Addiction

Addiction is a compulsion to engage in unhealthy or detrimental behavior . Human beings can become addicted to many forms of behaviors such as gambling, overeating, sex, or reckless behavior, but the term "addiction" is most commonly used to refer to a physiological state of dependence caused by the habitual use of drugs, alcohol , or other substances. Addiction is characterized by uncontrolled craving, increased tolerance, and withdrawal symptoms when deprived of access to the addictive substance. Addictions afflict millions of people in the United States alone.

Addiction results from an incessant need to combat the negative side effects of a substance or situation by returning to that substance or situation for the initial enhancing effect. The desire for drugs such as heroin, cocaine , or alcohol all result from a need to suppress the low that follows the high. Other forms of addiction occur where seemingly harmless behaviors such as eating, running, or working become the focus of the addict's life.

Addiction and addictive substances have long been a part of human culture. The use of alcoholic beverages, such as beer, was recorded by the ancient Egyptians. The Romans and other early civilizations fermented, drank, and traded in wine. The infamous "opium dens" of the Far East offered crude opium. The discovery of America was accompanied by the discovery of tobacco, grown by the indigenous population.

Addiction today, especially addiction to illegal drugs, takes a heavy toll on modern society. Illegal drugs are easy enough to obtain, but they have a high price. In order to get money to feed their addiction, some addicts resort to theft or prostitution. Aside from criminal damage, addiction disrupts families and other social institutions in the form of divorce, abuse (mental and physical), and neglect.

Addictions

There are two classifications for addiction: chemical and nonchemical. While dependency on substances that are ingested or injected is more commonly discussed, there are a number of nonchemical addictions that can lead to equally devastating lifestyles.

Chemical addictions

Chemical addiction is the general description for an addiction to a substance that must be injected or ingested. Alcohol, opiates, and cocaine are the most common of these chemicals. Though each of them is addictive, they have different effects on the body.

Addiction to alcohol, for example, may be the result of heavy drinking coupled with a malfunctioning type of cell in the liver of the alcoholic. Many adults can drink large quantities of alcoholic beverages and suffer only a "hangover"—headache and nausea. The malfunctioning liver in the alcoholic, however, does not detoxify the byproducts of alcohol ingestion rapidly. The resultant accumulation of a chemical called acetaldehyde causes several symptoms, including pain , which can be relieved by the intake of more alcohol. The consumption of ever-increasing amounts of alcohol with greater frequency can lead to organ failure and death if the alcoholic is left untreated.

Opium, produced by a species of poppy, is an ancient addictive substance that is still produced for its cash value. Although raw opium is not the form most addicts encounter, purified, powdered opium has been used in many forms for hundreds of years. Tincture of opium, or laudanum, was introduced about 1500. Paregoric, a familiar household remedy today, dates from the early 1700s.

Heroin, a derivative of opium, has become a common addictive drug. Heroin is a powder dissolved in water and injected into the user's vein, giving an immediate sensation of warmth and relaxation. Physical or mental pain is relieved, and the user enters a deeply relaxed state for a few hours. The powder can also be inhaled for a milder effect. Heroin is extremely addictive and with only a few doses the user is "hooked." Morphine , a refinement of opium, was discovered in the early 1800s. It was first used as an effective analgesic, or painkiller, and it is still used for that purpose. Its fast action makes it a drug of choice to ease the pain of wounded soldiers during wartime. Morphine has one-fifth the addictive power of heroin.

Cocaine in its various forms is another class of addictive compounds. In fact, it is the most addictive of these drugs; some people need only a single exposure to the drug to become addicted. Cocaine is processed from the coca plant and is used in the form of a white powder. It can be inhaled, ingested, injected, or mixed with marijuana and smoked. It is also further processed into a solid crystalline substance marketed as "crack." Unlike the opiates, which bring on a warm feeling and immobility, cocaine makes its users energetic. This strong stimulation and period of hyperactivity (usually no more than half an hour) is quickly followed by a period of intense depression , fatigue, and paranoia. In order to relieve these harsh side effects, the user will typically retreat to taking more cocaine or using another drug, for example alcohol or heroin. Suicide is a common occurrence among cocaine addicts.

Any of these chemical substances can become the object of intense addiction. Addicts of the opiates and cocaine must have increasingly frequent doses to maintain their desired physiological effects. Soon the addict has difficulty focusing on anything else, making it nearly impossible to hold a job or maintain a normal lifestyle. These drugs are of economic importance not only because of their high cost, but also because of the crimes committed to obtain the cash necessary to buy the drugs. The drug enforcement resources dedicated to policing those crimes and the rehabilitation programs provided to the drug addicts are costly.

Some experts consider drinking large amounts of coffee or cola beverages evidence of an addiction to caffeine . In fact, these substances do provide a short-term mood lift to the user. The first cup of coffee in the morning, the midmorning coffee break, the cola at lunch, and the dinner coffee are habitual. Withdrawal from caffeine, which is a stimulant, can cause certain mood changes and a longing for additional caffeine.

