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Cocaine and the Brain: The Neurobiology of Addiction

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Biology 202
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Cocaine and the Brain: The Neurobiology of Addiction

Christine Farrenkopf

In the eyes of the public, the word addict stirs up a negative image: a person of low moral character who willfully chooses to engage in questionable behavior. This image is perpetuated in the media; on a recent episode of E.R., the chief surgeon criticizes another doctor for allowing a heroin addict (who has been treated for an abscess) to exchange a dirty needle, explaining "we donât want these low-lives hanging around the hospital." The social stigma attached to addicts reflects the great gap that exists between scientific knowledge and public perception of addiction. Just as mental illness was viewed as a social problem instead of a medical issue until the last several decades, drug addiction continues to be seen as a character flaw instead of as the biological problem that it is.

As defined by the American Psychiatric Association, addiction is a "chronically relapsing disorder that is characterized by three major elements: (a) compulsion to seek and take the drug, (b) loss of control in limiting intake, and (c) emergence of a negative emotional state when access to the drug is prevented" (1). This disorder results from the repeated use of a drug over a prolonged period of time, causing physical changes in the brain.

Perhaps the most addictive of drugs is cocaine. Cocaine acts on the mesoaccumbens dopamine (DA) pathway of the midbrain, extending from the ventral tegumental area (VTA) to the nucleus accumbens (NAc). (2). This pathway is also known as the reward pathway as it is the area of the brain that is activated when someone has a pleasurable experience such as eating, sex, or receiving praise. (NOTE: The reward pathway was discovered through the technique of intracranial self-stimulation (ICSS) (3, p.53). An electrode was implanted in different areas of the brains of rats and was activated when the rats voluntarily pressed a lever. Stimulation in most sites in the brain was not reinforcing (ie, the rats did not regularly activate the electrode), but one site in particular was reinforcing: the reward pathway. Because of the positive effects felt when this pathway is stimulated, such behavior is reinforced.

In the DA pathway of a normal person, a transmitting neuron releases dopamine (a neurotransmitter), which then binds to dopamine receptors on the receiving neuron; an action potential is then propagated in the receiving neuron. (4). After this has occurred, the dopamine reuptake transporters (DATs) of the transmitting cell pump the dopamine back into the cell to be used again.

Cocaine binds to the dopamine reuptake transporters, thus blocking them from functioning. (See web reference (5). for an animation of this process.) As a result, dopamine levels increase in the synapse, and consequently, the receiving neuron is continuously stimulated. This constant firing of the neurons leads to a feeling of euphoria. In addicts, cocaine blocks between 60 and 77 percent of the DAT binding sites; in order to attain a "high," at least 47 percent of the binding sites must be blocked by cocaine. (6).

Cocaine also acts on the reuptake transporters of serotonin and norepinephrine, and therefore, the levels of these neurotransmitters are also increased. (2). Serotonin plays a role similar to dopamine in the DA pathway. Norepinephrine stimulates the "fight or flight" response of the sympathetic nervous system characterized by heightened heart rate, blood pressure, respiration rate, and body temperature as well as dilation of pupils and sweating; these phenomena produce an energizing feeling (7). p.103.

At a certain point, cocaine usage ceases to be a voluntary action: this is the onset of addiction. The positive reinforcement of the sensation of euphoria eventually alters the brain so that the use of cocaine is obligatory. Animal models have been used to demonstrate such positive reinforcement (8) p.1262-4. Lab rats were fitted with long-term intravenous catheters and were taught how to self-administer doses of cocaine by pressing a lever. The fact that the rats continued to self-administer cocaine demonstrates the desire of the rats to be under the influence of the drug. In addition, there is a correlation between the level of the dose of cocaine and the number of infusions a rat would give itself: the lower the dosage, the smaller the gap in-between self-administrations. This indicates that the rat is aware of the level of cocaine in its system and its desire to maintain that level through subsequent injections of the drug. These experiments demonstrate the "compulsion to seek and take the drug" aspect of the definition of addiction.

Another factor in the reinforcement of cocaine use lies in the fact that after cocaine administration, dopamine levels fall significantly below normal, pre-consumption levels (8) p.1272. The user therefore feels a "low," and the immediate response to alleviate this low is to take another hit of cocaine to again raise the level. Such behavior is referred to as a "binge," when a user continuously takes hits of cocaine to recover from ensuing lows (3) p.158. This demonstrates the "loss of control in limiting intake" aspect of the definition of addiction.

Recent research has shown that reinforcement is also linked to cocaineâs ability to act on genetic material: it activates the gene that codes for the protein delta-FosB (whose levels are elevated in addicts) (9). This protein in turn activates the gene that produces a component of glutamate receptors (GluR2), which binds the neurotransmitter glutamate. An increase in GluR2 production has been shown to increase sensitivity to cocaineâs rewarding effects.

Over a long period of usage, the brain responds to the above-normal levels of dopamine that are present during a hit. The main manifestation is a reduction in the number of dopamine receptors on the dendrites of neurons (10).; if there are fewer receptors, then there will be less stimulation of the nerves in the DA pathway. This demonstrates how the brain of an addict is physically different from that of a normal person.

Due to this physical change in the brain, an addict will respond differently to a particular dosage of cocaine. Tolerance develops in many addicts, wherein a larger dosage is needed to attain the same high that a user initially experienced (11, p.38). Sensitization may develop instead, wherein a user becomes more responsive to cocaine without increasing the dose (12). The biological mechanisms behind these two phenomena are not completely understood. There is evidence that whether tolerance or sensitization develops depends at least in part on the manner in which cocaine is delivered to the body: if cocaine is taken in spaced out intervals, sensitization results; if cocaine is taken continuously through an IV or through closely spaced injections, tolerance results (13). (14).

Because of the altered physiological state of the brain, events that previously caused stimulation of the DA pathway (pleasurable experiences other than cocaine use) no longer do; only cocaine can induce the feeling of happiness. When an addict ceases taking cocaine, he has no source of stimulation of the DA pathway and therefore experiences severe depression, irritability, and anxiety (symptoms that are opposite of the effects of the drug) (8) p.1271. (This is the "emergence of a negative emotional state when access to the drug is prevented" aspect of the definition of addiction.) Other factors also contribute to the negative behavior associated with withdrawal. For example, tests in lab animals have shown that levels of coricotropin releasing factor (CRF), which induces stress, rise while in withdrawal (8) p.1273.

