MEDICALIZE ADDICTION

Victor Bloom MD

Criminalizing addiction has not worked. Legalizing drugs is too drastic. Medicalizing addiction may be the answer to this chronic problem. What is meant by medicalizing addiction?

Mental health professionals have long known that most addiction comes from attempts at self-medicating psychological and neurochemical problems. Psychological problems usually have their basis in growing up in dysfunctional families with inadequate parenting. Inadequate parenting usually comes from a similarly disturbed childhood of the parent, characterized by chaos, abuse and neglect, so there is usually a pattern of passing down emotional problems from generation to generation.

We have learned that some of the inherited problems are genetic as well as environmental, and that many environmental problems are socio-cultural in origin, and so the latest buzz-word in psychiatry is ôbiopsychosocial.ö Needless to say, emotional problems are deep and complex and necessitate expert evaluation and treatment.

One of the most common causes of addiction, starting with attempts at self-medication is bipolar disorder, also known as manic-depression. These are people with mood disturbances, people with labile (changeable) moods, in which feelings are felt in excess. Emotions may be high (manic) or low (depressive). In these people the mood may change drastically with minimal provocation. We call them hyper-excitable or hyper-sensitive, even explosive. Sometimes the slightest insult or rejection will cause a massive emotional reaction, which may or may not show on the outside.

It is probable that recent school shootings were perpetrated by such people, who could not take the cruel teasing and bullying which often occurs in everyday life. They were teased once too often and it was the straw that broke the camelÆs back, leading to fantasies of revenge which are impulsively carried out, or sometimes after long planning. It is hard for most of us to realize how bad some people can feel when they are badly treated. Imagine the worst feeling you ever had, and multiply it by ten or a hundred. That is how bad a person with a neurochemical imbalance can feel. Just because it doesnÆt show, doesnÆt mean it isnÆt there. People learn early on to cover up their feelings and not show their vulnerability.

The teenage years are known to be times of emotional turmoil in any event, and those with a susceptability to extremes of emotion are looking for ways to ease the pain of everyday life. Almost all teenagers succumb to the temptation to try illegal drugs, mostly marijuana, which is very available. Alcohol is also readily available to under-age teenagers and some of them find the buzz or artificial high is intoxicating, in more ways than one. Those with the most emotional pain actually look to get bombed out of their mind with alcohol, drinking to the point of getting sick or unconscious. Amazingly, despite horrendous experiences with excess alcohol, they repeat it again and again and are on their way to becoming chronic alcoholics. Those who enjoy marijuana give sophisticated explanations of their growing dependency. They enjoy the feeling, the reaction to music and sex is more intense, sounds and colors are more vivid, they call it consciousness-expanding, a higher state than ordinary sobriety.

Dependence on alcohol and marijuana often leads to experiments with harder street drugs, such as cocaine and heroin. In a large percentage of cases, cocain is addicting with the very first experience, it is so exhilarating and mind-blowing. The teenager prefers being high than suffering the exaggerated pain of everyday life, and so seeks more and more opportunities to get high. After a while, increasing amounts of addictive substance is needed to produce a high and then life becomes consumed with getting the next fix and avoiding withdrawal symptoms, which are horrible. At this time there is a complete breakdown of personality and positive character traits and the person is obsessed with doing whatever it takes to get the next fix. There is such a drive and determination to get more of the drug that values and morals go out the window. Kids in such a state will commit larceny and assault, hock the parents jewelry or any items of value. As was vividly dramatized in the film, ôTraffic,ö a young girl will resort to prostitution to maintain her cocaine habit. Without help, the youngster will be lost, go down the drain.

The movie showed that often these young druggies will be caught and arrested, and if convicted, serve extensive jail sentences, and their lives will be ruined. Presently our jails are full of drug convicts, and there is little indication that incarceration has served any useful purpose. It certainly has not been a deterrent, as the drug trade is as active and pervasive as ever, and few of the young addicts get adequate medical care.

The famous American psychiatrist, Karl Menninger, wrote a book called, ôThe Crime of Punishment.ö In it he reasons that punishment in itself is a crime. Time has shown that it serves little purpose, especially in the case of drug addicts.

Therefore, it makes more sense to medicalize the addiction problem. Right now the government is spending billions fighting a losing war against drugs. If a portion of this money were put into government programs to train more mental health workers in rehabilitation (rehab) of addicts, more young people will be helped rather than simply discarded.

Presently we understand the social, psychological and neurochemical precursors to drug addiction much better than before. Many rehab centers are truly helping drug addicts, but there are not enough of them. It is time to stop wasting money waging war against powerful South American countries whose economy largely depends on the drug trade. It is a losing war. Rehab centers are winning the war with selected individuals, one by one. We can and should increase these numbers by diverting more attention to treatment and care, which does some good, rather than incarceration and punishment, which does no good.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a member of the American Academy of Psychoanalysis and on the editorial board of the Wayne County Medical Society. He welcomes comments at his email address--- vbloom@compuserve.com, and visits to his website--- www.factotem.com/vbloom