Sunday, August 1, 2010

Multiple Addictions

Why isn’t one drug enough?

The newer views of addiction as an organic brain disorder have cast strong doubt on the longstanding assumption that different kinds of people become addicted to different kinds of drugs. As far back as 1998, the Archives of General Psychiatry flatly stated: “There is no definitive evidence indicating that individuals who habitually and preferentially use one substance are fundamentally different from those who use another.” This quiet but highly influential breakthrough in the addiction paradigm has paid enormous dividends ever since.

The behaviors known as pan-addiction, substitute addiction, multiple addiction, and cross-addiction demonstrate that some addicts are vulnerable in an overall way to other addictive drugs as well. If it was one addiction at a time, that was known as substitute addiction. If it was many addictions simultaneously, researchers called it pan-addiction. The fact that a striking number of alcoholics also had cigarette addictions, and were heavy coffee drinkers, or had been addicted sequentially or simultaneously to various illegal addictive drugs—this was no great secret in the addiction therapy community. Indeed, it was clear that many addicts preferred the mix of two or more addictive drugs. And the phenomenon has serious social and economic ramifications.

Addicts show a remarkable ability to shift addictions, or to multiply them. Many addicts seem to be able to use whatever was readily at hand—alcoholics turning to cough syrup or doctor-prescribed morphine; pill poppers switching to alcohol; cocaine addicts turning to pot. If addiction was really, at bottom, a metabolic tendency rather than a sociological aberration, then it could conceivably express itself as a propensity to become seriously hooked on any drug that afforded enough pleasurable reinforcement to be considered addictive.

One leading school of thought views the metabolic disorder we call addiction as a manifestation of an “impaired reward cascade response.” This fact matters more than the differing details of addictive drugs themselves. This is where and how addiction happens. It is understood that addiction has its cognitive and environmental aspects as well, but the scientific mystery of how normal people become uncontrollable addicts has been substantially explained. Addictive drugs are a way of triggering the reward cascade. Cocaine, cocktails, and carbo-loading were all short-term methods of either supplying artificial amounts of these neurotransmitters, or sensitizing their receptors, in a way that produced short-term contentment in people whose reward pathway did not operate normally.

Naturally, you have to allow for environmental and social factors, but no matter how you add it up, a certain number of people are going to get into trouble with drugs and alcohol—it doesn’t really matter which drugs or what kind of alcohol. And a percentage of that percentage was going to get into trouble very quickly. These were the people who were hard to treat, and seriously prone to relapse. They would get into trouble because drugs did not have the same effect on them that they had on other people. Like a virus infecting a suitable host, drugs—any addictive drug--went to work on those kinds of addicts in a hurry.


Dusty said...


The high number of heavy smokers at rehab clinics (not to mention the cigarettes-and-coffee regimen that fuels many an AA meeting) is a longstanding testament to the phenomenon of cross-addiction.

What I've always heard anecdotally is "I started smoking a lot more in recovery".

Layman's speculation:

There is also the interesting (and tragic) association of gastric bypass surgery with increased risk for alcoholism.

"Food addiction" is a controversial notion and surely liable to be overused if it becomes a clinically accepted diagnosis.

But when someone becomes physically incapable of overloading with carbs/comfort foods, and in response they turn to alcohol abuse, it seems like an awfully clear indication that a person was indeed a food addict.

Dirk Hanson said...

I agree.

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