter.)
While amphetamines are prescription drugs, illicit speed is used in a variety of ways, from shooting up to smoking it, which takes it out of the realm of "popping a pill." Street speed is also so prevalent that it must be included here as a street drug. Methamphetamine (known as crystal meth or crystal) use is on the rise around the world. In Thailand, for example, it is the "working man's and woman's preferred intoxicant," and according to an investigating writer for Time magazine, in one Bangkok slum of 5,000 residents it is difficult on weekends to find anyone who is not high on yaba (mad medicine), the local name for meth.
Speed is neurotoxic, meaning toxic to the nervous system, and chronic use can produce rapid or irregular heartbeat, weight loss, malnutrition, insomnia, irritability, restlessness, anxiety, panic, paranoia, psychosis, loss of coordination, tremors, seizures, stroke, and heart failure.
Heroin and other opiates operate on the brain's natural painkillers, endorphins and enkephalins. With heroin use, the body makes less of these substances and tries to reduce the effects of the introduced opiates. The result is higher doses of heroin are needed to produce a high. The primary health consequences of heroin abuse, in addition to the risk of overdose and the contraction of HIV from sharing needles, are respiratory depression and arrest, confusion, insomnia, anxiety, and depression.
Although much has been made of the horrors of heroin withdrawal, addicts report that a severe illness such as hepatitis B is much worse.
Many also report that it is more difficult to give up cigarettes. The focus on heroin as the bogeyman of withdrawal overshadows the real dangers of withdrawal from Valium and other benzodiazepines, which unlike heroin can be life-threatening. With any drug, if the natural medicine therapies you will learn about in part 2 were instituted in detoxification centers everywhere, withdrawal as we have known it would be a thing of the past.
While marijuana is regarded by many as a harmless drug, 10 to 15 percent of marijuana users become dependent on it, that is, are unable to give it up. In the brain, marijuana binds to receptor sites in areas that regulate mood and memory Impaired memory and learning, anxiety, and panic attacks are among the health consequences of chronic marijuana use. Other consequences include frequent respiratory infections, cough, and elevated heart rate.
Excerpted from The Natural Medicine Guide to ADDICTION by Stephanie Marohn. Copyright © 2004 Stephanie Marohn. Excerpted by permission of Hampton Roads Publishing Company, Inc..
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