Why addiction must be treated as a chronic disease
Not so long ago addiction was generally considered a bad habit or a weakness of character. But in recent decades, scientists have come to realise that addiction is an illness. In fact, it is a chronic disease and if treatment is to have any success at all, it must be lifelong.
According to Professor Charles O’Brien of the Philadelphia University Medical Centre, a leading American expert on addiction, treatment in the 1960s and 70s didn’t take the medical aspects of addiction into account.
"Drugs and alcohol, when taken in large enough amounts and over an extended period of time produce biological changes in the brain, permanent and physical changes. Any therapy which ignores that fact will be useless." It’s in the brain
Becoming addicted is a result of the way our brain works; it involves the ’reward system’, the part of the brain that makes a person feel good after accomplishing something. It’s what makes us want to ’do things’. Drugs and alcohol have an immediate effect on the brain, and produce the happy feelings in a short-circuited way. You don’t need to write a book first, or build a log cabin, or run a marathon, to feel good.
The problem is that our brain is very good at remembering ’good times’, and soon everything related to the drug in question will trigger an intense desire to get satisfaction ’no matter what’. This is called ’craving’, and Professor O’Brien was one of the first to identify this particular phenomenon.
"My work with Vietnam veterans has taught me a lot. American soldiers in Vietnam had a very high frequency of heroin addiction. Forty percent of the enlisted used heroin! Now most of them just stopped when they returned, but in urban areas, like in Philadelphia, there was a high relapse rate. This was the result of specific ’cues’ that triggered the craving. The simple fact that drug dealers were out there, wheeling and dealing in their typical secretive way, was enough to make former heroin users want to get their hands on the drug again. And once the craving is there, it is very hard to resist."
Professor Charles O’Brien
Addiction in the scanner
In the 1980s, when Charles O’Brien and his colleagues recognised ’craving’ as something fundamental in the way addiction works, they set up lab experiments. Vietnam veterans were given a brain scan and presented with specific cues which made them think of their favourite drug.
The tests corroborated the theory of cues and craving: the desire for any kind of drug, whether it is alcohol, or nicotine, or cocaine, or whatever, makes certain brain cells ’fire’; they light up in the brain scan.
When an addicted person is presented with objects, sights, sounds or smells which remind him or her of the drug in question, the same brain cells light up again, and that will still happen years later. Thus the clinking together of two wine glasses can cause an alcoholic to want to drink again, and the sight of an ashtray can produce an overwhelming desire to ’light up’.
What Professor O’Brien had proved was that addiction is in fact:
"An over-learned memory, something like riding a bicycle. You may not ride a bike for decades, but as soon as you climb on, you know what to do. It’s that strongly engraved in our brains, it’s physical and permanent. This involuntary nature is the essence of being an addict."
Trigger for former nicotine addicts
While this makes treatment difficult, it isn’t completely hopeless. Craving can be resisted, with the proper tools. This can be very mundane; a nicotine-addict simply shouldn’t have ashtrays in his house. Friends and family of an alcoholic should never tempt him: "One glass won’t harm you!" Yes it will! A former heroin addict should avoid those parts of town where he or she knows dealers will be around.
Also, behavioural therapy can help, and even drugs which influence the award system in the brain. In scientific terms, they can block the dopamine system by interacting with the neurotransmitters which produce the artificial feeling of well-being.
But most of all, both the patient and the therapist must realise that addiction is chronic. It will never go away, and even in the very long-run relapses may occur. Intense treatment will be needed in the beginning, and after stabilising, maintenance may hopefully be enough. Even so:
"Being a former addict will require vigilance throughout life, and quite apart from the patients themselves, policy makers should be aware of that as well
by Thijs Westerbeek
Amazon books; Alcoholism: The Family Disease