the roots of addiction
Dr Ron Alcorn, lead consultant in Substance Misuse Services in Camden and Islington, examines the latest thinking about the causes of dependence on alcohol, nicotine and other drugs
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There are probably as many theories about the causes of addiction as there are people brave enough to tackle this age-old question. People get passionate about pet theories, which are sometimes linked to what they want to believe, or have experienced themselves, or have seen in another person. For almost every hypothesis you can say: 'Yes, that's right ... but not for everyone and not always.'
It's interesting to turn the question on its head and ask what stops people from becoming dependent. After all, we all have access to alcohol and tobacco, and many other drugs are not hard to get hold of. Many people have tried various drugs, or even use them frequently, but don't get addicted. Is it the power of beliefs or scruples? That we have other interests that can compete with drugs? That we don't get the same buzz that another person gets? Or that we've learnt other ways of coping with life's ups and downs?
The only logical way to tackle the question of dependence is to consider a complex web of factors: factors in the drug itself, in the person who takes it and in the environment in which they find themselves (you can make an analogy with a seed, its soil and the prevailing climate). The technical jargon for this is the bio-psycho-social model – in other words taking into account biological, psychological and social factors.
social factors
The main theories relating to social factors (or the environment) centre around the availability of a drug, its cost, its 'marketing' and the behaviour of those around you.
Availability is what gets legislators and public-health specialists (and many parents) worked up. There are glaring inconsistencies in the way countries and governments handle the problem, promoting drugs like alcohol and nicotine while restricting others. The message from a lot of research is: the cheaper the drug and the easier it is to get hold of it, the wider and more slippery the slope into addiction.
psychological factors
The emotional make-up of the person taking the drug (the psychological dimension) is also important. There are various psychological theories of addiction. One is the 'self-medication hypothesis'. People who have a profound experience of relief or happiness, or just think they function much better when they take a drug, may want more, particularly if they can't find other ways of tapping into those experiences. So people who are shy or depressed or anxious or traumatised may slip into repeatedly taking a drug and risk addiction. But the catch with this theory is that research also shows that some people who use drugs a lot develop a range of psychological problems which they didn't have before. In other words, it's often hard to know whether the psychological problems led to the drug dependence or vice versa.
Other psychological theories – and there are many – focus, for example, on how we learn to use drugs (for example how we observed our parents using alcohol), and on the powerful associations and rewards that go with taking a drug. There are also psychoanalytical theories, which suggest that drugs and drug-taking are symbolic or symptomatic of conflicts at an unconscious level. Drug-taking might be a defence against unconscious aggression or sexual impulses, some believe, or might help to repress memories of traumatic events such as childhood sexual abuse.
biological factors
There is evidence that both nurture and nature are risk factors for addiction, so family background and genetic make-up are both important. There is no one gene for addiction, but there may be gene types or combinations of genes that increase the chances. A family history of alcoholism, and some other drug addictions, is associated with an increased risk of developing an addiction even if you are brought up away from your biological parents. (The evidence comes from studies of identical and non-identical twins raised either together or apart.) Overall, however, research suggests that the genetic component of a person's susceptibility is probably not as great as we once thought.
Taking a drug repeatedly seems to be the trigger to what goes on in a user's brain and how it adapts. Drugs of addiction are teaching us a lot about how the brain works. It is a fascinating but frustratingly incomplete story.
One thing that has become clear is that addictive drugs all share certain properties. Experimentally, they are what psychologists term 'reinforcing': animals exposed to these drugs want to go on to try them again and again and may prefer them above food, sex and other stimuli. All addictive drugs grab the brain's attention by mimicking or 'turning up the volume' in the brain circuits linked to reward or pleasure. These circuits are some of the oldest in terms of the brain's evolutionary development. They are deep in the brain (in the limbic area) and have very close links to those fundamental drives that keep us alive, such as sex and appetite.
What drugs of addiction seem to do is to 'hijack' some of these systems by influencing transmitters or receptors in certain regions of the brain. If this goes on repeatedly, we now know, the brain changes to adapt (neuro-adaptation). The well-known examples of this are the way a user develops a tolerance for greater amounts of a drug and also starts to notice unpleasant things when the drug is taken away (withdrawal states).
But it is subtler than that. Neuro-adaptation also goes on in learning and memory circuits, heightening responses to drug-related cues and situations. An example of this is the powerful craving or full-blown withdrawal experiences that can be triggered simply by the idea of a drug, or by something that represents it, for example tin foil for a crack smoker. The idea of the drug as a sort of 'evil tutor' in the brain is starting to gain currency, and the 'hard-wiring' that results – actual structural and functional changes – may explain some concepts that have been around for a long time.
One example is the idea of alcoholism and other forms of drug dependency as a long-term or even permanent condition. Alcoholics Anonymous, for example, has always stressed that abstinent former drinkers must be ever watchful of their vulnerabilities. Relapsing into use of a drug is often due to persistent craving or vulnerability to stress. Addicts can find themselves back into heavy patterns of use alarmingly quickly and even have an exaggerated response to a dose of the drug that previously wouldn't have affected them (sensitisation). These vulnerabilities can last for a long time after someone has stopped taking a drug and may, in part, be explained by some of the brain changes that have gone on over the years of drug use.
adding it up
How does all this add up? For an individual with a drug or alcohol problem the best approach is usually to take an honest, hard look at all possible factors. They can then be listed in terms of relative importance. A route out of addiction, and any treatment, can then be aimed at specific problems.
