Maybe there‘s a little addiction, disorder in all of us

Addiction and Recovery

By Bob Gaydos

   
Opioids and alcohol get most of the attention, although marijuana, currently undergoing a reputation rehabilitation, has been grabbing plenty of headlines lately. But if you spend any amount of time studying the issue, it doesn’t take long to wonder if there isn’t an addiction, compulsion, behavioral disorder — call it what you will — for every human on the planet.

    Some conditions are more serious than others, but all

either involve the brain’s reward system or relieve anxiety, stimulate compulsive use and bring with them an opportunity for negative consequences. Consider the following an inventory of sorts, a look at some of the substances people use or behaviors they engage in, perhaps to excess. Maybe someone you know shows some of the signs of trouble.

Medically recognized substance use disorders

    Alcohol Use Disorder: Alcohol is a depressant. Alcohol use disorder is more common among adult men than among women, but the gap is narrowing. It typically develops at a young age. Severe use is commonly referred to as alcoholism.

Caffeine Intoxication: Heavy intake of caffeine resulting in symptoms including restlessness, nervousness, insomnia, gastrointestinal disturbance, rambling thoughts and speech, cardiac rhythm disturbances.

Cannabis Use Disorder: Highest among 18- to29-year-olds. Often the first drug used and often used with other drugs. Prevalence decreases with age.

Hallucinogen Use Disorder: These substances alter perception. Phencyclidine — “angel dust” or PCP — produces feelings of separation of mind from body.

Inhalant Use Disorder: Sniffing glue. Inhalant substances are volatile hydrocarbons, toxic gases that are released from glues, fuels and paints, that can have psychoactive effects. Occurs primarily among ages 12 to 17.

Opioid Use Disorder: Opioid drugs include heroin and prescription pain-relievers such as oxycodone, codeine, morphine, and fentanyl. According to the American Society of Addiction Medicine, opioid-related overdoses are now the leading cause of death in Americans under 50 years of age and prescribed opioids are the “overwhelming initial source” of addiction.
    Sedative, Hypnotic, or Anxiolytic Use Disorder: Addiction to sleeping pills and anti-anxiety medications (Valium, Xanax, Librium). These are brain depressants. Rates are highest among 18- to 29-year-olds.
    Stimulant Use Disorder: This group include amphetamines, Ritalin and cocaine. These drugs are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. Cocaine use in the U.S. is highest among those aged 18 to 25.

Tobacco Use Disorder: Nicotine in tobacco acts as a stimulant for the central nervous system. Studies show that 68 percent of adult smokers want to quit and 50 percent of smokers have tried.

Behavioral disorders

Binge-eating disorder (overeating disorder): Uncontrolled eating, often accompanied by purging (bulimia).

Gambling disorder: Because of the quick feedback, it can provide reward symptoms to the brain much like alcohol or cocaine.

        Gaming disorder: It has been recognized officially by the World Health Organization, but is still under study in the United States for classification as an addictive behavior. Other behaviors under study include smartphone use, Internet gambling, pornography, eating and shopping.

Compulsive behaviors

        These can include such things as hoarding, shopping, sex, eating, gambling, exercise, even talking compulsively. While the behaviors may not provide the pleasure reward of an addiction, they serve to relieve anxiety and stress and, if unchecked, can have serious negative consequences in a person’s life.

What else to know

        Simply put, an addiction is a repetitive use of a substance or engagement in a behavior because of the rewards message the substance or behavior transmits to the brain, despite numerous negative consequences the activity produces in the person’s life. Tolerance increases with time. The person may not even be aware of the damage being done by the behavior, or may continue in spite of it. At some point, the substance or behavior may dominate the addicted person’s daily life. It is highly likely that these conditions are accompanied by other mental health conditions, such as anxiety or depression.

    Science has been unable to come up with one cause of addiction, nor can it predict who will become addicted. However, there are numerous risk factors that can be recognized, some of which may be avoidable, some not. Genetics/family history play a significant role in determining vulnerability as do environmental factors, including growing up in a dysfunctional family and early exposure to substances or abuse. The presence of other mental health issues can also contribute to susceptibility to addictive behavior. Even physiology may play a role since men seem to be more susceptible to addiction than women.

That said, there are a number of conditions that can predict the presence of an addiction. The following list is adapted from one used by the Mayo Clinic. Substitute the specific substance or behavior for the word “drug.”
    — Feeling that you have to use the drug regularly — daily or even several times a day.

— Having intense urges for the drug that block out any other thoughts.

— Over time, needing more of the drug to get the same effect.

— Taking larger amounts of the drug over a longer period of time than you intended.

— Making certain that you maintain a supply of the drug.
    — Spending money on the drug, even though you can't afford it.
    — Not meeting obligations and school, family or work responsibilities, or cutting back on social or recreational activities because of drug use.
    — Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm.
    — Doing things to get the drug that you normally wouldn't do, such as stealing.
    — Driving or engaging in other risky activities when you're under the influence of the drug.
    — Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug.
    — Failing in your attempts to stop using the drug.
    — Experiencing withdrawal symptoms when you attempt to stop taking the drug.

Generally, two or three symptoms suggest a mild disorder, four or five a moderate one and anything more, a severe disorder.

The good news is that there is a variety of treatment available for all these conditions. If a problem is suspected, don’t try to deal with it alone. Consult with a health professional (doctor, psychologist, social worker, addiction specialist) and begin the road to recovery.

