Dependence on alcohol and other drugs, also called addiction, poses a triple threat to the dependent person and to society as a whole. It increases the probability that a person will do something potentially harmful, such as acting in a violent or careless manner. It leads to impaired judgment that affects certain everyday activities, such as driving a car, thereby increasing the risk of injury or death. And it creates chemical imbalances in the brain and the body that increase the risk of illness and death. Nicotine, the drug found in cigarettes and other tobacco products, is extremely addictive.
A person who uses a drug for other than a recommended or prescribed purpose is said to be abusing that drug. Drug dependence (or addiction) is an uncontrollable craving for a particular substance, which can, in some cases, take over a person's life. A person who is psychologically dependent on a drug experiences emotional distress when the drug is withdrawn. Physical dependence means that the body has adapted to the presence of the drug, causing symptoms of withdrawal when deprived of it.
Drugs that can cause addiction fall into three general categories: those that depress the central nervous system, those that stimulate the central nervous system, and those that produce hallucinations and also affect the central nervous system.
Drugs That Depress the Central Nervous System A person who is addicted to a drug that depresses the central nervous system is both psychologically and physically dependent.
• Examples are opiates such as codeine, heroin, and morphine; barbiturates;
alcohol; and antianxiety drugs.
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100 • Short-term effects include euphoria, relief from pain, and prevention of with-
• Withdrawal symptoms for opiates include weakness, sweating, and chills, progressing to vomiting, diarrhea, and sometimes cardiac collapse, which can be fatal. Withdrawal symptoms for barbiturates and antianxiety drugs include tremor, anxiety, restlessness, and weakness, sometimes progressing to hallucinations and seizures. Withdrawal symptoms for alcohol include trembling hands, sweating, nausea, and, in some cases, cramps and vomiting. Other severe withdrawal symptoms for alcohol may include confusion, hallucinations, and seizures.
Drugs That Stimulate the Central Nervous System Tolerance builds up quickly with drugs that stimulate the central nervous system, which means that a person must take increasingly large doses to achieve the same effects.
• Examples are cocaine and amphetamines.
• Short-term effects include excitation, sleeplessness, hyperactivity, and euphoria.
• Long-term effects include hallucinations, delusions, and depression.
Drugs That Produce Hallucinations Hallucinogens do not produce physical dependence, so there are no withdrawal symptoms, but they may produce psychological dependence and genetic damage.
• Examples are LSD and mescaline.
• Short-term effects include exhilaration, sensory distortion, illusions, paranoia, and panic.
• Long-term effects include flashbacks.
Some people are more susceptible than others to drug dependence for reasons that may include both genetic and environmental factors. Heavy use of any addictive drug may encourage the use of other drugs; adolescents who use alcohol, tobacco, or marijuana are more likely than their peers who don't use these drugs to use cocaine or heroin eventually. In general, the younger people are when they start and the more types of drugs they use, the greater their risk of addiction.
People start taking a drug for a variety of reasons. They may be having problems coping with a difficult situation, such as divorce or unemployment. They may be bored or curious or under pressure to conform to the behavior patterns of their peers. Most do not realize that they are risking becoming dependent on the drug. Dependence not only causes physical problems such as lung and heart disease from tobacco smoking and liver disease from drinking excessive amounts of alcohol, but it also contributes substantially to the breakdown of families, to unemployment, and—in some cases—to crime.
Effective treatment for drug dependence consists of both physical detoxification and mental and social rehabilitation. Detoxification, or withdrawal of the drug gradually over a period of a week to 10 days, is usually done in a controlled setting such as a hospital, where the person's physical symptoms can be treated. Sometimes a less harmful drug with similar effects is substituted, such as methadone for heroin. Formal rehabilitation programs, which may include therapeutic communities and may use self-help groups such as Narcotics Anonymous or Alcoholics Anonymous, have been shown to greatly increase a person's chances of staying off drugs permanently.
Alcohol is the most commonly used drug in the United States. Nearly 14 million Americans are dependent on it or have other problems associated with drinking. These problems cost the nation more than $100 billion annually in medical care and lost productivity. Alcohol accounts for one of every 20 deaths and one of every four hospital stays. Nearly 60 percent of all violent acts—including murders, child abuse, family abuse, and other felonies—are associated with the consumption of alcohol. Alcohol dependence is a chronic disease characterized by a tendency to drink more than was intended, unsuccessful attempts to stop drinking, and continued drinking in the face of adverse consequences.
