addiction

This post has nothing to do with sequential liability, prodcos and agencies, social networking, or frankly anything creative.  It is about a subject that has affected virtually all of us in some way or another-Addiction.  I am going to focus on alcohol and drug addiction, though certainly there are many other types-to food, gambling, sex, shopping, and too many others to list.

I am a licensed social worker and interventionist practicing in New York City and currently run one of the largest, private inpatient programs in New York.  I have personally interviewed, admitted, run groups for, and counseled thousands of patients during the past 18 years.

I am asked many questions about addiction on a daily basis and will address a few of them in this post. 

Q) Why do people get addicted?  Is this really a disease?  Are there ways of predicting who will become an addict?

A) Generally people try drugs for the first time voluntarily.  Once, however, they are truly addicted, it is no longer a choice.  Prolonged use changes the brain in drastic and long lasting ways which result in uncontrollable drug craving and use, which is the essence of addiction.  I cannot tell the audience how may individuals I have worked with whose addiction started with dental surgery or back pain.  Before they know it, they cannot manage without pain medication-oxycontin, vicadin, and the like.  I will address this particular addiction in a bit.

In my own very unscientific study, the number one factor in who becomes addicted is whether or not there is a family member who has had a history of addiction.  Fully 80% or more of the thousands of patients I have treated have had a family history.  This clearly indicates that there is a biological predisposition towards addiction.  Simply put, a person with a family history who tries alcohol or drugs has a much larger chance becoming an addict than someone without a family history.  And who as a teenager doesn’t try drugs or alcohol?  

Q) Which drugs are the most addictive?

A) There is a difference between physical addiction and withdrawal vs. mental/psychological addiction.  For example, cocaine, crack and crystal meth are NOT physically addictive.  Basically, sudden stoppage in use after a period of days, weeks or even years will NOT result in physical withdrawal.  However, the psychological addiction and cravings are profound.  I have personally seen countless lives ruined over the inability to stop using these stimulants.  

For opiates there is a physical withdrawal that manifests as the worst flu-like symptoms one can imagine.  As I stated earlier, the number of people I have personally met with who started out with a prescription for pain pills that turn into an addiction is in the hundreds.

Alcohol and other benzodiazepines (xanax, valium) are a different story-they are all highly addictive, and cause physical discomfort when use is stopped.  More significantly, withdrawal can cause seizures and death if chronic use is stopped suddenly and with no medication to manage the withdrawal symptoms.  When these symptoms are managed in a treatment setting, there is little to no danger during the withdrawal.

Q) Lastly, and perhaps most controversial-why should we treat addicts?

A) Obviously, I am a strong advocate for drug treatment.  I could go on forever but won’t.  Here’s my bottom line: imagine a chronic debilitating disease for which there are documented, effective treatments.  Imagine that this disease costs society $110 billion a year.  Imagine data that shows treatment is as, if not more effective than treatments for other chronic illnesses like heart disease, diabetes, and some mental disorders.  Studies from such institutions as Columbia University and the University of Pennsylvania have shown that comprehensive treatment can reduce use by 50-60%.  Treatment also reduces the risk of HIV infection and these interventions cost less than treating someone with AIDS.

It should be clear that society needs to rise above its moral outrage over the initial voluntary behavior of addicts and get them into treatment.  In order to significantly reduce the tremendous toll drug addiction exacts from all aspects of society, treatment availability must be a core element in our society.

David A. Bochner, LMSW

David is the Executve Vice President of Cornerstone of Medical Arts Center, the largest private provider of substance abuse services in New York. He graduated from New York University in 1990 with a Masters Degree in Social Work and has been part of the recovery community ever since. He lives in Tenafly, NJ with his wife and 3 kids.