Excerpt from CLEAN by David Sheff
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Excerpt from CLEAN by David Sheff
This book is excellent. I highly recommend it. An excerpt:
Addicts Aren't Weak, Selfish,
or Amoral-They're Ill
UNLESS YOU'VE BEEN THERE, you can't imagine what it's like to watch helplessly as someone you love descends into addiction. The transformation defies logic - until you understand that your loved one is gravely ill with a brain disease that's debilitating, chronic, progressive, and, if left untreated, often fatal.
Once and for all, people must understand that addiction is a disease. It's critical if we're going to effectively prevent and treat addiction. Accepting that addiction is an illness will transform our approach to public policy, research, insurance, and criminality; it will change how we feel about addicts, and how they feel about themselves. There's another essential reason why we must understand that addiction is an illness and not just bad behavior: We punish bad behavior. We treat illness.
I understand those who reject the notion that addiction is a disease because I used to be one of them. When my son was addicted, I heard the so-called disease theory in a lecture at a rehab where he was being treated. Later, I heard it at other rehabs and at AA meetings. Still later, I heard it espoused by therapists and counselors.
To me, the adherents of the disease theory were apologists for addicts (often they were addicts) who were attempting to rationalize and excuse outrageous, unconscionable behavior, hedonism, and debauchery. To me, when my son was addicted, he wasn't ill, he was an out-of-control, self-absorbed teenager who was looking for a good time and didn't care who he hurt.
During the question-and-answer segment of a lecture I attended about addiction, a father of an alcoholic raised his hand to speak. From his emotional description of sleepless nights and late-night phone calls to the police and emergency rooms, I knew how similarly we'd been suffering. Instead of the anger I'd felt, however, bewilderment was what he described. “This isn’t my son,” he said. “He wasn’t a selfish person. He never lied. He cared about himself and the family and school. Something changed him. He's a different person now. He's ill- very, very ill.”
Was he making excuses for his son's behavior? I understood those who took solace in the rationalization that addiction was an illness. They were - we were - grateful for any plausible explanation of our loved ones' transformation and transgressions. I thought, Maybe some people dismiss the idea that addiction is a disease until it hits their family.
When it does, they embrace the concept because it exonerates their loved ones or themselves. It's easier to believe that a person's behavior is a symptom of an illness rather than a series of reprehensible choices. But wanting something to be true doesn't make it true. This isn't an issue subject to "belief.' We don't believe that cancer is a disease. We know it is.
The Disease of Addiction
A disease is "an interruption, cessation, or disorder of a body, system, or organ structure or function,”' according to Stedman's Medical Dictionary. It’s a morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.”
Addiction fits every one of these criteria.
Studies that compare the brains of addicts have consistently identified anatomic alterations. “There are long-lasting changes in the brain, and they’re measurable,” according to Dr. Susan Weiss, associate director for scientific affairs at the National Institute on Drug Abuse. “The reward system is altered.”
The anatomic alterations are mainly in two areas. Both the brain structure and the flow of neurotransmitters through the nervous system are changed. This results in altered brain function, which in turn alter thinking, and altered thinking alters behavior.
Even the most common drugs, marijuana and alcohol, considered by many to be less harmful than others, change the structure of the brain. The gray matter controls muscle movement, sensory perceptions, memory, emotions, and speech. White matter is the network of fibers that link brain regions and allow signals to be sent between them. Anatomic alterations of marijuana users' white matter can clearly be seen in scans and detected in postmortem chemical tests of addicts' brains. The white matter in heavy marijuana smokers' brains has “poorer integrity,” says to Susan Tapert, professor of psychiatry at the University of California at San Diego.
What's poorer integrity? Joanna Jacobus, a colleague of Tapert's at UCSD, explains. ''A tract of fiber in the brain is judged by how compact and coherent it is. The better its integrity, the better it does its job, signaling between brain areas:' The researchers judge integrity by looking at the diffusion of water molecules within the fiber tracts. Dr. Jacobus compares it to a pot of spaghetti cooking in boiling water. The noodles represent the long, thin fiber tracts of the brain. In a pot of boiling water without spaghetti, the water molecules diffuse freely, because there's nothing to restrict them. Put spaghetti in the pot, and the water molecules are hindered. If you start pulling out pieces of spaghetti, the water molecules start to diffuse more freely again. "That's not what you want,” she says. “You want to see less diffusion, because it means more spaghetti in there, and more spaghetti means more and better communication within the brain.”
Tapert's scans have found less compact and coherent fiber tracts in the brains of pot smokers. Their white matter has atrophied. She says, "If there is tissue atrophy in white matter, the brain regions may not be able to communicate as efficiently and as quickly"
These changes appear to be similar to the loss of neurons in the hippocampus region of the brain that occurs as people age. The loss decreases their ability to remember and to learn new information. "Chronic THC exposure may hasten age-related loss of hippocampal neurons,” Jacobus says. In one study, rats exposed to THC every day for eight months showed a level of neuron loss equal to that of unexposed animals twice their age.
Addicts Aren't Weak, Selfish,
or Amoral-They're Ill
UNLESS YOU'VE BEEN THERE, you can't imagine what it's like to watch helplessly as someone you love descends into addiction. The transformation defies logic - until you understand that your loved one is gravely ill with a brain disease that's debilitating, chronic, progressive, and, if left untreated, often fatal.
Once and for all, people must understand that addiction is a disease. It's critical if we're going to effectively prevent and treat addiction. Accepting that addiction is an illness will transform our approach to public policy, research, insurance, and criminality; it will change how we feel about addicts, and how they feel about themselves. There's another essential reason why we must understand that addiction is an illness and not just bad behavior: We punish bad behavior. We treat illness.
I understand those who reject the notion that addiction is a disease because I used to be one of them. When my son was addicted, I heard the so-called disease theory in a lecture at a rehab where he was being treated. Later, I heard it at other rehabs and at AA meetings. Still later, I heard it espoused by therapists and counselors.
To me, the adherents of the disease theory were apologists for addicts (often they were addicts) who were attempting to rationalize and excuse outrageous, unconscionable behavior, hedonism, and debauchery. To me, when my son was addicted, he wasn't ill, he was an out-of-control, self-absorbed teenager who was looking for a good time and didn't care who he hurt.
During the question-and-answer segment of a lecture I attended about addiction, a father of an alcoholic raised his hand to speak. From his emotional description of sleepless nights and late-night phone calls to the police and emergency rooms, I knew how similarly we'd been suffering. Instead of the anger I'd felt, however, bewilderment was what he described. “This isn’t my son,” he said. “He wasn’t a selfish person. He never lied. He cared about himself and the family and school. Something changed him. He's a different person now. He's ill- very, very ill.”
Was he making excuses for his son's behavior? I understood those who took solace in the rationalization that addiction was an illness. They were - we were - grateful for any plausible explanation of our loved ones' transformation and transgressions. I thought, Maybe some people dismiss the idea that addiction is a disease until it hits their family.
