THE MECHANISMS OF ADDICTION

The most current statistics indicate that thirty percent of the American adult population have been alcoholics, been dependent on alcohol or abused alcohol in their lifetime.  An estimated 15 million are currently alcoholics and many as twenty million more are alcohol dependent or abuse alcohol.  When I was working as a mental health counselor we considered anyone who consumed 21 or more alcoholics drinks a week dependent on alcohol.  The 21 drinks per week could be consumed in one day or seven days and could be 21 beers, 21 glasses of wine or 21 hard liquor drinks or any combination of them.  We used the rule of thumb that for every person who is an alcoholic or dependent on alcohol, five other persons, usually family, friends and co-workers, are negatively impacted. While we spend billions on the “war on drugs”, the damage done to individuals, families and our society by alcohol is largely ignored.

The July sixteenth issue of TIME has an excellent article on the physical mechanisms of addiction that I recommend everyone read.  This article explains how all addictions, from alcohol to gambling, are brain based and how addictions are an out of balance condition in the chemical neurotransmitters in our brains that basically control how we think, feel and behave. As a culture, we like to believe that addictions of any type and other anti-social behaviors are simply reflections of a personal lack of character, “evil” persons or even demon possession but this article provides the scientific details of addiction.  Science is helping us to understand how addictions develop and get control over so many lives and, hopefully, now science can help free people from the addictions that are ruining their lives.

In the case of alcohol and gambling addictions, our culture and legal environment actually enable the development of some addictions.  While we know from our experience with the “noble experiment” of banning alcohol in the early twentieth century that legal prohibitions on substances, like alcohol, often backfire and cause even more illegal consumption. We only have to examine the power of advertising in our consumer society to understand the historic connection between it and the growth in alcohol, tobacco consumption and participation in the business of legal gambling activities. 

Out recent successes in reducing tobacco use in our country clearly demonstrates the power of education and economics in encouraging people to stop damaging their health and generating huge unnecessary medical costs to our nation, to say nothing about the personal and family agonies caused by the resulting illnesses and premature deaths.  Raising the cost of tobacco products by increasing taxes on each pack has provided many people with the economic motivation to quit and generated billions of dollars to cover the health care related to tobacco related illness although much of the money has been diverted by state legislatures to non-health related spending. We know that even with school based education on the dangers of tobacco; thousands of young people begin smoking every day. The tobacco companies know that if they do not convince a person to start smoking by age 21, the chances are they never will smoke. 

The tobacco producers, in their drive to maintain and increase profits, have chosen to diversity their product line away from tobacco, while, at the same time, moving their tobacco sales efforts to the billions of new potential consumers in he Third World who do have the education to understand the health dangers of tobacco. About 3,000 persons die in China every day from tobacco related illnesses. What can we conclude about corporations that, faced with the proof that their product causes great harm to its’ consumers, choose not to stop making and selling the product, but to switch their marketing efforts to a new population that is unaware of the harm the products cause?

The TIME article states that twelve million Americans try alcohol for the first time every day, and we know that alcohol use and abuse now extend down to children as young as ten.  While it is true that per capita consumption of alcohol declined to 2.23 gallons per person in 2004 from 2.76 gallons per person in 1980, it is still a 42% increase over the rate of 1940, 1.56 gallons per person.  Since abstainers, those who do not drink alcohol, are primarily in the lowest socio-economic class, I suspect that since the cost of alcohol has increased like all other products while wages and salaries for the lowest earners have stagnated, the number of economic abstainers has increased, indicating that the actual consumption rate of drinkers may be holding steady or even increasing, particularity among the higher earning groups since this group has the lowest rate of abstainers.

Based on my experience in mental health and my work in our local jail, I know that today alcohol and drug abuse go hand in hand.  Rarely did I encounter an inmate who had only a single addiction, they were addicted to nicotine, alcohol and drugs.  If we didn’t have severe drug and alcohol problems in this country, we would have a much lower crime rate.  I was always amazed at how the loss of normal inhibitions and judgment due to alcohol and drug use was the cause of many criminal acts. A number of police chiefs have stated that simply giving drug addicts their daily fix would substantially reduce property crime since many property crimes are committed to get money to buy more drugs.

