Monday, November 28, 2005

Is Addiction Real?

Bill Quick at The Daily Pundit has posted my latest article on the subject of addiction. Bill also has a link to this related article at LGF. I will post the full article that Bill has put up later today or early tomorrow.

And thanks Bill for the exposure.

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Is addiction real? A very interesting question.I think there is an answer to that question. Obviously I think the answer is not in the affirmative. Why? Well there in lies a tale.

For me it started with Dr. Lonnie Shavelson. In July of 2001 I read a review of his book "Hooked" and learned some things. One of the things I learned was that in his sample of female heroin users 70% were sexually molested before they started heroin use. He also found that male heroin users were 25 to 50 times more likely to have been sexually abused than the general population. I wrote an article on the subject. Heroin. What I suggested in that article was that a large number of heroin users were taking the drug for relief from severe PTSD.

The next piece of the puzzle came to me in November of 2002 when I read this report done on the CB1 receptor in mice. A cannabinoid receptor also found in human brains. The report showed that fear memories which seem to be mediated by the CB1 receptors decay at different rates depending on genetics. I wrote this review of that report: Addiction or Self Medication? What I figured out from the report is that the reason drugs are addictive (long term use) for some and not others was based on genetics. A very big key to the puzzle of addiction. In the past the fact that some get addicted and others do not was ascribed to the "addictive personality". Now no one could tell you what an addictive personality was. It couldn't be defined. So in fact it was mumbo jumbo. I now had another piece of the puzzle. However twin studies showed that genetics only accounted for 50% of the cause for addiction. What was the other 50%? Pretty obvious from Dr. Shavelson's report. Trauma.

Well that lead me to look deeper into the genetics aspect. I wrote an article Genetic Discrimination which goes into some of the genes involved in tobacco addiction and marijuana addiction. It turns out that the genes involved in tobacco addiction vary by race. It also turns out that some people do not produce enough cannabinoids to feel normal. Again the idea that genetics only accounts for 50% of addiction (in this case to pot) comes up.

Looking further into the opiate question I looked into endorphins, the body's natural heroin, and how the body produces them. Sex, food, and exercise. And of course we know about sex junkis, food junkies, and even exercise junkies.I wrote about that in an article called Big Mac Heroin Attack.

What about stimulants? Stimulants seem to work well for people with ADD/ADHD problems. Of course this has got the pharma folks in full hue and cry mode against street drugs.

The War On Unpatented Drugs

To sum up:
1. We now kow that severe PTSD may be the cause of 70% or more of heroin use.
2. We know that there is a genetic connection.
3. We know there is a trauma connection.
4. We know that stimulants treat a different class of problems than opiates

What I have done is come up with a hypothesis that fits the facts. Why some people and not others are susceptable to addiction (as opposed to habituation which we know how to treat: Detox). Surprisingly this is a Well Known Secret in some segments of the medical community.

What we do not know is the true extent of the problem. Exactly how much of what we call addiction is due trauma/genetics? We don't know the answer because the problem is not being studied in any systematic way. We have the most information on pot/PTSD and stimulants/ADD-ADHD. A very few studies on opiates. Most studies so far have been anecdotal rather than statistical. The reason in my opinion is that there is no research money out there to make a statistical study of the self medication hypothesis. Such studies would be very expensive if they included DNA work ups and extensive interviews.

Self medication appears to be a very lage part of our "addiction" problem. In fact we may not even have an addiction problem. What we may have is seriously undertreated population with various mental problems caused by imbalances in the brain.

What is needed is more research. The only way we will get that any time soon is to pressure the government.Obviously the drug companies have no interest in finding out what addiction is because it will impact their bottom line if people take drugs for Problem Solving. In fact there are a lot of actors in this farce who would stand to lose big if such a study showed what I expect it might. The only folks to be benefitted would be "addicts". And they don't have much of a lobby in Washington.

