Overcoming Addiction

By

Charles Atkins, MD

"Wouldn't it be great if you could love me first and let the bottle wait?"

--Dolly Parton

"They tried to make me go to rehab, I said, ‘No no no.’"

--Amy Winehouse

You know it’s killing you.  The alcohol, cigarettes, pain pills, illegal drugs whatever the habit is that you’ve tried to change—repeatedly—but without success.  Your conversations with yourself are familiar as a favorite tee shirt, “I’ve got to stop…I’ll do it tomorrow.”  And then tomorrow comes, and with it the urge to drink/smoke/use illicit drugs and despite your best intentions you give in.  “Okay, tomorrow then.  I’ll really stop tomorrow.”  So what’s wrong with us that we persist in behaviors that harm us?  And most importantly, how does someone finally make the needed change?

As a psychiatrist who works with people with drug and alcohol dependence I spend a lot of time on these questions.  While the answers can be complex, I’m drawn to some basic truths.  First, the destructive habit--whatever it is--serves a purpose, at least initially.  The "why" someone begins to drink or use drugs varies from person to person.  Alcohol provides a sense of relaxation and well being.  For people who are anxious or socially awkward it helps lubricate their tongues and makes them feel at ease in social situations.  Opiates (pain pills to heroin) induce a state of euphoria and relieve not only physical pain, but emotional suffering, as well.  It’s no coincidence that so many survivors of abuse and trauma become addicted to heroin and prescription opiates. 

For teens experimentation with drugs and alcohol has become a passage rite.  The not-fully wired adolescent brain doesn't register the danger in the behavior, and it’s during these young years where most pick up habits that turn ugly in time.  The magnitude of this is followed by annual surveys that monitor high-risk behavior in teens.  In 2009 24% of high-school students engaged in binge drinking, nearly ten percent had driven in the past month when they'd had alcohol, roughly 30% had been passengers in a car where the driver had been drinking, 20% smoked cigarettes, 20% had used prescription drugs without a doctor's order, over six percent had tried cocaine and/or Ecstasy, and 2.5% had tried heroin. 

Once established, negative behaviors take on a rhythm and turn into a habit.  A smoker hears the phone and lights up, the morning cup of coffee is accompanied by a smoke, and every work break includes a quick cigarette or two.  A drinker anticipates the weekend, or the end of the workday as the time for the first beer or cocktail.  Passing a liquor store they think about whether or not there's enough booze in the house, or who they’ll meet up with for drinks at a favorite watering hole. 

Depending on the drug of choice, problems start to develop and can damage any and all aspects of a person's life--physical and/or mental health, relationships, job, finance.  An arrest for Driving under the Influence (DUI) starts a cascade of losses and legal problems.  Physical effects of excessive drinking emerge, and dependence--the body's need for the continued presence of a substance--takes hold.  An opiate addict no longer gets the euphoric high, but instead is chased by the physical and emotional agony of withdrawal “Jonesing" that turns her life into an unending search for the next fix.  The alcoholic becomes shaky in the morning, starts to drink throughout the day, has unbearable anxiety, poor sleep, and somewhere around the 20-year mark of heavy drinking heads into serious alcohol-related diseases such as cirrhosis and certain cancers.  A dangerous and potentially fatal withdrawal syndrome--delirium tremens (The DTs)—traps the drinker and their ability to “just go cold turkey” is no longer a safe option.  As for cigarettes, there’s little doubt that they represent the number one cause of preventable death in this country from heart disease, cancer and stroke.

What's remarkable is that even in the face of terrible losses--job, health, family--the destructive behavior persists.  Deceit and minimization of the problem is common, and attempts to quit or cut back are frequent and short lived.  Motivation to do something about the behavior is mercurial, changing from moment to moment. 

Yet people can and do change.  And just as the reasons why someone starts a destructive habit are varied, the paths that lead someone to put down a bad habit are particular to them.  At some point there is an awakening and with it a call to action.  "This is killing me and I've got to stop."  For others it may be an external force, a spouse threatening to leave, a child who can no longer bear to see you drunk and cuts you out of their life, an illness or serious legal problem that's a direct result of the addiction.  Regardless, something in the equation shifts and motivation moves into action: throwing away the cigarettes, dumping the booze down the drain, checking into a detoxification program, attending a 12-step meeting.  Again, there are many paths and depending on the behavior, the severity of the addiction and the person these vary from “going cold turkey” on your own to intensive treatment.  Some will require the services of medical professionals to get them through potentially dangerous withdrawals (alcohol and certain Valium-family drugs), and many will turn to rehabilitation programs, drug counselors and well-established self-help groups such as AA and NA.  The first days are the hardest as well-worn patterns of behavior, and cravings have to be resisted and changed.  This is where familiar slogans from 12-step groups such as AA become life savers, “One day at a time”.  “Today I’m not going to drink or drug, I’ll deal with tomorrow when it comes.”     

What is clear for everyone who has successfully put aside a destructive habit is that they’ve transformed a desire to change into action.  In time, the old destructive behavior is replaced with newer and healthier ones.  As I often tell my patients, putting down a bad habit is both easy and hard.  The hard part is “just don’t drink” and the easy part is, “just don’t drink”.