and not be addicted to it. Dependence is a state in which an organism functions normally only in the presence of a drug and manifests as a physical disturbance (withdrawal) when the drug is removed. Someone who has cancer can be dependent on opioids for pain management, but he or she may not demonstrate the obsessive-thinking, drug-craving, and compulsive drug-seeking and drug-taking that define addiction.
Is addiction treatment worth the cost? The short answer is yes, and that’s one of the reasons this book exists. It is also why the government allocates resources to conduct research on the disease of addiction and how it can be most effectively treated. Addiction treatment is cost-effective in reducing alcohol and other drug use and its associated health and social costs.
According to the National Institute on Drug Abuse, every dollar invested in addiction treatment programs yields a return of between four and seven dollars in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are factored in, total savings can exceed costs by a ratio of twelve to one. Major savings to the individual and to society also come from improvements in workplace productivity.3
It’s much cheaper to help people stop smoking now than it is to treat their lung cancer later. In the same way, it’s much cheaper to help people stop using alcohol and other drugs than it is to pay for them to be hospitalized for an overdose, after a car accident from driving while impaired, or for a liver transplant.
The bottom line is that addiction treatment works. If the same principles are applied to the disease of addiction that are used to treat any other progressive chronic illness, we find that addicted persons respond to their prescribed treatment just as those who struggle with any other chronic illness do.
Recap: The most important points to remember are
CHAPTER ONE NOTES
2 By permission. From Merriam-Webster’s Collegiate® Dictionary, 11th Edition, ©2013 Merriam-Webster. Inc. (www.Merriam-Webster.com).
3 National Institute on Drug Abuse, “Understanding Drug Abuse and Addiction: What Science Says” (2007), http://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iv/6-cost-effectiveness-drug-treatment (accessed January 2, 2013).
The Brain Anatomy and Chemistry of Addiction
It takes two elemental factors to produce an addicted individual. First, it takes a substance or behavior that stimulates the reward center of the brain. The reward center is located in an area called the limbic system, in the midbrain. The midbrain lies below the prefrontal cortex, under the “thinking” brain that thinks consciously and makes decisions. Stimulating the brain reward center requires an action (for example, eating or sex) or the ingestion of a substance via smoking, swallowing, snorting, or injecting that is experienced as “rewarding,” or in other words, pleasurable.
Broccoli and aspirin don’t stimulate the reward center of the brain, but alcohol, marijuana, Xanax, Valium, heroin, opioid pain medications, cocaine, and crystal meth do. Food, chocolate, and sex all stimulate that part of your brain, but certain drugs actually “hijack” the reward center by causing the brain to release excessive amount of chemicals (called neurotransmitters), resulting in a much higher level of pleasure than the normal everyday things that people generally get pleasure from.
The second elemental factor is that with enough time and experience using mind- and mood-altering substances, the brain chemistry of the now-addicted person is so out of balance that he or she can no longer derive pleasure from normally pleasurable activities. The addict has stimulated his or her brain so much with extraordinarily chemically rewarding substances that life’s normal, everyday pleasures are no longer rewarding. Drugs end up displacing the normally pleasurable activities of eating, drinking, and having sex. Drugs distort the functioning of the brain’s reward center to the point that addicted persons believe they have to take them in order to survive. Only abstinence over time in recovery can return them to what is called allostasis, or a steady state in the brain. Allostasis refers to the ongoing adaptive efforts of the body to maintain stability (homeostasis) in response to stressors.
It takes both of those components to turn a nonaddicted person (a cucumber, to use our analogy from the first chapter) into someone who is addicted (a pickle), plus several other factors we don’t fully understand. We know that addiction is partly genetic. Research generally seems to indicate that addiction has about a 65 percent genetic component and a 35 percent environmental and interactional component. Thirty-five years of experience in addiction treatment leads me to believe that the genetic influence is greater than that, but these are the figures most often cited.
Alcohol and other drugs hijack the reward center of the brain. Mind- and mood-altering substances do this by releasing a hell of a lot more of the neurotransmitter dopamine than chocolate or sex. But by itself, that process is not necessarily enough to produce the disease of addiction. If it were, every single person who uses substantial quantities of these substances would become addicted, but that is clearly not the case.
When I was young I experimented with drugs myself. I’m in my sixties now, so I guess you can say I’m a product of the sixties. Back in the sixties it seemed as though everybody was doing LSD. Then there was the cocaine epidemic of the eighties and I remember doing a line of cocaine here and there and smoking pot at parties. Fortunately, I never became addicted (remaining a cucumber in our ongoing analogy) perhaps because (1) I was lucky and (2) I never had a genetic predisposition to addiction.
Addiction is a family disease because it affects everyone in the family system in which it occurs, but also because
