I personally am not an expert - I just live with a recovering alcoholic, which only classifies me as an interested party - but my resident alcoholic is a very studious sort and he does keep up with the literature, so I asked him if he could give me some useful links to pass on to Georgie. He gave me the following email, which is such a comprehensive review of good current sources that I'm reproducing it here in full, in hopes that Georgie and anyone else may find it useful:
Here are all sorts of links. Read through them and decide what to send along to Curtis and company.
As I think I mentioned, the best popular introduction to the physiology of addiction I've seen is in the book that went along with the HBO Addiction Series. Much of that information is on the HBO addiction website: http://www.hbo.com/addiction/ Follow the button on top labeled "Understanding Addiction". It's been a while since I read the book and I don't think I ever did more than skim the web site but I think the basics are there.
I remember being fascinated by this 45 minute video presentation: http://videocast.nih.gov/ram/ccgr121306.ram
The common thread in both of the above is Dr. Nora Volkow, who is the director of the National Institute on Drug Abuse and did a great deal of pioneering brain imaging work on addiction while at Brookhaven National Lab.
This article in SF Gate was pretty good too: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/11/MNGDEO2QOC1.DTL&feed=rss.news The picture is great. It's complex but it captures all the basics. This came out right after Gavin Newsom sought help with alcohol.
To understand what the addiction feedback loop is working on, it is helpful to know how the brain operates. I found this article on "normal" brain function really interesting: http://findarticles.com/p/articles/mi_m1200/is_18_156/ai_57799547/ There is nothing on addiction here, but this article clearly lays out that the brain operates by having a bunch of default habits and an interrupt system to cut them off where they are not appropriate. It this seems very natural for addiction to work by the any mix of mechanisms that builds drug-reinforced habits and/or weakens the interrupt mechanism.The single biological factor that's been most linked with addiction has been an allele associated with the brain chemical dopamine and in particular the D2 dopamine receptor. These are highly involved in the brain's pleasure and reward system that plays a role in those drug-reinforced habits. Dopamine shows up in that SF gate picture. A 1990 paper all but said there was an alcoholism gene (well, allele). This article (http://www.faqs.org/abstracts/Health/D2-dopamine-receptor-gene-is-associated-but-not-linked-with-alcoholism.html) is part of the follow-on discussion, and a far as I can tell, this is not too far from the view today: it's part of the explanation but not the whole explanation. As you can imagine, there has been lots of back and forth since in the research community. Do a search on "D2 dopamine receptor alcoholism" and you'll find a very mixed story. And having done that search, I like the discussion that starts at the bottom of the page here: http://books.google.com/books?id=UzhXJ4l3OBYC&printsec=frontcover#PPA97 I'm going to order the book.At a slightly more complex level is this Scientific American Article: http://www.sciam.com/article.cfm?id=seeking-the-connections-alcoholism-and-our-genes&page=1
And if anyone believes there is one type of alcoholic, I think this http://www.nih.gov/news/pr/jun2007/niaaa-28.htm puts that simple notion to rest. I've got the whole article, not just this press release.
Thank-you, John and hedera, for the wealth of information referenced here.
ReplyDeleteMost of my reference on the subject comes from reading hundreds of clinical note-files of actual addiction patients while working on disability cases for the Social Security Administration (where I labored for 27 years); though I have read up on addiction generally, and how certain chemicals affect the nervous system. This was big news during the 1960's, when our generation seemed to think that drugs were the answer to everything. (Maybe the coming drug bonanza of the Boomers is a delayed effect of that fascination 40 years ago!)
I was interested first to know how addiction worked, because I had grown up with two heavily addicted cigarette smokers (each was a two Camel pack a day junkie), and saw first hand the awful effects and self-delusional qualities associated with dependent personalities.
Some of the "effects" we see with addicts aren't true "causes" of the addiction, but are simply excuse and facilitation mechanisms which enable the sufferer to justify their dependence. Real addiction is indeed a brain disease, involving chemical receptors for pleasure--which I mentioned in the other thread over at my blog.
There are many different kinds of alcoholics, but the most stubbornly addicted have a physio-chemical susceptibility which makes them ten times more difficult to cure.
Dependent personalities can "cure" or ameliorate the causes of their condition, and control the symptoms (of which alcoholism may be one aspect), perhaps even breaking it off completely. Alcohol is often a trigger or starter-mechanism which re-ignites the dependency rituals.
Self-pity, anger, loneliness, loss, joviality, indulgence--all these may be doors into alcoholic addiction. That doesn't mean that these are all "different kinds of addiction" though. Alcoholic addictions have common associative factors, just as certain other drugs do (cocaine, for instance).
It is possible to be both a psychologically dependent personality, and to have a physical predisposition to alcohol. It's also possible to have neither.
Is psychological predisposition a common accompaniment to addictions? Probably. Certainly someone who has large personality issues is more likely to find solace in a soporific or sedative chemical, which alcohol ultimately is.
It's instructive to note the classic distinctions between the sorts of personalities which tend to be addicted to one kind of substance, over another kind. Individuals will rarely be susceptible to both kinds of effects (uppers and downers), though occasionally they will.
The effect of alcohol on the brain of predisposed individuals is not unlike that which effects smokers. Which is why smoking and serious drinking so often go hand in hand.
That is all very interesting stuff. I should ask my brother in law what he thinks are good references. He's the ultimate expert - a recovering alcoholic (or whatever you call it - I totally reject the whole 12-steps nonsense) - who is also a doctor who specializes in addiction medicine. (He hasn't had a drink in a very long time).
ReplyDeleteSince I'm the now-sober husband who wrote the e-mail Karen quoted, let me jump in here with two more thoughts from my reading about (and experience of) alcoholism and recovery.
ReplyDeleteBe careful to separate cause and effect regarding addition and addictive personalities. All sorts of people with all sorts of personalities get addicted. There have been plenty of totally unsuccessful attempts to identify addiction-prone personalities before the fact. Those common after-the-fact "addicted personality" things are mostly results, not causes, of the drugs' brain-warping work. These elements are real, of course, and they need to get worked in recovery, although just cutting out the alcohol or drugs itself can do quite a bit. The "addictive personality" might better be seen as an addiction-generated aberration to be ditched as one returns to his pre-addicted self. I think I've gotten most of the way back although that little voice never quite goes 100% away.
The whole nature-versus-nurture issue is about as resolved for addiction as it is for any psychological issue. It seems reasonable to believe some people are more susceptible than others. Thirty years ago, people thought heritable biological factors would explain everything. Actual mechanisms have been hard to come by. Exposure matters too. Animal studies show that with enough alcohol or other drugs, you can turn any perfectly normal laboratory mouse into an addicted rat who will drink or use (typically cocaine in these experiments) to the detriment of his own health. There no deep human psychology at work. Addiction lives at the more primitive, parts of the brain. The belief is that this animal model applies in humans as well: drink and use enough, and you will reinforce the "go" signals and weaken the "stop" signals enough to get addicted. What constitutes "enough", of course, varies and may well have genetic origins. But here enters the "nuture" part of the equation. Non-addictive drinking launches all this, and things like family upbringing and cultural expectations can play a big role here ... as can some individual personality issues. So while alcoholism is not just "in the bottle" as the temperance folks proclaimed 120 years ago, it's not just "all in the person" as AA and most of the post-prohibition world proclaimed 70 years ago either. It's some of both, plus family, plus culture, plus ...
-- Karen's husband, Jim