Thursday, 10 January 2013

Two Different Types of Addiction?

The most hopeful treatment for all additions (as I write) is Ibogaine (see link) and but it is still undergoing medical trials in the USA. There are many other psychiatric conditions for which this therapy could possibly prove effective, from most types of depression and post traumatic stress disorder (PTSD). 

However, to date there are still no Ibogaine trials planned for the UK. For now British patients would need to go abroad for this treatment (probably Mexico). This treatment was discovered in the 1960s. However, after taking out several patents to prevent others from researching or promoting it, the finder failed to develop it himself while thousands more people continue to die unnecessarily.   

Two Types of Addictions: Chemically Dependent, or a Wilful Abuser? 

In spite of many different substances and even 'addictions' to processes, such as shopping or gambling, I believe that all addictions have the same neural roots and will be found to be driven by the same mechanisms; involving the same endorphins and neurotransmitters. However, in, The Science of Addiction: From Neurobiology to Treatment, Erickson (2007) states that there are two different types of addiction. He claims that ‘chemically dependent’ addiction is the result of a congenital brain disease, while the other, which he describes as ‘wilful abuse’ is he claims, the result of choice. This group would probably include self-medicators, suffering from things like post traumatic stress disorder (PTSD) or depression. 

I had serious doubts about this 'wilful abuse' theory. I suspect that this idea is the result of treatment in the USA being paid for by insurance companies who don't want to pay to treat a condition if it is self-inflicted. However, after I explored the neurobiology behind addiction further, and talked to addicts I realise that there are at least two different kinds of addiction and there might even be more. Although there are definite similarities between addictions to different substances, there are also many differences between them. I believe that it is also possible to become addicted by accident rather than choice, especially with alcohol but it is less likely with heroin.

In order to understand the causes of addiction, I needed to learn more about what Erickson (2007) termed: wilful substance abuse, which according to him doesn't really need treatment, and chemical dependence. Many neuroscientists and pharmacologists like Erickson assume that alcoholism and heroin addiction are the same but there are important differences. Is addiction entirely the result of an innate brain disease or is it totally psycho-social or are these two combined with many other factors? In addition to psychology I studied philosophy, in spite of it not lighting my fuse (in fact much of it bored the Emanuel Kant’s off me). However, I think it is the right place to learn how to be analytically critical. I also needed to learn about logic and reasoning, rhetoric,  choice and what else influences human decision making. 

I needed to find out how much influence is from external factors like social pressure from the groups to which we belong. Tajfel and Turner, performed an interesting study on this] which showed how much of our identity is influenced by external factors like the company we keep. much from internal factors like poor self-esteem or depression. After a great many years of study, I conclude that we do have free will but not to the extent that most people believe. Although we are responsible for our actions, there are often mitigating circumstances outside our control. I am still not certain yet whether this somewhat limited freedom of choice extends to addiction. Is it really a choice or just a default option? I am however, absolutely certain that recovery is a choice. If you really want to know more about this, the link to Wikipedia is always a good place to begin:

We cannot prevent ourselves falling in love, nor can we control who we fall in love with, but unlike other animals we can usually control what we do about the feelings. Human beings can choose which emotions to act upon and which to ignore. I believe we have as much free will as we have determination, self-discipline also known as willpower. Self-discipline is something we develop through determination and practise; the more we use it the more we have, willpower never wears out. However, there are extreme circumstances when hormonally driven unconscious defence mechanisms take over.

One of the strongest of these is flight or fight mode where no amount of determination or self-discipline can work to control our actions because it has all been switched off. In practical terms we are on auto-pilot. We have no choice but to react blindly and instinctively; and do things that we would never do in a normal mental state. If a terrified animal/human cannot flee it is forced to fight; even with its owner if they are preventing its flight.

You will know what I mean if you have ever rescued a cat from a snarling dog, to have it turn on you; hissing, spitting, scratching and clawing its way up over your face and onto your head, where it will hang on by its claws until it calms down. Typical humans develop enough self-discipline during childhood to ignore most hormonal drives and destructive impulses. They can also choose between working hard to achieve the best life they can or they can choose to sit, dream, and sleep their lives away.

Psychologists who study social interaction and inter-group dynamics claim that most people need social affirmation and approval. Group members do not make any decision until they know what everyone else is going to do and take their position in group hierarchy very seriously. One team of researchers found that people dread the loss of their social or professional status as much if not more than they fear death (cannot remember their name). This might be very difficult for some people to believe, especially younger people who not yet achieved any status themselves. Status is incredibly important to people who have spent their whole lives working hard to achieve a certain position. This finding was confirmed in December 2012, by the tragic suicide of a highly respected and totally dedicated middle-aged nurse, after she was fooled by a prank phone call.

Her distraught family said that her career meant everything to her. It is easy to understand how this could have affected her self-esteem; and shaken her confidence in her ability to keep the respect of her colleagues. This loss of career status, combined with the threat of becoming the subject of work-place jokes was more than she could bear. One factor that might have had increased her feeling of hopelessness and isolation was that her family were so far away. I have noticed that sudden loss of a parent, or lack of family support can often be seen to be a factor in adolescent drug use.        

Discursive psychologists cite further constraints on human autonomy when they attribute the existence of everything to the power of language. They claim that nothing significant exists until it is spoken, written or thought about and put into words. So if you stub your toe on a rock while out hiking you had better say something about it fast before you are accused of hysteria.

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