A better knowledge of what happens in addiction is helping us develop better treatments, both psychological and medical. A combination of treatment approaches often works best. Treatment often has to go hand in hand with radical changes in a person's environment – where they live and with whom they mix. The amazing thing is that, despite all we still don't know, people still find the courage to work their way out of this most difficult and distressing human condition.
help and info
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A selection of relevant sources of information and help are included below. Or look at our article problems and services, which discusses ways of recognising dependency problems and explains how you can go about getting help if you want it. Alternatively, DIY detox talks about strategies for tackling problems on your own.
organisations
Addaction
67-69 Cowcross Street
London EC1M 6PU
Tel: 020 7251 5860 (Mon-Fri 9am-5pm)
E-mail: info@addaction.org.uk
Website: www.addaction.org.uk
Working solely in the field of drug and alcohol treatment, Addaction runs community-based and prison-based projects, plus specialist services for young people.
Alcohol Concern
32-36 Loman Street
London SE1 0EE
Telephone: 020 7928 7377 (Mon-Fri 9am-5pm)
E-mail: contact@alcoholconcern.org.uk
Website: www.alcoholconcern.org.uk
Alcohol Concern acts as the national umbrella body for 500 local agencies tackling alcohol-related harm and offering help to the families and friends of those with alcohol-related problems.
Alcoholics Anonymous
PO Box 1
Stonebow House
Stonebow
York YO1 7NJ
Helpline: 0845 769 7555 (24 hours)
Tel: 01904 644026
E-mail: aanewcomer@runbox.com
Website: www.alcoholics-anonymous.org.uk
Runs self-help groups throughout the UK. The only requirement for membership is a desire to stop drinking.
Al-Anon Family Groups UK and Eire
61 Great Dover Street
London SE1 4YF
Tel: 020 7403 0888 (9am-5pm)
Website: www.al-anonuk.org.uk
Offers understanding and support for families and friends of problem drinkers. Alateen is for young people aged 12-20 who have been affected by someone else's drinking. See the website for details of branches in Scotland, Northern Ireland and Eire.
Cocaine Anonymous
PO Box 46920
London E2 9WF
Helpline: 020 7284 1123 (10am-10pm every day)
E-mail: helpline@cauk.org.uk
Website: www.cauk.org.uk
A network of self-help groups offering support for those wanting to recover from cocaine dependence.
Drinkline
PO Box 4000
Glasgow G3 8XX
Helpline: 0800 917 8282 (24 hours, every day)
A free national helpline offering advice and information for people with alcohol problems
or anyone concerned about alcohol misuse. Provide advice on sensible drinking and
information on local support services to help people cut down on their drinking.
Drugscope
40 Bermondsey Street
London SE1 3UD
Tel: Office 020 7940 7500
Tel: Information Line 0870 774 3682 (Mon-Fri 10am-1pm)
E-mail: infor@drugscope.org.uk
Website: www.drugscope.org.uk
National drugs information agency with services that include a library, a wide range of publications, policy research and consultancy.
FRANK
Helpline: 0800 77 66 00 (Every day 24 hours)
Textphone: 0800 917 8765
E-mail: frank@talktofrank.com
Website: www.talktofrank.com
Provides free confidential drugs information and advice 24 hours a day. All calls are confidential. Use the website's search facility to get the contact details of organisations offering practical help and support in your area.
Narcotics Anonymous
Helpline: 020 7730 0009 (Every day, 10am-10pm)
E-mail: helpline@ukna.org
Website: www.ukna.org
A non-profit fellowship of men and women for whom drugs had become a major problem, who meet regularly to help each other stay clean. Recovery in NA focuses on the problem of addiction, rather than on any particular drug. The website has information for those who think they may have a drug problem, for professionals working with addicts seeking recovery, and for recovering addicts.
websites
Action on Addiction
www.aona.co.uk
An information service for people who are worried that they have an addiction or that a friend or member of the family might have a problem.
Addiction Network
www.addictionnetwork.co.uk
Contains extensive information on alcoholism and other addictions. Offers advice, education, treatment options and more for professionals and the general public at large. Updated daily, it deals with technical enquiries through its 'Ask the Expert' facility and also has its own agony aunt.
Recovery.org.uk
www.recovery.org.uk
A website run by Cyswllt Ceredigion Contact which provides wide-ranging information and advice about alcohol abuse, drug abuse and eating disorders, including Q&As, recommended reading, teen pages and advice on finding help.
reading
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The Addictive Personality by Craig Nakkan (Hazelden, 1996) |
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Overcoming Addiction by Corinne Sweet (Piatkus Books, 1999) |
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Forbidden Drugs: Understanding Drugs and Why People Take Them by Philip Robson (Oxford University Press, 1999) |
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(revised February 2003, resources updated February 2005)
