Addiction: To hell and back

Addiction has the ability to ruin lives. Photo / Thinkstock

Kate* knew it had to stop. She'd been surrounding herself with all this, with bad people doing bad things, for years; it was just the way it was in her circle in her hometown. But, for the last few weeks, it was like she'd finally woken up from a long, drug-induced coma.

After three years of smoking the drug methamphetamine, Kate was badly addicted.

She was sometimes using way more than her body could cope with, greedily consuming up to five grams - between $6000 and $7000 worth, she estimates - each week. But it was no longer working its magic. Instead of the intense, exciting rush of energy, instead of the feeling she was invincible, there was this big, black hole.

She was skinny, miserable and depressed. She had been having suicidal thoughts. She'd enraged, estranged and manipulated her family. She'd lost jobs. She'd worked as a prostitute. Her boyfriend, a gang member, was in prison.

She looked about her. All she could see in the faces of her associates - all P users too - was sadness and failure.

"I was sitting there in this room with all these drugs and all these dodgy people," she says now, "and I thought, 'what life am I living? I don't want to live this way any more.'

"Then it just hit me in this moment. I used too much and ended up overdosing ... and that kind of woke me up to the reality that I was killing myself."

It's been eight years since that day. Kate is now an addiction success story. She got help, reconciled with her family, went into rehab and talked and talked herself back to health.

These days she's a 28-year-old living in Auckland with a partner and kids and has a degree in social work underway. She's now involved in helping others escape drugs and despair. Hers is a cautionary tale, but one with a happy ending.

Kate's story is what we expect of addiction: bad people doing bad things to get bad drugs. When we think of addiction, it's P labs and crime and the sad queue outside that legal-high store in Palmerston North at midnight on Easter Friday. It is the notorious (and late) Antonie Dixon attacking two women with a samurai sword while out of his mind on P. It is the dead-eyed homeless guy in Aotea Square pissed out of his brain and the worker on the street puffing feverishly on a cigarette.

Even in the language of official statistics, addicts are this cliche. Yet according to experts, addiction - something University of Canterbury researchers believe they've found a revolutionary treatment for - is a much broader phenomenon, even if many of us still treat it as the moral failure of the witless few.

"I think the person [who is addicted] gets blamed quite a bit," says Kate, "There's kind of that judgment in society. The people who stand out [for addicts] are the ones that actually understand ... who kind of supported them rather than just judging them - 'oh, he's just an alkie', or 'he's an addict, he's useless'."

Let's begin with the word. "Addict" derives from the Latin addicere, meaning "to assign".

According to behavioural biologist and science writer Paul Martin, "addict" was first used in the 1600s as a legal term for someone formally assigned or bound over to another person by the courts. "The underlying sense," Martin writes in Sex, Drugs And Chocolate: The Science Of Pleasure, "was that the addict's free will had been taken away and handed to a new master." By the 1800s the word had its modern meaning - enslavement to a powerful drug - but it was the Victorians who imbued it with a sense of immorality. "Addicts came to be regarded as morally deficient and weak-willed, rather than ill," Martin writes, "and their behaviour was seen as purely a matter of personal choice rather than compulsion."

It was another century before addiction, or at least alcoholism, was finally declared a disease by the American Medical Association in 1956, though it wasn't until 2011 that behaviours such as gambling were finally declared by the American Society of Addiction Medicine to be diseases of the brain.

However, the definition of what constitutes an addiction is still open to debate. Ask Tania Summerfield, a North Shore registered psychotherapist who works with addicts, including addicts of illicit pornography, what the definition of addiction is and she says, "Good question." It is, she says, where addicts themselves must start.

Fiona Howard clinical psychologist and senior tutor at the University of Auckland. Photo / Dean Purcell

Fiona Howard, a clinical psychologist and senior tutor at the University of Auckland's school of psychology, says her definition of addiction is quite broad. "Some definitions of addiction include only the physiological signs of dependency, such as increased tolerance to the drug over time and withdrawals when you stop. Other theorists go a little bit further and say it's also when you have the psychological components present that you are addicted, for example, the reliance on the substance to manage our mood.

"It's a continuum really, and where addiction stops and just substance abuse starts is anybody's guess."