With repeated drug use comes a phenomenon known as place conditioning, wherein particular places and cues become associated with cocaine use (15). Experiments using lab rats support such a conclusion (8) p.1267. Two distinct neutral environments are set up, one of which is paired with cocaine and the other with a placebo. When the rats are allowed to freely roam between the two environments after experiencing both the cocaine and placebo, we find that they choose to spend more time in the environment where they were given cocaine. This demonstrates that the drug comes to be associated with a certain place.

The road to recovery from cocaine addiction is a long one, particularly because a patient must struggle to overcome the odds of relapse: approximately half of recovering patients succumb to relapse within a year of detoxification (16).

The negative emotional state that results from cocaine withdrawal often causes patients to begin using the drug again. The challenge is to withstand the urge to use the drug during the time when the body "resets" the DA pathway (ie, more dopamine receptors will be activated due to the low levels of synaptic dopamine, which in turn will allow activities other than cocaine use to stimulate the reward pathway). Studies have shown that numbers of dopamine receptors will never return to pre-cocaine use levels.

Because addicts grow to associate certain places and cues with cocaine use, exposure to such stimuli may cause a relapse once an addict has "quit" (17). If reminded of an event linked with cocaine use (such as passing by a place where one formerly used the drug or watching people smoke crack), a recovering addict will very likely feel a strong craving (10). Such a reaction to these memory-based stimuli raises the question of how long memories are able to induce a response. Recent research has shown relapses in lab rats even after four months of abstinence (17).

There is no well-established treatment plan for cocaine addiction, but the most effective measures are to combine a medicine with drug counseling. Drugs such as vigabatrin are being developed that seek to reduce the pleasure of a cocaine hit (this drug stops cocaine from increasing dopamine levels in the DA pathway and prevents subjects from developing place/cue associations in baboons) (18). Anti-depressants are often prescribed to alleviate the negative behavior of withdrawal. New research is concentrating on neutralizing cocaine in the bloodstream so that it is unable to affect the DA pathway (18). While medications are an important part of the recovery process, counseling also plays a seminal role as the patient must learn to resist the urge to use cocaine. Group and individual therapy sessions aid patients in coming to terms with their problem and building up self-confidence (19). Cocaine-specific skills training (CST) teaches patients to identify the places and cues that cause them to feel cravings; they then seek to avoid or adjust their reactions to such stimuli (20).

Viewing cocaine addiction as a chronically relapsing disease of the brain is a new concept for much of the public. Such scientific evidence forces people to re-evaluate their views of addicts (in particular the stereotypes associated with them) as it demonstrates that an addict must be recognized as someone with an altered brain state, just as someone with a mental illness or Alzheimerâs (15). Addicts cannot be cured through incarceration; instead, the process of recovery requires both counseling and medication. In fact, the lasting biological effects of cocaine addiction are so far-reaching that rehabilitators often comment that there is no way to "cure" someone of cocaine addiction - - one can only learn how to live with it.

WWW Sources

1) The Neuroscience of Addiction, Research article on mechanisms of addiction

2) Addiction to Cocaine and Amphetamine, Research article on mechanisms of cocaine addiction

3) Addiction: From Biology to Public Policy Goldstein, Avram, M.D. Addiction: From Biology to Public Policy. New York: W.H. Freeman and Company, 1994., In-depth discussion of biological aspects (in addition to social aspects) of addiction, appropriate for undergrads

4) Cocaineâs Pleasurable Effects May Involve Multiple Chemical Sites , Description of cocaineâs effects at the neuronal level

5) Animation of Cocaine Blocking Dopamine Reuptake

6) Brain Scans Open Window to View Cocaineâs Effects on the Brain , Research on dopamine reuptake transporters

7) Psychology of Alcohol and Other Drugs: A Research Perspective. , Jung, John. Psychology of Alcohol and Other Drugs: A Research Perspective. Thousand Lakes, CA: Sage Publications, 2001.

8) Fundamental Neuroscience, Zigmond, Michael, ed. Fundamental Neuroscience. New York: Academic Press, 1999., General neurobiology textbook

9) Scientists Identify Brain Chemicals Involved in "Switching On" Cocaine Addiction, , How cocaine affects our genes

10) How It All Starts Inside Your Brain , Article on biological mechanisms of addiction, appropriate for the layman

11) Cocaine Addiction: Theory, Research, and Treatment, Platt, Gerome. Cocaine Addiction: Theory, Research, and Treatment. Cambridge, MA: Harvard University Press, 1997.

12) National Institute on Drug Abuse Research Report: Cocaine Abuse and Addiction , Good source of all aspects of cocaine and addiction

13) Addiction, Dopamine, and the Molecular Mechanisms of Memory , Research article on addiction

14) Addiction Becomes a Brain Disease, Scientific research on mechanisms of addiction

15) Addiction is a Brain Disease, and It Matters , Written by the director of the Nation Institute on Drug Abuse on addiction

16) Treatment: New Ways to Stay Clean , general article on drug treatment

17) Study Sheds Light on Cocaine Relapse , short article on cue-induced relapse

18) Seeking Ways to Crack Cocaine Addiction , Article discusses medications being developed to help overcome cocaine addiction

19) Combining Drug Counseling Methods Proves Effective in Treating Cocaine Addiction , Information on drug counseling

20) Coping Skills Help Patients Recognize and Resist the Urge to Use Cocaine , Information on therapy for cue-induced relapse



Continuing conversation
(to contribute your own observations/thoughts, post a comment below)

01/01/2006, from a Reader on the Web

A recent family member just arrived home after spending 30 days at Hazelden, which teaches the addict and the family that Cocaine addiction is a disease and not a question of will power. As a result, I began my research online and saw your article. You seem to state the same thing but I disagree with your conclusion, as I disagree with Hazelden's philosophy. Your paper did not prove that addiction is a biological disease, it only explains what happens when someone becomes addicted to cocain in a scientific manner. A disease is an illness that people don't have a control over, an illness that people don't invite into their lives. Your papers states that addiction becomes a disease after a period and intensity of use. How can that be an illnesss when you cause the condition? You are causing the problem. If a football atheletes perpetually hurts his back from the sport and has permanent back pain, is that a disease or a chronic pain? Your paper also states that to cure the addiction, an addict must resist the temptation and go through counseling and rebuild self esteem. That is will power, determination and control. How can you conclude that addiction is a disease then? I truly would appreciate a response back. I have an issue with this claim. I feel that to give an addict such reasonings is to tell them that they are not in control and that if relapse or death happens, it is the fault of the disease. That is misguidance in my view. An addict should be held responsible for his or her action and recognize their weaknesses and failures so that they can truly work on their problem. Thank you.


