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The Truth About Addiction

The Truth About Addiction
The Truth About Addiction
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Substance use disorder(s) (SUDs) is medicalese for addiction. For centuries, we’ve felt that addiction is the result of a  lack of will power; that addicts have weak character because of poor protoplasm. Simply put: they’re losers. The current understanding of addiction shows how stupid that thinking was and is. Addiction is so common in humans that virtually none of us are immune. Probably, the substance most of us are addicted to is food. Of course, this is gamed by the food industry who manipulate sugar and salt content to such a scientific exactitude that we constantly overeat.  Don’t believe me? Who stops at one Dorito? Nobody! Even the design of the chip is “jacked up”  so you get more goop on your scoop of dip.  Now you get why a third of us are obese and many more are overweight. Food is the number one drug that most of us use to cope with stress.

So exactly what is addiction?  It’s a disease: a brain disease involving many parts of our brain. It effects the parts that control whether we feel good or not, forcing us to do stupid and frequently self-destructive stuff so we’ll feel good. State of the art neuro imaging now shows how an addict’s brain paths light up with excitement when they feed their addiction. In many ways, they’re hard wired genetically to be addicts.

Does this mean, short of genetic manipulation, treating addicts is hopeless? Absolutely not. It does mean that we need to look at addiction, as we would any disease, and see if our treatments work. Take alcoholism, the most destructive drug in America by a landslide. Since the early twentieth century, Alcoholics Anonymous (AA) and twelve step facilitation (TSF) has dominated alcohol treatment. You’ll be shocked to learn that  these treatments simply don’t work. The evidence is overwhelming that this approach sucks. At best it cures around 5-10%. About the same as if you left the addict alone and he treated himself. Seriously, it’s that bad. Actually it’s worse. The addict often feels more of a failure when he fails AA and TSF. Especially since AA puts the onus of failing back on  the alcoholic. Their philosophy is: it’s not AA  failing, it’s you; you’re a weakling. How’s that for outcome denial! Way to go guys. Of course if you are part of the lucky 5-10% that AA or TSF does work for, use it. Don’t stop. The goal on DCOC is for you to be healthy by any means possible. No ideologues here.

For the other 90% there is no question that we need to change our approach. First off, we have to admit that the addict has no more control over his addiction than Kim Kardashian has over her need to self promote. It’s a disease folks.

The first step is seeing they have a disease. As you probably know, I’m Irish, so I have some familiarity with alcoholism and its destruction.  Being Irish allows me to disarm some patients and cajole them into admitting, yeah, they do have a problem.

Once that is admitted, the next step is treatment. Traditionally total abstinence was demanded.  No booze whatsoever.  A lot baulk at this and simply refuse.  Europeans think total abstinence is for the birds. And they’re right. Alcoholism isn’t a single entity. People drink for a whole variety of reasons: genes, anxiety, PTSD and on and on. Bottom line: all alcoholics aren’t the same, so the idea that one treatment fits all is silly. Yet, it’s what we’ve been doing since forever. The traditional view is not to treat  alcoholics with any medicine that has addiction potential. The fear being that you’d be substituting one addiction for another. Many are now challenging this theory. They prescribe meds to help patients from falling off the wagon and  to limit how much a binge drinker can down in one session.

Three drugs are in use with FDA approval. Naltrexone blocks opioid receptors, reducing your craving for alcohol. Works well for some with binge drinking. Doesn’t work well in others. Your response, or lack of, may well be genetically based. Acamprosate helps with severe withdrawal symptoms like insomnia, restlessness and depression. Disulfiram, makes you sick if you drink alcohol. Good for those with strong motivation.

These drugs are not miracle cures by any means, but they do help. Couple them with good therapy and you’ve got something.

Where does all this leave us? Addiction is part of who we humans are. Virtually every society in recorded history used some kind of substance to escape reality. Sometimes  reality needs escaping but alcohol or drugs is always going to whisper  louder to some than others. We shouldn’t abandon them because they heed the call. We should treat them.

Finally, back in the gagster era thirties “suds” was old time slang for beer. I wonder if the medical jargon police realized that when they chose substance use disorder(s) as the in-term for addiction.

 “If you are seeking treatment, please call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Drug and Alcohol Treatment Service at 1–800–662–HELP (4357) for information on hotlines, counseling services, or treatment options in your State. Drug treatment programs by State also may be found online at www.findtreatment.samhsa.gov.”




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