Books by John E. Smethers, Ph.D
Addiction is a compulsion to repeat a behavior regardless of its consequences. It is common for an addict to express the desire to stop the behavior, but find himself or herself unable to, which is why many addicts find themselves in rehab.
There is a lack of consensus as to what may properly be termed 'addiction.' Some within the medical community maintain a rigid definition of addiction and contend that the term is only applicable to a process of escalating drug or alcohol use. However, addiction is often applied to compulsive behaviors other than drug use, such as overeating, sex, or gambling.
Addiction is often characterized by a craving for more of the drug or behavior, increased physiological tolerance to exposure, and withdrawal symptoms. Many drugs and behaviors that provide either pleasure or relief from pain pose a risk of addiction or dependency.
The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological addiction. Addiction is now narrowly defined as "a compulsion to repeat a behavior regardless of its consequences; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered "compulsive," but within this narrow definition it is not categorized as addiction. In practice, however, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components. What are some examples? Gambling, food, sex, pornography, computers, work, and shopping/spending. Symptoms mimicking withdrawal may occur with abatement of such behaviors; however, it is said by those who stick to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. Which is it, a behavioral disorder or an addiction? In spite of protests and warnings that labeling may cause the wrong treatment to be used (thus failing the person with the problem), most professionals in the field recognize them as addictions.
There is also what’s called pseudo-addiction, where one will exhibit drug-seeking behavior reminiscent of psychological addiction. Here, they tend to have genuine pain. Unlike true addiction, these behaviors tend to stop as soon as their pain is treated. An example is grief.
What is a dry drunk? The term is usually attached to patterns of behavior that persist after a drug or behavior has been removed from daily living routines. This type of behavior is fairly common in early recovery for those recovering from all substance misuse, not just alcoholism.
Physical dependency on a substance is defined by the appearance of characteristic withdrawal symptoms when the drug is suddenly discontinued. While opiates, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, other drugs share this property that are not considered addictive: cortisone, beta-blockers and most antidepressants are examples. So while physical dependency can be a major factor in the psychology of addiction, the primary attribute of an addictive drug is its ability to induce euphoria while causing harm.
Some drugs induce physical dependence or physiological tolerance, but not addiction; for example, many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably Effexor and Paxil, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them. Of course, in these examples, there is no euphoria, which is why there is no addiction.
The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, and the individual. Some alcoholics report they exhibited alcoholic tendencies from the date of their first drunk, while, most? people can drink socially without ever becoming addicted. What about this?
Eating disorders are complicated pathological mental illnesses and thus are not considered addictions. More information about eating disorders can be found at http://www.edap.org or http://www.something-fishy.org
Another take on psychological addiction, as opposed to physiological addiction, is a person's need to use a drug or engage in a behavior out of desire for the effects it produces, rather than to relieve withdrawal symptoms. Instead of an actual physiological dependence on a drug, such as heroin, psychological addiction usually develops out of habits that relieve symptoms of loneliness or anxiety or whatever. As the drug is indulged in, it becomes associated with the release of pleasure-inducing endorphins, and a cycle is started that is similar to physiological addiction. This cycle is very difficult to break. Most countries have legislation which brings various drugs and drug-like substances under the control of licensing systems. In this country it’s the scheduling of drugs.
Table of Contents
1. What is Addiction?
2. The Scheduling of Drugs
3. Why Do People Start Using Alcohol and Drugs?
4. The Disease Concept
5. Drug and Alcohol Addiction is Not a Disease
7. Why Treatment?
8. Treatment Doesn’t Work
9. Rational Recovery
11. Drug Effects on the Reproductive System
12. Drugs and Pregnancy
13. Effects on Unborn Babies and Children Whose Mothers Used Drugs
14. Why Do We Use?
15. How Did We Start?
The Scheduling of Drugs
The Controlled Substances Act was when drugs were first classified. Schedule 1 substances are those having a high potential for abuse, and having no medical use, such as heroin, marijuana, cocaine, and the meth that’s cooked in clandestine labs today. Schedule II substances also have a high potential for abuse, but have medical uses, such as Morphine, Dilaudid, Demerol, and Oxycontin. Also under this schedule is barbiturates and amphetamines. Schedule III substances have an abuse potential less than those in schedules I and II, such as Tylenol with codeine, Doriden, and various hydrocodone preparations such as Vicodin, Tussionex, and Hycodan--the latter two are bronchitis preparations. Schedule IV substances have a potential for abuse less than those in schedule III, such as Chloral Hydrate, Placidyl (greenie meanies), and most tranquilizers such as Valium and Xanax. Schedule V substances have a potential for abuse less than those in schedule IV, and consist of those preparations formerly known as exempt narcotics.
