Missing the mark on addiction

When treating addiction, contributing mental health issues must be considered. Serious drug problems, and we’re seeing only half of it.

We continue the fight with prescription opioid addiction. Police say that heroin is now undercutting the price of prescription drugs. Intravenous overdose deaths quadrupled between 2011 and 2012, while orally administered prescription opioids – chillingly known as “painkillers” – are responsible for three-quarters of the fatalities. Total drug overdoses have surpassed automobile accidents as the leading cause of accidental death.

And that’s not all. Unsterile needle use for intravenous heroin is associated with multiple, potentially deadly, infections such as hepatitis C and B, HIV/AIDS, syphilis, tetanus, septic thrombophlebitis, skin abscesses/cellulitis, brain abscesses, osteomyelitis, pneumonia and endocarditis.

The problem has been studied from every angle, but we are missing something that’s very important.

Addicted patients have been treated over the years, many hospital-based dual-diagnosis programs with appointments with support workers and in private practice.

In almost every case of addiction seen, regardless of the substance, pre-existing and undiagnosed conditions such as depression, anxiety or bipolar disorder. Usually, it’s these conditions that brought on the addictive behaviour in the first place.

But when a patient comes in for drug treatment, he or she gets treatment for his addiction and only addiction.

The traditional addiction model was summarized by Eric Nestler, M.D., Ph.D., in 2013: “At its core, addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drives the compulsive seeking and taking of drugs, and loss of control over drug use.” Generally, adolescence represents the most sensitive time for a still-developing brain to be susceptible to drug use.

Traditional addiction treatment couples programs such as detoxification with Alcohol Anonymous-style self-help groups. Over more than 80 years, these programs have rescued millions of lives worldwide. However, a scathing June 2012 report from the National Center on Addiction and Substance Abuse states that “51.8 per cent of (programs) don’t assess co-occurring mental health disorders.”


Addiction treatment programs commonly miss that individuals attempt to “drown out” varying degrees of misery using alcohol and/or other drugs. Misery triggers addiction with a phenomenon known as “self-medication.” Mind states such as depression, anxiety, irritability and impulsivity can result from pre-existing and undiagnosed mood, anxiety and/or attention-deficit/hyperactivity disorder, causing pain that the sufferer tries to numb with drugs, including alcohol.

Usually, multiple addictions and disorders are present in every patient and addicted individuals are rarely aware of these underlying disorders.

Self-medication addiction treatment includes diagnosis of these pre-existing disorders, appropriate medication use and individual talking therapy, supplemented by (with informed consent) couples, marital or family therapy.

The comprehensive dual-diagnosis model and treatment integrate the “traditional” and “self-medication” models and treatments. Both are necessary to understand and treat addiction.

Pre-existing and undiagnosed disorders should be searched for as part of every evaluation of every addicted person, adolescent, adult or elderly. It is as much a mistake to treat the addictions and ignore the underlying disorders as it would be to treat the underlying disorders and ignore the addictions.

It’s a problem that can start young and last a lifetime.


A recent study determined that one in four Americans who began using any addictive substance before age 18 became addicted, compared to 1 in 25 Americans who started using at age 21 or older. Thus, parents need to frequently tell their children and adolescents not to begin smoking, drinking or using other drugs. Fear of upsetting parents is the biggest reason kids don’t use drugs.

But this is not a problem for drug treatment specialists alone. Approximately 80 per cent of Americans go to primary care practitioners – physicians, nurse practitioners, physician assistants – and receive an evaluation for addiction and treatment when needed.

These practitioners should additionally identify and treat these underlying mental health disorders or refer their patients to addiction and psychiatric physicians to do so. If pre-existing mental health disorders still remain undiagnosed, then addictions will likely worsen.

How many more millions of lives could be rescued, worldwide, if only the comprehensive dual-diagnosis model and treatment, described above, became routinely implemented by health care professionals?

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Why Some People Are Drug Addicts

Is science finally on the verge of cracking addictions?

We know that addicts lose control over their lives and that they would as soon give up breathing as stop using their preferred substance(s). Yet, the critical question of why one member of an adolescent peer group becomes an addict and the others do not remains open.

The oldest explanation of addiction as a moral weakness is unsatisfactory because it is circular. It does not tell us why some individuals are capable of resisting addiction. Scientists also dislike the moralistic interpretation because it evokes free will that is considered inherently unscientific.

Tossing out the moralistic pseudo-explanation, addiction researchers are left with two plausible theories. According to the disease model, an addict is someone who suffers from a biological vulnerability to some, or all, addictive drugs. The alternative explanation is that drug use is reinforcing and that addicts simply learn to repeat actions that had made them feel good.

The disease theory of addiction

Drug addiction causes all sorts of a medical problem but the disease theory holds that the addict has a biological vulnerability to addiction before they ever began to use the drug.

This perspective underlies the strategy of Alcoholics Anonymous that unquestionably saves many lives and it also seems helpful to family members and to therapists. If the disease theory were correct, it would offer the promise of a medicine that could correct the chemical abnormality of the brain underlying addiction.

