They Don't Teach THAT in Med School

Wow! So I just got back from visiting Leslie. She invited me to the rehab center for a talk on addiction by a local physician. It was great to see her again and she's looking happy and lovely. The talk was designed for family members of rehab participants... so it wasn't heavy on the nuances of the biological and physiological components of addiction... which was fine by me as I get plenty of that in med school.

Anyway, it was great. Essentially it was explaining to the layperson that addiction has a genetic component... and how the cycle of addiction begins and is propagated. Basically, here's the straight dope (hmm... maybe bad choice of words)...

So a "normal person" is defined as a person without the genes that pre-dispose them to addiction. Addiction can be anything I assume... gambling, food, etc. but for our purposes we are talking about drugs and alcohol of any kind. When a "normal" person uses a drug or alcohol, they experience the same sort of stupidity that anyone experiences while intoxicated. They'll experience a lack of accurate perception and lack the ability to make sound judgements. They also will feel a lack of inhibition, which feels really good and can be a lot of fun. They may drink occasionally or routinely... as frequency of intoxication is really not part of what defines addiction. When intoxication causes a normal person to experience adverse affects (like hangovers, acting like a fool, making bad decisions, getting a DUI, etc.), they will give up the drug or alcohol... because their perception is that the drug is not worth experiencing the adverse events.

When someone predisposed to addiction uses a drug or alcohol, they experience all the same stupidities and lack of judgement as the normal person described above... except one thing is very different. That is that alcohol doesn't just make them lose inhibition and they feel good and have a lot of fun. When this person uses drugs or alcohol they feel like Superman. or 10 feet tall and bullet-proof as the speaker said. Normal people feel good, but not this good. There has been research that shows a four fold increase in dopamine levels in those who are genetically predisposed to addiction when intoxicated as compared to "normal" people when intoxicated. So when this person drinks or uses, they do feel like Superman. And when adverse events start happening as a result of intoxication, they refuse to quit because feeling like Superman is THAT GOOD. Feeling that good leads to continuous use, which eventually leads to tolerance. Once their body is tolerant to a drug or alcohol, it starts to take more and more of that drug to experience the same feelings. Eventually, they're getting intoxicated not so they can feel like Superman anymore... but just so they can feel normal.

Now they are in a cycle in which they must protect their decision to drink, and therefore begin denying that they are making bad choices. The speaker discussed that denial is essentially the mechanism which propagates addiction... because it allows you to put your locus of control far outside yourself and you are able to blame others and circumstances for all that is going wrong. Drugs and alcohol skew one's perception so much that they can actually convince themselves that they ARE making correct decisions... and bad things keep happening to them.

Of course I've heard much of this before, presented in statistics and pretty bar graphs... but it felt quite different hearing it in plain English in a room full of recovering addicts and their families.