Dr Juan Canales, from the department of psychology at the University of Canterbury, says science has learned much about addiction. It is now known that there are all sorts of social and biological predisposing factors. Genetics are important too. For example in identical twins, if one is an addict, there is a 40 per cent chance the other will be too - even if they've been raised in different environments. Impulsiveness and novelty-seeking people are more likely to try drugs. But so are people raised or living in deprived and stressful environments.

Addiction is completely individual, he says, a combination of nature and nurture - but not of ill virtue.

"Until quite recently really, addiction was regarded as a morally flawed behaviour, something that people start doing but could easily avoid. But as result of all the research into the neuroscience of addiction, we've become aware that it is really a disease of the brain."

Juan Canales is researching addiction treatment.

However, there's a school of thought that sees addiction as a societal phenomenon too.

"Nearly everybody participates in some form or substance use or distracting behaviour, such as shopping or extreme sports, for example, to modify mood," Howard says. "So at that level it is very normal. To call it a disease would mean that everybody who is caught up in a regular use of some substance or behaviour to modify their mood [has a disease] ... that's not everybody's viewpoint."

The everyday addict is you and me. It's those of us who can't start our day without a coffee. It's those of us who regularly come back from the mall with stuff we don't really need. It's the weekly Lotto ticket-buyer and the teenager who spends all day on PlayStation. We do these things because they give us pleasure. They make us feel better, but they also help us cope with life. ("It's truly amazing," food writer Nigel Slater wrote in his memoir, Toast, "just how much you can put up with when you are getting regular sex.")

These sorts of behaviours are largely "soft" addictions and a survey (possibly not a very scientific one) done the United States in the early 2000s suggested 90 per cent of Americans have them. In other words, pretty much all of us are "addicted" to something.

Whether that is true or not, Summerfield says it seems not to be okay to have displeasurable feelings in our society. "We have to have happy feelings - so people will strive to achieve that."

In fact, we may be a more addicted society than we were 50 years ago, according to Howard. "But I certainly have no way of measuring it because there are too many indefinites, too many forms of addiction that we're talking about here. We might be talking about inappropriate use of certain behaviours and substances that are not necessarily addictions but are on a continuum."

Summerfield argues that addiction is a symptom of underlying problems. "Usually there's early, unmet psychological needs. I'm not saying that they've all had really bad upbringings or anything like that, but usually there's something that's been unmet where they haven't been able to talk about their internal world."

However for some, addiction is accidental. "It's part of a culture," Howard says, "that's encouraging us to do extreme sports, for example, and by accident we end up using it as a mood modification behaviour - it could be you, it could be me."

But for many sufferers - whether of obsessive shopping or meth - it's about failure to directly tackle an underlying problem, Howard says. "[Tackling the problem directly] is the more ideal, healthy, coping strategy. The unhealthy coping strategies are those that are more avoidant, like the diversion of attention from something. That comes in the form of gaming, shopping, drinking, drugging, smoking. They all have the effect of cancelling out awareness of mood state."

But here are the big mysteries: why does something we might regularly do, like drink, somehow lead to dependency and addiction? And how come only some people become addicted?

"That's the million dollar question," Howard says. "You have to put together many pieces of the jigsaw because ... genetics are only one. There is also background trauma. It is also the ability to handle emotions. It is also what your peer group does, what society you live in, how much money you've got ... there are all sorts of things that stack up and, when you put a few together, whammo, you're the person."

And if you are that person, you will be judged. While we are broadly aware as a society that addiction - whether it be cigarettes, pornography, P or alcohol - is a disease, we still judge addicts themselves. The American Journal of Psychiatry published a study a few years ago looking at, among other things, the stigma associated with alcohol dependence. The research compared attitudes in 1996 and in 2006, and found while those who thought alcoholism was a brain disease increased from 38 per cent to 47 per cent there was no difference in stigma. Quite the reverse. The percentage of people who associated alcoholism with "bad character" jumped from 49 per cent to 65 per cent.

Addiction is not healthy. Photo / Thinkstock

Kate says she still hears this attitude. "They don't understand how people can't stop. It's that whole mentality: if they wanted to stop they would and it's kind of their [the addict's] responsibility. But really you're in the grasp of an illness and disease that you've lost the power to control, you've lost the power to do anything about it."

