Читать книгу Tails of Recovery - Nancy A. Schenck - Страница 19
ОглавлениеAddiction is an all-consuming disease that often expresses itself as an overwhelming lack of concern for just about everything. The further the disease progresses, the deeper sufferers become immersed in the illness, the more their perception narrows until there is almost nothing left but the quest for more, be it more drugs, more alcohol, more food, or more “fill in the blank.” The American Society of Addiction Medicine defines addiction as “a primary, chronic, neurobiological disease.” It is a brain illness “with genetic, psychosocial, and environmental factors influencing its development and manifestations.” It is characterized by alterations in the brain that lead to habitual and compulsive drug-seeking and use despite demonstrated harmful consequences.
Many years ago, addiction was merely a pharmacologic term that referred to a person’s using enough drugs to cause tolerance—the requirement that greater dosages of a drug are necessary over time to produce an identical effect. While tolerance is part of the bigger picture, addiction is incredibly complex. It includes genetic, social, environmental, and behavioral components. Additionally, with some drugs, non-pharmacological factors may actually cooperate with the drug’s pharmacological actions to encourage compulsive substance use or abuse and ultimately lead to addiction.
Many medical professionals agree addiction causes changes in the brain’s mesolimbic pathway, which is one of four neural pathways in the brain. Scientists believe it is involved in producing pleasurable feelings and is associated with feelings of reward and desire. What all this boils down to is that not only is the predisposition to addiction present in the brains of those who have it—whether they use drugs or not—but once manifested by the ingestion of substances, changes take place in the part of the brain where we feel good things.
Human brains are wired to ensure we repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is kicked into gear, the brain makes a note that something is happening that needs to be remembered and repeated. It then teaches us to do the action again and again, without thinking. Because drugs of abuse, including the drug alcohol, stimulate the same circuit in our brains, many professionals believe we learn to abuse drugs in the same way we learn to repeat life-maintaining behaviors. This means that once addicts (people with the disease of addiction) use certain drugs, their brain fools them into thinking the substance is necessary for survival and demands they continue to eat, drink, smoke, snort, inject, or get it into their systems by any means possible. Emergency room records can testify to the various creative methods many addicts use to get drugs into their bodies.
Contrary to the findings of a vast number of eminent clinicians and researchers, some people believe drug abuse and addiction is a social failing or lack of moral values. They claim addicts could stop taking drugs if only they would change their behavior. Addiction, they say, begins when an individual makes a decision to use and then abuse drugs. Additionally, there are those who argue that addiction is hardly a disease, since the very act of ingesting or injecting a substance appears to be a self-willed decision. Most scientists, however, profoundly disagree. Dr. Avram Goldstein, a pharmacologist and neuroscientist whose career has been devoted primarily to research on addictive drugs, best explains the reality of addiction.
Goldstein, who for thirty-four years was the director of the Addiction Research Foundation at Stanford University, says that when animals are given an opportunity to repeatedly choose heroin by pressing a lever or engage in other life-sustaining activities such as eating, “that animal will press the lever repeatedly, ignoring the other activities. …It will become a heroin addict. A rat addicted to heroin is not rebelling against society, is not a victim of socioeconomic circumstances, is not a product of a dysfunctional family, and is not a criminal. The rat’s behavior is simply controlled by the action heroin (actually morphine, to which heroin is converted in the body) [has] on its brain.”
So if drugs are bad, then why use them?
The initial decision to take drugs is most often a voluntary action. This action is usually based on a variety of reasons, including (the desire) to feel good, to feel better, to do better, curiosity, and because others are doing it, according to the National Institute on Drug Abuse (NIDA). The agency explains:
“Some first take drugs to feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the ‘high’ is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction.
CHINA ELEPHANT BEATS HEROIN HABIT WITH DETOX
BEIJING (Reuters) - A once drug-addled elephant fed heroin-laced bananas by illegal traders will return home after emerging clean from a three-year detox program on China’s tropical island province of Hainan.
The four-year-old bull elephant, referred to alternately as “Big Brother” or “Xiguang” in state media reports, was captured in 2005 in southwest China by traders who used spiked bananas to control him.
After police arrested the traders and freed Xiguang a few months later, the elephant was confirmed to be suffering from withdrawal symptoms and sent to a wild animal protection centre in Hainan for rehab, Xinhua news agency said on Thursday.
A year of methadone injections at five times the human dosage had helped wean Xiguang off his addiction.
