The Tragedy of Drug Abuse
The story of drugs and addiction is filled with tragedy. The addictions destroy lives, cause heart rending pain for the families of the users and disrupt the lives and development of children. All ages are now affected by drugs of abuse as these substances have become available even to school children.
Drug abuse has reached pandemic proportions in this country and elsewhere. Despite the fact that the addictive drugs are dangerous and thousands die each year from over doses and related diseases caused by the drugs, people continue to engage in their use and abuse. The question is why?
As we look into this frustrating and terrible story it is important to keep in mind that those who are addicted are not morally debased or inferior. Addiction is a brain disease from the point of view of this therapist and many others in the field. Many High School and College students experiment with drugs but do not become addicted. These are young people who seem to go through a short period of experimentation after which they give it up and get on with their lives. Others cannot seem to stop using these substances, become addicted and suffer all kinds of awful consequences. Why?
People from all professions, socio economic groups, races, ethnic groups and ages are now affected by drug abuse. Among these people are lawyers, medical doctors, nurses, psychologists and the list goes on. Those who come from the most advantaged homes to those who come from the most disadvantaged homes are affected by drug abuse and addiction.
The families and parents of those who become addicted are left wondering and soul searching for answers as to what they had done wrong. Guilt reigns supreme. The trouble is that there is no simple answer to why some people become addicted.
The Why of Drug Abuse:
The answer to the question of why do people abuse drugs is extremely complicated and difficult to answer. The difficult nature of the answer informs us that the government's proposal some years ago to "just say no" was extremely naive. In fact, the complex nature of drug addiction also lets us know that simple detox programs with twelve steps do not, by themselves, end this sickness. People go through these programs and relapse. Why?
One way to look at drug abuse is that the drug abuser is suffering from a brain disease. From this point of view, the abuser is not choosing to be addicted. Instead, his addiction is the result of some type of short circuit in the neurons of the brain. The brain is made up of millions of neurons or brain cells as well as neurotransmitters that help carry messages along the network of neurons to and from the brain to all part of the body. If those neurotransmitters are faulty in someway then there is a vulnerability to mental illness or drug addiction. For example, many of the stimulant drugs such as cocaine, amphetamines and methamphetamines stimulate the neurons to produce huge quantities of dopamine. They also prevent dopamine from being re absorbed into the body, leaving unusually high doses of the neurotransmitter in the brain. Among other things dopamine regulates the sensation of reward and pleasure in the brain. If the amount of dopamine in the brain is too low the individual experiences depression. However, the large quantities of dopamine left in the brain as a result of the misuse of stimulant drugs is that the neurons in the brain are harmed causing them to malfunction. This is why so many addicts end up using extremely poor judgment. Their ability to think and reason in realistic ways is harmed. In addition, people develop a tolerance to the drugs. Tolerance means that larger doses of the drug are needed to reproduce the original euphoria effects that are sought after. Eventually, the person ends up needing the drug just to feel somewhat normal because without the substance they start to have extremely and dangerous withdrawal symptoms. Ultimately, these addicts can become psychotic or go into convulsions, suffer permanent brain damage and even die.
Another way to look at drug abuse is that is the result of dysfunctional family dynamics beginning with childhood. This view is not mutually exclusive with the biological theory of drug abuse but serves as an additional explanation. This is fundamentally a psychodynamic or psychoanalytic view of drug and alcohol abuse. These are persons who, as a result of unstable childhoods, developed personality disorders and use drugs in an attempt to self medicate their problems. The drugs are seen as defenses against rage, shame and depression resulting from psychological injuries suffered repeatedly during childhood. In other words, these people are viewed as being fragile and vulnerable to injury from others. The drugs are an attempt at self protection. Because of their "ego weakness" these addicted people are unable to tolerate their feelings and impulses and cannot sustain long term intimate relationships. It may seem as though the drugs are giving the addicted person pleasure but, in actuality they are harming themselves and experiencing lots of pain and suffering. Leading the life of an addicted person is not "fun and games." That is why some theorists propose the notion that the addict is an individual who is extremely judgmental and unforgiving towards himself and engages in a good deal of self punishment.
Treatment for Addictions:
While Alcoholic's Anonymous is very successful in the treatment and rehabilitation of people who suffer from alcoholism the same cannot be said for the other addictions. For a variety of reasons there is a higher rate of non compliance with twelve step drug rehab programs and a higher rate of relapse among drug abusers as compared to alcoholics. The main conclusion I draw from this is that one model of treatment cannot be applied to every addiction. Perhaps the nature of the substance makes it more difficult for drug abusers to benefit from the twelve step model than alcohol abusers. Drugs may have a particular impact on the neurons on the grain that causes a unique set of symptoms as well as responses to treatment. Perhaps it is the nature of the abuser that makes it more difficult for the drug abuser to benefit from these programs. One wonders if drug abusers either start out with more problems or end up with more problems as compared to alcohol abusers.
For example, those who abuse methamphetamines seem to benefit more from programs in which there are a built in set of rewards than the orthodox twelve step types of programs. Recent studies have shown that, for some reason, even very small rewards encourage those addicted to methamphetamine to strive to get better. It is also suggested by these studies that psychotherapy be an integral part of the recovery process.