When it does, they embrace the concept because it exonerates their loved ones or themselves. It's easier to believe that a person's behavior is a symptom of an illness rather than a series of reprehensible choices. But wanting something to be true doesn't make it true. This isn't an issue subject to "belief.' We don't believe that cancer is a disease. We know it is.
The Disease of Addiction
A disease is "an interruption, cessation, or disorder of a body, system, or organ structure or function,”' according to Stedman's Medical Dictionary. It’s a morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.”
Addiction fits every one of these criteria.
Studies that compare the brains of addicts have consistently identified anatomic alterations. “There are long-lasting changes in the brain, and they’re measurable,” according to Dr. Susan Weiss, associate director for scientific affairs at the National Institute on Drug Abuse. “The reward system is altered.”
The anatomic alterations are mainly in two areas. Both the brain structure and the flow of neurotransmitters through the nervous system are changed. This results in altered brain function, which in turn alter thinking, and altered thinking alters behavior.
Even the most common drugs, marijuana and alcohol, considered by many to be less harmful than others, change the structure of the brain. The gray matter controls muscle movement, sensory perceptions, memory, emotions, and speech. White matter is the network of fibers that link brain regions and allow signals to be sent between them. Anatomic alterations of marijuana users' white matter can clearly be seen in scans and detected in postmortem chemical tests of addicts' brains. The white matter in heavy marijuana smokers' brains has “poorer integrity,” says to Susan Tapert, professor of psychiatry at the University of California at San Diego.
What's poorer integrity? Joanna Jacobus, a colleague of Tapert's at UCSD, explains. ''A tract of fiber in the brain is judged by how compact and coherent it is. The better its integrity, the better it does its job, signaling between brain areas:' The researchers judge integrity by looking at the diffusion of water molecules within the fiber tracts. Dr. Jacobus compares it to a pot of spaghetti cooking in boiling water. The noodles represent the long, thin fiber tracts of the brain. In a pot of boiling water without spaghetti, the water molecules diffuse freely, because there's nothing to restrict them. Put spaghetti in the pot, and the water molecules are hindered. If you start pulling out pieces of spaghetti, the water molecules start to diffuse more freely again. "That's not what you want,” she says. “You want to see less diffusion, because it means more spaghetti in there, and more spaghetti means more and better communication within the brain.”
Tapert's scans have found less compact and coherent fiber tracts in the brains of pot smokers. Their white matter has atrophied. She says, "If there is tissue atrophy in white matter, the brain regions may not be able to communicate as efficiently and as quickly"
These changes appear to be similar to the loss of neurons in the hippocampus region of the brain that occurs as people age. The loss decreases their ability to remember and to learn new information. "Chronic THC exposure may hasten age-related loss of hippocampal neurons,” Jacobus says. In one study, rats exposed to THC every day for eight months showed a level of neuron loss equal to that of unexposed animals twice their age.
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The key is trying to get the addict to receive treatment for the addiction. It's almost impossible to force it upon them, and most live in complete denial and won't admit they even have a problem until it's so bad they are going to jail. Then they admit it, you get them help, until they decide to use again, an evil cycle.
I wish I knew the answer. Tight hugs my dear friend.
I wish I knew the answer. Tight hugs my dear friend.
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Join Date: Jul 2012
Posts: 793
I agree! Have you read Beautiful Boy by the same author, or his son's later book, Tweak? Really fascinating to read both the father's and the son's experiences. Thanks for sharing this with everyone. Reframing and accepting addiction as an illness has helped me immensely these past two years. If you ever have a chance to hear an addiction doctor speak, I highly recommend it.
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I might read those. They do sound fascinating. Here is some more from CLEAN:
Tapert has also studied the brains of heavy drinkers, and she found them to be altered too. Once again, her research focused on white matter. She found that heavy alcohol use caused even more pronounced than marijuana did. For example, the brains of binge drinkers she examined had “a number of little dings throughout their brains' white matter, indicating poor quality,” she told NPR. Alcohol is particularly neurotoxic, according to NIDA’s Dr. Baer. It causes actual degeneration of neurons.”
If pot and alcohol cause anatomical changes, it's un surprising that other drugs do too. For example, by mimicking naturally occurring opiates and binding to opiate receptors, which normally limit, or inhibit, the amount of dopamine released, heroin causes dopamine to flood the synapses. This damages nerve cells in the areas of the brain involved in learning, memory, and emotional well-being. According to Jeanne Bell, professor of neuropathology at the University of Edinburgh, it's similar to damage found in the early stages of Alzheimer's disease. Bell's chemical tests of the brains of young IV heroin users showed “significantly higher levels of two key proteins associated with brain damage.” Another study found that drug abuse causes low-grade inflammation in the brain. Bell told the Scotsman, “Taken together, the studies suggest that intravenous opiate abuse may be linked to premature ageing of the brain.” Similarly, the scans of the brains of methamphetamine addicts and postmortem chemical tests of their brains have shown that meth causes structural changes similar to those seen in people with degenerative brain diseases. Researchers have noted that some neuron ends in meth addicts are essentially singed. Chemical tests of meth addicts' brains showed modestly diminished levels of serotonin and other neurotransmitters and 90 to 95 percent lower levels of dopamine. These findings have led researchers to believe that meth physically changes the brain, more than cocaine, the other drug studied. (There's information about the impact of the various drugs in the appendix of this book.)
While drugs do cause structural changes in the brain, the most pronounced changes are functional. “The brain is hijacked,” Baler says. “Drugs take over the receptors - bind to them. The connections are impaired. The brain becomes dysfunctional.”
Indeed, a hallmark of the disease of addiction is the altered flow of neurotransmitters, especially dopamine. I've explained that all drugs change the flow of dopamine - that's how they work. However, mild drug use and in non addicts' brains, the alteration is temporary; the effect of the drug wears off and because of homeostasis, the system returns to normal. However, the brains of those with addiction respond differently. Drugs stimulate dopamine flow, and the floodgates open. For non addicts, as homeostasis kicks in, the floodgates close, and the heightened stimulation caused by drugs fades. For addicts, however, the floodgates take longer to close or they cease closing. Rather than recirculating, dopamine repeatedly stimulates receptors. Or maybe the door-opening mechanism becomes ultra-sensitive so that, in the future, even a minuscule amount of any drug causes them to swing wide open again. Either way, the brain is malfunctioning. It never stops "wanting" to heal. More of a drug can send another flood of whatever store of dopamine remains, but the receptors are less and less able to process the chemicals that reach them, if they reach them. Tolerance builds. Damage increases.
Indeed, addiction causes “an interruption, cessation, or disorder of a body, system, or organ structure or function,” The American Psychiatric Association's DSM describes some functional changes in its definition of addiction. Two of these occur when the addict's brain adapts to the influence of one or more drugs. First, it requires more and then more of a given drug in order to get the same - eventually, any - effect.
That functional change, the building tolerance, is a symptom of this disease. Second, the brain becomes dependent on the drug. Dependence explains why addicts can't just stop. It also explains why they experience withdrawal when the system is deprived of the drug. Physical withdrawal is another symptom of this disease.