The National Institute of Mental Health estimates that there are ten million seriously mentally ill persons in the US.  Since the mental health system in our country is essentially broken, many people with mental illnesses will “self-medicate” with alcohol, street drugs and illegally obtained prescriptions drugs, often resulting in them being arrested. 

The TIME article states that 3.6 million persons in the US are dependent on drugs, eight thousand try drugs for the first time very day and there are seven hundred thousand in treatment for addiction.  Compare these numbers with the numbers dependent on alcohol and you can see the disparity between the time and money spent on solving our problems with alcohol as opposed to drugs.  This is not to say that drugs are not a problem, they are.  But in terms of impact on individuals, families and society in general, alcohol abuse is much more costly in human and economic terms.  The political, law enforcement and media focus on the War on Drugs, and the simple fact that alcohol is legal for adults and part of our culture, means it is not as newsworthy.  It is one of negative social indicators that we seem to willing to passively accept unless it suddenly affects our personal lives.

While most states have lowered the blood alcohol limits for DUI, this has not necessarily translated into more DUI arrests since, like in my home state of South Carolina; loopholes in the law make it more difficult to convict drunken divers according to local prosecutors.  The South Carolina legislature also seems incapable of increasing the tax on cigarettes, seven cents per pack, the lowest in the nation, because of political influence from tobacco growers in the state. This is an example of how we enable drug and alcohol abuse in our nation by refusing to change our laws to protect ourselves from irresponsible behaviors based on the best information we have. In South Carolina we cannot raise the cigarette taxes, which would save lives and reduce medical costs in the long run, because the income of a very small number of people would decline. The legislators justify this behavior on the theory that raising the cost of cigarettes by increasing taxes will interfere with the rights of smokers and cause the poorest to pay more for their cigarettes.

Science is helping us understand the mechanisms of addiction and providing us with new treatment options, but that same science is creating new drugs that can be addictive if misused.  Prescription drug abuse is growing as the number of new drugs increases.  Drugs for the treatment of ADD and ADHD, for example, are frequently abused because they provide the same type of high as methamphetmine.  Methamphetmine is a good example of a drug that can be made in low-tech labs and ruin many lives in a short period of time, although most of the meth available in the US currently is made in Mexico. 

The growth of legal gambling in the US has created a whole new class of addicts.  Casinos, state and multi-state lotteries, and on-line gambling are all examples of the recognition of gambling as a new source of revenue for governments and private investors.  Gambling addictions are basically an impulse control issue.  The normal process of inhibition and control, the process of rational decision-making, simply doesn’t work and the person’s brain is rewarded by the excitement of anticipation of winning big at gambling, creating an addiction just like alcohol or drugs.  And, just like alcohol and drugs, we now have a Gamblers Anonymous organization to help people get control over their addiction to gambling. Although there are no drugs involved, the brain gets its “fix” by creating chemicals that reward the person’s brain with his or her “high”.

Addictions present a very real set of complex issues for a free society like the US.  We cherish and insist on our right to smoke, drink alcohol and gamble, yet we know that the damage from smoking will eventually result in much higher health care costs, illness and premature deaths. Alcohol or drug abuse and irresponsible gambling can be directly linked to child abuse and neglect, divorce, bankruptcy and increased levels of criminal activity. All of these negative results directly result in much higher healthcare and criminal justice system costs and social and family instability.

We have learned a great deal from our success with reducing tobacco use in our society and we need to apply the same techniques to drugs and alcohol.  We know that the key is education, education, education, beginning in the earliest school years and modeling in the home.  We also need to reduce the exposure of children to advertising and other media sources that glorify these substances and make the price of the product cover the costs of the damage they cause.