If there's a lack of understanding (or compassion), there is also hypocrisy. Putting aside many people's everyday dependency on coffee and the like - which ought to engender some kind of understanding - there has evolved a clear hierarchy of addicts. Someone addicted to, say, sleeping pills is judged differently to someone who is addicted to methamphetamine.

"They are absolutely viewed differently," Howard says. "One gains the negative judgment of society - that is the person on the illegal substance - and the other gains ... well actually it's hidden, nobody even knows because it is so acceptable and it is something that you do behind closed doors with the approval, with the sanctioning of your GP, who is a respected member of society.

"So we have a binary view of addicts in society that doesn't stack up against what's actually harmful. Some prescription meds are probably more harmful for some people ... than marijuana ... physically speaking."

The costs of addiction are very high indeed. Putting to one side the trauma for individuals and families, the estimated social cost - in crime, lost production, health and so on - of harmful drugs was $6525 million a year, according to a 2009 Berl report, the equivalent of our agricultural GDP. The social cost of harmful alcohol use was $4437 million.

These estimates are based on 2005/6 figures. God knows what the costs are now, but there's little doubt we have a vested interested in reducing addiction. However, recovery rates are low. Canales says science still doesn't fully understand addiction's mechanisms but, in the last decade, research targeting specific dopamine receptors in the brain has reaped results.

"All drugs of abuse increase dopamine in the brain," he says. "It's well demonstrated that if you target the dopamine system you can manipulate behaviours associated with alcohol, heroin and cocaine abuse."

And now there is real hope a craving blocker has been found. Research done by Canales and his team on new compounds created by the pharmaceutical giant Roche shows that they can "eliminate craving for cocaine", he says. The results were published last month in the journal Neuropsychopharmacology (which belongs to the Nature group).

In their experiments, rats were allowed to become addicted to cocaine through self-administration. The cocaine was then withdrawn for a fortnight before the rats were put back into a self-administration chamber. Those treated with the Roche compounds did not relapse while those that had not be treated did. Even rats that were given cocaine after they'd been given the compounds did not relapse.

"It's a major finding," Canales says. "What we have found there is a way of modulating or fine tuning the dopamine system. We've discovered that by activating chemically a receptor in the brain we can eliminate craving for cocaine."

And not just cocaine. He says they've done the same experiments with methamphetamine and had the same result. It is hoped the compounds will be useful in blocking cravings for other substance addictions as well as behavioural addictions like compulsive eating and gambling.

Human trials will begin soon and, if all goes well, he hopes a treatment could be available to the public in three to five years.

It won't be a single-shot silver bullet, however. "The memories of addiction are very long-lasting and those cues that provoke craving are going to be there for the rest of your life. The cure for addiction is not just purely pharmacological. But this pharmacological treatment will help tremendously because we have demonstrated that you can block craving, you can prevent relapse in a situation where without treatment you do relapse."

A cure for addiction is not, however, a cure for its deep causes - or to the attitudes some of us still have about addicts.

It's the former, the underlying problems, that are the most difficult to deal with, Kate says. It took her two years. "Once [the P] is out of your system, I found I didn't crave it so much. But I actually had to fight all this other stuff, the emotions, the living life on a daily basis when you've just haven't [done that] for some many years. It's completely about learning to live in society again."

And we really don't have a society in which we can easily admit our vulnerabilities. "There is more talk of [emotional issues] now than there used to be so we're very pleased about that, as psychologists," Howard says. "But we would like to see a shift in societal attitudes to more acceptability of people having emotional issues. We all have issues, but the trouble is that we hide them ... So the idea is that we need to be better educated about good emotional management strategies. How do we handle the variety of emotions that happen day to day, week to week in life, because life is hard and that isn't normalised enough. There isn't enough acceptability of the full range for human emotions and the need to address them without using addictive behaviours or substances by talking with someone."

A healthy dose of compassion, too, might be a cure, not least for those in the grip of serious addiction and for those trying to recover.

"This addiction, whatever it is, is their best friend," Summerfield says. "It's been their lover, it's been their liar, it's been their protector, it's rescued them. And [ending that] is like going through a divorce."

If you believe you, a friend or a family member has a substance or behavioural addiction contact your GP or go to adanz.org.nz or higherground.org.nz for information about treatment services in your area.

* Not her real name