Other functional impairments caused by addiction include a range of cognitive deficits. For example, the changes in the brain’s white matter that Drs. Tapert and Jacobus described correlate with abnormal functioning in the hippocampus - again, a region associated with memory formation. The diminishment of memory in pot smokers has been established. Dr. Vicki Nejtek, clinical researcher at the University of North Texas Health Science Center in Fort Worth, adds, "We know the myelin sheath around our brain cells acts like an insulator to an electric cords.” The insulator is like the outer layer of pieces of spaghetti. “When that’s stripped away it causes a reduction in brain cell activity. It can cause memory loss; it reduces our ability to concentrate.”
Marijuana has been shown to cause other impairments, including, according to Krista Lisdal Medina, assistant professor of psychology at the University of Cincinnati, measurable cognitive deficits. Other drugs cause similar impairments - a wider range of them. In many cases, they're more extreme.
A Progressive, Chronic Disease
Addiction is a disease, and one that's progressive and chronic. Progressive diseases are ones that worsen over time if they aren't treated. Like cardiovascular disease and many cancers, unless addiction is being treated, it usually advances. Addiction has also been shown to be a chronic illness, because at least some of the brain changes in addicts appear to be permanent, and even if they're not, the predisposition for addiction probably remains throughout a person's life. Animal studies have shown that sensory input, memories, and stress can cause flies, mice, and monkeys that are "addicts" (researchers have addicted them to a drug) to initiate intense drug-seeking behavior, even after long periods of being deprived of the drug. Human studies have shown that even after years of abstinence, addicts respond to triggers - Sights, sounds, smells, and even emotions that they associate with drugs. Their heartbeats and breathing speed up and they can feel intense craving. This craving can lead to relapse. Cancer is another disease that can go into remission but then reappear. The persistent possibility of relapse is another hallmark of addiction, which is why a lifetime of monitoring and treatment may be required.
Along with tolerance and withdrawal and the ongoing potential of recurrence (relapse), the disease of addiction has many other identifiable signs and symptoms. Normally, the nervous system monitors, controls, and balances mood, but addiction impairs that system, so addiction is associated with anxiety, mania, and depression. In addition to memory and cognitive impairments, there can also be impaired motor functions and addiction can disrupt normal autonomic body functions, including sensory processing, sleep, metabolism, breathing, heartbeat, and blood pressure.
Cognitive impairments caused by addiction explain another hallmark of the disease, a maddening one. We hear about patients' denial of cancer and other physical illnesses. Understandably, seriously ill people are scared, and they might deal with their fear by avoiding or sublimating it. Ultimately, however, it's difficult to argue with x-rays, scans, and biopsies, let alone deteriorating health. Sufferers usually eventually understand that they're ill. When they do, most seek treatment. It's different for addicts, though, because many of the initial symptoms of the disease are behavioral and cognitive. And though many people can't accept that a disease can cause someone to deny that he's ill, one of the symptoms of addiction is anosognosia, a medical condition in which a patient is unaware or does not acknowledge that he's sick.
Like many schizophrenics (an estimated 40 percent of them), many addicts (an unknown number) can't understand that they're ill because the part of the brain that's damaged by the disease is the same part that's responsible for self-awareness and self-analysis. Their impaired insight, another term used by psychologists, explains addicts' denial. The brain differences associated with impaired insight in schizophrenics and addicts seem to be similar - they occur in many of the same brain regions. We don't blame a schizophrenic for refusing treatment; at least we shouldn't, because his or her condition hinders rational thought. Brain cancer or dementia can have this effect too, depending on the disease's location and severity. Like people with a range of mental illnesses, addicts can become confused, irascible, and irrational, because their illness is rooted in the very brain center that normally would tell them that they're in trouble and need help.
The Addiction Gene
It's possible to concede that an addict's brain structure and nervous system are different than a nonaddict's while still rejecting the disease model. Didn't these addicts poison themselves, damaging healthy tissue and circuitry? The answer, which is of paramount importance, is no and yes. It’s true that addicts ingested, smoked, or injected illicit drugs into their bodies. However, this action didn't cause the addiction. If it did, all the people who took drugs would become addicted, but most don't.
There are two ways people become addicted. Anyone who takes enough of a drug to cause severe structural and functional changes in the brain can become addicted. But most people who become addicted do so because their brains are different before they use drugs, not because they use them. In fact, there's evidence that addicts' brains are different from birth; they have various neurological and genetic anomalies that, when combined with environmental influences, may cause them to respond differently to drugs than non addicts do. A study of cocaine addicts published in Science in 2012 showed that neurological abnormalities in addicts appear to predate any drug use. For the study, researchers at the University of Cambridge in England studied fifty cocaine addicts and their siblings who had no history of drug abuse. Karen Ersche, the study's lead author, told NPR that brain scans showed that both siblings - the addict and the one who'd never abused drugs - had brains that 'were atypical. She said, "The fibers that connect the different parts of the brain were less efficient in both [the addicts and their non addicted siblings].” Furthermore, she said that the fibers were ones specifically associated with self-control. "When the fibers aren't working efficiently, it takes longer for the 'stop' message to get through.” Both siblings' brains were different from normal brains, and the dysfunction was centered in the braking system. The fact that only one of the siblings became addicted is probably explained by environmental factors, but the addicts' brains appear to have been wired for addiction before drugs were thrown into the mix.
Why would siblings in particular be similarly wired for addiction? It’s likely that the main reason is the same as the one that explains why carcinogenic chemicals from household products, cigarettes, or radiation can cause cancer in some, but not in everyone. No one would suggest that people who succumb to cancer are weak; they probably developed the disease because of physiological anomalies, environmental influences, and other as-yet-unidentified factors. But there's also a consensus among scientists that genetics determine those who are more likely get many kinds of cancer, which is why family histories are critical when doctors examine patients. A family history of heart disease indicates genetic susceptibility to heart disease. Many diseases have genetic components.
And so does addiction. It's been proven that some people have a genetic predisposition to addiction in numerous studies, including studies of twins and siblings of alcoholic parents who were raised separately. A number of twin studies have shown that addiction is about 50 percent genetic (the other 50 percent is environmental). And studies of adopted children showed that those whose biological parents were addicts were twice as likely to become addicts as those whose biological parents weren't addicts.
As I've described, roughly 10 percent of humans have the constellation of genes that predisposes them to addiction. This doesn't mean that those without the addiction gene, or gene set, are immune, just as those without a genetic predisposition to lung cancer can still get that disease if they smoke too much. “Some people have a genetic predisposition to addiction,” Nora Volkow said in an interview with Time, “but because it involves these basic brain functions, everyone will become an addict if sufficiently exposed to drugs or alcohol.” Conversely, having a genetic predisposition doesn't guarantee the onset of the disease. It's not unlike other diseases that are influenced by DNA.
