ADDICTION - ARTICLE II - By Michael Stone, M.D.

I hope you read and enjoyed my previous article. So now you should know how I define addiction. I will describe how you got the problem and the physical nature of the disease.

Addiction is a brain disease. Addicts have physical changes (differences) in their brain chemistry which cause addict behavior and addict feelings, moods and drives. These changes are at the deepest level of the brain where one cell "talks" to another cell by sending messages (chemical messengers called neurotransmitters) to each other. How did these changes happen?

Genetics; Hereditary: We know that you can be born with these changes already set up in your brain because you have inherited the genes (and therefore the changes) to be an addict. This is similar to people who are born with the gene makeup to be a diabetic, who needs insulin, asthmatic or a person with high blood pressure. The more addiction there is in your family the more likely you will be born with it. Therefore when you look intensely at your family you may see an alcoholic, a gambler, a workaholic, a sex addict, an overeater, an "illegal drug" addict (cocaine, heroin, marijuana etc.) or even a "legal drug" addict e.g. Vicodin, Valium, Xanax etc. Whatever the addiction the family has, the closer in the bloodline to you, then the more chance you will inherit it.

Life; Environment; Family Dysfunction: Here there are two possibilities. You can be born, as above, with a strong genetic/hereditary factor or you can be born with a slight genetic factor or none at all. This is where what happens to you in your life, environment and family can cause the changes in your brain chemistry leading to the disease of addiction. The key to you getting addiction from life is getting "HIGH" - feeling really, really good - from some chemical or some action or behavior that you did. If you drink alcohol and you feel fantastic, fabulous, great, unbelievable, super-relaxed, can talk to anyone, no longer scared, can socialize, can date etc., this is getting 'high' from alcohol as opposed to having a drink and feeling relaxed and comfortable. If you drink a lot and don't get a hangover or sick, that is, no negative physical problems from heavy drinking, then addiction is more likely. If you have both factors - really get 'high' from drinking and don't get too sick, then you could be heading towards addiction.

This also goes for using any other "it". For example, if you feel great from an illegal drug when you try it or a behavior like gambling, sex, exercise, then you are more likely to become an addict than a person who does not like or does not get great positive feelings from the chemical or the behavior. If you don't like the effect of cocaine you are not going to get addicted to it. If you don't like sex or gambling you are unlikely to end up addicted to one of them. Remember life is not perfect and our knowledge of addiction is still in its infancy but there is no doubt in my mind that all the above have a lot to do with the development of addiction in you.

Remember also that getting "high" for one person may not be a "high" for someone else. For some people getting 'high' is getting rid of their anxiety, stress or fear. For others it is avoiding situations and unpleasant feelings and emotions. Others again want to avoid relationships, intimacy, responsibility or pain. So you can see that tranquilizers, sedatives, sleeping pills, pain killers, narcotics and muscle relaxants - all of which can lead to a "high" feeling - can lead to addiction, whereas antibiotics, blood pressure pills and diabetes pills which also make you feel better but not 'high', do not lead to addiction.

If you drink alcohol and feel really good (get high) then you drink again or drink more to get that feeling again and again. If you now find you have a compulsion, craving or strong drive to drink alcohol and sometimes when you drink you lose control and get problems, then addiction is developing. If you continue repeating this cycle then addiction has set in. Somewhere in all this the chemical -neurotransmitter - changes of addiction occur. This process can happen the first time you drink or it can take many years to develop. The stronger the hereditary/genetic factors in you the sooner addiction develops relative to your first contact with "it" (your drug or behavior).

Trigger; Catastrophe: If something happens suddenly to you, something very good or very bad, it can lead to using alcohol, drugs or behaviors that otherwise would never have happened or would not have happened to that degree. Examples:

A serious accident necessitating high doses of opiates or tranquilizers or muscle relaxants causing the brain chemistry change in the neurotransmitters system leading to addiction.

A sudden death of someone close or other significant loss e.g. house burned down, loss of job or relationship leading to heavy drinking or drug taking, again causing the addiction change in the brain chemistry.

A great promotion at work, winning of the lottery, big inheritance, leading to increased drinking or drug using, triggering the chemical brain change.

There are probably people who, because of their heredity and life, will never develop addiction and then others who, because of hereditary factors and life, are guaranteed to become addicts.

Denial: So now you have been told you are an addict or you have found out you are an addict. The immediate response is No! No way! Not me! Impossible! Mistake! This is one aspect of the condition, well known in the addiction field, called Denial. Why does denial occur in just about every addict at the beginning and why does it continue to rear its head over months and years? You are born into this world innocent and are then trained by "life". You lose your naïveté and develop "beliefs". Some of those beliefs are that addicts and alcoholics (the same condition) are bad people, are weak-willed, are sinners, are cowards, are dirty, are difficult, are crazy, are not wanted around, are disliked even hated. Then some one tells you or you find out you are an addict "one of those people" you have learned all your life until now, to despise. You have always felt better than "those sort of people". This is not good for your self-esteem; this is not a pleasant surprise; this must be wrong - an obvious mistake - DENIAL. You would be an unusual person if you did not show and feel this denial. It is going to take one major personal shift to accept this unwanted fact - you are an addict.

This, by the way, is the beginning of Step 1 of the program of Alcoholics Anonymous - Acceptance. The problem of denial and the process of working through it is extremely important and usually will not occur unless you actively work on it. You can attend Alcoholics Anonymous or the specific Anonymous meeting dependent on your specific addiction. You can go into addiction treatment. You can get help from Rational Recovery or your religious leaders. You can use whatever works for you but you must actively work through your denial and reach acceptance. Doesn't it make sense to be educated about this disease you find yourself with? The alternative is to continue the denial and remain active in your addiction (continue to drink alcohol, do drugs, gamble etc.) or stop the alcohol, drug or behavior and be clean or dry or abstinent but never understand and accept the disease. Remember how you felt when you learned you were an addict. Recognize that the only way to get your self-esteem back, and improved, is to actively participate in a recovery process. You could work on and resolve all the direct problems you find you have because of your active addiction. The only way to get your self-esteem back once you have accepted the diagnosis of addiction, is an active recovery program, I believe education and treatment of both you and your significant others is also very important. This can include Al-Anon and all the family programs attached to the other Anonymous programs as well as the family programs in all good addiction treatment centers.

Addiction is a disease which, when treated, can be inactive (in remission). It is caused by a brain chemistry change that is often genetic and/or brought to the surface by life and sometimes specific triggers. I believe it is not your fault that you have this disease, neither is it anyone else's fault but it is now your responsibility to get the help, treatment and recovery available to all addicts. Hopefully your significant others will work on their denial / acceptance and need for help just as you do.

What can you hope for? What should be your goal? Sobriety followed by recovery. There will come a day when you will be proud of your recovery, surrender to your disease and be thankful that you are a recovering addict. This is because this disease is chronic, powerful, progressive and often fatal but when treated, causes you to go through a fantastic life change which would probably never happen if you were not an addict. Thus your terrible disease of addiction can lead you from hell to a fantastic life once the denial is broken, and acceptance, surrender and education happens, leaving you a grateful, recovering addict.

MICHAEL STONE, M.D., Medical Director, Cornerstone of Southern California.