Additional comments made prior to 2007
just read your notes on cocaine addiction, i would also like to disagree with calling this addiction to cocaine a "disease", surely you are giving every coke addict a free ride to continuing with their addiction. if someone freeely takes this drug knowing the damages they can get from it that is a choice, not a disease.
so, is cocaine addiction,in the same category as,someone with ms or me, thats what i would think you were trying to say, these are also diseases, but people with these diseases didnt choose to have them, a cocaine addict made their choice on their first lesson of taking the drug.enough said ... Wendy Pearce, 18 February 2006



Serendip you do not understand what the word addiction means. Your example about back pain makes no sense. No one wakes up or is born intrinsically addicted to alcohol, porn, or cocaine. You have to experience a thing to become addicted. If you want to blame someone for that initial experience than that is a different story from telling someone it is their fault they are "addicted" Addiction is a biological and frequently psychological state, the brain transmitter chemistry has changed such that a person is completely driven to get the 'high' created by that drug. There is no matter of "willpower," their brain is telling them without the drug they will die. Addicts do not have control over that urge, it has become a chemical force of nature in their brain. Relapse itself even cannot always be considered willpower since the 'once addict' still has that wiring in their brain to tell them to get high. It is a very powerful force and not one that is easily overcome, and really only something that an addict can truly understand. Fortuntalely there is help for addicts beyond willpower, like using methadone maintenance to wean someone from the need for cocaine, but the road is long and hard regardless ... Reader on the web, 2 April 2006



Hi, just read your page, very interesting and very helpful. I have lived with an addict who injects cocaine. I have seen what has happened to a once lovely person and the effects his addiction has had on us innocent bystanders. He did this to himself, we didn't ask for him to inflict the misery on to us too. It is a self inflicted addiction not disease. My father is an alcoholic! His behaviour patterns are similar to my ex-husbands but neither has a disease. Addiction is not disease in the sense that my non-smoking healthy living grandfather, who died of lung cancer had. I am still very bitter towards my ex I must admit and so my empathy for addiction is low so maybe I am not looking objectively at your page, but addicts not only abuse themselves but those who love them. The Hep C he contracted using shared needles is a disease! ... Karon, 3 April 2006



I am responding to someone's response to the article on cocaine addiction. S/he states: "A disease is an illness that people don't have a control over, an illness that people don't invite into their lives," and then suggests that since becoming addicted has to do with choices the addict makes, it isn't really a disease; that treating it as if it were a disease somehow prevents the addict from being "held responsible for his or her action" -- that addicts must "recognize their weaknesses and failures so that they can truly work on their problem." Cocaine and the Brain: The Neurobiology of Ad... Reality is more complex than yes-no, black-white, or a disease-personal weakness dichotomy. Addiction is a coping mechanism, with, as both the article and responder point out, a scientific, biochemical neurological basis. And with the notable exception of crack babies, few addicts are born addicted. But addiction is a disease nonetheless, a social disease. Unfortunately, for some who survive the trauma of dysfunctional childhoods with repeated physical and emotional abuse, a drug induced 'feel good' may be the only joy they have ever known. Physiological and psychological addiction take over, and it will take community support, counseling, drug therapy and yes, individual will power, to break free. But the abused child who grows up to be a drug addict doesn't invite or choose the abuse. The disease model is closer to the truth of the cause of addiction -- a toxic social environment with multiple dysfunctional experiences. And like any other disease, some people are naturally more or less susceptible to addiction -- not everyone who grows up under socially adverse conditions becomes an addict, and some who seemingly have had ideal environments do get hooked. But just because the etiology is not bacterial or viral or genetic is no reason to circumscribe the paradigm of addiction to 'bad choices' or 'not enough will power'. The problem won't get solved without looking at the whole picture of causation, and the disease model holds the promise of bringing light, without heat, to this war zone ... Judy Brody, 14 April 2006



I am a cocaine addict. My choice is rock cocaine. I have been clean for a week and a half, and it is hard. Hard to sleep, i dream of smoking it. I get shaky and want it so much. I am not in any treatment plan or on any anti-depressant drugs. I have no job at the moment and no money. That is the only reason i am clean. I try to think of other ways to get high and can't. I am so uncomfortable in my own skin. I think of ways to kill myself and came close. I know the affects and that it is a serious thing, but i want it. I just don't care any more. I have been going through some serious withdrawl and i know if given the chance i will do it again. I do wish i would have never started. I don't know why i am typing this, i guess because i have no one to talk to. I am in pain and there isn't anything i can do ... Laura, 10 May 2006



I have been using for about half a year; my use escalated when I realized it helped me - or so I thought - stay sharp and alert on the job. I deejay overnights at an easy listening radio station.


I am scared and confused-- I came out to some members of my family when my use started getting out of control.


I curse the day I ever started using. I would like someone - anyone who is dealing with the same problem - to email me; perhaps (in addition to NA meetings) we could help each other deal with this.


My friends who don't use aren't talking to me much anymore.


Please help; I hope I can return the favor ... Ben, 29 May 2006



I think that your article made a lot of sense. I am trying to figure out how to deal with my fiance/ father of my child's addiction to cocaine. I have been with him for 3 yrs and I have recently found out that he had had a previous problem with it and was using it again. In fact, you broke down the process of cocaine addiction so well that I feel the need to leave him. I can't deal with the lifetime resposibility of having a cocaine addict with a permanently altered brain state as a partner. He will never be the same ... Krystle, 31 May 2006



I agree with the comments the last writer shared. I have a thiry year old son who feels smoking pot is OK. After all it's not crack/cocaine or heroin. Well he graduated to the former. I never really thought it was that powerful addiction unless you were using it. I don't agree that is really biological if you conciously choose to smoke it. I do believe it's a lot about self esteem and caring about yourself. My son was in a terrible auto accident in January and almost died. He was the passenger in the car of someone who had smoked crack the whole weekend prior to the accident. For six weeks I sat by his bedside praying he wouldn't die. Then he miraculously lives and ends up on my doorstep telling me he has been on a crack run for the past two months.


What to do? ... Reader on the web, 4 June 2006



In most academic institutions, my premise is akin to intellectual suicide. Society and science today probably finds my stance as laughable, yet the men and women upon whom this country (America) was founded would not be blind to the wisdom. Drug addiction, as well as alcohol and pornography addiction, are simply attributable to our human nature. The bible calls it "sin," yet we can't have that today, now can we? The Old Testament called it "idolatry" and today we call it "addiction." Christ died for us all and gave us a means whereby we can gain strength and the power to overcome. For us to think we might escape the claws of coccaine on our own is folly. A loving God really does care. (1 Corinthians 10:13): "No temptation has seized you except what is common to man. And God is faithful; He will not let you be tempted beyond what you can bear. But when you are tempted, He will also provide a way out so that you can stand up under it." I know this may sound like the crazy talk of a religious zealot, yet God is real... and He really does want us to go to Him for help. Coccaine and all ... Frank Zedar, 10 June 2006



I would like to respond to the reader that stated Cocaine addiction is not a disease because the individual's chosen actions brought it about. If this were true, then most Diabetes, heart disease and Cancer are also NOT disease, as lifestyle factors (smoking, lack of exercise, etc) predispose an individual to these illnesses.