So we might ask why some people take their drug use to greater extremes than others - why do some stop at marijuana or alcohol, some at taking pills, and some at shooting heroin? Again, Dr. Volkow compares it to cancer. "Some cancers are more malignant,” she says. “So you do have some vulnerabilities that are much more serious than others. There are people that have grown up in very supportive environments and yet when they get exposed to a drug they rapidly their use, even though their whole social infrastructure is very protective. And then you have individuals who have very little vulnerability perhaps through protective genetic factors, but the environment is so high-risk that it may drive them to take drugs repeatedly and eventually they may become addicted. It's like those individuals that can smoke until they're 100 years of age and they don't die from smoking related consequences like pulmonary diseases or cancer. It's just they have, for whatever reason, a particularly high resistance to the ravaging effects of tobacco smoking. On the other hand, others may develop cancer from secondary smoke. They don’t even get exposed to very high quantities.” The variations among people are vast, and so are their responses to drugs.
Variations in individuals’ genetic makeup contribute to the severity of addiction, as does environment, and the disease is often compounded by co-occurring psychological disorders. The effect of drugs is exacerbated when those with mental illnesses use them to self-medicate.
A Disease That Mimics Free Will
Fine. The brains of addicted people are different. But in true diseases, there's no volition. People choose to take drugs. This is the most common objection made by those who don't accept that addiction is a disease.
“It's true that drug taking begins as a choice,” acknowledges UCLA's Richard Rawson, “and one that appears to be a completely selfish and self-destructive one. A disease that causes you to walk into a bar and drink a beer? It's counterintuitive. People choose to walk into a bar or they choose not to. Symptoms of disease are fevers, nausea, hair loss, heart attacks, and seizures. They don't include reprehensible acts like lying and stealing.”
But choice has nothing to do with the disease of addiction. Not all those who try drugs and continue to use them have a disease. Eighty percent of adolescents in the United States try drugs. For a variety of reasons, some scientifically proven and explained in this book, and some as yet unknown, only one in ten becomes addicted. Only those who become addicted have the disease.
In the 1920’s, a coterie of doctors described alcoholism as a metabolic aberration leading to an inability to process the drug, and some doctors characterized it as an allergy, an idea reflected in "The Doctor's Opinion” section of the Big Book, written by Dr. William D. Silkworth, a colleague of Alcoholics Anonymous founder Bill Wilson. “These allergic types can never safely use alcohol in any form at all,” Silkworth wrote, “and once having formed the habit and found they cannot break from it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.”
Addiction isn't an allergy, but there are analogies between addiction and allergy that can help people understand the abnormalities in the brains of addicts. Most people eat peanuts without any negative reaction. Some, however, when exposed to a particular chemical compound in peanuts (generally the protein Ara hl or Ara h2), go into anaphylactic shock, which can be fatal. Yes, it's a choice to try peanuts; no one would blame a person for trying them - or for the fact that it turns out he's allergic. Even though he chose to eat peanuts, no one would claim that he didn't subsequently become ill. He suffers a disorder of the immune system.
Addicts aren't hypersensitive to drugs the way those with peanut allergies are hypersensitive to Ara hl or h2, but addicts process drugs in a completely different way than others do. When both addicts and non-addicts get high, they're reacting to a burst of dopamine. After that, the similarities cease; addicts and nonaddicts process the chemicals differently. Neurotransmitters in addicts' brains don't properly circulate and recirculate. The misfiring effectively turns the reward system on full blast and dismantles the braking system.
When an addict takes drugs, it appears to be a choice. One of the many reasons people reject the idea that addiction is a disease is the mistaken belief that people don't cause or contribute to "real" diseases. But they do: Eating fried chicken and pork rinds and doughnuts contributes to the onset and progression of heart disease and diabetes; smoking leads to lung cancer and emphysema. If people don't exercise, they can cause or worsen cardiovascular disease, if they spend too much time in the sun, they can develop skin cancer. In fact, it’s possible to argue that choice plays a larger role in some diseases than it does in addiction. The brains of people with heart disease who eat fried chicken haven’t been impaired, so they have no excuse. (Actually, there’s evidence that neurotransmitter flow may make it harder for some people to follow dietary restrictions.)
Addicts' Behavior Is a Symptom of Their Disease
Addicts’ impaired cognition can lead to behavioral changes. Also, with the prefrontal cortex dismantled and the rear brain in control, addicts are literally not in their right minds. The go system is raging, the prefrontal cortex is offline, and, as a result, addicts appear to be pathological narcissists, unable to empathize or sympathize. That's because the reptilian brain can focus on only one thing: the insatiable need for more drugs. In an AA meeting, an addict said, “Everything about my life was about heroin - using heroin, getting it. I was always calculating. Always. At night before I'd pass out, I knew I needed to save two tenths of a two tenths of a gram so I'd have it to wake up. All I was thinking about when I was high was the next high - where I'd score.” The unrestrained go system also accounts for what appears to be an addict's unending quest for pleasure - the modulating system is down. It's important to remember that pleasure isn't an end in itself. It's inextricably associated with survival. The brain doesn't merely want more dopamine. It needs it. When it gets what it needs, it rewards the addict with pleasure.
The cycle of addiction further explains why addicts do such self-destructive things - turning on the very people they need and love, committing crimes without regard for consequences. Diminished cognitive ability is a hallmark of addiction. When people are addicted, their worldviews are so altered that the irrational appears rational. They justify outlandish behavior. They can feel impervious - immune to consequences. They've been taken over by a single impulse: to use.
All the differences in addicts versus non addicts (or "normies," as people in AA meetings sometimes call them) - the genetic predisposition, damaged cellular structure in addicts' brains, misfiring neurotransmitters, the unusual processing of drugs, and more - prove incontrovertibly that addicts have a disease. They also explain why they do things that are outrageous, destructive, self-destructive, and morally reprehensible. Still, although disease isn't a choice, behavior seems to be. However, the same diminishments that cause anosognosia in addicts also cause what appears to be immorality and weakness. In adolescents, it can appear to be willful rebellion.
An unrestrained go system explains behavior that seems to be a reflection of a person's character. We've seen that when the go system blasts, the stop system is repressed. The stop system in the prefrontal cortex that normally regulates impulses and behavior would, if it weren’t impaired, moderate the physical compulsion to use. It would also enable clearer, more conscious thinking. The prefrontal cortex is active when a person considering a second or third drink or another hit of coke recalls the likelihood of a hangover or the consequences of driving while high. The stop system isn't working in those who are addicted, which is why they don't consider consequences.
Unlike most other disorders, addiction affects behavior that we think of as free will, which is one reason it's more insidious than other illnesses. Radically disordered brains lead to radically altered behavior and impaired thinking. We think of nausea, tremors, loss of appetite, and fever as legitimate disease symptoms, but we must understand that lying or violence can be symptoms as well.
And the disease has other behavioral and psychological symptoms. One is the reactive component that accompanies addiction. When people are addicted, their consciences are muted but not completely silenced. They feel guilt and shame. Their loved ones can't understand what's happened to them, and neither can the addicts. They're horrified.
Retreating from an overwhelming psychological burden, they're even more likely to succumb to craving. Meanwhile, they keep using to prevent withdrawal. And they keep using so they can avoid facing the devastation - the harm to relationships, career, finances, and so on - their drug use has caused.