In California in 1966, in the same bill that made LSD illegal, exempt narcotics were made available by prescription only. During the years preceding ‘65, exempt narcotics such as Robitussin AC (added codeine), Turpin Hydrate, and Cheracol were available in any pharmacy by signing an Exempt Narcotics Register. The rule being, no more than one bottle purchased within a 48 hour period. There are many states where it is still legal to purchase exempt narcotics. Here is where the controversy lies concerning exempts.
The tension between the duty of pharmacists to serve the health needs of patients and the duty to be "gatekeepers" to prevent drug diversion creates an environment that leads some to conclude that controlled substances are "bad" and that selling them only leads to legal entanglement. That mind-set is especially prevalent with regard to the so-called "exempt narcotics" in the Schedule 5 category of cough syrup. It is not uncommon for pharmacists to either refuse to sell or even carry these nonprescription medications out of fear that they may be prosecuted or lose their licenses to practice. This attitude is most unfortunate, because the products are useful and effective when used properly. However, there have been enough cases involving allegations against pharmacists for unlawful sales that reluctance to provide the medications is understandable.
Why do people start using alcohol and drugs?
* Because it's daring.
* Because it's fun
* Because peers are using.
* Because they are illegal.
* Because they want to!
* Because you’ve heard it's good.
* Blot out problems.
* Born dependant.
* Brought up in drug culture.
* Cheap form of entertainment.
* Compliments food, e.g. wine.
* Confidence builder.
* Cultural influence
* Desensitized to one – start on another.
* Don’t have enough strategies to deal with problems without drugs.
* Don’t know any better.
* Drown their sorrows.
* Enhance performance - sport, sex, study, work.
* Family, family history,
* Environment factors.
* Fashionable, trend, trendy.
* Forbidden fruit.
* Forced dependency.
* Genetic vulnerability.
* High self esteem.
* Lack of knowledge or understanding of risks and dangers.
* Life circumstances/experiences.
* Low self esteem.
* Maintaining standards.
* Male bonding.
* Pain relief.
* Parental drug use.
* Peer pressure.
* Performance enhancing.
* Quick fix to problems.
* Recreational activity.
* Reduce pain.
* Risk taking.
* Sheer boredom.
* Shift work.
* Social reasons--for meeting people.
* Spiked – unknowingly using.
* Sports use.
* Stress and bereavement.
* Studying, e.g. trying to keep awake while cramming.
* Thinking that they won’t become addicted.
* To boost self esteem.
* To get high or to get down
* To help relax.
* To know what it is like.
* To stimulate thinking.
* Vulnerability to drug use.
* Wanting to be in control.
* Weight loss or weight gain.
The Disease Concept
Substance addiction has been recognized "officially" as a disease for many years now, but there is still a great deal of ignorance on the subject--even amongst the medical profession.
Addiction is classified as a disease because it meets the criteria of all other terminal diseases:
It has pattern of symptoms which are similar across all types of substance abuse.
It is a chronic condition. It doesn't go away.
It is progressive. Addiction only gets worse with continued use, and ends with death.
The addict is subject to relapse. In Australia, 66% of addicts who are lucky to live long enough to make it to detox will eventually die as a direct result of the disease.
It is treatable. While substance addiction is a terminal illness, its progression can be arrested at almost any stage.
