DRINKING AND DRUGS: ADDICTION AS SELF-MEDICATION



Students at the local campus call it drinking to black —bingeing on beer to the point of passing out. One of the techniques: attach a funnel to a garden hose, so that a can of beer can be downed in about ten seconds. The method is not an isolated oddity. One survey found that two fifths of male college students down seven or more drinks at a time, while 11 percent call themselves "heavy drinkers." Another term, of course, might be "alcoholics."48 About half of college men and almost 40 percent of women have at least two binge-drinking episodes in a month.49

While in the United States use of most drugs among young people generally tapered off in the 1980s, there is a steady trend toward more alcohol use at ever-younger ages. A 1993 survey found that 35 percent of college women said they drank to get drunk, while just 10 percent did so in 1977; overall, one in three students drinks to get drunk. That poses other risks: 90 percent of all rapes reported on college campuses happened when either the assailant or the victim—or both—had been drinking.50 Alcohol-related accidents are the leading cause of death among young people between fifteen and twenty-four.51

Experimentation with drugs and alcohol might seem a rite of passage for adolescents, but this first taste can have long-lasting results for some. For most alcoholics and drug abusers, the beginnings of addiction can be traced to their teen years, though few of those who so experiment end up as alcoholics or drug abusers. By the time students leave high school, over 90 percent have tried alcohol, yet only about 14 percent eventually become alcoholics; of the millions of Americans who experimented with cocaine, fewer than 5 percent became addicted.52 What makes the difference?

To be sure, those living in high-crime neighborhoods, where crack is sold on the corner and the drug dealer is the most prominent local model of economic success, are most at risk for substance abuse. Some may end up addicted through becoming small-time dealers themselves, others simply because of the easy access or a peer culture that glamorizes drugs—a factor that heightens the risk of drug use in any neighborhood, even (and perhaps especially) the most well-off. But still the question remains, of the pool of those exposed to these lures and pressures, and who go on to experiment, which ones are most likely to end up with a lasting habit?

One current scientific theory is that those who stay with the habit, becoming increasingly dependent on alcohol or drugs, are using these substances as a medication of sorts, a way to soothe feelings of anxiety, anger, or depression. Through their early experimentation they hit upon a chemical fix, a way to calm the feelings of anxiety or melancholy that have tormented them. Thus of several hundred seventh-and eighth-grade students tracked for two years, it was those who reported higher levels of emotional distress who subsequently went on to have the highest rates of substance abuse.53 This may explain why so many young people are able to experiment with drugs and drinking without becoming addicted, while others become dependent almost from the start: those most vulnerable to addiction seem to find in the drug or alcohol an instant way to soothe emotions that have distressed them for years.

As Ralph Tarter, a psychologist at the Western Psychiatric Institute and Clinic in Pittsburgh, put it, "For people who are biologically predisposed, the first drink or dose of a drug is immensely reinforcing, in a way others just don't experience. Many recovering drug abusers tell me, 'The moment I took my first drug, I felt normal for the first time.' It stabilizes them physiologically, at least in the short term."54 That, of course, is the devil's bargain of addiction: a short-term good feeling in exchange for the steady meltdown of one's life.

Certain emotional patterns seem to make people more likely to find emotional relief in one substance rather than another. For example, there are two emotional pathways to alcoholism. One starts with someone who was highly-strung and anxious in childhood, who typically discovers as a teenager that alcohol will calm the anxiety. Very often they are children—usually sons—of alcoholics who themselves have turned to alcohol to soothe their nerves. One biological marker for this pattern is undersecretion of GABA, a neurotransmitter that regulates anxiety—too little GABA is experienced as a high level of tension. One study found that sons of alcoholic fathers had low levels of GABA and were highly anxious, but when they drank alcohol, their GABA levels rose as their anxiety fell.55 These sons of alcoholics drink to ease their tension, finding in alcohol a relaxation that they could not seem to get otherwise. Such people may be vulnerable to abusing sedatives as well as alcohol for the same anxiety-reduction effect.

A neuropsychological study of sons of alcoholics who at age twelve showed signs of anxiety such as a heightened heart rate in response to stress, as well as impulsivity, found the boys also had poor frontal lobe functioning.56 Thus the brain areas that might have helped ease their anxiety or control their impulsiveness brought them less help than in other boys. And since the pre-frontal lobes also handle working memory—which holds in mind the consequences of various routes of action while making a decision—their deficit could support a slide into alcoholism by helping them ignore the long-term drawbacks of drinking, even as they found an immediate sedation from anxiety through alcohol.

This craving for calm seems to be an emotional marker of a genetic susceptibility to alcoholism. A study of thirteen hundred relatives of alcoholics found that the children of alcoholics who were most at risk for becoming alcoholics themselves were those who reported having chronically high levels of anxiety. Indeed, the researchers concluded that alcoholism develops in such people as "self-medication of anxiety symptoms."57

A second emotional pathway to alcoholism comes from a high level of agitation, impulsivity, and boredom. This pattern shows up in infancy as being restless, cranky, and hard to handle, in grade school as having the "fidgets," hyperactivity, and getting into trouble, a propensity that, as we have seen, can push such children to seek out friends on the fringe—sometimes leading to a criminal career or the diagnosis of "antisocial personality disorder." Such people (and they are mainly men) have as their main emotional complaint agitation; their main weakness is unrestrained impulsivity; their usual reaction to boredom—which they often feel—is an impulsive search for risk and excitement. As adults, people with this pattern (which may be tied to deficiencies in two other neurotransmitters, serotonin and MAO) find that alcohol can soothe their agitation. And the fact that they can't stand monotony makes them ready to try anything; coupled with their general impulsivity, it makes them prone to abusing an almost random list of drugs besides alcohol.58

While depression can drive some to drink, the metabolic effects of alcohol often simply worsen the depression after a short lift. People who turn to alcohol as an emotional palliative do so much more often to calm anxiety than for depression; an entirely different class of drugs soothes the feelings of people who are depressed—at least temporarily. Feeling chronically unhappy puts people at greater risk for addiction to stimulants such as cocaine, which provide a direct antidote to feeling depressed. One study found that more than half the patients being treated at a clinic for cocaine addiction would have been diagnosed with severe depression before they started their habit, and the deeper the preceding depression, the stronger the habit.59

Chronic anger may lead to still another kind of susceptibility. In a study of four hundred patients being treated for addiction to heroin and other opioids, the most striking emotional pattern was a lifelong difficulty handling anger and a quickness to rage. Some of the patients themselves said that with opiates they finally felt normal and relaxed.60

Though the predisposition to substance abuse may, in many cases, be brain-based, the feelings that drive people to "self-medicate" themselves through drink or drugs can be handled without recourse to medication, as Alcoholics Anonymous and other recovery programs have demonstrated for decades. Acquiring the ability to handle those feelings—soothing anxiety, lifting depression, calming rage—removes the impetus to use drugs or alcohol in the first place. These basic emotional skills are taught remedially in treatment programs for drug and alcohol abuse. It would be far better, of course, if they were learned early in life, well before the habit became established.

 


Дата добавления: 2018-02-28; просмотров: 397; Мы поможем в написании вашей работы!

Поделиться с друзьями:






Мы поможем в написании ваших работ!