A common result of this spiral is the addict's tendency to victimize the ones closest to him. The addict lies to his family and steals from them. Family members can't understand why the person they love has turned on them, but there's a certain cruel logic to this behavior: home is familiar - the addict knows where the checks or prescription drugs are stored. And home is safer - he assumes that there's less risk of getting caught. If he is, there's less risk that he'll be arrested and prosecuted - addicts don't think their families will call the police, and they're usually right, at least at first. But when they victimize their families, their shame builds, and it can manifest as hostility toward their loved ones. It would be logical for that shame to cause an addict to keep his bad behavior as far as possible from family members. However, addicts say that their attacks on their family resulted from their embarrassment. One man in recovery from his cocaine addiction said, “I would do anything to avoid feeling shame and being judged, so I lashed out at the people who reminded me of what I was doing:.” This also explains addicts' duplicity - an old (and accurate) adage states, “An addict steals your wallet and then helps you look for it.” They want to appear good. They want to be trusted and loved. In the process, they become strangers to others and themselves. But meanwhile, those watching the descent are hurt, confused, angry, and horrified. They think, What’s happened to him? How can she not see what she's doing to herself? How can she not see what she's doing to us? He's become a monster. Addicts often feel like monsters.
They Can't Just Stop
They don't stop in spite of catastrophic consequences. This is another symptom of this disease - continued use in spite of negative consequences. Is it because addicts are selfishly choosing pleasure? They only want to have fun? If addicts were simply set on having fun, why would they continue using when drugs are no longer fun - quite the opposite? But they do. And they continue using even when drugs lead to trauma, physical illness, and a degradation of their lives. There may be a momentary respite the instant the drug effect comes on, but it doesn't last. People aren't choosing to use. Using is a symptom of their disease.
It's true that some people do stop using on their own, suggesting that, in spite of other evidence, willpower is enough, which further suggests that people who don't stop using don't try hard enough. However, longitudinal studies find that only a very small fraction actually quit on their own. In “Exploring Myths About Drug Abuse,” former NIDA president Alan Leshner wrote, “To be sure, some people can quit drugs cold turkey, or they can quit after receiving treatment just one time at a rehabilitation facility. But most of those who abuse drugs require longer-term treatment and, in many instances, repeated treatments.”
Maybe those who stop on their own aren't as addicted in the first place; they may have mild addiction. As Dr. Volkow says, “There are milder forms of cancer too.” Some people with certain personality types, genetics, and socioeconomic situations may be better able to stop on their own, and the ability to stop probably also depends on the specific drugs and amount and duration of use. Family, jobs, and friends likely play a role for these fortunate few, but none of these factors make a difference for most addicts who try to stop, often repeatedly, but are unable to.
“At its core, addiction isn't just a social problem or a moral problem or a criminal problem,” said Dr. Michael Miller, past president of ASAM. “It's a brain problem whose behaviors manifest in all these other areas. Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It's about underlying neurology, not outward actions.”
For centuries we've viewed addicts as immoral, weak, and pathetic. We told them to just say no, but they didn't. We declared war on them and locked them up, but they kept using. We judged them, vilified them, and banished them, yet they still took drugs. Our best efforts to stop them from using didn't work because we didn't understand the most important fact of the paradigm explained in Clean: addiction is a disease with a neurologic basis - a mental illness. When we understand this, we can finally put aside our prejudices and outrage and see that addicts aren't bad people, immoral, weak, or degenerate. Blame, shame, and anger can be replaced by compassion. Most important, when we understand that addicts are ill, we have a model to follow. If someone we love gets sick, we know the course forward.
Tapert has also studied the brains of heavy drinkers, and she found them to be altered too. Once again, her research focused on white matter. She found that heavy alcohol use caused even more pronounced than marijuana did. For example, the brains of binge drinkers she examined had “a number of little dings throughout their brains' white matter, indicating poor quality,” she told NPR. Alcohol is particularly neurotoxic, according to NIDA’s Dr. Baer. It causes actual degeneration of neurons.”
If pot and alcohol cause anatomical changes, it's un surprising that other drugs do too. For example, by mimicking naturally occurring opiates and binding to opiate receptors, which normally limit, or inhibit, the amount of dopamine released, heroin causes dopamine to flood the synapses. This damages nerve cells in the areas of the brain involved in learning, memory, and emotional well-being. According to Jeanne Bell, professor of neuropathology at the University of Edinburgh, it's similar to damage found in the early stages of Alzheimer's disease. Bell's chemical tests of the brains of young IV heroin users showed “significantly higher levels of two key proteins associated with brain damage.” Another study found that drug abuse causes low-grade inflammation in the brain. Bell told the Scotsman, “Taken together, the studies suggest that intravenous opiate abuse may be linked to premature ageing of the brain.” Similarly, the scans of the brains of methamphetamine addicts and postmortem chemical tests of their brains have shown that meth causes structural changes similar to those seen in people with degenerative brain diseases. Researchers have noted that some neuron ends in meth addicts are essentially singed. Chemical tests of meth addicts' brains showed modestly diminished levels of serotonin and other neurotransmitters and 90 to 95 percent lower levels of dopamine. These findings have led researchers to believe that meth physically changes the brain, more than cocaine, the other drug studied. (There's information about the impact of the various drugs in the appendix of this book.)
While drugs do cause structural changes in the brain, the most pronounced changes are functional. “The brain is hijacked,” Baler says. “Drugs take over the receptors - bind to them. The connections are impaired. The brain becomes dysfunctional.”
Indeed, a hallmark of the disease of addiction is the altered flow of neurotransmitters, especially dopamine. I've explained that all drugs change the flow of dopamine - that's how they work. However, mild drug use and in non addicts' brains, the alteration is temporary; the effect of the drug wears off and because of homeostasis, the system returns to normal. However, the brains of those with addiction respond differently. Drugs stimulate dopamine flow, and the floodgates open. For non addicts, as homeostasis kicks in, the floodgates close, and the heightened stimulation caused by drugs fades. For addicts, however, the floodgates take longer to close or they cease closing. Rather than recirculating, dopamine repeatedly stimulates receptors. Or maybe the door-opening mechanism becomes ultra-sensitive so that, in the future, even a minuscule amount of any drug causes them to swing wide open again. Either way, the brain is malfunctioning. It never stops "wanting" to heal. More of a drug can send another flood of whatever store of dopamine remains, but the receptors are less and less able to process the chemicals that reach them, if they reach them. Tolerance builds. Damage increases.
Indeed, addiction causes “an interruption, cessation, or disorder of a body, system, or organ structure or function,” The American Psychiatric Association's DSM describes some functional changes in its definition of addiction. Two of these occur when the addict's brain adapts to the influence of one or more drugs. First, it requires more and then more of a given drug in order to get the same - eventually, any - effect.
That functional change, the building tolerance, is a symptom of this disease. Second, the brain becomes dependent on the drug. Dependence explains why addicts can't just stop. It also explains why they experience withdrawal when the system is deprived of the drug. Physical withdrawal is another symptom of this disease.
