Addictions

Strictly speaking, an addiction is a compelling physical and psychological need for a habit-forming chemical substance, without regard for destructive consequences. In recent years, this definition has been expanded to include practically any compulsive behavior, ranging from overexercise and compulsive gambling to shoplifting and sex. There are now more than 200 such addictions that are being addressed by 12-step groups modeled on Alcoholics Anonymous.

The chemical addictions most prevalent in the United States are nicotine, alcohol, cocaine and crack cocaine, heroin, and amphetamines and other prescription drugs. No one fully understands why use of these substances evolves into abuse or addiction in some people and not others. However, research points to at least three possible explanations: a genetic predisposition, an abnormality in brain chemistry, and a personality disorder. Most likely, it is a combination of these factors that leads to addiction.

Diagnostic Studies and Procedures

Blood and urine tests can detect recent use of alcohol and other chemical substances, but there is no precise test to diagnose addiction. Instead, doctors look for specific patterns of behavior. The American Psychiatric Association's guidelines for a diagnosis of addiction, technically called "psychoactive substance dependence," require at least three of these statements to be true:

• The substance is taken in larger amounts or over a longer period than the person intended.
• There is persistent desire for the drug or unsuccessful efforts to stop its use.
• The person spends a great deal of time trying to get the substance, taking it, or recovering from its effects.
• Use of the substance disrupts social obligations or work activities.
• The person continues to use the substance despite knowing that it is causing problems; an example would be drinking, even though it makes an ulcer worse or threatens loss of a job.
• There is marked tolerance, meaning that increasing amounts are needed to achieve the same results. For example, it now takes an entire bottle of liquor to become intoxicated, compared to three or four drinks in the past.
• Attempts to stop using the substance produce withdrawal symptoms.
• The substance is taken to avoid the withdrawal symptoms.

Medical Treatments

Treatment, which varies according to the addictive substance, should be tailored to each individual. The chances of success increase if all of those involved -- doctor, patient, and family members -- recognize that addiction is an illness with complicated physical, psychological, and social components, and not simply a bad habit or sign of weakness. They should also understand that most addictions require a multi-faceted approach to treatment.

Nicotine. This powerful stimulant is the addictive substance in tobacco. Within seconds of being inhaled, nicotine reaches the brain, which signals the adrenal glands to pump out adrenaline and other stress hormones. People think that a cigarette is relaxing; in reality, it creates a heightened state of tension. When the effect wears off, the smoker experiences jitteriness and other withdrawal symptoms, which are quelled by another cigarette.

When used properly, nicotine-based drugs make quitting easier by relieving withdrawal symptoms, which -- in addition to jitteriness -- may include headaches, muscle aches, nausea, irritability, and fatigue. They come in two forms: a gum that is chewed very slowly and a medicated skin patch. (A nicotine nasal spray is in the testing stage.)

Nicotine from these sources is absorbed into the bloodstream, satisfying the body's craving for it and thus preventing withdrawal symptoms. There are hazards, however, and in an overdose, nicotine is a deadly poison, if nicotine gum and patches must be used exactly as directed, including NOT smoking, to avoid overdosage. After a few weeks, the person should be accustomed to not smoking, and can gradually be weaned off the drug.

To date, the only non-nicotine drug prescribed to aid smoking cessation is Clonidine, a medication originally developed to treat high blood pressure. Some studies suggest that it minimizes nicotine withdrawal symptoms, although it does not block entirely the desire to smoke.

Alcoholism. Medical treatment for alcoholism follows three stages. Stage one involves detoxification, during which alcohol is stopped completely and any nutritional deficiencies and other disorders are treated. Valium or other anti-anxiety drugs may be given to reduce tremor, hallucinations, and other withdrawal symptoms. Detoxification usually takes place in a clinic, hospital, or residential facility that specializes in drug dependency.

In stage two, the patient begins psychological counseling, which often entails joining the 12-step program of Alcoholics Anonymous or some other support group. Long-term abstinence and rehabilitation, which often involve the cooperation of family members, form the focus of stage three. Depending upon the severity of the drinking problem and the patient's overall health, counseling, and rehabilitation may be carried out in a residential program on an outpatient basis.