It is already a crime to obtain, own and use cocaine. Adding more blame on the addict may make you feel justified, but it does nothing to resolve this problem. Every addict also has blameless family and friends who are victimized. To search actively for this brain altering disease's treatment should be a priority; leave the blame game to the courts ... Bonnie Clancy, 27 September 2006



The mayor of Bridgeport, John Fabrizi, was exposed as a Coacine addict when the FBI was conducting an investigation on corruption in Bridgeport, and inadvertingly revealed the info on Fabrizi which the Feds didn't intend to divulge at that point in time. The mayor says he is off Cocaine and cured and is taking treatments or something to that effect. Connecticut Post, the leading newspaper in the area, conducted a series of interviews and tests on the mayor, which the mayor agreed to and reported that the mayor had no signs of being on Cocaine.


I knew a drug addict who was addicted to drugs and his wife threatened to leave him unless he went for rehabilatation. He went and kept getting high marks for recovering from drug addiction, but he confided to me that he was still on drugs and was able to fool all the experts. Is this possible?


Is it possible that a mayor of a city of some 200,000 people or the largest city in Connecticut can govern and make decision coherently. Can the mayor properly govern? Could he have fooled Conn. Post the same way the above mentioned addict fooled his wife and even his doctors? ... George Mougios, 24 November 2006



i found the aricle interesting and learned a lot about what the drug can to do the bis handrain as a recovering alcoholic sober for six years i can appriciate the info as i live with and am married to what was a closet coke addict, just since christmas of this year did things get really out of control, our kids and myself are homeless and struggling to make it while he is working a great job and staying out every time there is a dime in hiack... s hand i am at wits end i love him to death but need to know what kind of meds would work for himif any he really needs an out as do i and the kids we want our family back, thanks ... Judi Lamb, 8 June 2007



I found your article extremely in depth. Comprehenable. It is unfortunate that in with all the information that we have that addiction is still so widely misunderstood. Choice comes into a drug addicts life maybe one or two times. Much in the same way unprotected sex comes into an HIV carriers life once or twice. Even Diabetes and many forms of Cancer are avoidable, yet once people have succumbed, it somehow seems easier for people to acknowledge the repercussions of aquireing mentioned diseases as just that. Agreed in almost all cases, the addict did at one time have a choice. Once this disease gets into the brain, it is like any other disease. If left untreated it will change your life immeasurably and more than likely kill you ... Warren, 17 October 2007



The response from [a] previous reader is INCORRECT. A disease or illness is not always unprovoked, look at the obese person who became diabetic or the smoker who has lung cancer ... Kristin, 22 July 2007



In response to the reader comment From 1/1/06.......... Since June, 2006, I have fallen prey to what I feel to be the beginning of cocain addiction. I Was baffled by the craving and submission aspect of this drug and my struggle with my lack of power over it. that is, untill I read your article on the subject. After reviewing the article and one readers comments, I have to thank you sincerely. in my younger years,( I am 44) I partook from time to time(once every year or two) with friends and relatives on special occasionsand never craved afterwards. i believed that i wasn't capable of becoming addicted because it really wasn't important to me at any other time. Until March 2006, it had been some 15 years between usage. last summer with what I believe to be wonderful, nice caring successful people, we all kinda got into it together. And I of course believed I was above the possibility of becoming addicted. Then around January 2007, I decided that I was over my phase and was going to quit. Two weeks later, told myself that it was under control and that every now and then was still ok. But I descovered after every shameful morning after, I would say that this was the last time, and a few weeks later, was unable to say no. This went on until June. then one night one of my close friends that was my party buddie and I started talking and we both realized that we both had the same concearns and decided to quit together. and we did. for 103 days. And we did it twice more since then. and now I can finally admit that I am an addict. My stuggles continue, but i try to accumulate more and more Successes, days. We now call each other when we have the cravings, and are going to continue fighting the monkey.Ther are still moments of discouragement, but the successes are greater and adding up. I am weak, but i'm going to win. I believe the statement to be correct that at a certain point, when you cannot control your mind, the addiction has become a disease. i also believe this is not true for everyone. I call it two types of addiction, voluntary and chemical. My fiance who struggled with alcohal all her life passed away two years ago. and after watching for four years, I can honestly say that she had a disease, no control over it whatsorver. thanks for having a place for information. were not all bad people. Learning day by day ... Jon Meadows, 3 November 2007



My 24 y.o. daughter died of cocaine intoxification Octtober 21, 2006. She had been diagnosed with having bipolar disease by her child and adolescent psychiatrist. She had had this psychiatrist for the last eight years. Previously, she was a heroin addidct and used methodone. When she tapered off of the methodone, she immediately went to cocaine. I either was in denial, or clueless to how affected by drugs she was. I sent her to therapy constantly, as well as to as many rehabs as I could afford. I feel I could have done more, and will never forgive myself for not doing more to help her. I miss her so much. I will never get over this or forgive myself. Please help me ... Shelly Crawford, 12 December 2007


Anonymous's picture


I am writing because as someone who has been dating a recovering crack addict for the last year I feel that I have come to terms with accepting that there are withdrawals that I cannot relate to. I have decided to end the pursuit of this relationship because my partner is short tempered, and emotionally disturbed, I know he smoked crack for 8 years straight and he is on his second year of being clean, I am not sure if this is a disease or if indeed it is a choice but the reality is has done the damage to the nervous system and it is evident in his behaviour. I am sad about this but I believe in accepting this change in my life and moving forward wishing him the best with his recovery.

Anonymous's picture

Disease or not, another addicts opine

I have just read through the comments and find the complexity of my problem more complex. I had been clean for two years up until two days ago. What made me go out there, who the hell knows. I do know that I have been experiencing serious depression, feelings of unhappiness, unfulfillment and stress. I have jeopodized the love of my life, family and my own freedom.

As a cocaine/crack addict, I did choose to use initially. Now it chooses me.
I do know that triggers are real. Places, people, and situations can create that twinge in the stomach no matter who you call. There are times and circumstances that I must summon the whole fight inside of me.

