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Addict In The Family
by Dr. Andrew Byrne
REASONS FOR DRUG USE
WHO IS NOT A DRUG ADDICT? PREVENTION
IS IT A DISEASE? PREDISPOSITION: GENES & ENVIRONMENT
ENZYMES, TOLERANCE AND RECRUITMENT
INITIAL DRUG USE:
WHO ARE THE PUSHERS?
GATEWAY OR STEPPING-STONE MYTHS
Why one person becomes an addict and another does not is a fascinating but frustrating question. It is posed by parents, friends, psychologists, doctors and journalists. But most of all the question is asked by addicts themselves.
"Where did we go wrong?" "Why me?" ?Why my wife (or husband, or son or daughter)?" These questions are never satisfactorily answered but there are lots of interesting theories. For someone with an established addiction, these questions are academic. Addiction happens. Addicts come from all walks of life. There are certain racial differences. Some addictions are more common in one sex or the other, but no group is immune.
Most drug users simply say that heroin makes them feel good. They used it first because it was there and they come back for more because they liked the effects.
Why do some 'nice' people become smokers? Tobacco is a 'dirtier' drug in many ways than narcotics or cannabis. But smokers are all around us. Advertising is still seen and this toxin is freely available. 'Nice' people also sometimes become gamblers, they get fat, they drink and smoke and some even use heroin. The theory that there are predisposed personalities for people with these vices has never been established. People from all strata of society are afflicted by all of these compulsive disorders.
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This book is primarily concerned with the young adult who is using heroin on a daily basis. The term 'drug addict' is sometimes used for those using amphetamine, cocaine, tranquillizers or combinations of these drugs.
Just because a teenager uses cannabis occasionally or takes an ecstasy tablet does not mean they are destined to turn into a heroin addict. The vast majority of such young people never develop a problem with drugs at all. From the medical point of view it is probably more worrying to find that one's child is smoking tobacco than to learn of occasional cannabis use.
Some coffee, tobacco and alcohol consumers could be termed addicts, the only difference being the legal nature of their drug-of-choice. Whether legal or illegal, most adults use a variety of drugs in a controlled way and only a minority get into difficulties.
There is virtually nothing a parent can do to prevent a child being exposed to drugs. What we can do is to make sure that our children are equipped with the knowledge to prevent death and disease should they decide to try drugs. Honest and frank education is the basis for sensible decision making, whether in the field of drug use or other areas such as sex, diet or exercise.
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Another interesting debate is whether drug addiction is a disease. This argument can go on forever. The answer lies in the definition of a disease, the definition of addiction as well as the individual's personal attitude towards their drug use. Debate of this kind is unproductive, like the unresolvable issue of calling a drug user a client or a patient. It is not worth the energy.
What can be said is that drug use can lead to serious medical complications and death. Medical treatment and public health measures can favourably influence some of these consequences. And like many other human conditions, it can relapse and there is no simple 'cure' as such.
As with obesity, anxiety, hair loss or acne, drug use can be regarded as a normal part of the human condition at one end of the spectrum, but at a certain point, these conditions could also be given a disease designation. It should be up to the individual drug user to decide if this point has been reached, and therefore, whether they wish to be considered as a 'patient' with a medical problem.
Most professionals who work with addicts are struck by the variety of different types of individuals who are affected. Once the addiction is established, studies of the personalities of drug addicts show some common threads. This should come as no surprise as the lifestyle of illicit drug abuse necessitates haste, efficiency and deception, while these in turn breed impatience, apparent avarice and a general lack of reliability. Whether some of these predate the addiction has not been demonstrated. Similarly, studies of the pre-existing characteristics of alcoholics, smokers and compulsive gamblers also reveal an admixture of otherwise average citizens.
Another factor to take into account is that the high mortality in drug addicts may cause selection of the 'fittest' while some less well equipped for the lifestyle may fall by the wayside. Certainly there are some long-time survivors of many years of street drug use. They are remarkable and resourceful people, many of whom could write a riveting life history.
Up to 50% of heroin addicts have a first order relative with an opioid problem. This could be explained on the basis of environment, genetic make-up or a combination of both. Current research favours the latter. There are few families which are not affected by addiction of some sort.
China has 10% of the world's adults but its citizens smoke 30% of the world's tobacco. This country also had an enormous consumption of opium in the nineteenth century. By contrast, it is sometimes stated that Asians share with Jews a low incidence of alcoholism. How much of this is due to genetics and how much to environment is still unclear.
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Alcohol is the simplest substance abused by humans. Theories about alcoholism may apply to other drugs although differences occur with the more complex pathways of metabolism for other drugs.
There is evidence that some races lack enzyme pathways for metabolising lactose. Similar deficiencies are thought to occur for alcohol metabolism pathways. Without adequate levels of alcohol dehydrogenase and other enzymes, the first steps in alcohol breakdown are stopped. The build up of certain toxic products may then cause the so-called 'Antabuse' reaction including sweating, shakes, nausea and vomiting in those affected.
One theory states that certain of these breakdown products increase in some alcoholics as they drink. They respond by drinking more to avoid the unpleasant effects. Eventually, they become stuporous from alcohol toxicity.
The concept of 'tolerance#&039; explains why more drug is required to obtain the same response with time. This phenomenon applies equally to tobacco, alcohol, heroin and amphetamine. It is caused by a combination of metabolism, 'neuro-adaptation' and learned behaviour. This results in the user increasing quantities of the drug used until a certain plateau level is reached.
