If you take the opportunity to speak with those who have survived the ordeal of addiction and alcoholism and who are in recovery, you will find a wide range of stories and experiences. When we think about those who are alcoholics and addicts, they are typically viewed through the lens of late-stage affliction: homeless, disheveled, living on the street or under bridges, hanging out in seedy bars or shooting galleries, exhibiting anti-social and criminal behavior. What is less apparent until we take a closer look is that addiction is an equal-opportunity destroyer. I have spoken with men and women in recovery from many walks of life, from high-rolling investment bankers to common laborers; physicians, attorneys, and accountants; contractors and convicts, housewives and hookers. Each person has his or her own story, but an eerie commonality is shared among them.
Early patterns and progression of drug or alcohol use in addicts vary widely among individuals and their preferred drugs. Some drink to blackout from the first; others pursue what appears to be regular consumption for years before accelerated use. At times, surprisingly, early experience with alcohol or drugs is decidedly adverse, yet repeated use still follows. The substance used can also have a significant impact on abuse and behavior: drugs that cause large and rapid swings in neurotransmitters, such as crack cocaine, tend to produce more rapid behavioral change and addiction. At some point, early or late in the user’s history, the most significant change occurs: the addict begins to crave the drug obsessively, regardless of negative consequences or experiences. The drug is no longer merely wanted for its effects; it must be used, no matter what its effects. The fatal attraction has begun.
Repeated use of drugs or alcohol produces specific physical and physiological changes. The substances stimulate enzymes and metabolic pathways, which enhance their metabolism in the body. This phenomenon is known as tolerance. Tolerance occurs not only for the euphoric or mood-altering effects but also for other effects. For example, opiates in high doses in non-tolerant individuals produce sedation, severe constipation, and impaired respiratory drive and can result in cessation of breathing altogether. Yet opiate-tolerant individuals (addicts and those taking such medications for medical purposes, such as cancer patients) can tolerate doses that would be lethal in others, with little adverse effects.
The other significant physical effect of prolonged drug use is dependence, wherein sudden cessation of the drug results in a withdrawal syndrome that is highly unpleasant or even fatal. Exact symptoms vary by drug but often include irritability, mood changes, agitation, abdominal pain, sweating, hallucinations, and seizures.
A common misunderstanding — even among medical professionals — is that addiction, physical tolerance, and dependence are the same. They are not. Place the addict and the non-addict side-by-side, and administer potent narcotics such as morphine on a repeated basis over time. Both will develop tolerance and physical dependence, requiring more drug to achieve the same effects. Both will exhibit physical withdrawal symptoms if the drug is suddenly stopped. The difference is seen in what happens next: the non-addict will be glad to be off the drugs with their unpleasant side effects; the addict will obsessively seek them again, even if their euphoric effects are no longer experienced – a dilemma which is increasingly likely as the length of use and dose increases.
It is this obsessiveness and the resulting compensatory mental responses to its demands that lie at the heart of addiction and alcoholism. The drugs themselves in susceptible individuals produce intense physical cravings for more — far exceeding such instinctual demands as hunger and sex — but it is the mental obsession that is ultimately so destructive. Were the adverse physical and social effects of addictive drugs — and their rapidly diminishing euphoric benefits — the only problems addicts and alcoholics faced, most would endure the suffering of withdrawal to restore their physical, emotional, and social well-being. But the obsession persists even when sober, ultimately laying the trap for recurrent use, progressive physical, personal, and social adversity, even to the point of insanity, incarceration, illness, or death. This process occurs while the addict or alcoholic remains blissfully and stunningly unaware of profound negative consequences.
As drug or alcohol use accelerates and physical and social problems multiply, the obsession does not relent but rather intensifies, resulting in a host of psychological defense mechanisms, including denial, minimizing, and rationalization. Deceitfulness is also a cardinal manifestation, lying to oneself and others until the line between truth and untruth is no longer discernible. Indeed, the ability to use free will becomes severely impaired as the pursuit of the obsession becomes equated with survival itself. As Dr. Jeffrey Smith states in his discussion of alcoholism and free will:
Alcoholics and addicts not yet in recovery behave as if they were fighting to preserve life itself. They act as if they are citizens in a malevolent society where operatives are using every technique including authoritarian force, manipulation and seduction to attack their existence. They valiantly resist all efforts to effect change. They may not like to lie, but they will if necessary. They use specialized psychological defenses including denial, minimization, rationalization, blaming, intimidation, all the while proclaiming the right to make their own decisions in life. Like victims of oppression, they go underground in their attempts to protect their freedom. Their defenses become habitual and function smoothly even when cognitive faculties begin to fail.
Such a perversion of thought and action is extraordinarily destructive to the individual and immediate acquaintances, family, co-workers, and society. It is unsettling and mystifying to see an end-stage alcoholic, days from death, denying his problem and demanding a drink, but this is the end result of a process of compulsive self-deception driven by forces far larger than the ability of mere human will — no matter how determined — to resist. It is the failure to understand the physical power and mental distortions of addiction that results in so many simplistic societal solutions, doomed to failure, however coercive or well-intentioned. By understanding these forces, however, although simple solutions to this pervasive problem do not immediately spring forth, the journey to freedom can begin. This is the testimony of many who have recovered and repurchased their lives from its destructive slavery.