I know that my brain has been altered, and when that occurs, I am an ill man. And is diseased. i also find that it takes more to stimulate pleasure and happiness in my life.

I am responsible for my actions and make no excuses. What I do know is that nobody wants to be an addict. I don't always put to work every tool I have learned, which increases the likleyhood of relapse. But I approach each day with the effort to stay clean today. Most addicts are very serious about quitting; however, many of the triggers we face live with us at home, work and other unavoidable areas of our lives. Let us never be faithless enough to believe that aperson can't or doesn't want to not use. i start my fight again today.

Anonymous's picture

I Hear You :: Fortitude

I am only just beginning to research the road to recover from "b" and relate to so much of what is written.....You are clear about your position in this paradox. I have been perplexed about my lucidity about my addiction and my continued use despite growing negative consequences.

I write here to, at a minimum, to communicate in print my problem....I am out of control and afraid that I may die if I continue....I'm here on the planet to do better work and be more....and it's easy when I am in flow. I am gifted and when I'm sober and engaged in my world, I'm electrifying to my community.

I've been killing myself and am perplexed. I do not identify at all with the counsel that a lack of self love is at the core of my own self mistreatment through continued use.....yet I look at my behavior, the consequences and realize that this context, is indeed true.

I want to stop so bad and have begun telling the truth of my struggle to important people in my life.....My behavior is so contrary to my feeling of want to stop that I literally don't believe myself anymore. The fact that I will wake up tomorrow and have no substances to use and will attempt to begin yet again, a life of nromalcy and no "b" feels like a empty goal...I've failed so many times, so concstently, I'm jaded about my own ability to quit...and in truth, I haven't even given quitting ehat I consdier to be a basic attempt..... pathetic.

A dear friend I reached out to, who knows this issue well, wrote me this and it woke me up to the paradox:

"You are not an 'inept character', {name deleted}. I hear you but I challenge that misbelief. You are caught in a brain chemistry, dopamine addiction loop. It's larger than your cerebral cortex can sort out. The aspect of your mind that is demanding that you continue to use cannot S P E A K or be heard. Imagine that for a moment. This dimension of your mind has NO LANGUAGE. That's why all human beings who have become addicted to drugs cannot understand WHY they can't STOP. The command for you to use chemicals is coming from an unconscious aspect of your physical psyche. There is no way to negotiate with it. It simply demands relief from suffering in a language-less stream of peptides. It has control of you and I knew this would happen. So did you.?"

He's so right. and somewhere, I did also know.

seeking prayers.

Serendip Visitor's picture

Hi. Since you mention your

Hi. Since you mention your brain talking to you, might I suggest searching the Internet for youtubes (they are free) along the lines of what type if relief you are seeking. There are many helpful meditations and suggestion recordings for eliminating self sabotaging activities. I have used them myself for insomnia, procrastination, and other bad habits. There are many speakers, a wide variety of content, topics and music. I have found the power of a few of these recordings very helpful to my sleeping life and my waking life.
Just google the topic you are interested I and write youtube and you will discover dozens of tapes. Perhaps one or two of them will speak to you in some way and be of help.
Best of luck.

RozNor's picture

I'm sure someone in your

I'm sure someone in your position right now isn't looking to complicate an already complicated situation.

What I find so great about your post is that you seem to be someone who will use your relapse as a learning experience to strengthen your continued recovery rather than allow it to ruin all the hard work you've most certainly done over a two-year period.

I sincerely hope this post finds you in better spirits.

high school kid's picture

lab tests

not all lab tests are good anyways sometimes the lab workers just make mistakes but that infection u had probly had something to do with them making your test false positive. or now days some lab tests are done by machines, maybe the machine saw something simular to a chemical found in cocaine and made you fail the test

Anonymous's picture

Drug Lab Test

I am a cocaine addict I will be for the rest of my life. I attend programs once a week for two years. It has been over two years that I been cocaine free. This November I got a flu shot three days after I did a drug test and tested positive got seen to the lab one came out positive. I when to the second lab tested negative 45 minutes later.

Two weeks later I come down with brochitis asma other words a big infection again test positive this time i did not get a second lab test.

This test to me are unexplanable for the fact I have not use.

Is there anything that can cause this reaction???

rebecca willis's picture

I have heard

FIRST, hats off to you for your courage every day to stay clean. My son is adicted to crack and it has nearly destroyed my family!
As far as your test, Ihave researched chemicals alot as I have a strong medical bakround and what I have found about cocaine is that it stores in your body much like cholestoral and at any time a piece an be introduced into your system. Thus the research claims that this is why people have withdrawls for so long after gettig clean.

RozNor's picture

Actually, cocaine doesn't

Actually, cocaine doesn't remain in the body for too long. I believe it's somewhere in the range of 36 to 48 hours or so. Though I did see someone test positive 7 days after using. This was someone who averaged a 14 to 30 day cycle for almost 20 years. He tested negative on urine screens during the prior 4 months he was abstinent.

The withdrawal issue isn't that there's cocaine in the system. The withdrawal issue is what the brain can't seem to do on its own without the introduction of the drug back into the system. Cocaine/crack and meth do some serious "rewiring" of the brain, so-to-speak.

I've heard that the brain COULD possibly re-regulate itself in as little as 6 months, but for a hard-core or long-term user, 6 months doesn't seem likely at all, especially if there was an underlying chemical balance to begin with.

RozNor's picture

Not all tests, or labs for

Not all tests, or labs for that matter, are 100% on the mark 100% of the time. So, if you showed negative on a second test within an hour of a positive on the first test, it would seem you had a false-positive.

I have read that Amoxicillin and liver/kidney disease and diabetes MIGHT cause a false-positive for cocaine, but I haven't seen any peer reviews about it. You should call your physician and ask what might, if anything, cause a false-positive for cocaine. I'd be interested in knowing the answer to that question myself.

high school kid's picture

false positives for cocaine

to Roznor, there are many chemicals found in cocaine and some chemicals found in other medications you may be taking might be simular to those in cocaine and perhaps the lab technition was confused, or maybe he was on crack...who knows.

RozNor's picture

High School Kid ~ Oh yeah.

High School Kid ~ Oh yeah. No doubt that there's a combo of certain meds will show a + for (insert illicit drug here). I'd just like to find a list from a credible source pointing out what those combos are. There was a site I came across that had this incredible list of what med would show + for what drug, but I can't say it was something I'd recommend anyone rely on :/

Anonymous's picture

Husband's addiction to crack cocaine

What am I supposed to do? I love him. but he is addicted to crack. I wonder if he is 'out" doing it while i am at work, and then yes, he is and who is there with him?