Now clean, Xiguang was expected to arrive on Saturday at a wildlife park in Kunming, capital of the elephant’s home province of Yunnan on the mainland.
Xiguang’s return would cap a 1,500-km journey home, Xinhua said, and mark another step in the elephant’s triumph over addiction.
Copyright 2008 Reuters. Reprinted with permission from Reuters. Reuters content is the intellectual property of Reuters or its third party content providers. Any copying, republication or redistribution or Reuters content is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in content, or for any actions taken in reliance thereon. Reuters and the Reuters Sphere Logo are registered trademarks of the Reuters group of companies around the world. For additional information about Reuters content and services, please visit Reuters website at www.reuters.com. License # REU-5376-MES
“Many take substances to do better. The increasing pressure that some individuals feel to chemically enhance or improve their athletic or cognitive performance can similarly play a role in initial experimentation and continued drug use.
“Others first begin taking drugs out of curiosity and ‘because others are doing it.’ In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure; they are more likely, for example, to engage in ‘thrilling’ and ‘daring’ behaviors.”
Whatever the original reasoning that leads a person to drug use, all drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The over-stimulation of this system produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.
For the person predisposed to addiction—the individual who may eventually become an addict—drugs can take over and control his or her ability to manage personal actions. The person’s will is seriously weakened and he or she becomes “addicted.” The original decision to use drugs is replaced by obsession with the drug(s), uncontrollable cravings for the drug(s), and compulsive use of the drug(s).
Brain imaging studies reported by NIDA have shown that drug-addicted individuals show physical changes in areas of the brain critical to judgment, decision making, learning, memory, and behavior control. It is believed these changes alter the way their brains work and may help explain the compulsive and destructive behaviors of addiction. Every drug leaves its own signature on the brain, and while all of the different drugs of abuse share a similar way of affecting the brain, each drug also has a unique way of changing how that special organ functions. They run the gamut from altering the memory and thinking processes, to changing a person’s motor skills, including walking and talking. In many instances, a particular drug can become the single most powerful motivator in an abuser’s existence. Once addicted, he or she will do almost anything for the drug. In effect, the addict has lost self-will and lives only to use drugs.
ALL DRUGS OF ABUSE TARGET THE BRAIN'S PLEASURE CENTER
“I take drugs because …”
At first, some who take drugs justify their behavior by identifying what they believe are positive aspects of drug use. They may also believe they can control their drug use. It usually becomes painfully obvious that those initial arguments and beliefs are flawed. In the majority of cases, drugs quickly take total control until, over time, the pleasurable effects of the drug weaken and excessive use and abuse become necessary for addicts to simply feel “normal.” They arrive at a point where they continually seek and take drugs, despite the tremendous problems caused for themselves and their loved ones. This is one of the major components of addiction.
It has been shown that many individuals who use drugs become addicted far earlier than once believed. Studies reveal many abusers began feeling the need to take higher or more frequent doses in the early stages of their drug use. In experiments carried out on rats, a team of American researchers at Brown University in Rhode Island showed that even a single dose of morphine physically altered neural pathways. The change persisted long after the effects of the drug had worn off. Other studies have shown that a single dose of methamphetamine has resulted in damage to nerve terminals in the dopamine-containing regions of the brain. While this reveals the severe toxicity of methamphetamine, it also may be indicative of how addictive the substance is.
Research supports the argument that not only do drugs interfere with normal brain functions, creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn drug abuse into addiction—a chronic, relapsing disease.
Like many other illnesses, addiction can be influenced by environmental conditions, behavior, and the ability to respond to treatment, which nearly always includes long-term lifestyle modification. Studies on addicts reveal both environmental and genetic influences in the disease, as well as interactions between the two.
NIDA reports one biological/environmental argument for the disease of addiction includes having a family history of drug or alcohol abuse. This may genetically predispose a person to drug abuse. Another explanation is that starting to abuse a drug may lead to affiliation with more drug-abusing peers, which, in turn, exposes the individual to other drugs.
“Different patterns of drug initiation have been identified based on gender, race or ethnicity, and geographic location,” NIDA explains. “While most youth do not progress beyond initial use, a small percentage rapidly escalates their substance abuse. Researchers have found that these youth are the most likely to have experienced a combination of high levels of risk factors with low levels of protective factors. These adolescents were characterized by high stress, low parental support, and low academic competence.”