In the past, the drug disutfiram (Antabuse) was widely prescribed as a deterrent to drinking. Antabuse produces severe nausea, palpitations, and other very unpleasant physical reactions when combined with even a minute amount of alcohol. But it is not a cure for alcoholism, and most treatment programs have abandoned its use.

Cocaine and Crack Cocaine. Treatment for cocaine abuse usually follows the same three-step program as for alcoholism, with one important difference: Because cocaine withdrawal can result in severe depression, antidepressant drugs are often prescribed for the early stages of detoxification.

Heroin. Substitution of methadone, a comparatively harmless addictive drug, for heroin continues to be the treatment of choice for this addiction. Although methadone itself is addictive, people taking it can hold a job and live a normal life if they are disciplined enough to use the drug exactly as recommended. The major disadvantage is that methadone must be taken daily to prevent withdrawal symptoms.

Prescription Drugs. People who abuse tranquilizers, narcotic painkillers, amphetamines, and other prescription drugs should not stop taking them without medical supervision. Because withdrawal symptoms can pose a serious danger, gradual detoxification is usually necessary.

Alternative Therapies

Although overcoming some addictions requires medical supervision, alternative therapies can ease withdrawal. More importantly, certain alternative therapies provide the tools a person needs for permanently changing behavior patterns that fostered the addiction.

Acupuncture. No one knows how it works, but there's considerable anecdotal evidence that this ancient Chinese procedure helps people overcome drug addictions. Typically, the acupuncturist inserts sterile steel needles in the cartilage of the outer ear, twirling them, and leaving them in place for half an hour. With repeated treatments, many persons have been able to stop smoking, and others have even been able to overcome heroin addiction.

Hypnosis and Visualization. Cigarette smoking is especially amenable to these approaches, perhaps because nicotine withdrawal does not require medical supervision. During hypnosis, a person is highly receptive to the power of suggestion. Some hypnotists instruct their clients to discard all cigarettes, lighters, and ashtrays at a specific time. They may also plant the notion that smoking is unpleasant; for example, that cigarette smoke has a disgusting odor. Hypnotists often teach visualization or self-hypnosis as additional tools in resisting the urge to smoke.

Meditation and Yoga. Many people tum to cigarettes, alcohol, or other addictive substances as a means of dealing with stress. Meditation, yoga, and other relaxation therapies provide an alternative that is not self-destructive and has other health benefits as well. Relaxation therapy often precedes the actual cessation of smoking; in treating alcoholism and drug addictions, it is usually added during the counseling or rehabilitation stages.

Self-Treatment

Self-treatment remains the most effective way of giving up smoking. About 95 percent of smokers who quit do so on their own, usually abruptly, or cold turkey. Relapses are common, however, and most people make several attempts before quitting for good. To improve your own chances of success, make a systematic plan for stopping, beginning with an analysis of why you continue to smoke and a list of alternatives. For example, many women won't give up smoking because they are afraid of gaining weight. Joining an exercise class can help prevent weight gain and provide other health benefits as well.

Self-treatment is not recommended during the detoxification stage of overcoming substance addictions. After this initial phase, however, self-treatment is the key to success. The goal of counseling, for instance, is to help strengthen a person's emotional resources so that he can overcome the urge to resume previous behavior. This does not mean, though, that one must go it alone; there are dozens of support and self-help groups ready to help.

The 12 Steps To Overcoming an Addiction

1. Admit we are powerless over [our addiction] -- that our lives have become unmanageable.
2. Come to believe that a Power greater than ourselves can restore us to sanity.
3. Make a decision to tum our will and our lives over to the care of God as we understand Him.
4. Make a searching and fearless moral inventory of ourselves.
5. Admit to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Become entirely ready to have God remove all these defects of character.
7. Humbly ask Him to remove our shortcomings.
8. Make a list of all persons we have harmed and become willing to make amends to them all.
9. Make direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continue to take personal inventory and when we are wrong, admit it.
11. Seek through prayer and meditation to improve our conscious contact with God as we understand Him.
12. Having a spiritual awakening as the result of these steps, and trying to carry this message to others and practicing these principles in all our affairs.