ADDICTION IS A DISEASE, NOT A MORAL LAPSE

For all that has been written and spoken about addiction as a medical
disease, most people, including most physicians, understand little about
what draws people to drugs and keeps them hooked, often despite severe
consequences and repeated attempts to quit.

A better understanding of the pull and tug of addiction can help those who
are hooked and those who want the monkey off their backs for good.

The savings in human life, quality of life and lost income can be huge, not
to mention the costs of drug-instigated crime and medical care.

According to the National Institute on Drug Abuse, $133 billion a year is
spent just on treating the short-term and long-term medical complications of
addiction.

Among the many health consequences of addictions are sudden cardiac arrest,
irreversible kidney and liver damage, AIDS, fetal harm and many cancers,
including cancers of the lung, bladder, breast, pancreas, larynx and liver.

That it is possible to become free of addictions and remain so is
unquestioned.

Seeking Definitions

The nature of addiction is the same no matter whether the drug is cocaine,
heroin, alcohol, marijuana, amphetamines or nicotine.

Every addictive substance, according to a report this month in The New
England Journal of Medicine, induces pleasant states or relieves distress.

Furthermore, the authors of the report, Dr. Jordi Cami and Dr. Magi Farre of
Barcelona, Spain, wrote, "Continued use induces adaptive changes in the
central nervous system that lead to tolerance, physical dependence,
sensitization, craving and relapse."

In other words, addiction is a brain disease, not a moral failing or
behavior problem.

Of course, not everyone who smokes a cigarette, be it tobacco or marijuana,
takes a drink, or snorts cocaine is destined to become an addict.

Most drinkers, for example, know when to stop before they become intoxicated
or tolerant to large amounts of alcohol.

Still others may be protected by their genes. Most Asians, for example,
carry a gene that makes them physically ill and flushed before they can
consume an addicting amount of alcohol.

But genes can work two ways. The risk of addiction can be inherited. The
genetics of alcoholism have been well-studied, and heredity accounts for
about 40 percent of the risk, though it is unclear whether what is inherited
is an underlying emotional disorder that drives people to seek relief or a
particular physiological reaction to addictive substances that gets them
easily hooked.

According to the Institute of Medicine of the National Academy of Science,
32 percent of people who try tobacco become dependent, as do 23 percent of
those who try heroin, 17 percent who try cocaine, 15 percent who try alcohol
and 9 percent who try marijuana.

Changing The Brain

In a recent article in The Journal of the American Medical Association,
Brian Vastag wrote, "The brain changes during addiction."

Vastag explained that the drugs in question activated a pleasure pathway in
the brain, the "dopamine reward circuit," which is connected to areas that
control memory, emotion and motivation. Any activity that activates those
pathways reinforces the pleasurable behavior.

By repeatedly supplying the body with the substance, a new state of "normal"
is created, causing the person to continue using it to feel normal.

The changes in the brain, though not permanent, can be long lasting. The
dopamine system of cocaine users remained impaired for up to three months
after the last snort.

And despite years of abstinence, former addicts may experience intense
cravings when they are exposed to certain cues, such as drug use by a movie
character.

Preventing Relapse

For someone who used drugs to relieve an emotional problem or psychiatric
disorder that was not otherwise treated, the temptation to revert to the
assuaging drug can be irresistible. Without follow-up treatment for the
addictive disorder and the underlying mental illness, the chances of a
lasting recovery from addiction may be slim.

Further, there is clearly not one route to recovery. Some addicts manage to
kick their habits without outside help; others require inpatient programs
and continued reinforcement. Still others may need a year of outpatient
treatment plus aftercare.

Many former addicts find that support groups such as Alcoholics Anonymous
and Narcotics Anonymous help them maintain their drug-free status.

Because prolonged exposure to abused drugs results in long-lasting changes
in the brain, "addiction should be considered a chronic medical illness,"
the Barcelona scientists said.

As with other chronic illnesses, including hypertension and diabetes,
addiction and its treatment require "long-term strategies based on
medication, psychological support and continued monitoring," they concluded.
Experts also say treatment of addiction should be fully insured.