Other functional impairments caused by addiction include a range of cognitive deficits. For example, the changes in the brain’s white matter that Drs. Tapert and Jacobus described correlate with abnormal functioning in the hippocampus - again, a region associated with memory formation. The diminishment of memory in pot smokers has been established. Dr. Vicki Nejtek, clinical researcher at the University of North Texas Health Science Center in Fort Worth, adds, "We know the myelin sheath around our brain cells acts like an insulator to an electric cords.” The insulator is like the outer layer of pieces of spaghetti. “When that’s stripped away it causes a reduction in brain cell activity. It can cause memory loss; it reduces our ability to concentrate.”
Marijuana has been shown to cause other impairments, including, according to Krista Lisdal Medina, assistant professor of psychology at the University of Cincinnati, measurable cognitive deficits. Other drugs cause similar impairments - a wider range of them. In many cases, they're more extreme.
A Progressive, Chronic Disease
Addiction is a disease, and one that's progressive and chronic. Progressive diseases are ones that worsen over time if they aren't treated. Like cardiovascular disease and many cancers, unless addiction is being treated, it usually advances. Addiction has also been shown to be a chronic illness, because at least some of the brain changes in addicts appear to be permanent, and even if they're not, the predisposition for addiction probably remains throughout a person's life. Animal studies have shown that sensory input, memories, and stress can cause flies, mice, and monkeys that are "addicts" (researchers have addicted them to a drug) to initiate intense drug-seeking behavior, even after long periods of being deprived of the drug. Human studies have shown that even after years of abstinence, addicts respond to triggers - Sights, sounds, smells, and even emotions that they associate with drugs. Their heartbeats and breathing speed up and they can feel intense craving. This craving can lead to relapse. Cancer is another disease that can go into remission but then reappear. The persistent possibility of relapse is another hallmark of addiction, which is why a lifetime of monitoring and treatment may be required.
Along with tolerance and withdrawal and the ongoing potential of recurrence (relapse), the disease of addiction has many other identifiable signs and symptoms. Normally, the nervous system monitors, controls, and balances mood, but addiction impairs that system, so addiction is associated with anxiety, mania, and depression. In addition to memory and cognitive impairments, there can also be impaired motor functions and addiction can disrupt normal autonomic body functions, including sensory processing, sleep, metabolism, breathing, heartbeat, and blood pressure.
Cognitive impairments caused by addiction explain another hallmark of the disease, a maddening one. We hear about patients' denial of cancer and other physical illnesses. Understandably, seriously ill people are scared, and they might deal with their fear by avoiding or sublimating it. Ultimately, however, it's difficult to argue with x-rays, scans, and biopsies, let alone deteriorating health. Sufferers usually eventually understand that they're ill. When they do, most seek treatment. It's different for addicts, though, because many of the initial symptoms of the disease are behavioral and cognitive. And though many people can't accept that a disease can cause someone to deny that he's ill, one of the symptoms of addiction is anosognosia, a medical condition in which a patient is unaware or does not acknowledge that he's sick.
Like many schizophrenics (an estimated 40 percent of them), many addicts (an unknown number) can't understand that they're ill because the part of the brain that's damaged by the disease is the same part that's responsible for self-awareness and self-analysis. Their impaired insight, another term used by psychologists, explains addicts' denial. The brain differences associated with impaired insight in schizophrenics and addicts seem to be similar - they occur in many of the same brain regions. We don't blame a schizophrenic for refusing treatment; at least we shouldn't, because his or her condition hinders rational thought. Brain cancer or dementia can have this effect too, depending on the disease's location and severity. Like people with a range of mental illnesses, addicts can become confused, irascible, and irrational, because their illness is rooted in the very brain center that normally would tell them that they're in trouble and need help.
The Addiction Gene
It's possible to concede that an addict's brain structure and nervous system are different than a nonaddict's while still rejecting the disease model. Didn't these addicts poison themselves, damaging healthy tissue and circuitry? The answer, which is of paramount importance, is no and yes. It’s true that addicts ingested, smoked, or injected illicit drugs into their bodies. However, this action didn't cause the addiction. If it did, all the people who took drugs would become addicted, but most don't.
There are two ways people become addicted. Anyone who takes enough of a drug to cause severe structural and functional changes in the brain can become addicted. But most people who become addicted do so because their brains are different before they use drugs, not because they use them. In fact, there's evidence that addicts' brains are different from birth; they have various neurological and genetic anomalies that, when combined with environmental influences, may cause them to respond differently to drugs than non addicts do. A study of cocaine addicts published in Science in 2012 showed that neurological abnormalities in addicts appear to predate any drug use. For the study, researchers at the University of Cambridge in England studied fifty cocaine addicts and their siblings who had no history of drug abuse. Karen Ersche, the study's lead author, told NPR that brain scans showed that both siblings - the addict and the one who'd never abused drugs - had brains that 'were atypical. She said, "The fibers that connect the different parts of the brain were less efficient in both [the addicts and their non addicted siblings].” Furthermore, she said that the fibers were ones specifically associated with self-control. "When the fibers aren't working efficiently, it takes longer for the 'stop' message to get through.” Both siblings' brains were different from normal brains, and the dysfunction was centered in the braking system. The fact that only one of the siblings became addicted is probably explained by environmental factors, but the addicts' brains appear to have been wired for addiction before drugs were thrown into the mix.
Why would siblings in particular be similarly wired for addiction? It’s likely that the main reason is the same as the one that explains why carcinogenic chemicals from household products, cigarettes, or radiation can cause cancer in some, but not in everyone. No one would suggest that people who succumb to cancer are weak; they probably developed the disease because of physiological anomalies, environmental influences, and other as-yet-unidentified factors. But there's also a consensus among scientists that genetics determine those who are more likely get many kinds of cancer, which is why family histories are critical when doctors examine patients. A family history of heart disease indicates genetic susceptibility to heart disease. Many diseases have genetic components.
And so does addiction. It's been proven that some people have a genetic predisposition to addiction in numerous studies, including studies of twins and siblings of alcoholic parents who were raised separately. A number of twin studies have shown that addiction is about 50 percent genetic (the other 50 percent is environmental). And studies of adopted children showed that those whose biological parents were addicts were twice as likely to become addicts as those whose biological parents weren't addicts.
As I've described, roughly 10 percent of humans have the constellation of genes that predisposes them to addiction. This doesn't mean that those without the addiction gene, or gene set, are immune, just as those without a genetic predisposition to lung cancer can still get that disease if they smoke too much. “Some people have a genetic predisposition to addiction,” Nora Volkow said in an interview with Time, “but because it involves these basic brain functions, everyone will become an addict if sufficiently exposed to drugs or alcohol.” Conversely, having a genetic predisposition doesn't guarantee the onset of the disease. It's not unlike other diseases that are influenced by DNA.
So we might ask why some people take their drug use to greater extremes than others - why do some stop at marijuana or alcohol, some at taking pills, and some at shooting heroin? Again, Dr. Volkow compares it to cancer. "Some cancers are more malignant,” she says. “So you do have some vulnerabilities that are much more serious than others. There are people that have grown up in very supportive environments and yet when they get exposed to a drug they rapidly their use, even though their whole social infrastructure is very protective. And then you have individuals who have very little vulnerability perhaps through protective genetic factors, but the environment is so high-risk that it may drive them to take drugs repeatedly and eventually they may become addicted. It's like those individuals that can smoke until they're 100 years of age and they don't die from smoking related consequences like pulmonary diseases or cancer. It's just they have, for whatever reason, a particularly high resistance to the ravaging effects of tobacco smoking. On the other hand, others may develop cancer from secondary smoke. They don’t even get exposed to very high quantities.” The variations among people are vast, and so are their responses to drugs.
