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Where to go for help
In the first instance the national co-ordinator
of the pharmacists’ health
support programme should be contacted.
The telephone number
01327
264531
appears in The Pharmaceutical Journal each week in the
Society section.
All calls are treated in strictest confidence. |
Dreamstime.com
Chronic stress can cause addiction |
For thousands of years humans have used psychoactive compounds to alter
their state of consciousness to enable them to cope with their life and
environment. If psychoactive drugs did not affect brain chemistry in
a desirable manner, then they would not be used.
There is solid evidence
that Sumerian people of 4000BC deliberately cultivated the opium poppy,
and throughout history the use of mood altering substances (from mushrooms
and belladonna in the middle ages to “ecstasy”, “G”,
and crack cocaine in modern times) has been part and parcel of life for
some people.
Addiction is a controversial subject about which people have strong feelings
and prejudices. There is a view that addiction to a drug (an overwhelming
urge to continue taking the drug despite adverse consequences) is a consequence
of moral or personal weakness and if only these people got a job, pulled
themselves together, stopped being weak or realised what thhe were doing
to themselves, they would have no need to take the drug and society as
a whole would be better. Such a view, however, fails to take into account
brain function.
The frontal cortex of the brain is the area responsible for love, morality,
decency, responsibility, spirituality, and is the seat of self and one’s
personality. If addictive drugs had their effect in the frontal cortex
they would understandably affect one’s personality and reasoning,
and go some way to explaining why drug- or alcohol-addicted people do
bad things.
It is possible to induce addiction in laboratory animals. It follows
therefore that once a rat, for example, becomes addicted to a drug then
we must say that that rat’s morality, decency, responsibility and
spirituality have been affected by the drug acting in the frontal cortex.
But
we cannot, because alcohol and drugs do not act in the frontal cortex.
And rats do not weigh moral consequences. In an addicted animal, given
the choice between pressing a lever for food or pressing a lever for
the addictive drug, the animal will continue pressing for the drug to
the exclusion of all other survival behaviours, even to the point of
death, and the reason for this is because of where the drug acts in the
brain.
Addictive drugs work in the midbrain. The midbrain filters incoming sensory
information and can be described as the survival part of the brain. Natural
highs, such as food, loving relationships, sex, sports performance and
personal success, cause the release of dopamine in the midbrain. Drugs
causing the release of dopamine in the midbrain mimic natural highs and
are available on demand, as and when the person needs a lift.
An agent that actually causes addiction is chronic, severe, unmanaged
stress — stress that is defined as a life event that a person cannot
cope with. Stressors vary from person to person because we are all different
and have different personalities. Repeated dopamine (pleasure) surges
in the midbrain triggered by a drug cause the drug to be “tagged” as
the number one coping mechanism for dealing with incoming stressors.
In
a drug user, a misperception of incoming sensory information is delivered
to the frontal cortex and the addict develops a personal relationship
with and becomes emotionally attached to the drug. This dysregulation
of the midbrain dopamine system results in symptoms of decreased functioning
leading to loss of control, craving and persistent drug use despite adverse
consequences. The overwhelming desire to continue taking the drug is
as strong as hunger or thirst.
Someone addicted to alcohol or drugs does not have a choice about whether
to use the drug. The “choice” argument fails because it does
not take into account craving. The addict cannot choose to crave. The “choice” argument
measures addiction only by the behaviour of the addict (some of it bad)
and ignores the suffering (some of it very bad). Punishment will not
stop drug use because nothing is higher than survival. No threat matches
loss of survival.
Is addiction really a disease? In the disease model there are organs,
and an agent causing a defect in an organ leads to symptoms of disease.
For example in diabetes, the organ is the pancreas and the causal agent
is islet cell death (no insulin) leading to hyperglycaemia, blurred vision,
coma etc. In addiction the organ is the brain and the causal agent is
stress (dysregulation of the midbrain dopamine reward system) leading
to craving, loss of control and persistent drug use despite adverse consequences.
Addiction
thus fits the disease model and ought to be treated as such rather than
moral weakness. This is not easy for some people to accept,
because something important happens when addiction becomes a disease:
when we treat addiction as a disease then addicts become patients. All
the ethical principles that apply to other groups of patients now apply
to addicts and addiction has parity with other diseases.
As health professionals we are naturally inclined to offer help and support
to all our patients. Nevertheless, pharmacists are often horrified to
learn of a colleague who has trouble with drink or drugs. Broadly speaking,
health professionals are good at looking after other people but not so
good at looking after themselves. One exception to this is the pharmacists’ health
support programme, which has been provided by the Benevolent
Fund of
the Royal Pharmaceutical Society since1991.
The pharmacists’ health support programme exists to provide a safe
place that a pharmacist or close family member can contact when they
are worried about their own or someone else’s relationship with
alcohol or drugs and is run by health professionals experienced in addiction.
Contacting
the pharmacists’ health support programme does not amount
to shopping a colleague. It is asking for help for someone who cannot
ask for it himself.
The service is confidential, offering help and advice
to a pharmacist ideally before progression of the disease brings them
to the attention of the authorities. There is also practical support
if needed and efforts are made to introduce the pharmacist to other
recovered health professionals to sustain long-term
recovery. ACKNOWLEDGEMENTS Thanks are due to Kevin McCauley, MD, and Joe Mee,
MBE, for their help with this article. |
The
Pharmaceutical Journal