In no way should this be interpreted to mean that either Alcoholics Anonymous or other twelve step programs are not successful or useful. The point being made here is that as we learn more about the addictions, new and improved treatments will be available to those suffering from the addictions. In addition, as we learn more about alcohol and substance abuse it is becoming clear that they are not all the same and, therefore call for different treatments depending on the type of substance being abuse. In a final note on this part of this web log I want to emphasize that: twelve step programs are, for now, the best way to get help for most addictions. There are those programs that emphasize spirituality and there are those that eliminate that part of it. The major point here is that, at least for now, twelve steps are the favored treatment, along with psychotherapy, to help people recover from their addictions. These programs are found on an in patient drug treatment basis or on an out patient basis. There are residential programs, day programs including intensive out patient programs.
The Desperate Family, What To Do:
Drug addiction is a tragedy for the abusers and their families. Parents become torn with terrible feelings of guilt, blaming themselves for their adult child's addiction. Some family members become furiously angry at the abuser, laying blame at the feet of the abuser as though they are doing it and continuing to do it to be spiteful. Of course this is not the case. There is an excellent book about how the brain is affected by drug abuse called The Selfish Brain. Drugs alter the brain in ways the set up the relentless craving that makes the treatment of drug abuse so very difficult. These brain alterations are one reason why there is such a high relapse rate with the addictions.
Drug abuse wrecks families, ends marriages, alienates abusers from their children, destroys romantic relationships that had been headed towards marriage and puts a huge strain on the marital relationship of the parents of the abuser.
Because of parental guilt, many parents continue to support the drug addicted family member unwittingly permitting the continuation of the drug addicted life style.
Just as the addicted person needs to enter into detox and rehabilitation programs, it is essential that the family members of the abuser enter programs designed for those affected by the addicted individual. Alcoholics Anonymous has Alanon for family members and so do all the other programs that serve those addicted to everything from marijuana to heroin. Family members need this support to help them learn how to reduce their feelings and guilt but, even more, to learn how to stop enabling the drug abuse. The old saying is the "the road to hell is paved with good intentions." In the case of substance abuse, providing money and shelter to someone who continues their addiction is to "pave their way to hell."
Those who are addicted need to find their own motivation to stop their drug abuse. It is clear that loved one's cannot influence to abuser to stop their disease. However, they can stop the enabling process. Stopping the enabling process is sometimes referred to as: Tough Love. Tough love refers to the determination on the part of loved ones to no longer provide food, shelter and money to the abuses as long as they continue their drug abuse. Addicted individuals often find the motivation to enter into recovery by "hitting bottom" or losing everything they have. At time this means homelessness and at other times it means arrest and jail time. For other's it may mean losing a marriage or losing parental rights.
Your comments about his painful and tragic topic are welcome and encouraged
love - but there is a limit - Cheryl Wright-Watkins - Nov 3rd 2009
I came home from school and found my sister drinking a beer and smoking a cigarette when she was 10 years old. My parents were strict Southern Baptists, never had alcohol in the house, and I don't know where she got either. I pitched a fit. When she was 12, 2 friends came and got me, told me that we needed to go pick up my sister. I was 16, she was 12 and passed out drunk, a Bourbon bottle in hand, on the parking lot of the local burger joint. I tried for years to "fix" her, show her a better life. She resented me for having that better life, cursed me out hundreds of times for it - while I was in college, she was living in a shabby mobile home, Reynolds Wrap on the windows, hiding from the police. She went from pot to snorting and shooting up things I don't even know the name of. She had a baby, my precious niece, whose childhood she robbed. While that child should have been in kindergarten, she was instead playing underneath tavern tables. My parents got legal custody of my niece when she was 6. My sister faked sober long enough to get her back 2 years later. She has aggressively tried to wreck the girl's life ever since.
We have watched her drive to pick up older boys to bring to the house for her daughter, and I personally was there during one visit to walk in and find my niece with her bedroom door closed and that boy and 3 others with her! She was 15 years old! The girl had 3 STDs before she was 18! She had tattooes before she was 16! She had 2 abusive boyfriends before she was 16, 1 they actually took to court and got a restraining order against. My sister has stolen money, jewelry, irreplaceable items from everyone in the family. She got so wasted the day my grandmother died that I had to demand that she stay away from the funeral. The night of the funeral, she attempted suicide after an overdose days long. She has lied, accused people in my family of things that are not true, she is the most vile, evil, immoral person I have ever seen. On my niece's 18th birthday, my niece walked into the house where she knew her mother was visiting to find her mother engaged in sex with 2 men (neither of whom was her husband). Undying love is a fine concept, but after this kind of crap for 37 years, I'm sorry, you have to protect yourself.
AA is only ONE of a number of 12 step progs - Jackie - Sep 8th 2009
Why are you 'commenters' so hung up about AA. Google/Ask/Yahoo searches will show you that there are loads of different 12 step programs and clearly the 'program' does work for some people (my own father is 41 years sober and was helped by not only the 12 steps of AA but also its members and community).
