The Anatomy of Addiction (8 page)

A
mericans have a curious, inconsistent perspective on alcohol and drug addiction. Studies have shown that the majority of Americans now believe that genetics and biological factors play a role in the development of addiction. However, when asked about it in a different way, a recent survey revealed only 34 percent of American adults saw addiction as primarily a disease or a health problem.

It's tempting to blame an ill-informed public on this apparent contradiction, but even 43 percent of the physicians when polled said that alcoholism is primarily the result of a personal weakness or moral failing. But as a physician for five years in the ER at Los Angeles County General Hospital, treating the physical effects of lives ravaged by alcohol and drugs on a daily basis, I know that addiction is a serious disease that requires medical care.

Addiction contributes to more than seventy other conditions requiring medical attention. While each popular addictive drug differs in its effect on the body, there are overlapping medical consequences, including brain damage, psychiatric symptoms and syndromes (delusion, paranoia, anxiety, and depression), and physical symptoms from gastrointestinal (extreme stomachaches, terrible pain, and uncontrollable diarrhea and vomiting) to increased risk of hypertension, high blood pressure, heart disease, liver disease, various cancers, bone fractures, pancreatitis, pneumonia, hepatitis, kidney failure, ulcers, and urinary tract infections.

For women, addiction can result in the end of menstruation, miscarriages, and children with birth defects (more on the needless tragedy of fetal alcohol syndrome in Chapter 10). For men, addiction can result in shrunken testicles and impotency. But perhaps the most sobering statistics concerning the medical consequences of addiction is the heightened occurrence of suicide: Approximately 18 percent of alcoholics commit suicide and more than 50 percent of all suicides are associated with alcohol or drug dependence.

Neurological Impairment

All excessive behaviors have consequences. If people drink too much alcohol, they first lose coordination, and then their thinking gets screwed up. This is called
neurological impairment
. It is also called being really drunk.

Despite alcohol consumption being both socially acceptable and perfectly legal, it inflicts more damage and kills more people
than any other drug in the United States. Alcohol is the third leading cause of death because it attacks every vital organ system in the human body. Simply put, the list of medical problems directly related to immoderate use of alcohol is more than all other recreational drugs combined.

Alcohol may mix harmlessly in polite social settings where moderation and decorum are the established and observed standards, but alcoholism is something else entirely. Those who overindulge in alcohol often use other drugs as well, and that's a big problem. Alcohol does not mix well with anything else. For example, there is a potentially dangerous interaction between cocaine and alcohol. This mixture is the most common two-drug combination that results in drug-related death. Also, mixing alcohol and heroin may be the true reason for overdose deaths attributed to heroin.

I previously mentioned the various types of damage alcohol can do to your body. If you want a more detailed list of alcohol-related damage, here it is: high blood pressure, damage to the heart muscle, heart failure, strokes, severe thiamine deficiency, diabetes, pancreatitis, night blindness, pneumonia, dehydration, kidney failure, vitamin D deficiency leading to bone fractures, inflammation of the digestive system, ulcers, holes in the intestines or stomach, infections of the urinary tract, and, ultimately, death from alcohol poisoning, excessive intoxication, and organ malfunction.

I haven't even mentioned sexual problems (such as erectile dysfunction and impotence), cirrhosis of the liver, and long-term brain damage. Your liver can handle only one drink per hour.
Binge drinking is devastating to the liver. Between 10 and 35 percent of alcoholics have hepatitis or inflamed livers. Cirrhosis occurs when healthy liver cells become replaced by scar tissue. The damage can be so bad that the only treatment option is a liver transplant.

Alcohol slows your reactions, impairs your decision-making abilities, and makes performance of any task requiring accuracy pretty much a lost cause. Alcohol increases confidence but reduces performance. You do everything worse on alcohol, and everyone knows it except the person on alcohol.

Drinking alcohol in extreme weather conditions can be suicidal. Drinking to warm up in the freezing cold has the exact opposite effect. You think you are warmer because of increased blood flow at the surface of your skin, but you are actually losing heat quicker.