I have also written about soldiers/police and PTSD here:

The Soldiers Disease
Aftermath
A test for PTSD
Police and PTSD

And if you go to my sidebar I have lots of other links to articles on the subject.

21 comments:

Mahndisa S. Rigmaiden said...

11 29 05

Hey M. Simon: I will highlight this post for my blogwatch section tmw. Thx, as usual for providing us with your insight:) Have a nice day:)

Hoots said...

Very good summary post. I blogged it this morning. You may not get any hits from me because my traffic is so small,* but I personally am impressed with your work.
(*To me the handfull of readers I have are the most informed and erudite anywhere. They make up in brains for being few in number.)

Mover Mike said...

the first of the 12 steps of AA is "We admitted we were powerless over alcohol--that our lives had become unmanageable." We interpret "powerless" as addicted. If I am not addicted then maybe I am cured. Maybe I'll go test this thory of Power and Control and let you know if I am addicted.
Mover Mike

M. Simon said...

mike,

The question is:

do you have power over your pain?

If you are in pain should you be denied relief?

BTW a favorite of the AA crowd is tobacco. Tobacco is an anti-depressant.

Mover Mike said...

RE: "I learned was that in his sample of female heroin users 70% were sexually molested before they started heroin use."
James Frey in his excellent book A Million Little Pieces writes about Lily a girl of 13 who was sold into prostitution by her mother, a heroin addict, and then addicted to heroin by her mother. Does this qualify as sexually molested. Does it really matter how they were addicted, just as long as they were addicted? You are arguing that it is not a disease because of the trauma. But that doesn't take away from the fact that alcohol and drug addiction are progressive diseases. Does it matter that Maleria which is a disease wouldn't have affected anyone if it weren't for the mosquito. It is still a disease.

M. Simon said...

"Addiction" is a disease caused by trauma. To those genetically susceptible the trauma gets embedded in the brain and becomes disabling.

The question then becomes: if pain relief improves such people's functioning should it be denied them?

Suppose tthe trauma is "legitimate" i.e. from warfare. In the 1800s war induced alcoholism was recognized as a legitimate response to the trauma of war.

The "new morality" defines such pain relief as illegitimate.

I don't think that is an improvement.

In fact our current system persecutes the traumatized. The new morality in actiion.

In the case of alcoholism, doctors used to try to move such people to cannabis which was much less debilitating. After 1937 such treatment was illegal. We have come a long way. Not necessisarily in a good direction.

I do understand your idea that sufferers of PTSD and such do not deserve relief through drugs if no other relief is possible. After all addiction is worse than pain in our culture. In fact we would prefer the sufferers of extreme pain suicide rather than become chronic drug users. That is because we are a kind hearted Christian nation.

Gibbie the labrat said...

Addiction is either chemical or pyschological. Has anyone who has posted here been addicted to anything? I have, it's real. Most drugs aim to cover up underlying trauma, whatever the cause. The revelations here are not new at all and indeed are a foundation of modern psychological treatment. I encourge those interested in the subject to talk to psychologists about the issue.

M. Simon said...

Gibbie,

We know how to treat "chemical" addiction. It is called detox.

What we do not know how to do is to erase the underlying trauma from the brain. The "psychological" addiction part.

And if the psychology is so well known why are we still punishing users and their suppliers.

infinitepi said...

Great article, very well thought and you make a good point.
"The question then becomes: if pain relief improves such people's functioning should it be denied them?"
It shouldn't be denied to them, but take this example.
A guy with rapid cycling bi-polar disorder finds that when he smokes pot, he feels better, more stable. Though some would say medication can have the smae effect, but the guy doesn't like the idea of taking pills every day.
"The "new morality" defines such pain relief as illegitimate."
I agree, but I think there is more to the reason. I don't want to sound like a conspiracy nut, but the pharmacudical industry has a vested interest in people not self-medicating. If theey self-medicate, they probably won't buy as many pills.
I think most of the countries health problems could be solved if we could get the industry to realize it should not be an industry. I think it's revolting the way the hospitals, insurance and drug companies can rake in such huge amounts of money, and still tell us they are here to help us. They are only concerned with the bottum line and any way they can increase profits.

