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Coping With Addictions
How to recognize the signs of addictions in yourself or someone you love

by Gary L. Hopkins, M.D., Dr.P.H. and Joyce W. Hopp,

No one intends to become an addict, but many do.

Why do people do things that they know are harmful? The next time you go to the grocery store and see an elderly man pulling an oxygen bottle behind him with the tubes going into his nostrils at the same time he is smoking a cigarette, stop and think. Why is he doing something that he knows is the cause of his inability to breathe well? It doesn't make sense, does it? That very man would probably advise others not to smoke while at the same time be unable to correct his own problem.

Have you ever sat in an ice-cream parlor and seen an extremely obese individual come in and order a banana split? You scratch your head and wonder what is going on. Maybe that person is just not very smart. But is it an issue of intelligence? Let's explore.

When people drink alcohol or smoke tobacco, they are taking a drug. If you ask people who do these things why they are doing them, they will give you different answers. "I like it." "It wakes me up." "It calms me down." And so on. Be it conscious or unconscious, dangerous or not, people do what they do for reasons.

The study of behaviors and specifically of addictions is interesting. Addictive behaviors are not normal or ordinary; they are often compulsive and terribly self-destructive. It seems as though people would naturally limit their behaviors to things that give pleasure and avoid pain, but those who have addictive tendencies or destructive behaviors don't function in that way.

Addicts often go to great effort to obtain and use their drugs in spite of the consequences. For example, professional athletes are paid millions of dollars for playing football or baseball with the knowledge that they will be randomly tested for drugs. They are aware that if drugs are found in their system they face the probability of suspension from their jobs, with the possibility of lifetime expulsion from participation in their sport. The same athletes get caught with drugs in their blood, often again and again, and ultimately lose their multimillion-dollar incomes because of the use of cocaine or some other drug. Some people have exhausted their financial means in order to live the high life and to support their drug use.

So put yourself in their position. Someone offers you your dream house, and all you have to do is to avoid alcohol use. It sounds simple, doesn't it? It isn't. If it were easy, people would make the correct decision every time.

People (millions of them every day) use drugs or engage in other addictive behaviors, knowing that they will--not maybe, but will--eventually face consequences. There is nothing normal about addictive behavior. It is not simply a deviation from the norm.

Just as people use drugs for different reasons, they also respond differently to drugs. Some say that the use of alcohol is liberating, seems to set them free, or really takes the "edge off" the stress of a hard day at work. Two people who look very similar may react in absolute contrast to each other when given the same substance. Most people have the same opportunity to use alcohol; it is in stores everywhere. Yet some develop problems with it, and others don't. It appears that the problem, the reason for the addiction, is in the person rather than in the drug.

People who have addiction problems are often thought of as deficient in character, deviant, or lacking in moral fiber. This is often the case among conservative religious groups, where substance use is prohibited. During the middle of the twentieth century the medical community realized something very abnormal existed in people who had alcohol abuse problems. Eventually criteria for substance dependence was defined as a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

Intolerance, as defined by either of the following:

A. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
B. Markedly diminished effect with continued use of the same amount of the substance.
Withdrawal, as manifested by either of the following:
A. The characteristic withdrawal syndrome of the substance.
B. The same (or closely related) substance is taken to relieve or avoid withdrawal of the symptoms.
Growing use of the substance, often taken in larger amounts or over a longer period than was intended.
A persistent desire or unsuccessful efforts to cut down or control substance use.
Spending a great deal of time in activities necessary to obtain the substance (visiting multiple doctors or driving long distances), use of the substance (such as chain smoking), or recovering from its effects.
Continuing substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or provoked by the substance (for example, someone continuing using cocaine despite recognition of cocaine-induced depression, or continuing drinking despite recognition that an ulcer was made worse by alcohol consumption).

You may recognize some of the items in this list because you have seen the behaviors either in your own personal life or in the lives of others. You may have heard of someone waking at night and driving a considerable distance to purchase a pack of cigarettes or to purchase pornographic material because they cannot afford to be seen doing so in their local community. People with addictions will go to great lengths to satisfy the needs of their cravings.

Addictions come in many forms. Computer addiction has recently been recognized as a problem for many. Dr. Maressa Hecht Orzack, an expert in this area, created a list of features common to computer addicts:

A mother has difficulty getting her child to do chores when computer games occupy all after-school time.
A husband finds his wife increasingly neglecting family duties or irritable at family gatherings, and the phone bill to an online service number has become astronomical.
Someone connects to the Internet at 9:00 p.m. and suddenly discovers that it is dawn and he has not left the computer.
A child's grades fall, and the teacher notes that she is falling asleep in class.
A college freshman gets a midterm warning because he is not keeping up with coursework. Instead, he is spending every evening on the Internet communicating with all his family and former high school classmates, and rarely joins in school activities on campus.
An employee starts to fall behind at work, and a rising number of sick days raises questions about usefulness to her employer.
A corporate department head stays late each night to meet deadlines. In-house monitoring of computer use reveals he frequently accesses inappropriate sites, including gambling and pornography.
An office supervisor suddenly resigns from her job. A lot of work is unfinished, and the company asks her family to encourage her to return. They find her at home, hunched over the computer and out cold, completely oblivious to her surroundings.