RozNor's picture

If you have children, you

If you have children, you HAVE to think of them first. Always. No exceptions. Crack addiction WILL take a very nasty and dangerous turn unless your hubby makes the total commitment to recovery. As long as he continues to use, you and your kids, if you have them, should be as far away from him as possible.

The thing you need to remember is who you love right now is who your addicted husband wants you to see. The priority for someone in active addiction is their drug and how and when they're going to get it. Period. They will manipulate people and situations to ensure they'll be able to continue to use.

Some things you need to be mindful of are his loaning the car to the dealer for more drugs. The dealer then uses the car to deliver drugs elsewhere. So, not only are you a sitting duck because your home address is on the paperwork in the car, but if the dealer gets in some sort of trouble with the law, your husband will face some serious consequences.

There's one way you can MAYBE tell if he's at the very least SHARING his drugs and that's how much money he's blowing through during one run. If he's going to a crack house and he's blowing, say, $1200+ in a 12 hour period, it's pretty safe to say he's at the very least "sharing" his crack with someone. If he's an addict with the resources to pay for a motel room to use, $1200 MIGHT be a sign he's alone. But there's no guarantee on either of those scenarios.

The most important thing you can do for you is to GET TESTED NOW. And if you choose to stay with him, GET TESTED EVERY TIME HE USES. If you have never been tested before, an HIV test is done twice in a 6 month period and each test runs about $100, give or take. And, of course, HIV is the worst case scenario, but other diseases can be passed by sharing a crack pipe with an infected fellow user. Go to the Centers For Disease Control and look up STDS.

Make sure to educate yourself about addiction in general as well as crack addiction. There's a TON of addiction info on the 'Net for families and there's a good deal of different recovery options for him. It doesn't just stop at 12-step programs.

Best to you.

Anonymous's picture

Addiction or disease?? I am

Addiction or disease??
I am a recovering crack abuser and I can tell you that cognitive behavior and skills go out the window when my mind and body seem to go on auto pilot.I am left to think that this is a disease and that my disease comes out of remission and I am left to take measures that will put my disease back into remission.I do believe that the road to curing this disease is through medication( which helps to identify the inbalances in my body)and through counselling (which helps deal with the reality of my addiction/disease)
People that suffer through any kind of disease are usually persuaded to change their lifestyle choices as well as being perscribed the appropriate medication to help with balances within thier bodies.
Dealing with people with addiction on a purely cognitive basis is only dealing with half the problem thus leaving half of the problem unattended.
I don't have the answer but I try.
please anybody, keep the blinders off don't negate anything, the answer is close

RozNor's picture

There is a drug that was

There is a drug that was designed for narcolepsy that was found to help cravings for cocaine addicts in studies done 2 or 3 years ago. The drug is called modafinil. I'd get a reference from your primary physician for a good shrink to talk about the option.

In my quest to help someone who was a 20 year crack addict, I brought up this med idea to a couple of shrinks who said they would Rx it to him. So, the study is a valid one and is well-known.

As with anyone who takes any meds, modafinil should be taken ONLY in conjunction with therapy.

Anonymous's picture

Question about cocaine addicted father

My biological father is a cocaine addict and I dont know where he is right now nor have I ever knew him. I still dont have a clue if because he was a crack addict if that effected me as baby or my mother's pregancy. Could later on in life I develop disorders such as bi-polar?

RozNor's picture

Just because a parent is a

Just because a parent is a drug user doesn't mean you automatically are going to have any learning disabilities or a mood disorder. Bi-Polar (BP) is mostly a hereditary illness. So if anyone in your immediate family has it, like your parents or your siblings, or if any of your aunts and uncles or your grandparents had it, the possibility you will develop it is higher, than say, a person who comes from a family with no history of BP. But it not a definite you will develop it.

BP rears its head in the years up to early adulthood normally. Some kids exhibit the symptoms at a young age automatically, some "become" BP because of serious stress in their early years. But in both cases, it normally comes from a hereditary connection.

There's a chance your Dad might suffer from BP. The numbers I've heard have been 52% of those suffering from BP have some sort of addiction (not necessarily meaning illicit drugs or alcohol). Also, many addicts who suffer from any number of mental illnesses use drugs as a means to self-medicate.

If you are exhibiting the signs of BP, like deep or suicidal depression AND feeling like you're TOO happy, and you are cycling between these two moods often, then make an appointment with your family doctor and get a referral to a good shrink and just talk about your concerns with him or her. BP, if left untreated, is pretty intense and dangerous for the person who has it and makes life almost impossible to handle with all the crazy cycling. There are some excellent meds for BP these days. Some are an all-in-one med with little side-effects.

Good luck.

Anonymous's picture

is it possible to quit using Crack?

This question is to anyone who can help......
my husband started using Crack about a year ago, and had been using it about 2 times a week, it seems that he wants to do it on the weekends and "all weekend"
he runs out of money then comes home and feels bad and says he this is the last time he never wants to do it again, I really can not figure out how to get him to STOP , If he wants to stop like he says.... And believe me when I say he really is sinceer when he says he wants to stop, I have heard from ppl.. "do not let him get on the med, Methadone... because it just gets him hooked on that and it sorta replaces the drug, and he will then "be hooked " on Methodone because once he stops the methodone he will start the crack again. We have two children together , I love him very much, and I Do NOT know where to start, if fact I am wondering if he really does want to Quit....please I am open to any suggestions and any comments Thank you.

Anonymous's picture

My husband is also ac crack

My husband is also ac crack user. He has used for the past year and has hit what i would perceive as rock bottom and the drug still continues to call to him. we have two small children and I have a son from a previous marriage. It has been the hardest struggle of my life to stand by him as he continuously takes from my children. At this point, I'm not sure how much longer I can go through another job or hear another apoplogy. I have control of all the money and cars of the household but when the urge takes over somehow he always finds a way to get high. The only way I am coping with it is knowing that in 18months i will be finished with school and financially able to support my family with or without him. I believe addiction is a choice. I have lived with an alcoholic mother a crack addict brother and a meth user older brother. Addiction has surrounded me my whole life. I am determined for my children not to become as accepting of it as I am or as tolerant. Life is hard!!!! DEAL WITH IT!!!!!

RozNor's picture

Crack addicts don't go on

Crack addicts don't go on methadone. Methadone is a synthetic opiate. Crack is not an opiate. Crack is the purest form of cocaine.