Anonymous said...

I want to ask if this trauma-originated addiction to heroin also could apply to marihuana or is marihuana more of a estabilizer or antidepressent substance to someone like a bipolar person, greetings from Mexico

M. Simon said...

Anon from Mexico,

Yes.

Look at Is Addiction Real?

also

PTSD and the Endocannabinoid System

I love Mexico. I spent some great times in the village across from Hautla up the hill from Puento Fiero in the Oaxaca mountains. The name excapes me at this time. And Mexico City, the Natural History Museum is great.

M. Simon said...

San Ysidro was the name of the village. I think.

A Jacksonian said...

I cannot speak to addiction, although I am more on the personal accountability side for use and abuse. I really don't care what harm you do to yourself with these things, so long as you do not put others at danger while under the influence of them. What really gets me is that a number of medications have actual, real utility, and then were moved into the prohibited Schedules because of abusers. Really, the Government shouldn't be telling me what to do with my body so long as I am not endangering society or other individuals in that doing. Drug use and abuse prior to the 20th century was relatively widespread with opiates and morphine, but that was also a distinctly gender biased affair with men preferring alcohol over those other drugs. The amount men drank in that period, especially hard liquor, was prodigious. Morphine use by those wounded in the Civil War and the rather crude surgery of the day was more necessity than addiction. The shift to addiction is problematical, as society still seemed to have gotten along with it, adjusted to it and otherwise only noted a modicum of social ills due to it. The Interstate Regulatory power was pushed for taxation and licensing and has gone far beyond that realm to pharmaceutical regulation for what one does on one's own property at no cost to society. And all Prohibition did was give a hefty kick start to organized crime to let it grow into other areas. Somehow that cure was worse than the disease for both of these, but that is my opinion only.

I cannot speak much for addiction as it is a multi-variate problem with underlying systemic concerns. Addiction to pleasure, as in gambling, is also well known, as the low and highs of that are driven by the body's own system and looking for the 'next high' becomes a quest on its own. It is a habituation to addiction, but the underlying physiology must be amenable for that habituation to take hold as an addiction. So addiction just to the way one's brain operates, at a biochemical level, is also well within the scope of this, although some things tend to diminish the actual term 'addiction' when applied to much broader categories. Basically we have yet to quantify the interaction of behavior, personality, temperament and biochemistry enough to call it a science. Until someone is willing to put hard fast and measurable means against those, actual understanding and diagnosis will remain more of an 14th century art than a 21st century science.

Coming from another part of those needing medications on a daily basis for physiological survival, I can say that I have *never* been impressed with the pharmaceutical industry, its outlooks, its procedures nor its stringing individuals on with overblown progress which just, somehow, never pans out.

But then, I do have strange thoughts.

Anonymous said...

I was a heavy user of hard drugs for a long time, and know many people in the situation. Having some sort of unpleasant past or fractured personality was an almost universal factor- long before most of these people ever started using drugs- physical detox fails because leaves underlying psychological factors intact (in many cases I don't think people can ever really be "cured" anyway). The war on drugs has made criminals people who are mostly either looking for relaxation/stress relief, or escaping some form of psychic torment.
oh- Literally every female junkie I've met had either been raped or molested.

fu said...

