Understanding Addiction

238 Pages·2001·1.72 MB·English

by  Elizabeth Connell Henderson

Understanding Addiction
Understanding Health and Sickness Series
Miriam Bloom, Ph.D.
General Editor
Understanding Addiction
Elizabeth Connell Henderson, M.D.
www.upress.state.ms.us
Copyright © 2000 by University Press of Mississippi
All rights reserved
Manufactured in the United States of America
08 07 06 05 04 03 02 01 00 4 3 2 1
The Twelve Steps and excerpts from pages 16–17 of the book, Alcoholics
Anonymous, are reprinted with permission of Alcoholics Anonymous World
Services, Inc. (A.A.W.S.). Permission to reprint the Twelve Steps and these
excerpts does not mean that A.A.W.S. has reviewed or approved the contents of
this publication, or that A.A.W.S. necessarily agrees with the views expressed
herein. A.A. is a program of recovery from alcoholism only —use of the Twelve
Steps and these excerpts in connection with programs and activities which are
patterned after A.A., but which address other problems, or in any other non-A.A.
context, does not imply otherwise.
Illustrations by Regan Causey Tuder.
Library of Congress Cataloging-in-Publication Data
Henderson, Elizabeth Connell.
Understanding addiction / Elizabeth Connell Henderson.
p. cm.—(Understanding health and sickness series)
Includes bibliographical references and index.
ISBN 1-57806-239-X (cloth : alk. paper)—ISBN 1-57806-240-3
(pbk. : alk. paper)
1. Compulsive behavior. 2. Substance abuse. 3. Dual diagnosis.
4. Addicts. I. Title. II. Series.
RC533.H465 2000
362.29—dc21 00-042856
British Library Cataloging-in-Publication Data available
Contents
Introduction
1. What Is Addiction?
2. Who Gets Addicted and How?
3. The Addicted Brain
4. Alcohol and Addictive Drugs
5. The Course of Addictive Disease
6. Addiction and the Family
7. Recovery from Addiction
8. Dual Diagnosis
9. Gambling, Sex, and Other Addictions
10. The Search for a Cure
Appendices
A. Regulation of Addictive Substances
B. Sources of Additional Information
Glossary
Index
Introduction
Who has woe? Who has sorrow? Who has strife? Who has
complaints? Who has needless bruises? Who has bloodshot eyes?
Those who linger over wine, who go to sample bowls of mixed
wine.
Do not gaze at wine when it is red, when it sparkles in the cup,
when it goes down smoothly!
In the end it bites like a snake and poisons like a viper.
Your eyes will see strange sights and your mind imagine confusing
things.
You will be like one sleeping of the high seas, lying on top of the
rigging.
“They hit me,” you will say, “but I’m not hurt! They beat me, but I
don’t feel it! When will I wake up so I can find another drink?”
—Proverbs 23:29–35, New International Version
Addiction is nothing new, as we can see from the above quotation, in which
the biblical writer paints a hauntingly accurate picture of the devastation caused
by alcohol addiction. Alcoholism, drug addiction, and addictive behaviors affect
every group at every level in our society. In the United States, one out of four
people has a parent, child, or sibling who is addicted. In 1995 the National
Institutes of Health estimated the economic cost of alcohol and drug abuse at
over $240 billion. Lost productivity, illness, premature death, and health care
expenditures are all part of this picture, as are costs associated with motor
vehicle accidents and with crime and incarceration. The emotional and social
damage is immeasurable. Abuse of alcohol and drugs disrupts personal
development, relationships, and families, corrupting the very fabric of society.
Addiction to nicotine is a problem of massive proportions, and the difficulty of
shaking that habit is familiar to millions. Behavioral addictions include
pathological gambling and sex and compulsive overeating. Most of us are
affected, directly or indirectly, by addiction or its consequences on others.
We are familiar with the image of the skid row wino and the strung-out
junkie, but addicts don’t usually look or behave like that; they are more likely to
resemble your next-door neighbor. They are often accomplished people, and
many have achieved fame. In recent years, public figures have become more
open about their problems with addiction. Betty Ford, the wife of former
president Gerald Ford, struggled with alcoholism, then dedicated her life to
establishing an addiction treatment center. Golfer John Daly also talked of his
problems with alcoholism, as did the baseball hall of famer Mickey Mantle
before his death from the physical consequences of addiction.
Our knowledge of the biology of addiction has grown tremendously in
recent years. We have learned that the addicted brain does not function normally
and that it is impossible to separate the brain’s biological function from a
person’s psychology and will. Clinicians who treat addiction know that there is
no one perspective or approach that is correct. Recovery for addicted people and
their families involves physical healing, behavioral changes, relational
reconciliation, and psychological and spiritual growth. This book brings those
various aspects together to provide the reader with a useful working
understanding of the problem of addiction and a basis for continued learning.
As a practicing psychiatrist and addiction specialist, I believe that arming
the patient and family with information about an illness is essential for success
in treatment. It is wise to know your enemy. In this book, I will attempt to
provide a comprehensive overview of the problem of addiction from several
perspectives, including that of the addict, the addict’s family, and the treating
clinician. As you learn about addiction, you will find that there are no simple
answers and no routine cases.
I begin by answering the question “What is addiction?” When does casual
use become something more? How much is too much? Why are some people
able to drink socially and maintain control, while others become alcoholics?
Why can’t the alcoholic or addict just straighten up and exert some will power?
How is it that some people can just put it down while others continue to the point
of destruction or death?
After discussing who gets addicted and why, I explain the biological basis
of addiction and just what it is that makes a substance addictive. I look at a
typical course of addiction and explore the pathway to recovery. Since addiction
affects the whole family, I describe how family members can help. I explore the
topic of recovery, discussing some of the techniques and strategies that are used
to help addicts. Sometimes a psychiatric disorder or severe mental illness
coexists with addiction, and I look at the problems that accompany such a dual
diagnosis. Pathological gambling, sexual addiction, and other compulsive
behaviors that are behavioral addictions are also discussed. Because addiction is
a major personal, family, and social problem, it is being studied in many
laboratories, and I end the book by reporting on promising new research. The
appendices give some history on the regulation of addictive substances and
provide sources for further information.
When people discuss addiction, they often assume that there is a difference
between alcoholism and addiction to other drugs. Although some important
differences between alcohol addiction and drug addiction do exist, there are
many similarities. When I examine the basic nature of addiction, alcohol and
drugs are considered interchangeable, and the term “addict” is used to denote
both the alcoholic and the drug addict, because the basic biological and
psychological processes of addictive disease are the same for both.
As a result of the social changes that occurred during the 1960s and 1970s,
it is more common than it was in earlier times for people to have used multiple
drugs in addition to alcohol. The social and demographic differences between
alcoholics and drug addicts have also diminished. But the basic nature of
addiction is the same across categories of substances and shares common
characteristics with compulsive behavior disorders such as pathological
gambling. I will point out any important differences among substances;
otherwise the reader may assume that the point being made regarding one could
apply to any other.
Understanding Addiction gives an overview of an immensely complex
subject in a form that is accessible to readers with no medical background.
Addicts and their families will find it a useful resource in their efforts at
recovery. Anyone who works with people will encounter addiction. Personnel
directors, law enforcement and correctional officers, lawyers, social workers,
teachers, pastors, managers, and legislators frequently face the problem of
addiction and its effects and should find this book a helpful reference. The Web
sites listed in appendix B make available much more detailed information for
those interested in further study.
It is my hope that Understanding Addiction will help in the struggle to
prevent and treat this pervasive and perplexing disorder.