Drug and Alcohol Addiction is Not a Disease
History and science have shown us that the existence of the disease of drug and alcohol addiction is pure speculation. Just saying addiction is a disease, doesn't make it true. Nevertheless, medical professionals and American culture lovingly embraced the disease concept and quickly applied it to every possible deviant behavior from alcohol abuse to compulsive masturbating. The disease concept was a panacea for many failing medical institutions adding billions of dollars to the industry and leading to a prompt evolution of pop-psychology. Research has shown that addiction is a choice, not a disease, and stripping drug and alcohol abusers of their choice, by applying the disease concept, is a threat to the health of the individual. Consider this: diabetes is a disease--it invades your body, like most diseases do, uninvited. Diabetics didn't choose diabetes. Addicts, however, chose to use drugs and alcohol.
The disease concept oozes into every crevice of our society perpetuating harmful misinformation that hurts the very people it was intended to help. It is a backwards situation where the assumptions of a few were adopted as fact by the medical profession, devoid of supporting evidence. And soon after, the disease concept was accepted by the general public. With this said, visiting the history of the disease concept gives us all a better understanding of how and why all of this happened.
Okay, consider this. From doctors and patients to drug companies and the media, there are relentless pressures to classify any condition as a disease. Doctors, particularly some specialists, welcome the boost to status, influence and income that comes when new territory is defined as disease. One way to support the word "disease" when relating to addiction, is dis-ease-meaning not being at ease. International pharmaceutical companies have an apparent interest in medicalizing life's problems. Also, alternative approaches such as those emphasizing the importance of personal coping strategies - are played down or ignored. The disease-mongers gnaw away at our self-confidence. Inappropriate medicalization carries the dangers of unnecessary labeling, poor treatment decisions, economic waste, as well as the costs that result when resources are diverted from treating or preventing more serious disease.
The biggest hurdle to overcome is stated in the first step: We admitted we were powerless over our addiction, that our lives had become unmanageable.
Out of the 2.03 million inmates in this country today, drug offenders represent 60% of federal prisoners and over one-third of state and county prisoners. That doesn’t include all the inmates who are incarcerated for crimes committed while under the influence, or the ones who were committing crimes for money to finance their chemical indulgences. The reason why I looked so sinister in this photo, is probably due to withdrawal. I recovered from a seemingly hopeless case of mind and body while I was in prison.
Methods of Treatment
A medical detox can include anxiolytics such as Librium to reduce symptoms of alcohol withdrawal. Alternatives to medical detox include "cold turkey?" or acupuncture. In opiate addiction, a surrogate drug such as Methadone is sometimes available as a form of opiate replacement therapy. In my opinion, Methadone is jumping out of the frying pan into the fire.
Other Treatment Modalities are, but not limited to
* 12-Step programs
* Outpatient counseling
* Online counseling
* Pastoral counseling
* Residential rehabs
There are those rare people who are capable of what’s called spontaneous remission, which means that one day they say, "No more! I’ve had it, that’s it," and they stop. However, the dry drunk syndrome is usually prevalent with this population.
Does the family of an addict also need treatment?
Addiction, more often than not, is a family disease. Often the family members of addicts are as sick or sicker than the addicts themselves; therefore, there are groups for families and children who have addicted family members. Nar-Anon and Al-Anon members are relatives and friends who are concerned about the drug or alcohol problem of another. Nar-Anon’s program of recovery is adapted from Narcotics Anonymous. Al-Anon is associated with AA like Nar-Anon is associated with NA. Other similar groups are:
CODA (Co-dependents Anonymous)
ACoA (Adult Children of Alcoholics)
Nearly all addicts believe in the beginning that they can stop using on their own, and most try to stop without treatment. However, most attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function. These drug-induced changes in brain function have many behavioral consequences, including the compulsion to use drugs despite adverse consequences.
Understanding that addiction has such an important biological component may help explain an individual's difficulty in staying clean without treatment. Stress or family problems, social cues (such as meeting people from one's drug-using past), or the environment (such as encountering streets, objects, or even the smells associated with drug use) can interact with biological factors to make relapse more likely. Research indicates that even the most severely addicted individuals can participate actively in treatment and that active participation is essential to good outcomes.