Needless to say, there is no such magic bullet and there may never be. The alternative theory focuses on the addictive properties of drugs.

Are addictions learned?

The notion that addiction is produced by reinforcing properties of drugs got a boost from experiments showing that lab animals would work at pressing a lever in order to receive small injections of addictive drugs.

This approach is uniquely helpful in explaining why crack cocaine that is smoked is more addictive than the snorted variety. The smoked variety gets to the brain sooner. The idea is that more immediate reinforcement strengthens the drug-taking behaviour more.

The learning theory of addictions is also backed up by neuroscience because addictive drugs activate dopamine-based reward systems that are designed by natural selection to strengthen naturally-rewarded behaviours such as feeding and mating.

This evolution-based interpretation of learned addictions actually provides an elegant explanation of why addiction occurs. Yet, it does not help in explaining why some individuals get hooked whereas others having a similar drug history do not.

The riddle of who gets addicted

The problem of why some individuals become addicts remains an open question but biological psychologists may be zeroing in on a solution. It has long been known that addicts have underactive dopamine systems and suffer from a decreased capacity to experience pleasure in their ordinary lives.

That is not too surprising because brain receptors tend to get depleted from over-stimulation by the neurotransmitter. Now researchers are reporting genetic abnormalities in dopamine systems that are correlated with addictive tendencies prior to the development of addictions (1).

Reading between the lines, it is possible that some people are more prone to addiction because they obtain less pleasure through natural routes, such as from work, friendships and romantic relationships. That could explain why they are more thrill-seeking, or “stimulus-hungry.”

Dopamine abnormality might also be related to a lack of social inhibition found in some addicts. Alcoholics ignore many of the social conventions about alcohol use, for instance: it should be social; it should never begin before noon; it should be restricted to the evening meal; never have more than three drinks, and so forth.

Supposing that these approaches pan out, we may finally begin to understand why some individuals succumb to addiction. The answer may combine aspects of the disease theory and a sophisticated understanding of the effects of drugs on the brain.

Written by Nigel Barber PhD 2013

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Prescription Drugs Dependency

Where shall we start? At the beginning.

It all started when I first went to see my doctor. I knew something was not right, as I was feeling really low and anxious, and had no understanding as to why I was feeling like this. My doctor asked me to take a PAL test, which was a questionnaire with tick boxes. The score suggested that I was struggling with anxiety and depression, which was flagging cause for concern.

It was suggested that I need to be on some pretty serious medication due to my condition. I was initially prescribed Citalopram and Lorazepam. I was advised that this would make me feel a little easier and a bit calmer. I was also referred to the local mental health team for an assessment.

The mental health team were very nice to me, sat me down and we had an informal chat about how I was feeling on a day to day basis. They were very understanding, and it was of their opinion that I would benefit from taking more medication, so they prescribed me with Quetiapine. This was to be taken in addition to my current prescription. It was explained to me that there would be side effects; some of these may not be pleasant.

After a short period of time, within a few weeks, I started to notice that I was becoming very tired a lot of the time, and my appetite was starting to disappear. I also developed a skin irritation, with visible side effects. I also became very confused, i.e. not really aware of time.

Things took a turn for the worse when I had an accident at my place of work, injuring my back. After a couple of days, I got to see my doctor about the excruciating pain, which had left me finding it very difficult even to walk. I was prescribed co-codamol on top of my existing medication. After a few weeks, my back was feeling worse, so my doctor then prescribed a higher dose of co-codamol and I was given another prescription for Targinact to help with the worsening pain.

As time went on my depression was causing me more problems, I found I was unable to find the willpower or energy to carry out what I would call normal daily tasks. This made me feel very low, and my self-esteem was becoming non-existent.
I was experiencing a feeling of worthlessness and felt trapped.

After only a few months, the effects of all the medication I was taking started to wear off. I felt as if I was wasting my time? My doctor and my mental health worker then decided to change my medication? This caused me to experience an even higher level of anxiety, and I felt I was just not coping with my daily way of life. There were days when I felt like just giving in, and just didn’t want to carry on with the way things were. I consider myself very lucky to have had, and still have the support of my close family and a few trusted friends. Without this support, I think I would not have the willpower to continue.

I do get what I would call my good days, where nothing or no-one can harm me or bring me down. Those days are when I am at my best, mentally and physically. This gives me hope.

My daily routine?

The first thing I do when I wake up is to take my first instalment of tablets, which ones depend on whether I will need to drive or not. Lunchtime, more tablets. Evening, yes you guessed it, more tablets. Then just to finish an eventful day, more tablets. I end the day taking Zopiclone, which is supposed to help me sleep.

Some of my friends have said to me that if they were to pick me up and shake me, I would rattle, given the number of tablets I take on a daily basis. I laugh this off, but I know this is a genuine concern for me. I am very worried about the amount of medication I am being prescribed and the potential damage this could be causing me. I do have personal fears about whether it is safe for me to be taking so much.

