Addiction is a very old problem, with serious consequences for society, and for individuals too. The compulsion caused by chemical slavery is so bad that crackheads will sell their bodies to get a little rock the color of toenail fungus. They’re not all from bad neighborhoods; some came from nice families and made a dumb mistake. Men will do that too; that Less Than Zero stuff is for real. I’ve never smoked Satan’s boogers; I’d rather drop a cinderblock on my foot. However, I had a dream about it once, and it was like confronting an evil spirit.
Modern science gives us a better idea of what’s going on, but treating it has been a frustrating pursuit. There are drug therapies out there – good pills to get over bad pills, essentially. Still, it’s been pretty well demonstrated that an opiate is an opiate. Certain antidepressants might help recovering addicts, though they’re not perfect and can have undesired side effects of their own. Ultimately, so far there’s no silver bullet, and perhaps there never will be.
The traditional focus has been on chemical addictions, which have been documented since the ancient Greeks, if not longer. Then there are the behavioral addictions which have received much more attention in modern times. Here’s what we do know at least.
The way mood-altering drugs work is by changing the activity of neurotransmitters. The big three are serotonin, norepinephrine, and dopamine. Some drugs bind to one or more of these receptors, imitating the natural chemicals already floating around in the synapses. Others inhibit the reuptake of these neurotransmitters, which increases the amounts existing in these connections between the brain cells. Some do both; for instance, cocaine is a dopamine agonist and also inhibits its reuptake. (It’s all fun and games until you’re feeling invisible spiders crawling all over you.) There are also cannabinoid receptors and opioid receptors, which God or evolution put there for unknown reasons. Alcohol, benzodiazepines (Valium, Xanax, etc.), and barbiturates operate on the GABA receptors.
So effectively this temporarily raises the wattage in these neural circuits. These various neurotransmitters do different things, which is why getting drunk is a different high than getting stoned, etc. If these drugs are taken regularly, then homeostasis kicks in, and the brain starts producing less of its own natural neurotransmitters. That’s what gets people hooked. This means that when addicts go cold turkey, they feel terrible until the homeostasis process starts increasing natural neurotransmitters to normal levels again.
Unfortunately, this doesn’t happen overnight. For example, it takes two or three weeks of constant opioid use to get hooked. After discontinuation, withdrawal symptoms will slowly subside at the same rate. The Viet Cong therapy for heroin addicts was pretty effective, which involved tossing them into an oubliette for three weeks. That’s a lot faster than a methadone taper-down program, and being put in a hole in the ground surely wouldn’t easily be forgotten.
So that’s how drug tolerance sets in, and eventually addiction. It’s been said that the first time someone sniffs coke will be the best high he or she ever gets from it. After that, cokeheads are simply trying to re-create the experience with increasing quantities. It becomes a perceived need, like hunger and thirst, which the user never had before.
Another factor is downregulation. Unnaturally elevated levels of neurotransmitters will make their receptors less sensitive. When an addict isn’t high, the natural neurotransmitters are at a reduced level, and what little is there is has become less effective. That’s why addicts deprived of their drug of choice will feel like chewing gum on the bottom of a shoe. This is usually reversible with time, but not always.
Eventually, hardcore cocaine addicts (and abusers of other substances that affect dopamine) may develop anhedonia, the inability to experience pleasure. At the extreme, they even can fry their dopamine system entirely and develop Parkinson’s. All throughout, death by overdose is a real possibility. (All these are more reasons why cocaine dealers and smugglers deserve to be taken out and shot.) Finally, some drugs cause outright brain damage, like meth or inhalants. MDMA (Ecstasy) burns out synapses, a process that begins pretty quickly. That’s the reason they get “e-tarded”. Why do you think they call it dope?
Other than getting a chemical high, there are behavioral ways that people modulate their neurotransmitters to produce thrilling or otherwise pleasurable feelings. This is why people ride roller coasters, chow down on food, and (of course) get laid. What could be more natural than that? I’ve tried skydiving once; it was a pretty rattling experience, but afterward I wondered why anyone would stick a needle in his arm when he could jump out of a plane instead.
Still, excess is a danger, a fact known to ancient Greek, Chinese, and Persian philosophers. In The Republic, Plato pointed out that a life of excess produces higher highs and lower lows, but the lows predominate. Meanwhile, in a life of moderation, the modest highs predominate over the modest lows. Therefore, moderation is rational.
Immoderate food consumption can be a problem, which I’ve had to deal with myself. Kleptomania and pyromania are behavioral addictions too; they get hooked on the rush of committing crimes. Video games can be habit forming, leading to vast amount of wasted time and lost productivity. However, occasionally deaths have resulted from self-neglect or neglect of children during all-day poopsocking sessions. These behaviors might start out as being fun, but eventually become a drag, though it’s still difficult to quit.
Flashing, voyeurism, and other perversions can constitute behavioral addictions. An unexpected effect of modern technology is that porn induced erectile dysfunction has become an epidemic among 20-somethings. Typically, they’ll have to start watching more extreme content to get the same thrill. So they might start out watching bikini models, then a year later they’re beating off to tentacle porn. Rather oddly, there are many anecdotal reports of straight guys sometimes ending up watching gay stuff. Some get curious enough to bang a dude and get grossed out by the experience, they aren’t actually gay, so they don’t really like giving blowjobs and all that.
Behavioral addictions can be pretty stupid and irrational, of course. Still, that’s what happens when things like that get established in the limbic system’s pleasure / reward circuits. MRI studies show parts of the brain lighting up during a porn session, the same ones that light up in cocaine addicts. There’s no dumb dust involved, but someone doing an hours-long edging session to hardcore porn is tweaking his dopamine too.
Chemical addictions also have a behavioral component. A junkie cooking heroin in a spoon will get a thrill in anticipation even before the needle goes in. It’s much like Pavlov’s dog slobbering as soon as he heard the dinner bell.
Attempts to understand addiction
So in one way, addictions are essentially very bad habits. The traditional explanation was moral weakness. In more recent times, addiction started being seen as a psychological problem. Others considered it a disease. This results in reducing the stigma which (as the theory goes) will encourage people to seek help without feeling bad about it.
A schizophrenic can’t help being crazy, and (again, as the theory goes) neither can an addict. Thus, it’s no more of a moral fault than catching the flu. Other than that, “alcoholic” sounds at least a little better than “habitual drunk”. When it was a new word, it put a fresh spin on things. Still, we’ve stepped too far away from personal agency. Furthermore, when people do bad things, they should feel bad about it, and others should call them out on it. Ultimately, people have the capacity to choose between right and wrong.
Would anyone smoke crack right in front of a policeman? Of course not; the crackhead will choose to wait for an opportunity to do so unobserved, since getting busted means going to jail for six months. Therefore, addictive behavior is a choice, though it’s a lot harder to “just say no” after someone is hooked. So addicts who want to quit have to become their own policeman.
The twelve step model
The famous 12 steps of Alcoholics Anonymous are the following:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory, and when we were wrong, promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
AA and similar programs do work for many people. If it gets them where they want to be, then they should run with it.
Still, I do have a few quibbles with some of it. The thing about being totally powerless over alcohol, to the point that only an act of God will work, seems somewhat disempowering. Further, all that might be pretty hard to swallow for an atheist. Step 3, however, does very clearly indicate that a rational choice is involved in breaking free of this bad habit. If a wino doesn’t want help, will God miracle him out of his bottle of Thunderbird? Probably not.
So the power of reason is the essential part, and I’m sure Plato would’ve agreed. The rational mind belongs in the driver’s seat.