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.
Drug Dependence
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 A person who is psychologically dependent on a drug experiences emotional distress when the drug is withdrawn.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.
• Short-term effects include euphoria, relief from pain, and prevention of withdrawal symptoms.
• Long-term effects include depression, malnutrition, constipation, and, when injected from a contaminated needle, an increased risk of infection with HIV or hepatitis B.
• 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.
• Withdrawal symptoms include severe depression, sleeplessness, mood swings, headaches, muscle pain, apathy, and drug cravings that may last up to a year. 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
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 evolutionary adaptation and survival produce pleasurable feelings that make people want to repeat those behaviors again and again. Sensory inputs and 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 codependents 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.
If you answered yes to any of these questions, you may be addicted to alcohol. If you think that you—or someone you love—has a drinking problem, seek help immediately. Stopping now will significantly improve your life and your health, no matter how long you have been drinking. Here is how you can get help:
• Ask your doctor for the name of a healthcare professional who specializes in treatment for alcohol dependency.
• Call the employee assistance program where you work.
• Call nearby hospitals or a local mental health center to ask if they provide a program for alcohol addiction.
• Call the local chapter of AA, a support group of alcoholics who meet regularly to help each other stop drinking and stay sober.
• If you are concerned about the drinking of a family member or a friend, call the local chapter of Al-Anon, a support group for relatives and friends of alcoholics.
Tobacco
Smoking, directly and indirectly, causes more death and illness in the United States than any other single activity. Each year, more than 300,000 Americans die of smoking-related illnesses, including lung cancer, emphysema, and heart disease. Although the incidence of smoking among men has declined to about 32 percent from its peak of 54 percent in the mid-1950s, smoking remains one of the most difficult habits to kick. Much of what is known today about the harmful effects of tobacco was learned from medical studies of the effects of cigarette smoking on the lungs. The effects of smoke from cigars and pipes are also dangerous,
although in somewhat different ways.
Harmful Effects of Smoking
The risk of developing lung cancer is 10 times greater for cigarette smokers than for nonsmokers. Decades of study in many countries have shown a direct link between smoking and lung cancer. Since cigar and pipe smokers do not inhale as much tobacco smoke, they have a slightly lower risk of lung cancer, but the risk is still significantly higher than it is for nonsmokers. Tar and nicotine, as well as smoke, play a role in the development of lung cancer. The risks for lung cancer increase proportionately with the number of cigarettes smoked, the length of time the person has smoked, the age at which the person started smoking, and the amount of smoke inhaled. Other types of cancer caused by cigarette smoking include cancers of the throat, esophagus, bladder, kidney, pancreas, and mouth. Pipe and cigar smokers also have an increased risk for cancers of the lip and mouth. Since some of the tars in tobacco are swallowed, there is also an increased risk of stomach cancer. Respiratory diseases associated with smoking include chronic bronchitis, sinusitis, and emphysema. Each year in the United States, these diseases account for tens of thousands of deaths from respiratory failure. Cigarette smoking slows down the action of the cilia, tiny hairlike projections that line the airways and help clean the lungs. When the cilia are immobilized, dust and dirt particles are able to invade the lungs and cause inflammation. As a result, cigarette smokers also have more chronic coughs, phlegm production, wheezing, and other respi-ratory symptoms. People with allergies and asthma are particularly vulnerable to the negative effects of cigarette smoke. For men, the most significant health hazard of smoking is coronary artery disease—the most common cause of death in men in the United States. A young man who smokes 20 cigarettes a day is three times more likely than a nonsmoker to develop coronary artery disease. The risk increases proportionately with the number of cigarettes smoked. Smokers have been shown to have severe and extensive narrowing of their coronary arteries, the vessels that deliver blood to the heart muscle. They also have higher blood levels of LDL (low-density lipoprotein), the “bad” cholesterol, and are more likely to have high blood pressure. Smoking lowers the threshold for the onset of angina, chest pain associated with heart disease, and is a major risk factor for peripheral vascular disease, which affects the arteries of the legs, causing painful neuropathy (degeneration of the nerve endings). Smoking also affects the arteries leading to the brain, thereby increasing the risk for stroke.