If you keep drinking when you have cirrhosis of the liver, you will most likely be dead within seven years. In the meantime, you can develop kidney failure and all kinds of disturbing brain disorders.

Brain Damage

Damage to the brain first shows up as headaches, blackouts, and numbness in the hands and feet. Keep on drinking and you can have permanent structural damage and premature aging. A thirty-five-year-old alcoholic may well have the shriveled up brain of a sick seventy-year-old.

You can tell when this brain destruction is going on. Between
45 and 70 percent of alcoholics do not perform well on tests of problem solving, abstract thinking, memory, and shifting concepts. About 10 percent have serious impairments.

As long as we're talking about brain damage, let's not ignore impairment to the entire central nervous system, which causes alcoholic blackouts, memory loss, seizures, convulsions, delusions, hallucinations, dementia, and violent behavior.

Psychiatric Problems

More than 40 percent of investigated alcoholics turn out to have one or more psychiatric conditions. Research also shows that out of the group of people with a psychiatric disorder, 28 percent suffer from alcohol dependence. So the question often asked is, What came first, the psychological problem or the alcohol problem?

Yes.

Alcohol and other drug use can
cause
psychiatric symptoms and
mimi
c psychiatric syndromes. Alcohol can cause delusion, auditory and visual hallucinations, anxiety, and depression. Some patients may experience auditory hallucinations for weeks or months after they stop drinking and are then misdiagnosed as schizophrenic.

According to a recent study, people with alcohol problems have psychiatric disorders almost twice as often as those who don't have alcohol problems. Drinking and drugging can initiate psychiatric disorders and make them worse. It can also
mask
psychiatric symptoms. Withdrawal can cause psychiatric symptoms and mimic symptoms.

It is also very possible for psychiatric disorders and alcohol and drug problems to exist independently of each other.

To make it even more complicated, psychiatric behaviors can be misinterpreted as drug and alcohol problems. This is one more strong argument for diagnosis by an addiction medicine specialist before initiating treatment as well as for a psychiatric evaluation.

Suicide in a Bottle

There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Approximately 18 percent of alcoholics commit suicide, and more than 50 percent of all suicides are associated with alcohol or drug dependence.

Because alcohol is not digested but absorbed directly through the lining of your mouth, throat, stomach, and intestines, it irritates these organs' linings. The result: gastrointestinal disease accompanied by horrid stomachaches, terrible pain, and uncontrollable diarrhea.

If alcoholics didn't already have enough problems, add being undernourished. That doesn't sound so bad until you realize it means your pancreas isn't going to work right. That makes more work for your liver. Your glucose levels are low, and that causes more brain damage.

If you're a guy, and you want shriveled, shrunken testicles and a nice set of man boobs, keep drinking. Your testosterone levels drop with excessive alcohol use, as does your sperm count. You won't have to worry about sex issues, because you will probably be impotent and unable to have sex anyway.

Female alcoholics often quit menstruating, begin early menopause, or menstruate without ovulation. If they get pregnant, they often miscarry. The babies who survive often suffer from fetal alcohol syndrome.

Other Addictive Substances

Although alcohol is the most destructive and dangerous of all social and recreational intoxicants, there are medical dangers in the misuse of even a benign medication.

OPIOIDS

Pain is one of the most common reasons people consult a physician. The most effective pain relief is from opioid analgesics—narcotic painkillers.

Medications that fall within this class include hydrocodone (for example, Vicodin), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza), and codeine. Heroin, which was once prescribed as a painkiller, is the most widely used illicit opioid.

You may become physically dependent on painkillers if you take them regularly, but physical dependence is not the disease of addiction. If you stop taking them abruptly, you may develop nausea, sweating, chills, diarrhea, and shaking. When people take these medications for pleasure instead of pain reduction, there is a heightened risk of the disease of addiction.

The FDA estimates that more than 33 million Americans aged twelve and older misused extended-release and long-acting
opioids during 2007—up from 29 million just five years earlier. And in 2006, nearly 50,000 emergency room visits were related to opioids.

