This is gonna come as news to some of you. To others not so much. What I am gonna lay on you is something that a lot of people in recovery understand, the doctors I work with get, and a smaller amount of people then I’d like, are starting to get. That information is that if you have issues with addiction, that pills, illegal drugs, and alcohol are not your problem. Let me delve a little further into what I mean and give you some real world examples.
1.Drugs are not addictive– If you just spit your morning coffee all over your keyboard reading that statement I’ll give you a minute to clean it up and get back.
This whole idea of drugs being addictive has been around for a long time. Drugs, in the 1980’s (and before that) were to blame for any number of societies problems. The whole War on Drugs (which started before the 80’s) and the whole Just Say No campaign was premised on the idea that drugs of any kind were so bad that just taking a small amount would send you into a downward spiral from whence there was no return. Start experimenting with marijuana and you were on your way to be a lifelong addict, using IV heroin and living under a bridge. However, after years of research we know that’s just not true.
Let’s take a step back to when the “War on Drugs,” started. The War on Drugs, as it came to be known, was started by the Nixon administration in response to the increased number of soldiers using heroin in Vietnam. The heroin was considered the culprit, and so the war on a substances started. The soldiers were required to “dry out,” before coming back to the United States and in following them afterwards the relapse rate was about 5% (NPR 2012). 5 percent! Heroin, which is considered to be one of the most “addictive” drugs around, had a ridiculously low relapse rate. So clearly heroin wasn’t the issue.
Furthermore, on average the number of people who initially experiment with any type of drugs, only cross the line into what can be clinically classified as “addiction,” or what we in the we in the clinical community refer to as a “Substance Abuse Disorder,” about 10% of the time. Now that’s a rough estimate. Some studies indicate that rates for people who initially use heroin may be as high as 24%. Still if only 24% of people who try heroin end up in addiction, then clearly something else is going on.
2. We confuse addition with dependence– There is a big difference between addiction and dependence. People become dependent on many things. In terms of opiates like pain pills or heroin, it is impossible not to become dependent. The bodies natural reaction to taking any opiate long term is to develop tolerance and leave you needing to take more to achieve the same desired effect. And it doesn’t matter if that effect is getting high or having your pain subside.
I have a 11 year old son who has Type 1 diabetes. He is dependent on his insulin, he’s not addicted to it. We treat pain patients who are “dependent” on their pain medications, that are a part of their pain management plan. Those medications help them to live a better quality of life, and their not addicted to them. I am dependent on my job, and despite looking forward to going into work most days, I promise you I am not addicted to it.
Dependence on something does not make your life unmanageable. If anything, in a lot of cases, it makes your life more manageable. I don’t want to think about what my 11 years life would be like if he didn’t have access to his insulin. I’m a good tenant, but my landlord doesn’t take good intentions or noble ideas as a form of payment.
The majority of people who end up with a dependence on substances such as opiates, after taking them for a period of time, and then end up tapering off, go through the same withdrawals as anyone else. The difference is that they don’t have an overwhelming urge to go back and use the opiates again or try and achieve that “high” or euphoria. They were just dependent.
3. It’s not the drugs. It’s your brain (probably).- Thank God for modern medicine and research. If you are one of the people dealing with addiction you’re probably asking yourself, “So if only roughly 10% of the population who experiments with, or is prescribed narcotics, crosses over into full blown addiction, then how the hell did I get so lucky?!” Well according to new research, it’s not really your fault. The newer research on dopamine receptors (NBCI 2009) is suggesting that people with a lower amount of dopamine receptors, respond very differently to “addictive substances,” then those damn normal people who have the right amount of receptors.
For years, those of us in the recovery community have been saying, especially for a person in early recovery, being clean and sober is an abnormal state of being. It feels wrong somehow. Off balance, like something’s missing. Well, if you’re a person with addiction, your brain thinks so too.
This explains why the majority of people don’t “like” drugs or their effects; at least not in large quantities. We all know that person who doesn’t like to go to the dentist, because the pain meds make them feel all “weird.” For those of us who have this disease called addiction, we hear that statement and our response is “Ya they do! Woo-Hoo.”
That response is a part of what makes it so hard to quit for people with addiction. Intellectually you understand (I hope) that continued use of these substances is just going to cause more harm, but you are fighting against your stupid brain that’s telling you “To Hell with that! Gimme that back. I need more!” For some people that message is overwhelming, which further explains, what many people without addiction don’t get, and that’s why we keep going back to something we know damn well could kill us. Our brains won’t shut the hell up and leave us alone.
4. If drugs aren’t addictive, then why do we have such a huge crisis?– There are a lot of answers to that question. The first is that we have always had a crisis, if you consider a crisis the presence of a group of people who seem hell bent on self destructive behavior despite all the rational reasons for them not to be. The difference is that today we are, fortunately, moving toward acceptance of addiction as a disease and more people are coming forward to say that they need help. Take away the stigma and you have more people willing to admit they have an issue.
Secondly, we have more people. According to the US Census Bureau, in 1920 we had about 107 million people living in the U.S.. Today we have somewhere in the neighborhood of 323 million. So if you take 10% of those people with addiction issues, we jumped from about 17 million people to 33 million people in terms of those with addiction issues. That’s a lot more people with an issue. Combine that with a better acceptance of having addiction issues, and all the sudden everyone knows someone who either has addiction issues, or is affected by someone with addiction issues. You can’t ignore it anymore, it’s just too big.
Lastly, we have access to a lot more drugs then we used to, and as Americans, boy oh boy do we ever consume them. Recent surveys showed that as a country we consume somewhere in the neighborhood of 80% of the world’s opioid supply, 99% of the world’s Hydrocodone (Vicodin) supply and around 66% of all illegal drugs. We’re #1! AND….bear in mind we make up about 5% of the world’s population. We may be small, but man do we ever make up for it in effort.
I’m not going to say that we can point the finger at any one particular party. There are a lot of factors and I’m not here to argue to the right or wrong of prescribing all these medications or call out evil “Big Pharma.” Nor is this a piece on the decriminalization of or legalization of drugs. Addiction in America, and access to all of these drugs of abuse, is a complex issue and probably best left for another article.
In the end it doesn’t really matter how we got here in terms of helping those who have issues with addiction. None of us have a time machine that can take us back to the moment where it all went wrong. Heck, for a lot of us we’d need to just never be born since the whole lower dopamine receptors is a genetic thing for some people. What matters is we’re here. As individuals and a country we most definitely are in a crisis when it comes to addiction. Looking back may help us realize mistakes we made in terms of access to addictive substances, or in finding ways to reexamine the role we have in the medical community in prescribing certain medications, but it isn’t going to change the fact that we have 33 million people in this country with addiction issues, and who knows how many more on the way.
At Recovery Works NW we have a team of doctors, and clinicians with decades of combined experience in treating people with addiction. We’re serious about what we do and I think we do a pretty good job. We don’t have some magic bullet, we can’t make your brain all the sudden make more dopamine receptors, but what we can do is help you put your addiction in remission and offer you tools to help keep it there.
If you or a loved one is struggling with addiction please call us. We’re here to help.
National Center for Biotechnology Information. Imaging dopamine’s role in drug abuse and addiction (2009). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696819/
NPR. What the War In Vietnam Taught us About Breaking Bad Habits. (2012) http://www.npr.org/sections/health-shots/2012/01/02/144431794/what-vietnam-taught-us-about-breaking-bad-habits