Tobacco use is also addictive (due to the nicotine found in tobacco). Cigarette smoking, for example, is one of the most difficult habits to stop. Withdrawal symptoms are more pronounced in the smoker than in the coffee drinker. Reforming smokers are subject to swift mood swings and intense cravings for a cigarette. A long-time smoker may never overcome the desire for cigarettes.

Withdrawal symptoms are caused by psychological, physical, and chemical reactions in the body. As the amount of addictive chemical in the blood begins to fall, the urge to acquire the next dose is strong. The hard drugs such as heroin and cocaine produce intense withdrawal symptoms that, if not eased by another dose of the addictive substance or an appropriate medication, can leave the user in painful helplessness. Strong muscle contractions, nausea, vomiting, sweating, and pain increase in strength until it becomes extremely difficult for the user to stay away from the drug.

The nonchemical addictions

Addictions can involve substances or actions not including addictive chemicals. Some of these addictions are difficult to define and may seem harmless enough, but they can destroy the lives of those who cannot escape them.

Gambling is one such form of addiction, affecting 6-10% of the American population, according to some experts. Gamblers begin as most others do, by placing small bets on horses or engaging in low-stakes card games or craps. Their successes are a form of ego enhancement, so they strive to repeat them. Their bets become larger, more frequent, and more irrational. Gamblers have been known to lose their jobs, homes, and families as a result of their activities. Their pattern is to place ever-larger bets to make up for their losses. Gamblers are difficult to treat because they refuse to recognize that they have an abnormal condition. After all, nearly everyone gambles in some form: on the lottery, horses, home poker games, or sporting events. Once a compulsive gambler is convinced that his or her problem is serious, an addiction program may be successful in treating the condition.

Food addiction can be a difficult condition to diagnose. Food addicts find comfort in eating. The physical sensations that accompany eating can become addictive, although an addict may not taste the food. Food addicts may indulge in binge eating—consuming prodigious quantities of food in one sitting, or they may consume smaller quantities of food over a longer period of time, but eat constantly during that time.

A food addict can become grossly overweight, leading to extremely low self-esteem, which becomes more pronounced as he or she gains weight. The addict then seeks comfort by eating more food, setting up a cycle that probably will lead to a premature death if not interrupted.

The opposite of addiction to eating is addiction to not eating. This addiction often starts as an attempt to lose weight and ends in malnutrition . Two common forms of this type of addiction, anorexia and bulimia, are typically associated with young females, although males and females of all ages may develop this disorder. Anorexia is a condition in which food is almost completely rejected. These addicts literally starve their bodies, consuming as little food as possible. Bulimia on the other hand, involves consuming large amounts of food uncontrollably until satisfied and then purging the food they took in as soon after eating as possible. Some experts claim that nearly 100 people a year die of malnutrition resulting from anorexia or bulimia. Others believe the number is much larger because the deaths are not recorded as anorexia or bulimia, but as heart failure or kidney failure, either of which can result from malnutrition.

Anorexia and bulimia are difficult to treat. In the minds of victims, they are bloated and obese even though they may be on the brink of starvation, and so they often resist treatment. Hospitalization may be required even before the official diagnosis is made. Treatment includes a long, slow process of psychiatric counseling.

The sex addict also is difficult to diagnose because "normal" sex behavior is not well defined. Generally, any sex act between two consenting adults is condoned if neither suffers harm. Frequency of sexual activity is not used as a deciding factor in diagnosis. More likely the sex addict is diagnosed by his or her attitude toward sex partners.

Other compulsions or addictions include exercise , especially running. Running releases certain hormones called endorphins in the brain , giving a feeling of euphoria or happiness. This is the "high" that runners often describe. They achieve it when they have run sufficiently to release endorphins and have felt their effects. So good is this feeling that the compulsive runner may practice his hobby in spite of bad weather, injury, or social obligation. Because running is considered a healthful hobby, it is difficult to convince an addict that he is overdoing it and must temper his activity.

Codependency could also be regarded as an addiction, although not of the classical kind. It is a form of psychological addiction to another human being. While the term codependency may sound like a mutual dependency, in reality, it is very one-sided. A person who is codependent gives up their rights, individuality, wants, and needs to another person. The other person's likes and wants become their own desires and the codependent person begins to live vicariously through the other person, totally abandoning their own life. Codependency is often the reason that women remain in abusive relationships. Codependent people tend to trust people who are untrustworthy. Self-help groups and counseling is available for codependents and provide full recovery.