Costs for drug abuse in the US are nearly $500 billion per year. NIDA says this figure includes treatment and prevention, as well as other healthcare costs. Add to that the costs associated with reduced productivity or lost earnings and other costs to society, such as crime and social welfare, and one can see the enormity of this chronic and, if untreated, fatal disease. The costs of drug abuse are as substantial as that of other chronic conditions; diabetes costs society $121.7 billion and cancer $171.6 billion annually. This includes healthcare expenditures and lost earnings. Throw in the costs associated with accidents that occur because of drug abuse, and the drug abuse costs easily outweigh those of these other life-threatening diseases. This is a huge burden that affects us all—those who abuse substances and those who don’t.
BENEFITS OF ANIMAL-ASSISTED PROGRAMS IN CORRECTIONAL INSTITUTIONS
The first prison dog programs began in the 1980s as a way to improve prison conditions and help inmates become contributing members of society. They began in women’s prisons, but now can be found in many correctional institutions around the country. The concept behind these programs is that dogs that are to be used as service animals for individuals with disabilities (e.g., guide dogs for the blind) or as police dogs need months of dedicated training, and prisoners have the time and can establish the routine needed to accomplish this. The inmates learn usable job skills, practice responsibility and commitment, and become less self-centered. Professional dog trainers assist in the process.
The programs have proven to be beneficial in rehabilitating prisoners, as well as benefiting society and many unwanted animals (most of the dogs used are rescued from shelters). Most prison dog programs are run by outside volunteer organizations, not by the prisons or the government. After the inmates complete their training period, most dogs are given to a guide dog school or law enforcement agency for placement or further training. Some programs use the inmate training to make dogs more adoptable and after training is complete, the dogs are able to be placed in permanent homes.
Drug abuse is, without question, one of the greatest health issues facing society today. The tentacles of addiction reach into every level of American life. Directly or indirectly, every family, every business, and every community is affected by drug abuse and addiction. Drugs take a catastrophic toll on our society. Consider the following from the Bureau of Justice Statistics:
Fifty-three percent of state inmates and 45 percent of federal inmates were abusing or dependent on drugs in the year before their admission to prison. Abuse included repeated drug use in hazardous situations or recurrent occupational, educational, legal, or social problems caused by drug use.
Forty-seven percent of violent offenders in state prison met the criteria for recent drug dependence or abuse; 28 percent committed their current offense while under the influence of drugs. Ten percent said that the need to get money for drugs was a motive in their crimes.
Fifty-six percent of state inmates used drugs in the month before the offense in 2004, while 32 percent committed their current offense under the influence of drugs. One in six state inmates committed their current offense to get money for drugs. Marijuana remained the most commonly used drug, with 40 percent reporting use in the month before the offense, followed by cocaine or crack (21 percent), stimulants (12 percent), and heroin and other opiates (8 percent).
Reports of prior drug use by federal prisoners rose on all measures between 1997 and 2004. Among federal inmates, drug use in the month before the offense rose from 45 percent to 50 percent and use at the time of the offense increased from 22 percent to 26 percent. These changes were the result of an increased use of marijuana, methamphetamines, and Ecstasy.
No place left to go
It’s hard to imagine how individuals caught in the destructive cycle of addiction can continue to do the things they do to nurture and feed the disease. Their lives crumble before their eyes as their families dissolve and their friends leave them. Yet the only focus, the only reason to live is to get and use more drugs. Nothing else matters more than the drugs that are beckoning the addict to certain death.
Addiction causes emotional and spiritual death, and in time, will result in physical death. But death is not the only way addiction can end, and in fact, some in active addiction often wish for death to bring a welcome end to their suffering. Prison and mental institutions are common stops en route to the addict’s final resting place. These places can provide a last opportunity for the addict to discover the depths to which he or she has spiraled. As long as life remains, though, recovery is possible.
I struggled with the challenge of how to present the following story, for it graphically illustrates how appalling and destructive addiction is. However, the story of recovery and the hope it offers cannot be told without telling the story of the horror living in active addiction often brings. What is shared here is unsettling and tragic. Unfortunately, this exemplifies the true nature of addiction.
The next story from one recovering addict will be difficult to read, but it captures the horror of what this devastating disease can lead a person to do.
SECOND CHANCE
My name is Frank, and I am an addict. I am clean and have been in recovery for twenty-one years.
Writing this is bittersweet. It entails recalling the two most painful circumstances I have ever experienced. In fact, even as I write, my grieving process is less than thirty days old, which makes it all the more difficult. But I have a story I think needs telling.
