MOST AREN'T TREATED FOR ILLNESS, DOCTORS SAY

For doctors, an addiction is an illness.

It comes with identifiable symptoms like an illness and it responds to
specified and well-documented treatments like an illness. And it also
comes with a strong genetic component.

"Addiction is a broad spectrum illness," says Victoria addiction
specialist Dr. Chris Fraser, medical director of the Cool Aid
Community Health Centre on Johnson Street. "It is analogous to cancer
in terms of the varieties and heterogeneity of causes and
heterogeneity of treatment approaches."

Medically speaking, he says, addiction can be regarded as a disorder
of the functioning of the brain. The substance's mood-altering
properties hijack the brain's ability to discriminate and make sound
choices.

"The choice to use a substance is lost and it becomes a compulsion,"
says Fraser. "We speak in addiction medicine of the Cs of addiction:
The Compulsiveness of it, the loss of Control over it, the
Consequences of it."

And those consequences -loss of career, family, health and dignity
- -will worsen as the illness progresses, making treatment more difficult.

Unfortunately, most people suffering don't get treatment, says Dr. Mel
Vincent, director of psychiatric services for the Edgewood, a private
treatment centre in Nanaimo.

They just get sicker and sicker.

"They may not even realize they have a problem -denial being what it
is. Most addicts hope that they can change it, or think at some point
they'll get it under control, but they keep going until some crisis
comes along that is the wake-up call. They lose a job. The wife
leaves. They're bankrupt. They get charged legally or something
happens and they say: 'Whoa! Hold it we have a problem here,' "
Vincent says.

"Before that they continue to get sicker and sicker and sicker, and
their denial goes up in parallel with that so they actually have a
blind spot for how sick they are actually becoming."

Often they aren't the only ones in denial.

If a man is diagnosed with multiple sclerosis or cancer, his spouse
might turn to neighbours for help and support. With alcoholism or
addiction, however, the spouse would more likely keep it a secret,
says Neal Berger, executive director of the private Cedars treatment
facility in Cobble Hill.

The reaction is not necessarily unjustified.

In its national report card on health care in 2008, the Canadian
Medical Association cited survey results that only 32 per cent of
Canadians say they would be likely to socialize with a friend who has
an alcohol addiction; that falls to 26 per cent for a drug addiction.
Only four per cent would hire someone who has an alcohol addiction,
and only two per cent would hire someone with a known drug addiction.

Yet, as Berger points out: "No one that I knew ever decided to be an
alcoholic or to develop an addiction disorder."

According to the B.C. Medical Association and the Canadian Centre for
Addiction and Mental Health, people usually develop an addiction due
to factors such as genetics, health, the age of first use, family
history and social network.

These people find the behaviour of consuming alcohol or doing drugs
extremely rewarding -perhap for the excitement or the pleasure, or
perhaps to numb them to other physical or emotional suffering.

Fraser says he often sees street-level substance abusers, people who
have lost everything and live from hand to mouth. A diagnosis of
addiction is easy for these people, but the treatment will often be
hugely complex.

Fraser said severe addicts who have been abusing substances for
several years are probably abusing more than one substance. They also
have a high risk of other chronic illnesses, such as hepatitis C,
transmitted though sharing needles. And if they are living on the
street or close to it, they will not have supportive families or friends.

Street-level addicts are also more likely to have mental illnesses,
such as bipolar disorder, which will require diagnosis and treatment.
Schizophrenics, for example, can often be easy victims for stimulant
substances like cocaine or methamphetamine.

Meanwhile, addicts in the middle-class or with high incomes can be
much more difficult to diagnose, although ultimately easier to treat,
says Fraser. These addicts are more adept at hiding or disguising an
addiction, but then show up at the doctor's office with
gastro-intestinal disorders.

High-functioning addicts are typically habitual abusers of alcohol or
marijuana.

"It's a rare early morning jogger or exerciser in the city of Victoria
who hasn't smelled cannabis coming off the cars of construction
workers who are headed for the trade sites," says Fraser. "Anybody who
uses cannabis at 8 a.m. as their 'get you going' is definitely showing
signs of addiction."

Higher income addicts, once diagnosed, are motivated to get help. They
have more to lose in terms of income and social status, and they tend
to have better support systems and fewer social problems.

"They often have access to paid counselling, paid treatment and
recovery programs; they have supportive family members, supportive
partners, children," says Fraser. "They have people who are going to
be there and take the extra steps and extra efforts."

B.C. has far more middle-class addicts than street-level
ones.

The 2009 B.C. Medical Association report, Stepping Forward: Improving
Addiction Care in British Columbia, said about 400,000 British Columbians
have some form of substance addiction or dependence problem, not including
tobacco. Estimates peg B.C.'s homeless population at about 12,000 people.

Of the 400,000, only about 33,000 have a serious dependence on illicit
drugs. Most suffer from a dependence on alcohol -and our use of
alcohol seems to be rising.

In 2008, the provincial health officer estimated health and
enforcement costs exceeded revenues from alcohol sales by $61 million
in 2002-03. That report showed consumption had increased about eight
per cent since 2002, with consumption rates growing in particular on
Vancouver Island and in the Interior.

Still, the percentage of those with a substance dependence seems to be
holding steady, says Rob DeClark, director of programming for Cedars.

A disturbing trend, however, is the younger age of people with
addiction issues.

"What we're seeing now is earlier onset. We're getting phone calls now
about 14-, 15-, 16-year-olds who have been using hard drugs for three
years," DeClark says.

bcleverley@timescolonist.com rwatts@timescolonist.com

THE SERIES

Sunday

Public vs. private treatment: If ever there's been a clear example of
two-tiered health care in B.C., it's in treating alcoholism and drug
addiction.

Tuesday

The rise of harm reduction: From a safe injection site in Vancouver's
Downtown Eastside to Victoria's former troubled needle exchange on
Cormorant Street.