Another form of addiction is addiction to work. No other addiction is so willingly embraced than that of a workaholic. Traits of workaholics are often the same traits used to identify hard workers and loyal employees. So, when does working hard become working too hard? When work becomes an addiction, it can lead to harmful effects in other areas of life, such as family neglect or deteriorating health. The individual drowns himself/herself in work to the point of shunning all societal obligations. Their parental duties and responsibilities are often handed over to the other spouse. The children are neglected by the parent and consequently end up having a poor relationship with the workaholic parent. Identifying the reason for becoming a workaholic and getting help, such as counseling, are key for overcoming this addiction.

Internet addictions are a new illness in our society. The Internet is an amazing information resource, especially for students, teachers, researchers, and physicians. People all over the globe use it to connect with individuals from other countries and cultures. However, when the computer world rivals the real world, it becomes an addiction. Some people choose to commune with the computer rather than with their spouses and children. They insulate themselves from intimate settings and relationships. Internet abuse has been cited as a contributing factor in the disintegration of many marriages and families and even in the collapse of many promising careers. Since it is a relatively new disorder, few self-help resources are available. Ironically, there are some on-line support groups designed to wean people from the Internet.

The addict

Because addictive behavior has such serious effects on the health and social well being of the addict and those around him or her, why would anyone start? One characteristic that marks addicts, whether to chemicals or nonchemical practices, is a low sense of self esteem. The addict may arise from any social or economic situation, and there is no way to discern among a group of people who will become an addict and who will not.

It has been a basic tenet that the individual who uses drugs heavily will become addicted. However, soldiers who served in Vietnam reported heavy use of marijuana and heroin while they were in the combat zone, yet the vast majority gave up the habit upon returning home. There are reports, however, of people becoming addicted to a drug with exposure only once or a few times.

Some experts believe people are born with the predisposition to become addicted. Children of addicts have a greater probability of becoming addicts themselves than do children whose parents are not. Thus, the potential for addiction may be hereditary. On the other hand, a psychological problem may lead the individual into addiction. The need for instant gratification, a feeling of being socially ostracized, and an inability to cope with the downfalls of life have all been cited as possible springboards to addiction.

Treatment of addiction

Habitual use of an addictive substance can produces changes in body chemistry and any treatment must be geared to a gradual reduction in dosage. Initially, only opium and its derivatives (morphine, heroin, codeine ) were recognized as addictive, but many other drugs, whether therapeutic (for example, tranquilizers ) or recreational (such as cocaine and alcohol), are now known to be addictive. Research points to a genetic predisposition to addiction; although environment and psychological make-up are other important factors and a solely genetic basis for addiction is too simplistic. Although physical addiction always has a psychological element, not all psychological dependence is accompanied by physical dependence.

Addiction of any form is difficult to treat. Many programs instituted to break the grip of addictive substances have had limited success. The "cure" depends upon the resolve of the addict, and he or she often struggles with the addiction even after treatment.

A careful medically controlled withdrawal program can reverse the chemical changes of habituation Trying to stop chemical intake without the benefit of medical help is a difficult task for the addict because of intense physical withdrawal symptoms. Pain, nausea, vomiting, sweating, and hallucinations must be endured for several days.

Most addicts are not able to cope with these symptoms, and they will relieve them by indulging in their addiction.

The standard therapy for chemical addiction is medically supervised withdrawal, along with a 12-step program, which provides physical and emotional support during withdrawal and recovery. The addict is also educated about drug and alcohol addiction. "Kicking" a habit, though, is difficult, and backsliding is frequent. Many former addicts have enough determination to avoid drugs for the remainder of their lives, but research shows that an equal number will take up the habit again.

See also Alcoholism; Amphetamines; Barbiturates.

Resources

books

Bender, D. and Leone, B. Drug Abuse: Opposing Viewpoints. San Diego: Greenhaven Press, Inc., 1994.

Kuhn, C., Swartzwelder, S., and Wilson, W. Just Say Know. New York: W.W. Norton & Co., 2002.

Silverstein, A., V. Silverstein, and R. Silverstein. The Addictions Handbook. Hillside, NJ: Enslow Publishers, 1991.

Young, Kimberley. Caught in the Net: How to Recognize theSigns of Internet Addiction—and a Winning Strategy for Recovery. New York: John Wiley and Sons, 1998.

other

Substance Abuse and Mental Health Services (SAMSHA), an agency of the United States Department of Health and Human Services (301)443-8956. <www.samsha.gov> (March 10, 2003).

Larry Blaser

KEY TERMS

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Detoxification

—The process of removing a poison or toxin from the body. The liver is the primary organ of detoxification in the body.

Endorphins

—A group of natural substances in the brain that are activated with exercise. They bind to opiate receptors and ease pain by raising the pain threshold. Of the three types, alpha, beta, and gamma, beta is the most potent.

Opiate

—Any derivative of opium (e.g., heroin).

Opium

—A natural product of the opium poppy, Papaver somniferum. Incising the immature pods of the plant allows the milky exudate to seep out and be collected. Air-dried, this is crude opium.