Variations in individuals’ genetic makeup contribute to the severity of addiction, as does environment, and the disease is often compounded by co-occurring psychological disorders. The effect of drugs is exacerbated when those with mental illnesses use them to self-medicate.
A Disease That Mimics Free Will
Fine. The brains of addicted people are different. But in true diseases, there's no volition. People choose to take drugs. This is the most common objection made by those who don't accept that addiction is a disease.
“It's true that drug taking begins as a choice,” acknowledges UCLA's Richard Rawson, “and one that appears to be a completely selfish and self-destructive one. A disease that causes you to walk into a bar and drink a beer? It's counterintuitive. People choose to walk into a bar or they choose not to. Symptoms of disease are fevers, nausea, hair loss, heart attacks, and seizures. They don't include reprehensible acts like lying and stealing.”
But choice has nothing to do with the disease of addiction. Not all those who try drugs and continue to use them have a disease. Eighty percent of adolescents in the United States try drugs. For a variety of reasons, some scientifically proven and explained in this book, and some as yet unknown, only one in ten becomes addicted. Only those who become addicted have the disease.
In the 1920’s, a coterie of doctors described alcoholism as a metabolic aberration leading to an inability to process the drug, and some doctors characterized it as an allergy, an idea reflected in "The Doctor's Opinion” section of the Big Book, written by Dr. William D. Silkworth, a colleague of Alcoholics Anonymous founder Bill Wilson. “These allergic types can never safely use alcohol in any form at all,” Silkworth wrote, “and once having formed the habit and found they cannot break from it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.”
Addiction isn't an allergy, but there are analogies between addiction and allergy that can help people understand the abnormalities in the brains of addicts. Most people eat peanuts without any negative reaction. Some, however, when exposed to a particular chemical compound in peanuts (generally the protein Ara hl or Ara h2), go into anaphylactic shock, which can be fatal. Yes, it's a choice to try peanuts; no one would blame a person for trying them - or for the fact that it turns out he's allergic. Even though he chose to eat peanuts, no one would claim that he didn't subsequently become ill. He suffers a disorder of the immune system.
Addicts aren't hypersensitive to drugs the way those with peanut allergies are hypersensitive to Ara hl or h2, but addicts process drugs in a completely different way than others do. When both addicts and non-addicts get high, they're reacting to a burst of dopamine. After that, the similarities cease; addicts and nonaddicts process the chemicals differently. Neurotransmitters in addicts' brains don't properly circulate and recirculate. The misfiring effectively turns the reward system on full blast and dismantles the braking system.
When an addict takes drugs, it appears to be a choice. One of the many reasons people reject the idea that addiction is a disease is the mistaken belief that people don't cause or contribute to "real" diseases. But they do: Eating fried chicken and pork rinds and doughnuts contributes to the onset and progression of heart disease and diabetes; smoking leads to lung cancer and emphysema. If people don't exercise, they can cause or worsen cardiovascular disease, if they spend too much time in the sun, they can develop skin cancer. In fact, it’s possible to argue that choice plays a larger role in some diseases than it does in addiction. The brains of people with heart disease who eat fried chicken haven’t been impaired, so they have no excuse. (Actually, there’s evidence that neurotransmitter flow may make it harder for some people to follow dietary restrictions.)
Addicts' Behavior Is a Symptom of Their Disease
Addicts’ impaired cognition can lead to behavioral changes. Also, with the prefrontal cortex dismantled and the rear brain in control, addicts are literally not in their right minds. The go system is raging, the prefrontal cortex is offline, and, as a result, addicts appear to be pathological narcissists, unable to empathize or sympathize. That's because the reptilian brain can focus on only one thing: the insatiable need for more drugs. In an AA meeting, an addict said, “Everything about my life was about heroin - using heroin, getting it. I was always calculating. Always. At night before I'd pass out, I knew I needed to save two tenths of a two tenths of a gram so I'd have it to wake up. All I was thinking about when I was high was the next high - where I'd score.” The unrestrained go system also accounts for what appears to be an addict's unending quest for pleasure - the modulating system is down. It's important to remember that pleasure isn't an end in itself. It's inextricably associated with survival. The brain doesn't merely want more dopamine. It needs it. When it gets what it needs, it rewards the addict with pleasure.
The cycle of addiction further explains why addicts do such self-destructive things - turning on the very people they need and love, committing crimes without regard for consequences. Diminished cognitive ability is a hallmark of addiction. When people are addicted, their worldviews are so altered that the irrational appears rational. They justify outlandish behavior. They can feel impervious - immune to consequences. They've been taken over by a single impulse: to use.
All the differences in addicts versus non addicts (or "normies," as people in AA meetings sometimes call them) - the genetic predisposition, damaged cellular structure in addicts' brains, misfiring neurotransmitters, the unusual processing of drugs, and more - prove incontrovertibly that addicts have a disease. They also explain why they do things that are outrageous, destructive, self-destructive, and morally reprehensible. Still, although disease isn't a choice, behavior seems to be. However, the same diminishments that cause anosognosia in addicts also cause what appears to be immorality and weakness. In adolescents, it can appear to be willful rebellion.
An unrestrained go system explains behavior that seems to be a reflection of a person's character. We've seen that when the go system blasts, the stop system is repressed. The stop system in the prefrontal cortex that normally regulates impulses and behavior would, if it weren’t impaired, moderate the physical compulsion to use. It would also enable clearer, more conscious thinking. The prefrontal cortex is active when a person considering a second or third drink or another hit of coke recalls the likelihood of a hangover or the consequences of driving while high. The stop system isn't working in those who are addicted, which is why they don't consider consequences.
Unlike most other disorders, addiction affects behavior that we think of as free will, which is one reason it's more insidious than other illnesses. Radically disordered brains lead to radically altered behavior and impaired thinking. We think of nausea, tremors, loss of appetite, and fever as legitimate disease symptoms, but we must understand that lying or violence can be symptoms as well.
And the disease has other behavioral and psychological symptoms. One is the reactive component that accompanies addiction. When people are addicted, their consciences are muted but not completely silenced. They feel guilt and shame. Their loved ones can't understand what's happened to them, and neither can the addicts. They're horrified.
Retreating from an overwhelming psychological burden, they're even more likely to succumb to craving. Meanwhile, they keep using to prevent withdrawal. And they keep using so they can avoid facing the devastation - the harm to relationships, career, finances, and so on - their drug use has caused.