Moderate drinking—two drinks a day for men—has been found to have health benefits. Statistically, moderate drinkers live longer than both nondrinkers and heavy drinkers, reflecting alcohol's ability to reduce some of the risks associated with heart attack, stroke, and diabetes. For example, alcohol lowers low-density lipoprotein (LDL), the "bad" cholesterol, and elevates high-density lipoprotein (HDL), the "good" cholesterol that protects against clogged arteries. Alcohol also helps prevent the formation of blood clots and increases estrogen production in postmenopausal women. Many people, however, find it impossible to drink in moderation. If you have questions about the benefits versus the risks of having one or two drinks a day, talk to your physician.
Alcohol's Effects on the Brain Alcohol exerts its effects by altering the function of different chemical messengers (neurotransmitters) in the brain. The initial effects of alcohol are to mildly sedate the brain: the drinker becomes a little less inhibited and anxious. The second and third drinks affect the brain's pleasure center, located in the lower midbrain, producing an emotional high.
The pleasure center evolved in all animals to ensure survival. Although the mechanism is not fully understood, sex, eating, and other behaviors that enhance
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102 evolutionary adaptation and survival produce pleasurable feelings that make
Staying people want to repeat those behaviors again and again. Sensory inputs and
Healthy thoughts are sorted out by the pleasure center in the brain and tagged as being good (pleasurable) or bad (hurtful or unimportant). Good things are remembered, unimportant things forgotten, and bad things feared. This is one of the ways we learn, but it is also the process that underlies addiction to alcohol and, very likely, other drugs. Once rewarded for something, such as alcohol intake, with an emotional high, we want to do it again.
Alcohol does not affect all people in the same way. Genetic differences may account for variations in the way the pleasure center responds to alcohol. There is, however, no single "alcoholism gene." Most likely, many genes are involved in a person's response to alcohol, and these genes interact in different combinations with environmental influences, such as peer pressure and the availability of alcohol. As the genetic contribution to alcohol becomes better understood, it may be possible to test for genetic susceptibility to alcoholism.
Men are four times more likely than women to become dependent on alcohol. As with other addictions, those who cannot stop drinking eventually have difficulty maintaining personal relationships and taking care of themselves. People who are dependent on alcohol often fail to eat properly or get adequate rest, which can lead to serious health problems.
Codependence Family members and friends who act in ways that allow a person to continue to misuse alcohol or other drugs are considered to be codepen-dents or enablers. These people often make excuses for the addicted person's behavior, such as calling in sick to work for him or her, to hide the problem from others. A person who is codependent may plead with a loved one to stop using alcohol or other drugs but rarely does anything else to help the person change the harmful behavior.
The best thing family and friends can do is to encourage the person who is addicted not only to stop taking drugs but also to enter a treatment program. Threats to withdraw regular contact or support, combined with professional intervention or counseling, may be the only way to persuade him or her to seek help.
Prevention and Treatment The following steps can help prevent the development of alcohol dependence:
• Limit your drinking to no more than two drinks a day.
• Drink slowly; do not have more than one drink per hour.
• Never drink to relieve anxiety, tension, or depression, or on an empty stomach.
• Do not feel embarrassed for refusing an alcoholic drink at a social occasion.
No single form of treatment works for everyone who is dependent on alcohol. Several different approaches may be used, often in combination:
• Psychological treatment usually involves psychotherapy on a one-on-one or family basis, or is carried out in groups using a variety of talk therapies.
• Social treatments often address problems at work and include family members in the treatment process.
• Physical treatment, needed by some people who are dependent on alcohol, may use a deterrent drug such as disulfiram to sensitize the person to alcohol. The drug causes extremely unpleasant symptoms when a person drinks, so that he or she eventually becomes reluctant to do so.
• Self-help organizations such as Alcoholics Anonymous (AA) are a particularly helpful form of support for people who are trying to quit drinking.
Some people require medical help in getting through physical withdrawal when they stop drinking. This process of detoxification, which takes 4 to 7 days, is usually followed by long-term treatment.
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