The end of addiction
Dr Volker Hitzeroth & Dr Liezl Kramer
Human & Rousseau
Acknowledgements
A special word of thanks is due to a number of people and organisations without whom this book would not have been possible.
Firstly, I would like to thank the academic institutions where I have studied over the last two decades, specifically the Universities of Pretoria, Stellenbosch and London. These institutions set my academic career in motion and have, over the years, nurtured and mentored me. Without the Department of Psychiatry at the University of Stellenbosch and the MSc programme at the University of London, this book would not have been possible.
Secondly, I would like to thank my colleagues in South Africa and the United Kingdom. I have valued their collegiality over many years. I have learnt much from them and look forward to learning even more in the future. Working alongside them has made the journey in the field of medicine, mental health and addictions more rewarding.
Thirdly, to all the patients who have allowed me to participate in their treatment. Academic theory has taught me much, but it is by practising it that I have come to appreciate the complexities that each of my patients has brought into my office.
A specific thank you to Ansie, whose patient and regular reminders have encouraged me to complete this book.
Finally, I would like to express my gratitude to my wife, who has kept the promise she made many years ago.
Volker Hitzeroth
Foreword
Over recent years I have felt the need to share some of the knowledge that I have acquired during my career as a psychiatrist working in the field of drug and alcohol addictions. I wanted others to benefit from the understanding and experience that I have gathered over the years.
The drug and alcohol field is a notoriously neglected psychiatric subspeciality. It usually ranks as a lower priority for funding and remains much stigmatised in the eyes of the general public. As a result, not much is known about drugs and alcohol, their physiological effect on the brain and the treatment of associated conditions. Making this knowledge generally available will hopefully be of practical help to those who abuse drugs and alcohol, their families and to healthcare professionals working in this field. It is my hope that the information in this book will empower those affected by such addictions to find their way to recovery.
Drug- and alcohol-related problems have been around since humankind began to ingest mind-altering substances, and they are likely to remain with us for a very long time to come. Recent evidence suggests that in certain parts of the world, drug- and alcohol-related problems are becoming more prevalent, more severe and are increasingly affecting younger people. Given ongoing changes in our society, in drug-use patterns and our medical understanding of drugs, alcohol and their associated problems, the field of addictions is likely to change over time.
Although scientific research (also known as the medical evidence base) for drug- and alcohol-related problems has increased in the last few years, much uncertainty still remains. It is this lack of certainty that often leads to alternative or unsafe treatment practices. I will therefore explain generally accepted treatment principles. Although a subspeciality as recent and controversial as addictions may well attract numerous different approaches and opinions, it is imperative to remain within the scope of safe and effective medical practice.
In order to make this book accessible to as many people as possible, I have attempted to provide a mainstream overview of the subject as well as to keep the text and style easy to read and understand. Accordingly, I will not be highlighting the latest research developments and scientific controversies, as these will (as yet) have little impact on the practical clinical situation in homes and offices. I will also try to demystify issues relating to addictions and their treatment.
Sources of information
The content of this book is not based on personal research or primary scientific articles, but has been collated from various secondary sources. A list of the books and articles that I have consulted appears at the end of the book. Anybody who has a deeper interest in drugs, alcohol, addictions and their treatment may wish to consult these sources.
Terminology
Whilst I have used various terms that reflect a predominance of the male gender, this should not be interpreted as meaning the field of drugs and alcohol is dominated by men. Indeed, wherever I have used the masculine term, it is meant to include the feminine. For the sake of simplicity and ease of understanding the terms “drug”, “alcohol” and “chemical substance”, as well as “user”, “patient”, “client”, “addict” and “dependant” are used interchangeably in this book. Yet it should be emphasised that in strict scientific literature these terms do have very distinct and different meanings. For example, when using the term “addict”, it is done for ease of reading, rather than implying a value-laden or judgmental connotation.
Non-discriminatory
Drug and alcohol problems do not discriminate. They occur in good and bad families as well as in happily married couples; they happen to the rich and the poor; to single divorced parents, to the young and the old, and to men and women alike. In short, they can happen to you and me; they can affect your family and my family. Also, drug- and alcohol-related problems are not “your” or “my” problems: they are “our” problems. You and I individually will have little impact on preventing or alleviating such problems, but together we can make a difference. The first step is to become as informed as possible about drugs, alcohol and their related problems.
CHAPTER 1
CLASSIFICATION OF DRUGS OF ABUSE
Drug users, their family members and the public at large are generally not well informed about the different types of drugs of abuse. They have difficulty finding their way through the “drug maze”. Most people have based their opinion on emotional and sensational snippets of information that only cause anxiety, and are probably more related to urban legend than scientific evidence. Such snippets of information usually highlight the dangers of drugs, their addiction potential and specific problem behaviours, actions and interactions resulting from drug use. A coherent understanding of the various drugs of abuse and how they work is often lacking.
It is important that anyone who is involved with people addicted to alcohol and drugs in a personal capacity, fami-ly relationship or professional therapeutic setting should understand drugs, their differences and their effects. Getting an overview and becoming informed is critical. If you, a friend or a family member suffered from a physical illness like diabetes, high blood pressure, cancer or epilepsy, you would learn as much as you could about the condition. The same is true for drugs and alcohol-related problems. The initial step to becoming more informed about drugs and alcohol is simply to understand an overview of the drug and alcohol world. Once the bigger picture is understood, it is easier to find your way around the problem. Most people are then ready and able to face the next step.
I am sharing my thoughts on the classification of drugs and alcohol in a way that attempts to cover most drugs of abuse and is easy to understand. Please remember, however, that this is only the starting point in the process of understanding drug use and treatment.
The large number of drugs with their various chemical compositions, different mechanisms of action and numerous clinical effects has led to much confusion. Attempts to classify drugs of abuse are fraught with difficulty.
One simple method to classify drugs would be to group them according to whether or not the substance is legal. Some substances are legal with unrestricted access (for example, caffeine), while others are legal, but have certain restrictions on their availability (alcohol and nicotine, for instance, although legal are not available to those under the age of 18, while certain medications are only available on prescription from a healthcare professional). Finally, many other substances are clearly illegal (for example, cocaine, heroin and