A common result of this spiral is the addict's tendency to victimize the ones closest to him. The addict lies to his family and steals from them. Family members can't understand why the person they love has turned on them, but there's a certain cruel logic to this behavior: home is familiar - the addict knows where the checks or prescription drugs are stored. And home is safer - he assumes that there's less risk of getting caught. If he is, there's less risk that he'll be arrested and prosecuted - addicts don't think their families will call the police, and they're usually right, at least at first. But when they victimize their families, their shame builds, and it can manifest as hostility toward their loved ones. It would be logical for that shame to cause an addict to keep his bad behavior as far as possible from family members. However, addicts say that their attacks on their family resulted from their embarrassment. One man in recovery from his cocaine addiction said, “I would do anything to avoid feeling shame and being judged, so I lashed out at the people who reminded me of what I was doing:.” This also explains addicts' duplicity - an old (and accurate) adage states, “An addict steals your wallet and then helps you look for it.” They want to appear good. They want to be trusted and loved. In the process, they become strangers to others and themselves. But meanwhile, those watching the descent are hurt, confused, angry, and horrified. They think, What’s happened to him? How can she not see what she's doing to herself? How can she not see what she's doing to us? He's become a monster. Addicts often feel like monsters.
They Can't Just Stop
They don't stop in spite of catastrophic consequences. This is another symptom of this disease - continued use in spite of negative consequences. Is it because addicts are selfishly choosing pleasure? They only want to have fun? If addicts were simply set on having fun, why would they continue using when drugs are no longer fun - quite the opposite? But they do. And they continue using even when drugs lead to trauma, physical illness, and a degradation of their lives. There may be a momentary respite the instant the drug effect comes on, but it doesn't last. People aren't choosing to use. Using is a symptom of their disease.
It's true that some people do stop using on their own, suggesting that, in spite of other evidence, willpower is enough, which further suggests that people who don't stop using don't try hard enough. However, longitudinal studies find that only a very small fraction actually quit on their own. In “Exploring Myths About Drug Abuse,” former NIDA president Alan Leshner wrote, “To be sure, some people can quit drugs cold turkey, or they can quit after receiving treatment just one time at a rehabilitation facility. But most of those who abuse drugs require longer-term treatment and, in many instances, repeated treatments.”
Maybe those who stop on their own aren't as addicted in the first place; they may have mild addiction. As Dr. Volkow says, “There are milder forms of cancer too.” Some people with certain personality types, genetics, and socioeconomic situations may be better able to stop on their own, and the ability to stop probably also depends on the specific drugs and amount and duration of use. Family, jobs, and friends likely play a role for these fortunate few, but none of these factors make a difference for most addicts who try to stop, often repeatedly, but are unable to.
“At its core, addiction isn't just a social problem or a moral problem or a criminal problem,” said Dr. Michael Miller, past president of ASAM. “It's a brain problem whose behaviors manifest in all these other areas. Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It's about underlying neurology, not outward actions.”
For centuries we've viewed addicts as immoral, weak, and pathetic. We told them to just say no, but they didn't. We declared war on them and locked them up, but they kept using. We judged them, vilified them, and banished them, yet they still took drugs. Our best efforts to stop them from using didn't work because we didn't understand the most important fact of the paradigm explained in Clean: addiction is a disease with a neurologic basis - a mental illness. When we understand this, we can finally put aside our prejudices and outrage and see that addicts aren't bad people, immoral, weak, or degenerate. Blame, shame, and anger can be replaced by compassion. Most important, when we understand that addicts are ill, we have a model to follow. If someone we love gets sick, we know the course forward.
Member
Join Date: Dec 2011
Location: Dallas TX
Posts: 2,282
I think it might be because our physiological architecture is
bilateral. We humans have a dyed-in-the wool need to see
everything in black/white, up/down, right/wrong.
It is a critical failure that even our best efforts to eradicate
/educate ( e.g. fight ignorance) have failed.
Disease/ not disease. It is a debate rooted in the foolish
human belief that semantics can trump science.
It cannot. Right now there are millions imprisoned, lives
wasted by eons of punitive revenge-----in order to propagate
our need for certainty in a world that (at it's core) is ruled by
probability clouds and a future unknowable.
I had a pal who died very angry. He did all the right things,
he had a marathoners contempt for all those 'lower' life forms.
He was angry because he thought living right would get him a
guarantee of a very long and healthy life. But cancer got him
...........hence the anger.........he had 'paid the price'.......life "owed" him.
But life owes noone.
I have no quibble with necessary suffering. It is part of life.
My sadness originates from knowing how many millions of addicts
are suffering in prison cells, as well as their families------both thinking they
are profound failures, losers, untouchables----and their simple minds
can only wrap around one fact. That they are there because they are bad
people. The families they came from are defective/ weak/ loser families.
A simple, satisfying, and gratuitous conclusion to those of us with
happy intact families and successful children we are very proud of.
But it's a lie. And every pair of intelligent eyes reading this sentence
knows it. My friend was so angry because his worldview was limited.
His only reality was that good people get the goodies------and bad people
get the crap. That was a useful fiction when we are 5 years old, and our
kindergarten teachers needed tools to 'herd' us.
Take this idea into adulthood......this moral certainty........and in all
likelihood you ( and perhaps an entire generation with 2M+ in prison)
..........are going to get slaughtered.
If life was binary, it'd be easy. But it's not (and it's not!)
Disease/Not disease. " Tastes great/ less filling". What an ignorant
dichotomy showing only ignorance of science, probability, life......
.................and luck.
bilateral. We humans have a dyed-in-the wool need to see
everything in black/white, up/down, right/wrong.
It is a critical failure that even our best efforts to eradicate
/educate ( e.g. fight ignorance) have failed.
Disease/ not disease. It is a debate rooted in the foolish
human belief that semantics can trump science.
It cannot. Right now there are millions imprisoned, lives
wasted by eons of punitive revenge-----in order to propagate
our need for certainty in a world that (at it's core) is ruled by
probability clouds and a future unknowable.
I had a pal who died very angry. He did all the right things,
he had a marathoners contempt for all those 'lower' life forms.
He was angry because he thought living right would get him a
guarantee of a very long and healthy life. But cancer got him
...........hence the anger.........he had 'paid the price'.......life "owed" him.
But life owes noone.
I have no quibble with necessary suffering. It is part of life.
My sadness originates from knowing how many millions of addicts
are suffering in prison cells, as well as their families------both thinking they
are profound failures, losers, untouchables----and their simple minds
can only wrap around one fact. That they are there because they are bad
people. The families they came from are defective/ weak/ loser families.
A simple, satisfying, and gratuitous conclusion to those of us with
happy intact families and successful children we are very proud of.
But it's a lie. And every pair of intelligent eyes reading this sentence
knows it. My friend was so angry because his worldview was limited.
His only reality was that good people get the goodies------and bad people
get the crap. That was a useful fiction when we are 5 years old, and our
kindergarten teachers needed tools to 'herd' us.
Take this idea into adulthood......this moral certainty........and in all
likelihood you ( and perhaps an entire generation with 2M+ in prison)
..........are going to get slaughtered.
If life was binary, it'd be easy. But it's not (and it's not!)
Disease/Not disease. " Tastes great/ less filling". What an ignorant
dichotomy showing only ignorance of science, probability, life......
.................and luck.
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