Now that we, by and large, are blaming people less for having addictions we can get a better glimpse into the popularity of the substances these individuals chose.
There has been a long and cruel history that has regarded addiction — to alcohol or drugs — as a weakness of character. Right on the heels of that erroneous and harmful characterization follow many personal and social disgraces and punishments. Individuals are ostracized, shamed, jailed, and often denied many societal benefits including housing, education, employment, safety, food, health care and comfort.
But addiction is not only another complex and confounding brain disorder it is a means by which individuals achieve definitive and demonstrable changes in their brains. These alterations in neurotransmitters and brain circuits are experienced in ways as varied as relief of pain, pleasure, calm, composure and stamina — depending on the agent used and its effect on any given individual.
People use psychoactive substances for a purpose. They often select among alcohol, tobacco, opioids, stimulants, marijuana, tranquilizers, and psychedelic agents according to the affects these agents produce. People with addictions imbibe, swallow, inhale, snort, and/or inject not because they are weak but because they have a brain problem, an illness, that these drugs help alleviate, at least at first. The view that people with addictions have greater brain responsivity to substances and that impels them to abuse these drugs has been disputed. In fact, for many, their brain reward pathways are less responsive to drug intake than those who are not suffering addiction http://www.drugabuse.gov/videos/dr-nora-volkow-addiction-disease-free-will).
Tobacco (nicotine) can relax tension and helps with cognitive focus. Alcohol calms and promotes socialization (it also is a pain killer, an analgesic). Opioids do many things well known to historians of science dating back millennia, including pain relief (in civilians and soldiers), enabling of stamina, escape from psychic agonies and abysmal circumstances, and even ameliorating melancholia. Stimulants enable us to deny our need for sleep while elevating our mood and confidence; in the short run they can enhance focus and productivity. Marijuana can take a person on a buoyant high and is an effective analgesic for some forms of chronic pain and debility. Tranquilizers, at first Valium and Librium, were introduced to offer a “non-addicting” alternative to barbiturates; now a host of their successor agents provide rather prompt relief from anxiety by both relieving its mental distress and its bodily tensions. Psychedelic agents, like psilocybin, ayahuasca and LSD, produce a sense of wonder that we often leave behind in childhood.
I do not mean to glamorize these drugs. Instead, I seek to stress the nature of their attraction to us humans with our panoply of sufferings and desires. If we can appreciate the utility of drugs we can develop new strategies to combat them that may be more successful than the failed efforts to control their production and distribution (http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-04-19/substance-use-treatment-works-better-than-any-war-on-drugs).
For example, psilocybin has been researched for many years at The Imperial Medical College (London) as well as at Johns Hopkins, NYU and Stanford. Initially, it was to assist terminally ill patients who were suffering emotionally from the imminence of their death. Now, work is underway for its use in treating addictions, as well as for depression and obsessive-compulsive disorder (Michael Pollan, The New Yorker, http://www.newyorker.com/magazine/2015/02/09/trip-treatment) (1).
For example, a recent medical journal report and accompanying editorial (2,3) discussed the use of opioids for the many cases of depression that do not respond to conventional treatment with medications and therapy. An Op-ed in the New York Times by Dr. Anna Fels added their potential in treating Borderline Personality Disorder, which produces chaotic and self-destructive relationships and behaviors (4). These reports identified a synthetic opioid introduced into this country over a decade ago, buprenorphine (called Suboxone when combined with an opioid blocker to help prevent diversion, abuse and overdose), as a possible treatment that we have now, not one that awaits discovery. All urged caution as well as exploration.
Alternative measures to reduce pain are not confined to chemicals, though most alternatives would also likely act on the brain’s chemicals and circuits in ways that resemble ingested drugs. One particularly promising, and ancient, approach is Mindfulness (and Mindfulness Meditation), which, for example, was studied and shown to be effective in people with chronic low back pain (5). Other researchers, using imaging techniques, determined that Mindfulness induced pain reduction was associated with parts of the brain that control thinking and emotional regulation. When these researchers administered naloxone, which blocks our internal opioid response, to the study participants the meditation still worked, suggesting that it was doing the job of pain relief in our brain in a different way (5).
Our species is quite extraordinary in its capacities for thinking, emotion, awareness, empathy, adaptiveness, mastery and resilience. But we are merely human: we have our pains and pleasures, our griefs and discontents, and our mental and additive disorders. These are not apt to simply vanish or suddenly abate from further efforts to try (futilely) to “say no” or control access to them. Solutions to our psychic and physical ails need to start by recognizing that people are driven to get what they need, often at any cost. That understanding can be the gateway to seeing an end to addiction as we have known it.
1. Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA: Mithoefer, MC, Grob, CS, Brewerton, TD, Lancet Psychiatry 2016; 3: 481-88
2. Opioid modulation with buprenorphine/samidorphan as adjunctive treatment for inadequate response to antidepressants, Fava, M, Memisoglu, A, et al, Am J Psychiatry, 2016: 173:499-508
3. An Opioid for Depression? Kosten, TR, Am J Psychiatry, 173:5, May 2016
4. Can Opioids Treat Depression, Fels, A, NYT, Sunday Review, June 5, 2016, p10
5. As Opioid Prescribing Guidelines Tighten, Mindfulness Meditation Holds Promise for Pain Relief, Jacob, JA, JAMA, Medical News & Perspectives, May 20, 2016.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
Dr. Lloyd’s two new books are now available: Improving Mental Health: Four Secrets in Plain Sight (2016) and Current Controversies in Mental Health and Addictions: An Expert’s Anthology (2017)