As a survivor of childhood sexual abuse, I am living proof that Opiates soothe the effects of PTSD. I have seen this effect in several other people. It's a shame that Those in chronic pain are denied pain relief, me being one of them. Although I am not some scientific researcher, rather a college junior, I do believe there is a link between pain tolerance and past trauma. I am certain that mental pain manifests itself as physical pain. The term "addiction" is too loose. They say someone who "needs" these meds is addicted. Well what about someone who "needs" their insulin or high blood pressure meds?How is that any different? Just because the so-called junkie is not going to die without the Opiates does not mean his quality of life will not suffer. S/he will just go to the "street" where it is easier and less degrading to obtain relief. Alcohol, in my opinion, should be outlawed. But it is also a popular self medicating technique, used to dull physical and mental pain. Because alcohol is legal, it is viewed as acceptable. However, more accidents, domestic disputes, and crimes are committed as a result of alcohol use. Opiates are catching up though, probably because too many people are hearing "there's not enough narcotics in the world to take care of your pain", as I hear from my jerk of a doctor. Well I beg to differ! I know there's plenty. The study of addiction is a fascinating topic. There is little we actually know about it and some things are more or less from a jaded opinion. I really think we should take a hint from places like Amsterdam, where they don't care. You can get what ever you want there, and I do believe their crime rate is lower. They don't have people attempting to rob a pharmacy with a hammer, like some desperate soul close to where I live did. To tell people that their pain is not legitimate is not only wrong, it's unethical.

J-BoyOnTop said...

M. Simon, I believe you're correct in your description of what addiction really is, however, your method of treating addiction is off. Sure, addiction is a result of pain, and it's possible there are genetic susceptibilities that make some's trauma get stored in the brain in the form of what you call mental problems. However, the answer to this pain relief can't really be continued drug use? Is that really the point you're trying to make!? I think the only solution is to quit drugs and try to make sense of the pain, and walk through it...hopefully changing your brain chemistry along the way, as much as that's possible that is. You are right about the sick AA'ers, though. That organization has become a sad mockery of itself...full of many of the most screwed up people I've ever met. There are shining stars in the mix, but discerning them amongst the mix of the others is difficult...and to be one of them amongst all the bad in that organization is even more difficult. Also, yeah, cigarettes are an antidepressant for some people, a nasty habit for others, but regardless, they are detrimental, especially to people who want to be in sobriety.

M. Simon said...

J-Boy,

Of course you treat pain with pain relievers.

If you lack insulin you get prescribed insulin. If you have an endorphin deficiency heroin makes a pretty good substitute.

See we have irrational phobias in America. Against pleasure. And pain relief is very pleasurable.

It really is a class war thing.

Class War

Treatment vs Recreation

Round Pegs In Round Holes

The upper classes can be trusted with pain relief. The lower classes only deserve pain.

And here is a bit of science for you:

PTSD and the Endocannabinoid System

Especially read the Max Planck Institute link in the above.

M. Simon said...

Here is something else that might interest you:

Schizophrenia and Tobacco
Schizophrenia and Tobacco

Really. We have an irrational fear of non-doctor prescribed psychoactive drugs in America. Taboos and superstitions. You would think we were some long lost jungle tribe instead of civilized rational humans.

BTW that irrational stuff is another function of the amygdala.

J-BoyOnTop said...

M. Simon, I see your point but pain relievers are not a cure but a cover up. They help mask the true problem and create a lot of other problems, as well. We can't all function on drugs.

M. Simon said...

Can you point to a cure for pain embedded in the amygdala? I must have missed it.

BTW I don't think you read the links I provided.

But tell you what. You should take no pain relievers the rest of your life. Because they are not a cure for pain just a cover up. Surgery without pain relievers. Dental work without pain relievers. Get bones set without pain relievers. etc. Stop covering up your pain. Do not let pain deter you from living a normal life under any circumstances.

It sounds to me like you are a victim of "therapy".

If the pain is severe enough to impair function Western medicine is REQUIRED to provide pain relief. Excepting pain embedded in the brain. When in which case you deserve to suffer unless you can afford the doctor and pharmacy fees.

Here:

Read this and the Max Planck Institute link provided and then comment there so I have proof you read it. I'm not going to reply further otherwise.

PTSD and the Endocannabinoid System

M. Simon said...

People function on drugs all the time. Long term anti-depressant use is considered a blessing. At least by those that benefit from them.

I don't know where you are getting your information (I have my suspicions) but, you sound like a typically misinformed American.

Living in fear is not conducive to top performance. Anti-depressants help.