First of all "abuse," according to the APA, describes use that causes impairment of social or occupational functioning. Compare that to "dependence," characterized by either tolerance and/or withdrawal symptoms. Recovery rates from both of these forms of alcohol and drug abuse follow a model of treatment outcomes applicable to most psychologically-based disorders: one-third recover fully; one-third cyclically stop and return to it again; and one-third do not recover. Now, what I’ve just read is one side of the coin. The other side of the coin is:
Treatment Doesn’t Work
Like those in 12-step programs, treatment professionals claim success in the face of contradicting evidence. AA literature boast that "Rarely have we seen a person fail who has thoroughly followed our path." The truth is, people rarely succeed when following the path of those in 12-step programs. Ninety five percent of the existing treatment centers in the United States adhere to 12-Step philosophies. Not surprising, the success rate of treatment is no different from the success rate of 12-step programs, which is 3%.
While treatment professionals boast that "treatment works," the question is, what is it exactly that’s working? The blanket assurance that "treatment works" does precious little for most people who drink or use too much." Of course treatment’s alternative counterpart and co-conspirators, 12-step programs, leads with the same misleading and outright dishonest assurance that their programs "Works if you Work it." Twelve steppers conveniently claim success without any foundation. In reality the statement is a complete contradiction to empirical evidence. Both 12-step programs and treatment are outright failures when held to any standard but their own. But, apparently it’s a matter of semantics. It comes down to who is using the word "works."
The general public would believe that these programs "working" would be a testament to helping people with substance abuse issues get sober. In other words the people who join the groups can get well. But, after arriving in treatment or a 12-step program with the hopes of finding recovery, those in need are told that they can never get well, there is no cure. So, what exactly is working?
What I just read is the beginning of a much larger paper. I’m not inclined to use our time reading the whole thing. I just want you to see both sides of the coin. If you want to read it, let me know and I’ll give you the URL for the web site.
* Recovery from addiction is not a group project; it is an individual responsibility. You are ultimately on your own.
* There are no Rational Recovery groups anywhere in the world! Your desire for "support" is nothing more, and nothing less, than a plan to get loaded in the absence of support.
* There is nothing in your past, in your genes, in your brain, or in your personality that compels you to drink or use. Using is voluntary, purposeful behavior.
* The sole cause of your addiction is a voice in your head that tells you to "Do it!" in a thousand different ways. That is your Addictive Voice.
* Personal problems don’t cause addiction; addiction causes your personal problems.
* Self-improvement does not result in recovery from addiction. Recovery leads to self-improvement.
* You drink or use because you love to get high. Admit it!
* The worst possible way to quit something you love is one-day-at-a-time.
* Stay away from recovery groups of all kinds; it’s doubtful that you’ll recover there. They’ll never let you go, and you’ll be "in recovery" for the rest of your life.
* Stay away from shrinks and counselors; most substance abuse counselors are members of recovery groups, unable to trust themselves without a support group.
* Your physician can’t help you with your addiction; he may even be supporting it. Most refer to recovery groups, to which many of them belong.
* Consider that the real truth about addiction and recovery lies in the exact opposite of most popular beliefs.
* Recall your original family values, the ideas about right and wrong you knew by the age of 5 or 6. Those are your foundation for recovery from addiction.
* Your beliefs about God are perfect for now. If you try to create a god of your own understanding, it will only be made in the image of your addiction. Seek God only if you are interested once you are fully recovered.
* Rational Recovery is as difficult as you make it, and takes as long as you choose.
* If you won’t trust yourself, why should anyone else?
Endorphins are endogenous opioid biochemical compounds. They are produced by the pituitary gland and the hypothalamus, and they resemble the opiates in their abilities to produce analgesia and a sense of well-being. In other words, they work as "natural pain killers." Using opiate drugs increases the effects of the endorphins.
Scientists debate whether specific activities release measurable levels of endorphins. Much of the current data comes from animal models which may not be relevant to humans. The studies that do involve humans often measure endorphin levels, which do not necessarily correlate with levels in the CNS. Other studies use an opiate antagonist, usually naloxone (remember this word), to indirectly measure the release of endorphins by observing the changes that occur when any endorphin activity that might be present is blocked.
