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Friday, November 25, 2011

Addicts -- Voluntary or Involuntary?

Addictive Personalities

Much of the established medical community does not accept an addictive personality as a diagnosis used to explain why some people become addicted to alcohol, drugs, activities, and even emotions.

The substance-based addictions, such as alcoholism, as well as nicotine, prescription and narcotic addictions, are more easily explained and identified neurologically. Dr. Alan Leshner, PhD, of the National Institute on Drug Abuse describes addiction instead as "a brain disease" and "a chronic relapsing disease," in that there are visible alterations in the brains of addicted individuals and these effects are long-lasting within their neurological patterns.

Particular drugs, such as crack and heroine cause massive surges in dopamine in the brain, with different sensations ranging from invincibility and strength to euphoric and enlightened states. Use of these substances almost immediately changes particular aspects of the brain's behavior, making most individuals immediately susceptible to future abuse or addiction.

But what about all the reasons people get into addiction? As Dr. Leshner can attest, many people still see drug abuse and addiction as a moral failure and a weakness that needs to be approached solely from punitive actions. These people believe addiction is not a disease but a choice in lifestyle. ("An Interview With Dr. Alan I. Leshner," Frontline,

Leshner says, "Deep in their hearts, many people believe that drug addicts 
did it to themselves, therefore they're bad, 
and the only way to deal with them is to tough it out."

Other people show great compassion for drug addicts. They philosophize that addiction results from involuntary behavior.

Leshner concludes, "Of course, it (addiction) is a combination of the two. Drug use is a voluntary behavior. You do make the initial choice to use the drug. The problem is that, over time, the drug use changes your brain in fundamental and long-lasting ways, and you develop, in effect, another brain state. The person you're dealing with isn't the same person who started using drugs voluntarily. They can't exert the same level of control."

Even if the addict is not using, according to Leshner, the changes in the brain are still there, which is why people relapse. Leshner believes drug addiction should be approached like other chronic diseases, such as diabetes and high blood pressure.

Dr. Nora D. Volkow, who succeeded Leshner as director at the NIDA in 2003, observed that the frontal cortical area of the cocaine addict’s brain was disrupted, even after not using for 100 days. Dr. Volkow found

"The disruption of the dopamine pathways leads to a decrease 
 in the reinforcing value of normal things, and this pushes 
the individual to take drugs to compensate."

("Drug Addiction: Choice or Disease,", 2011)

So, Are Some People PRONE To Become Addicted?

Investigation began long ago and still continues into aspects of psychological makeup that may contribute to addiction. Are there common threads that weave through all addictions, from hard drugs to cigarettes, from gambling to overeating?

One often cited study (admittedly done close to 30 years ago) prepared for the National Academy of Sciences and authored by Alan R. Lang, a psychology professor at Florida State University, concludes that there is no single set of psychological characteristics that embrace all addictions. But the study does see common elements from addiction to addiction.

The report finds that there are several 
''significant personality factors'' 
that can contribute to addiction: 

- Impulsive behavior, difficulty in delaying gratification, an antisocial personality and a disposition toward sensation seeking. 

- A high value on nonconformity combined with a weak commitment to the goals for achievement valued by the society. 

- A sense of social alienation and a general tolerance for deviance. 

- A sense of heightened stress. This may help explain why adolescence and other stressful transition periods are often associated with the most severe drug and alcohol problems. 

Lang and others familiar in the field believe a continuing search for the personality traits that play a part in the development of addictions is an essential part of the broader fight against addiction. ''If we can better identify the personality factors,'' he said in an interview, ''they can help us devise better treatment and can open up new strategies to intervene and break the patterns of addiction.'' (Bryce Nelson, "The Addictive Personality: Common Traits Are Found," The New York Times, January 18 1983)

Implications For Certain Personalities

Wouldn't it make sense that parents, families, relatives, doctors, school officials, enforcement officers, and any others who occupy the roles of guardians look out for certain traits early on in the life of a child? As a retired educator, I know teachers are often faced with class members who exhibit nonconformity, alienation, compulsive behavior, and high rates of stress.

Usually, these students are sent to the principal's office or to the guidance office where they receive the traditional "good person" vs. "bad person" lecture, are given a chance for behavior modification, and are meted out a punishment crafted to improve general behavior and foster discipline. Does this adequately address the true needs of a potentially addicted personality? Will these strategies really prevent and help curtail negative personality traits? I think you and I both know the answers to these questions.

Why can't these personality factors, when evidenced, be used as significant signs of the need...

1. For professional intervention?
2. For medical and psychiatric evaluation?
3. For class instruction in stress reduction, impulsive behavior, etc.?
4. For school programs and activities designed to deal with alienation, nonconformity, etc.?
5. For parental and community education about addiction -- myths vs. realities?
6. For alternative disciplinary measures? 

“No one wants to be an addict. 
All anyone wants to be able to do is knock back a few drinks 
with the guys on Friday or have a cigarette with coffee or take a toke on a crack pipe. 
But very few addicts can do this. 
When someone goes from being able to control their habit 
to mugging their grandmother to get money for their next fix, 
that convinces me that something has changed in their brain.” 

-Dr. Herbert D. Kleber, the medical director of the National Center on Addiction and Substance Abuse

Treatment is the only answer 
regardless whether drug addiction is 
a choice or a disease.
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