According to former FDA commissioner Margaret A. Hamburg, “Opioid drugs have benefit when used properly and are a necessary component of pain management for certain patients, but we know that they pose serious risks when used improperly—with serious negative consequences for individuals, families, and communities.”

Heroin was synonymous with rock-n-roll, and heroin overdoses were involved in the deaths of such musical luminaries as Tim Buckley, Kurt Cobain, Janis Joplin, Jim Morrison, and Sid Vicious. Like any street drug, heroin is dangerous by virtue of the fact that it is not regulated. If anything, the drug is more dangerous than at the height of the hippie drug culture of the 1960s and 1970s. Joplin likely overdosed on heroin that was 3 to 5 percent pure. Today's ultrapure smack can be 95 percent heroin. There's no evidence that actor Philip Seymour Hoffman's death by heroin overdose in 2014 was related to a suicide. It was ruled accidental in that he simply took too high of a dose of heroin.

However, contrary to public opinion, taking multiple regulated prescription painkillers in relatively low doses does not safeguard the user. Like Hoffman, Oscar-nominated actor Heath Ledger died of an opioid overdose, but the poison of his choice was a dizzying array of prescription pills. His autopsy showed that he didn't die from a large dose of any one drug (like Hoffman's overdose of heroin) but rather the cumulative effect of simultaneous and relative small doses of oxycodone, hydrocodone, alprazolam,
diazepam, temazepam, and doxylamine. Taken together, they proved to be a fatal drug cocktail.

STIMULANTS

Cocaine is a stimulant, as is caffeine. Obviously, cocaine is stronger. Amphetamines are also stimulants and have proper medical uses. Methamphetamine, stronger yet, also is used medicinally. Recent studies show promise in using methamphetamine in the treatment of various conditions, including Alzheimer's disease. Amphetamines are prescribed appropriately and safely for children as young as six years of age without ill effect. As with all medicines, appropriate use for a specific condition is beneficial. Misuse and abuse, however, cause all manner of problems.

When stimulants are taken in excess for recreation, the consequences can be delusions, anxiety, hypertension, seizures, stroke, arrhythmia, chest pain, heart attack, and hyperthermia. Long-term meth misuse can cause extreme psychosis similar to schizophrenia.

There's the misguided idea that cocaine addiction is somehow easier to control than other drugs. It's not. The deaths of John Belushi, Whitney Houston, and Robin Williams are all associated directly or indirectly with the drug.

Cocaine abuse is also associated with numerous detrimental health effects. Ten cocaine-induced psychiatric disorders are described in the
Diagnostic and Statistical Manual of Mental Disorders
, all of them the result of continued excessive indulgence.

COKE BUGS

Coke bugs, meth mites, and speed bugs are common names used for the delusion that there are bugs crawling on your skin, under your skin, or infesting your clothing, furniture, or even your pets. Amphetamines, methamphetamine, and/or cocaine can cause the physical sensation known as
formication
, which, when combined with the seeking, searching, and exploring behavior that is symptomatic of stimulant overuse, gives rise to the false belief of infestation and parasitic insect activity. The obsession over or observation of nonexistent bugs is called
parasitosis
.

With cocaine and methamphetamine, this phenomenon occurs because the human body can't digest the hazardous additives, or “cut,” that were mixed in to increase the seller's profit margin. The body forces these toxic substances out through the pores, causing sores, acne, and chronic scratching.

Stimulants also cause your body temperature to go up, and you begin to perspire heavily. When the sweat evaporates, it removes the skin's protective oils. The combined effects of sweating, lack of protective oils, and dehydration creates a sensation that feels like something irritating or crawling on or under the skin (delusional parasitosis).

This phenomenon was first noted in the 1890s and has been observed in all decades subsequently. In addition, people suffering from stimulant overuse find their attention directed to raised follicles or small irregularities in the skin, and they pick or pluck at these until they have numerous scars and lesions.