They are self-help fellowships run by the members themselves, wherein members share their “experience, strength, and hope” with one another.
Frequently, the most effective approach is a combination of professional treatment and twelve-step program participation. I tell my patients (quite truthfully) that it’s really therapeutic for them to associate with people who have the same disease they do and have been through similar kinds of experiences. As such, people in twelve-step programs can understand, relate to, and support one another in ways that few others can. But it’s not professional treatment; it’s not professional counseling, and people involved in twelve-step programs alone are not learning about addiction as a brain disease, and do not have access to medications that might help them maintain abstinence or assist them with psychiatric or medical problems. Without professional treatment, needs that can be critical to the recovery process frequently remain unaddressed. Twelve-step program involvement and professional addiction treatment complement each other and work hand in hand.
How can family and friends make a difference? Family and friends can play a critical role in the recovery process by participating in professional treatment in the form of family therapy with the addicted person and/or attending one of the twelve-step programs for the family members and significant others of those struggling with addiction, such as Al-Anon or Nar-Anon. One of the valuable things that significant others of addicted persons learn in these programs is that they do not have any control over the behavior of other people; they have no control over whether the addicted person uses alcohol or other drugs. They learn what they can and cannot realistically do to help the addicted person and themselves in dealing with this problem. These groups provide information, mutual aid, support, and important opportunities to connect with people who share very similar experiences.
Addiction is a state in which an organism engages in compulsive drug-taking. The behavior of drug use is neurochemically self-reinforcing, which leads to a loss of control in limiting intake. The hallmark of addiction is this compulsive out-of-control drug-seeking, combined with obsessive thinking, drug craving, and physical dependence. Remember, people can be dependent on a substance/medication and not be addicted to it. Dependence is a state in which an organism functions normally only in the presence of a drug and manifests as a physical disturbance (withdrawal) when the drug is removed. Someone who has cancer can be dependent on opioids for pain management, but he or she may not demonstrate the obsessive-thinking, drug-craving, and compulsive drug-seeking and drug-taking that define addiction.
Is addiction treatment worth the cost? The short answer is yes, and that’s one of the reasons this book exists. It is also why the government allocates resources to conduct research on the disease of addiction and how it can be most effectively treated. Addiction treatment is cost-effective in reducing alcohol and other drug use and its associated health and social costs.
According to the National Institute on Drug Abuse, every dollar invested in addiction treatment programs yields a return of between four and seven dollars in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are factored in, total savings can exceed costs by a ratio of twelve to one. Major savings to the individual and to society also come from improvements in workplace productivity.3
It’s much cheaper to help people stop smoking now than it is to treat their lung cancer later. In the same way, it’s much cheaper to help people stop using alcohol and other drugs than it is to pay for them to be hospitalized for an overdose, after a car accident from driving while impaired, or for a liver transplant.
The bottom line is that addiction treatment works. If the same principles are applied to the disease of addiction that are used to treat any other progressive chronic illness, we find that addicted persons respond to their prescribed treatment just as those who struggle with any other chronic illness do.
Recap: The most important points to remember are
CHAPTER ONE NOTES
2 By permission. From Merriam-Webster’s Collegiate® Dictionary, 11th Edition, ©2013 Merriam-Webster. Inc. (www.Merriam-Webster.com).
3 National Institute on Drug Abuse, “Understanding Drug Abuse and Addiction: What Science Says” (2007), http://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iv/6-cost-effectiveness-drug-treatment (accessed January 2, 2013).
The Brain Anatomy and Chemistry of Addiction
It takes two elemental factors to produce an addicted individual. First, it takes a substance or behavior that stimulates the reward center of the brain. The reward center is located in an area called the limbic system, in the midbrain. The midbrain lies below the prefrontal cortex, under the “thinking” brain that thinks consciously and makes decisions. Stimulating the brain reward center requires an action (for example, eating or sex) or the ingestion of a substance via smoking, swallowing, snorting, or injecting that is experienced as “rewarding,” or in other words, pleasurable.
Broccoli and aspirin don’t stimulate the reward center of the brain, but alcohol, marijuana, Xanax, Valium, heroin, opioid pain medications, cocaine, and crystal meth do. Food, chocolate, and sex all stimulate that part of your brain, but certain drugs actually “hijack” the reward center by causing the brain to release excessive amount of chemicals (called neurotransmitters), resulting in a much higher level of pleasure than the normal everyday things that people generally get pleasure from.
The second elemental factor is that with enough time and experience using mind- and mood-altering substances, the brain chemistry of the now-addicted person is so out of balance that he or she can no longer derive pleasure from normally pleasurable activities. The addict has stimulated his or her brain so much with extraordinarily chemically rewarding substances that life’s normal, everyday pleasures are no longer rewarding. Drugs end up displacing the normally pleasurable activities