Unfortunately, the percentage to date for crack addicts staying clean is very, very low. Crack is so incredibly powerful and so incredibly addictive. Meth at this point, I believe, has surpassed crack, however, meth is pretty much found in certain areas of the country (not widespread) unlike crack cocaine which is absolutely everywhere.

Unless your husband begins to *show* you he wants to stop using (i.e. rehab, 12-step meetings, rational recovery, private therapist, etc), and he does everything in his power to not use, THEN you can believe he's serious about not only getting clean but STAYING clean. Making the statement he wants to get clean is simple; STAYING that way is extremely difficult.

If you have children you are risking losing them especially if he's using anywhere near them. Should your husband get jammed up because he loaned out his car to the dealer in exchange for more crack (and this is a COMMON practice), you run the risk of your kids being in the line of fire with dealers showing at your house (insurance and registration with your home address being in the car).

And since crack is cocaine based, you can be almost certain he is sexually active to one degree or another while he is using. Cocaine is notorious for creating sexual arousal and with crack it's far more intense. The longer someone uses the drug, however, the arousal is there but the machinery ceases to function (i.e. can't get it up). But the addict will still perform oral sex on someone or will have it performed on him even though there may not be a formal "conclusion".

Herpes can be passed without intercourse and it can be passed when someone isn't in the midst of a breakout (read up on herpes and viral shedding). Also, HSV-1 (cold sores) can turn into HSV-2 (genital herpes). And lastly, straight men in the throws of a run have been known to be intimate with other men.

Crack isn't only smoked, it is also injected. Should he share his pipe or a needle with someone, you are in danger of not only HIV/AIDS, but other diseases as well. All it takes is one addict with an open sore on his or her lip and passing the pipe to your husband and TAG! You're it.

So, please... think of your children first, you second and your husband last. Your kids' safety and emotional well-being should be the only thing you think of right now. They don't need to see Daddy use to be horribly scarred. He's an adult and can make decisions for himself... your kids don't have that choice.

Serendip Visitor's picture

STD's and Legal liabilities

I agree with this respondent. Those that take a lot of coke or crack can be very promiscuous. Even if they are normally heterosexual they may engage with homosexual activity when they get really high. It is a frightening reality. When it became clear to me that my ex was using regularly - though not around me, always in secret - I started getting regular HIV tests. Eventually the relationship ended as the strain of worrying about my health became too much for me. Also, the company he kept made me ill at ease. Don't lend him your car. You say he is helping you get through the next 18 months of school. Where is he getting the money from?
It sounds like your situation is very difficult. I hope you can find another way to compete your education and get this man out of your life. He is putting you and your children at risk. I am sorry to hear your story. Mine was not exactly the same, but similarly devastating. I loved and trusted a man who was way I into cocaine. It was heartbreaking and exhausting. I cannot believe I did not see the depth of what was happening around me sooner.
Good Luck.

RozNor's picture

Addiction is a choice.

Addiction is a choice. Millions in the rooms who have chosen to not pick up, if only for this minute in time, have proven as such. No one said not giving into the compulsion to use is any easy feat, but it can be done and has been done.

I don't know if this was stated above, but is worth mentioning again if it was. Jellinek's research was the basis for the disease concept of addiction. His research, for which he himself admitted its serious limitations, was based on questionnaires distributed to AA members through their newsletter, "The Grapevine". 158 questionnaires were returned, 60 of which were discarded because members had "averaged" their answers. It should also be noted no questionnaires from women were used (source: Substance Abuse 3rd Edition 2005).

The disease concept of addiction is still only a theory that not all addiction experts or other experts in the health field agree with (Stanton Peele and Herbert Figarette to name just two). In fact, if you read recent data, you'll find that the field of addiction is actually beginning to steer AWAY from the disease concept.

And let's be really honest here; don't you think cancer patients and diabetics would give everything they had just to be able to go to a meeting every night in order to arrest or put in remission their diseases and not have to pay the emotional and financial costs of treating such? I know my father would give his eye-teeth to "talk it out" with a sponsor rather than be hooked-up to a dialysis machine 3 days per week.

Granted, addiction can lead to disease, but to say addiction is and of itself a disease is completely off the mark. And besides, with all the addiction issues we're dealing with today, don't you think the pharmaceutical companies would be flooding the market with meds in order to "cure" or at the very least "arrest" addiction? Ain't much they've come up with, unless you consider Antabuse, but that doesn't stop the compulsion to drink; it just makes you sick as a dog if you do drink.

Addiction is a choice. The addict has the choice to use or not use. Period.

Anonymous's picture


Addiction is NOT a disease. It is self inflicted. ANd the AA concept is a joke. Addiction is something you do to yourself, and will power is what you need to cure addiction. And relapse is NOT a part of recovery, and you can't think the rest of your life that you're powerless. You might as well jump off a cliff!!!

Anonymous's picture

Crack cocaine use - - a choice ?

At the age of 57 I tried crack cocaine when my judgement was affected by a prescribed stimulant for ADHD. I had no history of drug abuse or use . I opposed the use of drugs which were taken just for pleasure. I lost everything and could not stop . My attitude remained anti-drug but my behavior was different. It is now 11 years later . My advanced degree is
still mine but my functioning has changed . Over the years I lost my family , had a heart attack , suffered brain dysfunction, lost all material goods (amounting to several million dollars in 10 years), became homeless, and underwent drastic personality change . I have 8 months clean . I have attended five treatment programs. I have attended 12 step groups regularly and often daily. I am responsible for my illness and its effects on me and others. I have a criminal record in part for trying to purchase base cocaine from an undercover police officer . Genetics plays a big role , psychiatric problems play a role, and the very structure of myself . Addiction needs to be understood with systems theory . There may have been a few occasions when I had a choice and did not use . People who think simplistically about cause and effect may reassure themselves of their moral virtue , but a very close examination of their lives does not reveal choice about many things . If there is free will it is not always present , unscientific myth is being perpetuated about our personal powers . I could detail many illnesses that involve behavioral choice at one time or another . Before penicillin syphilis was rampant . Today the consequences of that sexual behavior all but disappeared , About 1980 HIV appeared and was not understood . Other life forms like bacteria , spirochetes , and arguably the evolving virus world compete for survival . We do not yet understand the complexity of life and yet believe that our "wise choices" will protect us . That is human arrogance and with addiction many people wear a moral coat which they actually believe will protect them . Today knowledge is bringing new light into the darkness of archaic thinking and beliefs .

Anonymous's picture

addiction is a disease

I am a recovering cocaine addict and alcoholic. I have been in recovery for almost ten months now. I have struggled for 17 difficult months just to reach the ten month mark. Finally, after a trip to rehab and continuous therapy and medication I have been able to remain clean and sober.