The user who has not used drugs for some time is in a situation of great risk. Such people can be dangerously overdosed on comparatively small doses of drugs because their tolerance has diminished. This can happen in less than a week of abstinence with short acting drugs such as heroin.
Certain groups of drugs share 'cross-tolerance' between members. Examples are heroin and methadone; alcohol and benzodiazepine tranquillizers. Use is made of this effect in the medical use of certain drugs to block withdrawal effects of a related substance.
The concept of chemical 'recruitment' is also fundamental to all addictions. This refers to the observation that, following periods of abstinence, relapsing addicts often rapidly return to previous levels of drug use. Although it may have taken many months or even years to develop an addiction initially, subsequent periods may involve a full blown habit within a week or so.
Therefore, an ex-smoker who used to smoke 25 cigarettes daily is very likely to quickly return to the same levels when taking up the habit again. This 'recruitment' principle may also explain why a change to tobacco with a lower nicotine content often causes an increase in the number of cigarettes smoked per day. The old medical concept of 'blockade dosage' of maintenance drugs may also touch on this, but we are into the realm of speculation again. More research is needed in this area.
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Hypothetical question: 'How did you get your first taste for gambling (or sex, or beer, or Vegemite, or nail biting)?'
Many taste, some reject, others come back occasionally for more and a number get caught up in a big way. These latter are the most visible consumers who are addicted to whatever it may be.
While many addicts express embarrassment and regret over their drug use, some of them express pride in their activities. There are examples of this approach in other areas of human activity. Don Giovanni boasts of over one thousand women he has seduced. Shakespeare's Falstaff tells of the gallons of ale he has consumed. Other stories of big gambling wins, the 'fish that got away' and the like are tall tales of the would-have-been, could-have-been, all recounted with gusto and exaggeration.
The commonest reason that drug users give for their first drug experience is that 'it was there'. Like 'the mountain' in need of being climbed, the very existence of the drug in one's proximity makes it an option. Then a small window of interest turns into an irreversible moment.
More important, and instructive, are the descriptions of what the subjects experienced from this first episode of drug use. They often describe a sense of relaxation, calmness, confidence, energy or exhilaration which was previously unknown. A number describe it as the first time they have ever slept soundly. It was almost as if it were curing some illness that they had.
But often the initial heroin experience is not totally pleasurable. Some people recount severe symptoms of vomiting, sweating and passing out. Smoking also causes coughing and spluttering initially, but these undesirable symptoms do not always dissuade the user from further experimentation. Such symptoms usually subside as the acquired taste takes over.
The second episode of drug use may occasionally be delayed for a number of years after the first 'taste' of narcotics. It may then be some time further on that the subject becomes addicted to the drug.
For those who do become addicted, it is usually a matter of days or weeks to the second episode of drug use, and less than twelve months to the point of addiction. Once the decision is made to use heroin, some describe a full-on quest which occupies their entire being until 'fulfilment' in drug use. But not everyone who tries heroin becomes an addict.
It is often said that 'every user is a dealer' and 'every dealer is a user'. There is some truth to this since the majority of users having been involved in distribution at some point. Equally, a majority in the drug trade are also heroin users themselves.
Some heroin users prefer to buy from dealers who are not users themselves since they think that they are less likely to adulterate the drug for their own needs. Some such dealers subsequently develop a predilection for the substances they deal in, and become addicted themselves. It is harder to be sympathetic towards such individuals. It would, however, be unduly judgemental to say that individuals 'deserve' their addiction.
So, who are the real 'pushers' for tobacco, alcohol and other drugs? The growers, manufacturers, marketers, other smokers (through peer pressure) or even doctors in the old days. In fact none of these is the single major factor. The main 'pusher' is the drug itself. It sells itself and creates its own market.
Tobacco companies claim that their advertising is not aimed to increase overall consumption, but at increasing market share for their own brands. While this is an expedient argument, advertising clearly aims to place smoking as a normal and desirable part of society, with which most veteran smokers would disagree. No-one could honourably recommended a habit which kills over 50% of its consumers!
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Although some people consider certain drugs to be 'gateways' to others, scientific evidence is lacking. The concept of 'gateway drugs' is not accepted by most medical authorities. It may even be a fiction invented by latter-day prohibitionists.
It has never been shown that any single drug leads to, or gives a taste for another drug. Some people argue that if cannabis were harder to obtain, then young people would not want to use heroin. Although superficially attractive, this theory is fundamentally flawed. It ignores the fact that it is impossible to eliminate either cannabis or heroin. It also is countered by the fact that the vast majority of those who smoke cannabis never even try narcotics, let alone become addicted.
It is a common scenario for a drug user to commence with alcohol and tobacco use, then to progress to cannabis, amphetamine or cocaine and on to heroin. However, this does not give tobacco or any other substance the distinction of being a 'gateway' drug. We can debunk the 'gateway' theory as being of no relevance to either treatment or policy.
The only arguable progression in drug use is not metabolic, but is demonstrated by those who first use heroin when their cannabis dealer runs out of 'soft drug' supplies. By placing both cannabis and heroin in the same illicit category, governments have unwittingly yielded control to drug dealers who do not distinguish between different drugs. Hence it may well be that if cannabis were more easy to obtain that fewer young people would try heroin.
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|Dr. Andrew J. Byrne received the prestigious Marie Award at the 2006 national conference of the American Association for the Treatment of Opioid Dependence.|
|For more information about pain management and opiate pain medication, check out ManagingChronicPain.org.|