Internet sexual addiction has become an enormous problem. Dr. Dana Putnam maintains a Web site for individuals who are concerned about their Internet sexual interests, where they can take a test to measure the seriousness of their possible addiction. Putnam reports that this Web site gets more than 1,000 visits every day. People are suffering from various forms of dangerous behaviors that are out of control. These same people often find it necessary to hide their problems, as they can't afford to have these behaviors known to others in their surroundings.

Understanding the brain chemistry associated with addictions is a science producing new insights almost daily. Research in this area suggests that there are two different systems in the brain responsible for "liking" and "wanting." Researchers believe that drugs of addiction primarily activate the "wanting" system. It is for this reason that drugs can cause very intense cravings.

Other research suggests that the brain has a specific system responsible for reinforcing. Stimulation of this system, which occurs with the ingestion of an array of drugs and possibly even with exposure to pornographic images, causes the brain to release a drug similar to heroin or morphine. Specifically, drugs appear to stimulate the release of dopamine, a brain chemical associated with pleasure. This suggests that people take substances or drugs in order to stimulate the reinforcing mechanism in the brain that will result in a pleasurable response. In other words, people take drugs in order to gain pleasure, in spite of the consequences of the use of the drug.

Scientists have studied whether or not addictions are related to genetics. They found that different strains of laboratory mice and rats differ in their use of alcohol. Both alcohol-preferring and alcohol-avoiding strains of rats have been selectively bred in laboratory settings. Studies such as this have led to the conclusion that there is significant evidence of a genetic contribution to the risk of becoming an alcoholic. Men who have a family history of alcoholism are actually at an increased risk of becoming an alcoholic themselves. This genetic tendency is not limited to alcohol; further studies on different strains of mice and rats have demonstrated different preferences for cocaine.

Whatever the addiction, whether it has identifiable genetic roots or not, a typical cycle of despair tends to emerge. It looks something like this:

No one intends to become an addict, but many do. There is no intention to self-destruct and ruin health, jobs, and important relationships.
Addicts lie to everyone in their lives. A common phrase used among addicts in treatment is: "The way that you can tell when an addict is telling a lie is that their mouth is open." They live a false, concealed life of deceit.
Things start missing in the home or office. As the problem escalates, the amount of deceit and dishonesty increases.
Addicts are often intelligent and creative people who appear to have hope for the future, which adds to their problems. People around them see their potential strengths and deny the visible weaknesses, hoping that eventually their strengths will overcome their weaknesses.
Addicts typically enter into their affliction because they attempt to compensate for some personal deficiency or life situation. They are often depressed, unhappy, or incapable of dealing with their life situations, which may include the loss of a loved one or job. This causes the individual to seek help in the form of a drug, alcohol, or sex. The cycle begins.
The behaviors are the painkiller. Addicts avert emotional and physical pain by engaging in their behavior, thereby gaining a temporary or illusionary escape from life. When they are unable to cope with some aspect of their reality, they go to their addictive behavior for a temporary escape.
The more a person uses their drug, the more inflated the problem becomes. More and more problems result from repeated use. The behavior becomes the center of their universe. Soon the individual finds the need to use continuously and will do anything to get "high." They are now caught in the cycle.
They become difficult to communicate with, find it hard to focus on a single topic for even 10 or 20 seconds. They withdraw and begin to exhibit strange behaviors associated with addiction.
The more the person uses their drug, the more guilt begins to drive their lives. This results in depression, discontent, and despair.
Now their use begins to affect their personal relationships, their job, their finances, and anything of value in their lives. They use more.
Their use eventually has less to do with getting "high" and more to do with avoiding withdrawal. Addictions are a medical problem. Many forms of treatment are available. Some are more successful than others. One form of treatment is referred to as cognitive behavioral therapy where the addict is taught to identify the problem, to solve the problem, and to learn coping skills to prevent relapse.

Don't accept nonprofessional speculation. Seek expert counseling. Find out what is available in your community and get treatment.

If the problem is in a loved one, confront them with others who care for them after you have arranged for a professional consultation. After the confrontation, take that person directly into treatment. Don't even consider trying to convince a person who is "high" or intoxicated that they have a problem. Wait until they are sober.

Take addictions seriously. Work with the person about whom you have concern to recognize the problem and get medical help. Individuals who have successfully gone through treatment often suggest that there would not have been success without a spiritual component to their treatment. Find a Christian physician who will refer you to treatment resources that have a spiritual basis. There is hope for the addict, whatever the source of the addiction.

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Gary L. Hopkins, M.D., Dr.P.H., is the associate director at the Institute for Prevention of Addictions, Andrews University, Berrien Springs, Michigan. Joyce W. Hopp, Ph.D., M.P.H., R.N., C.H.E.S., is a distinguished professor at the Department of Health Promotion and Education at the School of Public Health, Loma Linda University, Loma Linda, California.

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