What is a Placebo?. The placebo effect has been linked to endorphins. In one study, a volunteer received pain by a compression cuff on his arm. In the first trial, no drug was administered and the patient showed signs of pain including facial grimaces, increased blood pressure, and sweating. During the next trial, the physician informed the volunteer that he would be injected with morphine and that he would feel no pain. The morphine was injected, the pain compression repeated, and this time the volunteer showed and reported no pain. The morphine and compression test was repeated several times. Then, the volunteer was unknowingly injected with a saline placebo, but still reported no sign of pain (the placebo worked), though the last time he was unmedicated the signs of pain were obvious. In a last test, the patients’ ‘morphine’ was actually an injection of naloxone, an opiate antagonist. Even though the volunteer believed the shot was morphine and expected relief, the endorphins’ effect was blocked by the naloxone injection and the volunteer displayed the same signs of pain as the first unmedicated trial.
Back in the fifties, there was a drug with the brand name of Naline--its chemical name, naloxone. The Naline test was used by parole officers to detect narcotic use among his parolees. If the parolee was under the influence of heroin, after administering a Naline test he would go into immediate withdrawal symptoms. This process, of course, was before they had the more sophisticated chemical tests we have now.
Another widely publicized effect of endorphin production is the "runner's high," which is said to occur when strenuous exercise takes a person over a threshold that activates endorphin production. Endorphins are released during long, continuous workouts, when the level of intensity is between moderate and high, and breathing is difficult. This also corresponds with the time that muscles use up their stored glycogen and begin functioning with only oxygen. Workouts that are most likely to produce endorphins include running, swimming, cross-country skiing, long distance rowing, bicycling, aerobics, or playing a sport such as basketball, soccer, or football.
Clinical researchers report that inserting acupuncture needles into specific body points triggers the production of endorphins. In another study, higher levels of endorphins were found in cerebrospinal fluid after patients underwent acupuncture. In addition, naloxone appeared to block acupuncture’s pain-relieving effects.
The good feeling one gets from eating chocolate, smiling, laughing, sunbathing, being massaged, meditating, singing, listening to one's favorite music, or having an orgasm is partially attributed to the release of endorphins.
Drug Effects on the Reproductive System
The Female Reproductive System
Procreation happens when the sperm cell from a male joins with the egg cell or ovum from a female. Initially the fertilized ovum is called a zygote. After two weeks the zygote grows into an embryo (which is when body parts begin to grow). At eight weeks the embryo because a fetus.
It cannot be overemphasized that drugs taken in the first three months of pregnancy can cause irreparable harm to the fetus. Most women usually become aware of being pregnant after the first two or three months. By that time the harm has already been done if mom was using drugs. All drugs can be harmful to a fetus. This even includes caffeine, any alcoholic beverages, and nicotine. The best rule for woman is (what?)--don’t drink or use when pregnant, especially while nursing. Drugs often stop the woman’s ability to reproduce, and some drugs stop the menstrual cycle and effect the eggs that are produced.
Drug Effects on the Male Reproductive System
Drugs can interfere with sperm produced by the body, and can cause impotence by blocking the pleasure center in the brain decreasing the desire for sexual relations.
The pleasure center is the general term for the set of brain structures, predominately the nucleus accumbens, theorized to produce great pleasure when stimulated electrically. Some references state that the septum pellucidium is generally considered to be the pleasure center while others mention the hypothalamus when referring to the pleasure center for intracranial stimulation.
Marijuana, tobacco, cocaine and meth effect the sperm. Marijuana decreases the number of sperm and sperm’s ability to swim to the egg. In men, marijuana decreases testosterone and shrinks the testicles, which contain sperm. Tobacco also lowers testosterone and lowers a male’s fertility, in addition to creating abnormal sperm. Cocaine and meth have shown to attach to sperm and causes birth defects in the fetus (Baby Faye being a prime example).
There are those who say that some drugs enhance their desire for sex, but that heightened desire often invites multiple partners, which can lead to many diseases such as AIDS and Hep C, unwanted pregnancies, hurt emotions, and even death. Besides HIV and Hep C, there are many other opportunistic diseases such as gonorrhea, syphilis, herpes, and urinary tract infections that can be spread through unprotected sex.