Government survey: Adolescents' drug use lessening

Addiction and recovery

By Bob Gaydos

Good news and drugs. It’s not a typical pairing in most people’s minds. Right now, for example, the United States is trying to come to grips with what many are calling an epidemic of deaths due to heroin overdoses tied to opioid addiction. The attorney general of the United States recently cited this serious reality in asking Congress for permission to prosecute states which have legalized the use of marijuana for medical purposes. This kind of political exploitation tends to confuse issues and make the bad news sound even worse. So I went looking for some good news.

It didn’t take long to find and it came, if you will, from the horse’s mouth, which is to say, the National Institute on Drug Abuse, which is part of the National Institutes of Health, which are part of the U.S. Department of Health and Human Services. The government.

Since 1975, the NIDA has been conducting the Monitoring the Future Survey, which tracks drug use and attitudes among eighth, tenth and 12th graders in the United States. Its most recent report was released in December of 2016. It contained quite a bit of good news.

According to the NIDA: “Use of many substances is at its lowest level since the survey’s inception (1975), including alcohol, cigarettes, heroin, cocaine, methamphetamine, inhalants, and sedatives (reported only by 12th graders). Other illicit drugs showed 5-year declines, including marijuana (among 8th and 10th graders), synthetic cannabinoids (K2/herbal incense, sometimes called "synthetic marijuana"), prescription opioids (reported in the survey as "narcotics other than heroin"), hallucinogens, amphetamines, and over-the-counter cough and cold medications.”

And on that national epidemic, here’s NIDA again: “Despite the continued rise in opioid misuse and overdose deaths among adults, past-year misuse of prescription opioids has continued to decline among high school seniors. Over the past 5 years, misuse has dropped 45 percent, from 8.7 to 4.8 percent. Heroin use remains very low, with past-year use reported by 0.3 percent in all grades.”

Bottom line, in a lot of ways an increasing number of adolescents are getting the message to do what Nancy Reagan suggested years ago regarding drugs -- just say no.

Of course, it took a little more to achieve these results than just telling teenagers to not do something because it could be harmful to their health. The all-time low levels of use of tobacco and alcohol surely are a reflection in part of federal laws that a) required states to raise their ages for purchase and public possession of alcohol to 21 or lose 10 percent of their federal highway funds (it worked) and b) banned cigarette and tobacco advertising on TV and radio, required warning labels on the packages and regulated product placement and ads in stores. It took a concerted, community effort, in other words.  

That effort continues with regard to tobacco, as Hawaii in 2015 led the way to raising the age for purchase of tobacco to 21. More than 100 cities and counties, including New York City, Suffolk and, recently, Orange County have also adopted the policy. Alabama, Alaska, New Jersey and Utah have set the legal age at 19.

These legislative efforts were accompanied by well-publicized campaigns that heightened awareness of the numerous health risks associated with smoking and drinking -- especially at a young age -- and the dangers of driving while under the influence of alcohol or other drugs. Stiffer DWI laws accompanied the raised drinking age in many states, again, a reflection of communities coming to terms with an unhealthy situation, discussing options and taking steps to remedy it. These positive actions and attitudes by adults are not lost on children and are passed on through generations, just as the negative ones are.

In response to the current opioid epidemic, law enforcement agencies have cracked down on over-prescription of pain-relief medicines and stricter regulations have been put in place to monitor their use. In addition, many communities have formed action groups to provide information about the abuse of prescription pain medicines and heroin, as well as other drugs. Such efforts increase awareness of the issue -- including the fact that help is available -- and tend to reduce the shame that prevents many who are suffering from addiction from seeking help.

As with the changes in drug and alcohol use among adolescents reported in the latest Monitoring the Future Survey, these attitudes and actions could certainly carry through generations. That would be more welcome positive news.  

From the 2016 survey

--  Marijuana: Among both 8th and 10th graders, daily marijuana use decreased over the past 5 years from 1.3 to 0.7 percent and from 3.6 to 2.5 percent, respectively. Among 12th graders, 6.0 percent continue to report daily use -- that’s about 1 in 16 high school seniors. Among all grades, the perception of risk associated with smoking marijuana regularly continues to decline, with only 31.1 percent of 12th graders reporting that regular marijuana use is harmful compared to 58.3 percent in 2000. However, disapproval among 12th graders remains somewhat high, with 68.5 percent saying they disapprove of smoking marijuana regularly.

-- Alcohol: The percentage of high school students who reported ever using alcohol dropped by as much as 60 percent compared to peak years. This year’s survey found that 22.8 percent of 8th graders reported ever trying alcohol, a 60 percent drop from a peak of 55.8 percent in 1994. Among 10th graders, lifetime use fell by 40 percent from 72.0 percent in 1997 to 43.4 percent this year. Among 12th graders, there was a significant 25 percent drop in lifetime alcohol use from 81.7 percent in 1997 to the current 61.2 percent.

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FYI

Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th and 12th grade students from more than 300 schools are surveyed (12th graders since 1975, and 8th and 10th graders since 1991). The survey is funded by the NIDA, a component of the National Institutes of Health (NIH), and conducted by the University of Michigan.

For more information about the Monitoring the Future survey:

-- http://www.monitoringthefuture.org/

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