At one stage I felt enough was enough, so I stopped taking everything. I felt I was not benefiting from all these tablets; they were no longer having the effects that I felt they should be.

My doctor was not happy, to say the least when I told him that I had lost faith and stopped taking all medication. He went on to inform me of the severe consequences that I could experience. I was in danger of a possible heart attack, severe panic attacks and other effects on my nervous system. It was implemented there and then that I should reinstate all medication.

So now I am on the following daily medication, with varied strengths

  • Co-codamol for Pain Relief
  • Mirtazapine for Depression
  • Targinact for Pain Relief
  • Zopiclone for Help with Sleep
  • Diazepam for Anxiety
  • Pregabalin for Anxiety
  • Red & Blue Inhalers for a Respiratory Condition

I am now fully aware that I can’t just stop taking my prescribed medication because of the side effects I may experience, such as hot and cold sweats, shakes, hallucinations and possible heart attack.

If there comes a time when my doctor agrees to reduce my medication, will I be at risk of swapping one addiction for another? I.e. Alcohol. Will I feel suicidal?

I try and come to terms with the fact that I am on, and will be on a lot of medication for the foreseeable future. For this to ever change, I know I will need a lot of support, and it will be a very long time before I am in the position to safely stop taking the levels of medication I am now dependent on.

Will, I ever be able to slowly reduce the amounts I am dependent on, history presumes otherwise.

It saddens me to think that prescription medication may forever now be part of my life

Anne Townsend (June 2013)

“Detox” The facts about a safe drug or alcohol detox?

If you’re trying to detox from alcohol or drugs, you may want to advise a medical consultant. Detoxing incorrectly from alcohol and some drugs can lead to serious side effects. Medical consultants are there to help you, and they will know exactly what to do to prevent your withdrawal symptoms from taking over while you detox.

If you’re considering detoxing on your own, knowing the facts will make it easier. If you stop drinking alcohol, cold turkey? it may cause you serious harm, seizures, or comas, depending on how much you usually drink. If you’re detoxing at home, you might be able to avoid professional help if you taper off your alcohol consumption and can stick to a serious regime. This means reducing the number of drinks or proof of alcohol little by little over time, which could be days or weeks, depending on how much of a tolerance or dependency you have. If you can’t do that, then you will need to watch for the signs of serious withdrawal and seek medical help when necessary.

If you are shaking and haven’t had any alcohol for an extended period of time, you’re probably heading for some serious withdrawal symptoms. You may need to seek medical detox treatment, since doctors will be able to provide medications to prevent withdrawal symptoms like seizures or heart failure, and you’ll be more comfortable while you detox. Simply drinking alcohol when these symptoms occur will not always help, and in some cases, it may complicate these problems.

Weaning yourself off alcohol may work if you haven’t been a heavy drinker, but heavy drinkers will face some additional issues that will likely cause a relapse if not treated correctly. Firstly, can you be sure that you can drink less and less alcohol over time, or will you relapse and end up binging? Second, do you have the expertise to know how much alcohol you need to take in or reduce by, in order to prevent symptoms of withdrawal that could be life threatening? Most likely, you will need medical help/supervision to keep yourself from relapsing, or from suffering serious side effects. Stopping without any help can actually lead to a much more difficult detox than if you seek attention for the problem.

Detoxification via a rehab/clinic is done with medication that can mitigate the side effects, and medical advisors will help you through, so you’ll be more comfortable and more likely to succeed.

Detoxing from drugs is different in some ways from detoxing from alcohol. Some drugs are relatively easy to quit, but opiates like heroin are a different story. Heroin withdrawal can start within a few hours after the last time you took the drug. The symptoms peak around 48 to 72 hours, and after a week you should not have many more withdrawal symptoms, besides some weakness or a little bit of pain.

The most serious withdrawal symptoms associated with heroin detox include seizures and comas. Normally, people who don’t take large amounts of heroin could suffer from restlessness, cramps, dilated pupils, chills, and other side effects, but those who take large amounts and try to quit without help could suffer the more serious problems, which, if not treated immediately, could cause death.

A physical withdrawal occurs because the body needs to have the drug to function correctly. If you have taken a drug for a long period of time, there could be more issues because you may have built up a tolerance, and you may have taken very high doses frequently throughout the day. Severe opiate addiction needs to be treated by a professional who can prescribe drugs like Suboxone, which will help reduce the likelihood of any withdrawal symptoms.

Another serious drug, crystal meth, can cause major problems if you detox incorrectly. The withdrawal process can cause mental changes that you will be unable to prepare for. Violent tendencies, sleeplessness, delirium, and paranoia are common, and these can cause injury to you or to others. During detox, these episodes can last for hours, which is why detox from this drug needs to be treated with care by a professional.

If you are considering a home detox? Tell your doctor or a family member/trusted friend.

Do not suffer in silence, Stay Safe…