How Other Drugs Cause Impotence
Depressant drugs like alcohol, opiates, and tranquilizers directly block the male’s ability to have an erection by blocking nerves to the penis. Drugs which are smoked, especially marijuana and tobacco create tar. Tar blocks the blood vessels to the penis. The penis gets erect through vasodilation. If the blood vessel to the penis is blocked by tar, vasodilation becomes difficult. Most other drugs, including alcohol, act on the central nervous system, and can decrease the nerve’s ability for erectile function. Over time this effect becomes greater. Older alcoholics usually have difficulty getting and retaining an erection.
Drugs and Pregnancy
More than 11 percent of babies are born with drugs in their circulatory systems; therefore, the drugs in mom’s blood are being fed to the developing baby. Low birth weight babies account for 60% of infant deaths. Drugs can and do interfere with normal development.
Many drugs cause premature birth and low birth weight. Low birth weight babies account for the majority (60%) of infant deaths. Alcohol causes the most damage to babies in the United States. Over half the children born in the U.S. with mental retardation had mothers who drank alcohol during pregnancy.
Effects on Unborn Babies and Children Whose Mothers Used Drugs
* Can cause heart and other organ defects
* (FAS) Fetal Alcohol Syndrom (caused by drinking during pregnancy)
* Low birth weight
* Faces that don’t look normal
* Mental retardation
* Can cause loss of nutrients and oxygen to an unborn child
* Early delivery and low birth weight
* Strokes and brain damage
* Withdrawal, leading to seizures and agitation
* ADHD (attention deficit hyperactivity disorder)
Can cause brain disorders
Physical defects (such as being born without arms or legs)
* Can cause stillbirth
* Premature birth
* Organ defects such as Baby Faye
* Can slow unborn babies’ growth which causes low birth weight
* Eye and vision problems
* The new marijuana can also cause birth defects
Will cause addicted newborn
Why Do We Use
This is a question researchers have grappled with for some time. As yet there's no definitive answer and no one has discovered a singular cause.
* Many of us drink and use as a way of getting away from ourselves, of dissociating from negative feelings about ourselves and our reality.
* Following the psychological shift to drug dependence, the brain's chemistry starts to adapt, demanding more and more of what it's grown used to and fiercely resisting the discomfort of withdrawal. The behavior takes on a self-perpetuating life of its own.
* What makes some people more susceptible is perhaps a genetic pre-disposition. This theory, with some evidence now to support it, makes sense especially since addiction crosses social divides. However, this is still debatable.
* There are cultural and social factors that put people at greater risk. For instance, you're less likely to become alcohol dependent growing up in a country where alcohol consumption is unacceptable, than where it's a normal part of everyday life. Growing up in a family where there's alcohol or drug abuse, in the same way, increases the risk.
There are those who believe that addiction is a thirst for wholeness.
* Andrew Weil, in his book The Natural Mind, suggests that altering consciousness is innate. Perhaps the internal need to release inhibitions, be devious, act crazy, fight, gamble, be promiscuous, lie, cheat, and steal is also an innate need to alter consciousness.
The widespread use of drugs is so striking that it must represent a basic human appetite. The appetite Weil writes about isn’t necessarily the appetite for drugs. Instead, he says, "it is my belief that the desire to alter consciousness periodically is an innate, normal drive analogous to hunger or the sexual drive.
Perhaps some people are destined to live by organizing principles that we are unaware of. Perhaps there is far more than we would like to admit that we simply don’t know. Perhaps many of our present theories are wrong.
* Christina Grof, in her book The Thirst for Wholeness, said that "as far back into my childhood as I can remember, I was searching for something I could not name. Whatever I was looking for would help me to feel all right, at home, as though I belonged. If I could find it, I would no longer be lonely. I would be happy, fulfilled, and at peace with myself, my life, and the world. I would feel free, unfettered, expansive, and joyful."
How Did We Start
* What can start out as casual experimentation, normal social behavior or even a doctor's prescription, can lead to repeating the behavior more frequently and with greater quantities. The more you do, the more you’re likely to do.