There are 100 different cures or treatments for headaches so why not 100 different cures or treatments for addiction. Dr Schwartz learned opinion is that a 12 step prog (in conjunction with other treatment) is the answer just like any other doctor will be certain that one analgesic is better than another - its a difference of opinion you have with Dr Schwartz, why the vitriol, why are you so certain your ideas are any better? People need hope and options, don't dismiss anyones ideas.
Incidentally AA literature discusses God as you understand him; a higher power et al and AA doesn't need me to defend it either.
Again, Evidence Please - speedy0314 - Jun 8th 2009
in this 'essay" you unequivocally state:
"In a final note on this part of this web log I want to emphasize that: twelve step programs are, for now, the best way to get help for most addictions."
while in a subsequent "sober conversation" on AA essay, you allow an unnamed 'editor' to suggest that an MD's (Dr. Harriet Hall) call for evidence substantiating this conclusion is 'out of context' for the discussion.
in this case, the context is clear & necessary. provide the evidence doctor or retract the statement.
the cochrane review findings (7/2006) referenced by dr. hall in her comment on the other blog post precedes this post by 5 months & i think it would be disingenuousto suggest that you were unaware of it when writing this post.
the abstract on that review states: "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed."
now you or the unnamed 'editor' can characterize this comment as 'demonizing', 'black & white', 'tearing down' or whatever demeaning euphemism you'd like. but the bottom line is you offer professional opinion that isn't born out by any scientific evidence.
"the best way"? - Ray Smith - Jun 8th 2009
"...twelve step programs are, for now, the best way to get help for most addictions. There are those programs that emphasize spirituality and there are those that eliminate that part of it."
Those that eliminate part of it? What, atheist/agnostics meetings? Ask any true AA member, those are renegade groups and not AA.
By what means do you judge AA to be the best? Every randomized longitudinal controlled study has shown AA to be lacking. Brandsma, Ditman, Walsh, Orford & Edwards, all put AA in a bad light. I work with substance abusers in a mental health program and take this research very seriously.
AA is and always will be a thinly disguised religious group. It is a splinter group that came out of the Oxford Group, also known as "First Century Christian Fellowship".
Every time the question of AA's religiosity has come before a higher court in the United States, the final outcome has been that AA is "religious in nature" and that court mandated AA is a violation of the Establishment Clause. (16 states, for now)
"To some people we need not, and probably should not emphasize the spiritual feature on our first approach. We might prejudice them. At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God and the people about us." The Big Book, pg 76-77.
I see that Jill has already linked to Hester & Miller's Handbook of Alcoholism Treatment Approaches. They examined 48 alcohol treatment methods; 12step treatment was rated #37, followed by AA, #38.
You keep mentioning that addiction is a brain disease. And the proper treatment for this disease is faith healing?
Missing My Kenneth - carmen - Aug 8th 2008
Hi everyone, my name is Carmen and I am the partner of an amazing, very handsome, very intelligent man who happens to be a Drug Abuser. Kenneth and I have been dating ( if you can call it that) for more then a year now, and even though he has been in two recovery programs ( he turned himself in each time), I am losing my beautiful man to a mistress called Cocaine. I never left his side in or out of these recovery programs. I fell in love with this man thinking that MY LOVE COULD HEAL HIS ADDICTION, never realizing how big the bottom of this ice berg really is. You see I have never touched a beer, cigerete or illegal drug in my life, so I was not equipped to recognize the signs of Drug Addition. Now the streets are his refuge at night, instead of my arms. I don't know exactly where he goes or who he is with. All I know is that I can no longer tolerate my own behavior. I wear myself out calling his cell phone, texting, worrying and wondering if he is safe and never getting a response for hours, or days, and when he does return, he is like Jekyl and Hyde. My heart is completly shattered and broken, I am lonely, and I MISS MY KENNETH IMMENSELY! I hate the addiction, because it keeps him away from me...mentally, emotionally and physically!! thank you for letting me speak
Illegal drugs - Sam - May 9th 2008
Drugs are of two types: Legal or prescription drugs and illegal or non-prescription drugs. The illegal drugs are the harmful drugs consumed by drug addicted people. But in many cases legal or prescribed drugs also shows addictive behavior and thus proved to be as harmful as illegal drugs.
I disagree - Jill - May 5th 2007
Hello Dr Schwartz,
It is refreshing to hear someone say that a one size fits all treatment doesn't work for all. However, why is it when someone in your field makes that statement, it is always qualified with the following "but AA is still the best". In the following link, please note that AA is somewhere near the bottom.
meth/how sick Iam - graham - Feb 15th 2007
Iam a 37 y/o man who has been using meth for the last 20 years... for the first time in my life Iam now seeking help. I have 25 days clean but Iam struggling...Also I have been diagnosed as bi-polar and prescribed lithium....I have a psychiatrist,therapist,technician and a sponser and I go to aa meetings daily...I have a small group of family and friends but the hole inside of my heart from turning away from my girlfriend and friends (still using) is killing me...The pain Iam feeling inside is thermonuclear..... my sponser tells me I need to wait a year befor I seek a girlfriend.... I have to find a new girlfriend who is straight to help me through this.... I want to hear some advice on this.... thanks Graham