Addiction

Addiction is a dependence on a behavior or sub-stance that a person is powerless to stop. The term has been partially replaced by the word dependence for substance abuse. Addiction has been extended, however, to include mood-altering behaviors or activities. Some researchers speak of two types of addictions: substance addictions (for example, alcoholism, drug abuse, and smoking); and process addictions (for example, gambling, spending, shopping, eating, and sexual activity). There is a growing recognition that many addicts, such as polydrug abusers, are addicted to more than one sub-stance or process.

Description

Addiction is one of the most costly public health problems in the United States. It is a progressive syndrome, which means that it increases in severity over time unless it is treated. Substance abuse is characterized by frequent relapse, or return to the abused substance. Substance abusers often make repeated attempts to quit before they are successful.

In 1995 the economic cost of substance abuse in the United States exceeded $414 billion, with health care costs attributed to substance abuse estimated at more than $114 billion.

By eighth grade, 52% of adolescents have consumed alcohol, 41% have smoked tobacco, and 20% have smoked marijuana. Compared to females, males are almost four times as likely to be heavy drinkers, nearly one and a half more likely to smoke a pack or more of cigarettes daily, and twice as likely to smoke marijuana weekly. However, among adolescents these gender differences are decreasing. Although frequent use of tobacco, cocaine and heavy drinking appears to have remained stable in the 1990s, marijuana use increased.

In 1999, an estimated four million Americans over the age of 12 used prescription pain relievers, sedatives, and stimulants for "nonmedical" reasons during one month.

In the United States, 25% of the population regularly uses tobacco. Tobacco use reportedly kills 2.5 times as many people each year as alcohol and drug abuse combined. According to 1998 data from the World Health Organization, there were 1.1 billion smokers worldwide and 10,000 tobacco-related deaths per day. Furthermore, in the United States, 43% of children aged 2-11 years are exposed to environmental tobacco smoke, which has been implicated in sudden infant death syndrome,low birth weight, asthma, middle ear disease, pneumonia, cough, and upper respiratory infection.

Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating, affect over five million American women and men. Fifteen percent of young women have substantially disordered attitudes toward eating and eating behaviors. More than 1,000 women die each year from anorexia nervosa. A 1997 Harvard study found that an estimated 15.4 million Americans suffered from a gambling addiction. Over half that number (7.9 million) were adolescents.

Causes and symptoms

Addiction to substances results from the interaction of several factors:

Drug chemistry

Some substances are more addictive than others, either because they produce a rapid and intense change in mood; or because they produce painful withdrawal symptoms when stopped suddenly.

Genetic factor

Some people appear to be more vulnerable to addiction because their body chemistry increases their sensitivity to drugs. Some forms of substance abuse and dependence seem to run in families; and this may be the result of a genetic predisposition, environmental influences, or a combination of both.

Brain structure and function

Using drugs repeatedly over time changes brain structure and function in fundamental and long-lasting ways. Addiction comes about through an array of changes in the brain and the strengthening of new memory connections. Evidence suggests that those long-lasting brain changes are responsible for the distortions of cognitive and emotional functioning that characterize addicts, particularly the compulsion to use drugs. Although the causes of addiction remain the subject of ongoing debate and research, many experts now consider addiction to be a brain disease: a condition caused by persistent changes in brain structure and function. However, having this brain disease does not absolve the addict of responsibility for his or her behavior, but it does explain why many addicts cannot stop using drugs by sheer force of will alone.

Social learning

Social learning is considered the most important single factor. It includes patterns of use in the addict's family or subculture, peer pressure, and advertising or media influence.

Availability

Inexpensive or readily available tobacco, alcohol, or drugs produce marked increases in rates of addiction.

Crack users. Crack, a form of cocaine, is one of the most addictive drugs. (Photograph by Roy Marsch, The Stock Market. Reproduced by permission.)

Individual development

Before the 1980s, the so-called addictive personality was used to explain the development of addiction. The addictive personality was described as escapist, impulsive, dependent, devious, manipulative, and self-centered. Many doctors now believe that these character traits develop in addicts as a result of the addiction, rather than the traits being a cause of the addiction.

Diagnosis

In addition to a preoccupation with using and acquiring the abused substance, the diagnosis of addiction is based on five criteria:

• loss of willpower
• harmful consequences
• unmanageable lifestyle
• tolerance or escalation of use
• withdrawal symptoms upon quitting

Treatment

Treatment requires both medical and social approaches. Substance addicts may need hospital treatment to manage withdrawal symptoms. Individual or group psychotherapy is often helpful, but only after sub-stance use has stopped. Anti-addiction medications, such as methadone and naltrexone, are also commonly used.

The most frequently recommended social form of outpatient treatment is the twelve-step program. Such programs are also frequently combined with psychotherapy. According to a recent study reported by the American Psychological Association (APA), anyone, regardless of his or her religious beliefs or lack of religious beliefs, can benefit from participation in 12-step programs such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). The number of visits to 12-step self-help groups exceeds the number of visits to all mental health professionals combined. There are twelve-step groups for all major substance and process addictions.

The Twelve Steps are:

• Admit powerlessness over the addiction.
• Believe that a Power greater than oneself could restore sanity.
• Make a decision to turn your will and your life over to the care of God, as you understand him.
• Make a searching and fearless moral inventory of self.
• Admit to God, yourself, and another human being the exact nature of your wrongs.
• Become willing to have God remove all these defects from your character.
• Humbly ask God to remove shortcomings.
• Make a list of all persons harmed by your wrongs and become willing to make amends to them all.
• Make direct amends to such people, whenever possible except when to do so would injure them or others.
• Continue to take personal inventory and promptly admit any future wrongdoings.
• Seek to improve contact with a God of the individual's understanding through meditation and prayer.
• Carry the message of spiritual awakening to others and practice these principles in all your affairs.

Alternative treatment

Acupuncture and homeopathy have been used to treat withdrawal symptoms. Meditation, yoga, and reiki healing have been recommended for process addictions, however, the success of these programs has not been well documented through controlled studies.

Prognosis

The prognosis for recovery from any addiction depends on the substance or process, the individual's circumstances, and underlying personality structure. Polydrug users have the worst prognosis for recovery.

Prevention

The most effective form of prevention appears to be a stable family that models responsible attitudes toward mood-altering substances and behaviors. Prevention education programs are also widely used to inform the public of the harmfulness of substance abuse.