Addressing addiction Part II - How people get hooked

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The following is the second part of a series on the opioid addiction epidemic, which delves into the psychology behind addiction and today’s cultural environment that cultivates it.

There is no broad brush that can paint a clear picture of addiction in Rhode Island, or any community in the world for that matter. The path to substance abuse is different for every person, and likewise the severity of that dependence and the ultimate triumph over – or succumbing to – the illness relies on a variety of factors.

This is not to say, however, that we know nothing about the physical and mental angles of addiction, or that we cannot glean understanding from common patterns of behavior.

While the brain still contains a host of mysteries, we have come to learn about how the brain’s “pleasure center,” the nucleus accumbens, gets flooded with the “feel-good” chemical dopamine following the use of addictive drugs. The brain’s memory center, the hippocampus, then stores this intense feeling of joy in your brain and the prefrontal cortex, the part of the brain that drives us to action, is likewise affected.

As a result, addictive drugs provide a powerful rush of euphoria, which we become hardwired to remember, even if there was a hangover or a period of nastiness after the effects of the drug wear off, and then we are driven to seek out that source of pleasure again. In some people, this drive is stronger than others. In a certain percentage of people, this drive is incessant – a trait which has proven to be genetic in nature – and an addiction forms.

For the experts who study addiction and try to help rescue people from its grips, these facts mean two things. They are dealing with people suffering from a serious, often genetically predisposed illness, and there are no two cases that are alike.

“Addiction is a physical, emotional, mental and spiritual illness,” said Peter Greenberg, a former addict turned psychotherapist who has been working with those suffering from addiction since 1990, from his office in Cranston. “If we look at the word ‘disease,’ the Greek origin of that word is, ‘ill at ease with self.’

Greenberg said that there is no foolproof way of being able to interpret when that switch towards destructive behavior will be turned on – or when the wick will be lit, as he described it – because every person is different.

“Nobody knows when the cucumber changes to a pickle,” he said. “All we know is that once you’re a pickle you don’t go back to being a cucumber. We can all expose ourselves and put ourselves in the marinade, and those with a strong genetic predisposition will pickle quicker than somebody else that doesn’t. Addiction is a universal human experience but it’s all relative to each individual.”

A cultural conundrum

While the beginnings of addictive behavior, to an extent, can be tacked down as a genetic issue, societal implications of creating and worsening addiction are also apparent.

Greenberg said that people are exposed to risk factors for possible addiction later in life all the time – such as watching adult figures in their life casually drinking alcohol while they are children – and that society can reinforce toxic beliefs that drugs, like alcohol, are a normal and necessary aspect of socializing.

“An 18-year-old might not feel elated that he stopped [using drugs],” Greenberg said. “He might still feel excluded or some exclusionary kind of uneasiness from missing out on what the average beer commercial tells people, which says, ‘If you’re a young adult, then this is the way to feel at ease and socialize and to be happy.’”

Bob Houghtaling, director of the East Greenwich Drug Program, agreed that society can shoulder plenty of blame for the current epidemic.

“In the 60s my generation used drugs to rebel,” he said. “Now, this culture today uses drugs to comply.”

Houghtaling cited an over-reliance on prescription medication to solve mental maladies, coupled with an unprecedented era of technology causing a degradation in traditional social-emotional development methods, as two of the huge factors creating increased depression, solitude and addiction amongst younger generations.

“We’ve created a culture where there’s a pill for everything,” he said. “I think prescription meds have a place and I think they’ve done some wonderful things, but in lieu of or not augmented by viable counseling, I think that we’ve got to a point where we’ve created a generation of people who don’t know how to problem solve or how to interact with themselves and each other anymore.”

Compiling that problem, as seen in the news recently following an investigation by The Washington Post and 60 Minutes, is the nation’s major problems in the over-availability of opiate prescription medication. The investigation revealed that not only does corporate pharmaceutical lobbying have a serious effect on enforcement efforts, but many high-ranking attorneys that once worked for the DEA have now switched sides and begun working in defense of the drug companies they once pursued.

Tragically ironic and further harming efforts to curb the availability of opioids, the new head of the White House's Office of National Drug Control Policy, as named by President Trump, was also the architect of newly approved legislation that actually makes it harder for the DEA to crack down on and levy fines against pharmaceutical companies that overproduce addictive prescription drugs – Rep. Tom Marino of Pennsylvania.

There is also evidence to suggest that today’s rapidly-changing culture for kids, especially in regards to technology, is causing higher levels of anxiety and depression in teenagers – both conditions which lend to a higher likelihood of developing an addiction to whatever drug alleviates those feelings.

Houghtaling said that, while we are the same biologically and anatomically as human beings that lived 5,000 years ago, we have yet to adapt to what has become a drastically different world in just the last couple of decades in the advent of computers, the growth of the internet and socializing taking place more often in a virtual world rather than in face-to-face interactions.

“It’s almost existential in nature,” Houghtaling said. “Who am I? Where do I fit in? I think people have become so disassociated from talking to each other interpersonally and spending probably 50 percent of their time in cyber space...I think in some instances that has caused great anxiety and difficulties with problem solving skills.”

Cravings for inclusion

At the core of the issue, both experts maintain, is the will and desire for young people to belong to a group and be included.

“When people have to find a way to get that recognition and affection and inclusion in order to not feel excluded and feel a depletion of those feel-good chemicals, then they start to risk becoming more like a chameleon to fit in,” Greenberg said. “Very often, especially for younger people, it’s that inclusionary piece that is so driving for them unconsciously.”

Houghtaling said he tries to create a drug-free “Cheers, where everybody knows your name” within his Youth to Youth programs at the East Greenwich schools. His approach to preventing students from falling into patterns of addiction is three-pronged.

First, he said you have to enlist the kids themselves as resources and listen to their point of view. Second, he said he guides kids towards being peer leaders, so they can set an example for their fellow students and lastly, he creates opportunities where students belong and can create a subculture of support amongst themselves.

“Now you have a culture that supports you, understands your lingo...then they create a subculture that supports one another,” he said. “You’re actually trying to change cultural norms. Just giving a bunch of people facts and telling them not to do it or trying to scare the living daylights out of them by threatening them, you can’t threaten addictions away. You can’t threaten needs away.”

Both Houghtaling and Greenberg were encouraged by how society has become more understanding of addictive behavior, and how there is less reactionary anger towards people afflicted by the illness.

“I think it has improved. In the mid-80s...there was a stigma around addiction, like you were a deviant,” Greenberg said. “Back then there was a shame-based identification and sort of an ignorance of it, being that that person was just making poor choices for their self. Today there’s an education understandably that it’s an illness and it’s not a matter of choice...Obviously there’s some percentage of choice that’s factored in, but especially for some people who have that predisposition, once that wick gets lit the choice gets diminished.”

Still, there is much room for society to improve, which will be the focus for the next edition of the series.

“There almost has to be a philosophy of substance abuse,” Houghtaling said. “I don’t think we should do a quick fix solution to this. This goes so much further than just the mechanics of addiction.”

“For people in general to understand the concept of addiction, they have to realize we’re all susceptible,” Greenberg said. “We’re habitual beings, and when we have a biochemical alarm that goes off in our system once we set up that cycle, for some people it becomes absolutely hypnotic. And that’s where it changes from use, to abuse, to dependency.”

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