For those of you who think addiction is simply a choice are wrong. Of course you can throw out an expert or two that support your judgmental opinions. You can find an expert to support almost anything. You are supporting the same type of arguments that once defined homosexuality as a mental disease that could be cured.

You are wrong. You are making it more difficult for people seeking help for their addictions.

RozNor's picture

I don’t understand how

I don’t understand how saying addiction is a choice makes things more difficult for an addict to seek help. In fact, it would seem more empowering that the addict has a say and a choice in their fate, rather than say they can’t be helped because they have a disease. There isn’t one disease I can think of that allows choice to arrest or put disease into remission. Not one. Just think of how many people with X disease would give their eye-teeth for that sort of choice?

While that's absolutely correct that it was only in the early 1970s that the APA finally took homosexuality out of the DSM as a disorder, I don't see how that helps the addiction as a brain disease theory. If anything, it shows that these organizations can be wrong in their assessments, and so, leaves addiction open to reassessment; it shows that what was once considered a disorder really isn't, which also puts addiction on the exact same chopping block.

So, if addiction as a disease was a proven, there wouldn’t be so much heated debate about it. Addiction professionals and experts are NOT all on the same page when it comes to this choice/disease. That’s why they are both called theories.

Saying addiction is a choice isn't a judgment of character. It is merely a statement of observable fact that an addict has the choice to use or not use; he can engage in his addiction or not. There is no connotation of good or bad associated with *that* point. There are people out there who do *not* base their opinion on someone because they are an addict, but rather, base their opinion of the addict on addict’s *actions* while they are in active addiction. There’s a huge difference between these two things.

Is it an easy choice to not use when that incredible compulsion is present? No way. But the ease or difficulty of choice doesn’t make a disease. A disorder of thought process? Probably closer to the truth in *certain cases*. A severe lack in coping skills? Absolutely.

Do I think addicts should be able to rely on insurance money to help them stop using and get recovery even though I believe the addiction is a choice? You bet!! Absolutely. There’s a problem that needs to be addressed. And if someone is to the point where they know they’re going to need long-term rehab, the last thing they should have to worry about is how to pay for it. The only thing on their mind should be “thank goodness I can get some help and get my life back!” Or “I have a chance to have a real life for the first time!”

Ric's picture

Addiction: Choice or Disease?

I cannot disagree more with your posting. Addiction is a complex and multidimensional public health problem that affects millions of people in the US alone. Comparing addiction to cancer, diabetes, ms, etc is both ignorant and simple-minded. If one assumes that addiction to a substance is a personal choice,
then apply this rationale to smokers, bulimics, diabetes sufferers, heart attack victims, hyper tense individuals, etc. There are certainly a host of conditions that were dealt to individuals without any consideration or choice- from genetic disorders to environmentally triggered diseases that no individual would choose to have.

Whether we are discussing genetic predispositions to certain behaviors that will trigger addiction to social and behavioral environments that lead to it, the facts point us to a very different type of understanding- addiction is a disease and it requires treatment to control or overcome.

The 1946 Jellinek study was merely the beginning of a long road of research and clinical data on the subject. The AMA's position on addiction today is clear: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice, and encourages physicians, other health professionals, medical and other health related organizations, and government and other policymakers to become more well informed about drug dependencies, and to base their policies and activities on the recognition that drug dependencies are, in fact, diseases."

It may have begun as a theory, but the most recent research and data clearly focuses on addiction as a disease which causes catastrophic and far-reaching damage. Studies from the NIDA archives and hundreds of published articles in the JAMA to name a few, show detailed clinical data describing permanent and irreversible changes to the brain and cellular networks of people using alcohol, tobacco and drugs. Many cancer and diabetic individuals do have a choice, but they still pursue behaviors and lifestyles that clearly cause their diseases.

If individuals were actually forced to ponder the consequences of their choices with a clear explanation of the demise they will face, do you really think they will actually change? The answer is no. Generally people who get sick simply are unaware, uninformed and make choices without an iota of forethought. Are they responsible? Of course, but moral and personal judgments aside, they are still victims of a disease.
Addiction is so widespread that pharmaceutical companies, health providers, and private businesses are indeed flooding the market with medications, possible vaccines, treatment options, more accurate diagnoses, and most importantly, awareness and objectivity.
The AMA has “reaffirmed its policy endorsing the dual classification of alcoholism under both the psychiatric and medical sections of the International Classification of Diseases.” Although there are critics of The Disease Model of Addiction (including Peele and Prentiss), they are a small voice next to an overwhelming tide of medical and scientific data. Most addicts now and through the ages, simply did not have the awareness, the support, skills, or even the access to embark on a path of social healing associated with the Life-Process model.
Today, Addiction is a gargantuan public-health and public policy menace. It also reflects a much wider failure of Government policies designed to control and regulate both legal and illegal substances.
The costs of addiction and the continued failures to properly address it as a disease are staggering both in economic and spiritual terms.

RozNor's picture

To Ric... Nice post! But I

To Ric... Nice post! But I still disagree with the addiction as a disease theory.

Addiction as a disease does include substances such as nicotine actually. So when you see someone light-up, you are looking at someone who is considered a person with the disease of addiction. Why isn't nicotine addiction included as being a part of the "addiction as a disease" as taught to the general public? I don't know. It could be because the consequences of nicotine addiction are no where near as devastating as are the consequences of crack cocaine addiction. Yes, the addiction to both crack and nicotine will most likely lead to disease and possibly death, but the family of a nicotine addict won't ever have to deal with issues such as drug dealer scares, DUIs, financial devastation as it relates to active addiction and so on.

Addiction includes non-substance related issues, such as pathological gambling and internet. And while food as it relates to over-eating is considered to be an addiction, bulimia and anorexia, according to the DSM-IV-TR, are considered eating disorders, not addictions. (As a side note, there also seems to be growing popularity in issues such as co-dependency as being a disease these days).

And why not compare addiction to other diseases, such as cancer and others you mentioned above? To my knowledge, addiction is the only "disease" where someone can "arrest" its progression simply by no longer engaging in the *behavior*. For a woman who has developed breast cancer, there is nothing other than medication that might set the disease into remission. Support groups or talk therapy or rehab to arrest her disease is not an option for her. The man with advanced nephritis has no other treatment option except dialysis. The diabetic has no other treatment option except insulin injections.

Saying addiction is a choice does not necessarily mean anyone is pointing some moral finger in an addict's face, and it should not imply the addict is somehow a lesser person. But there is an element of will-power that is needed to not engage in addiction when an addict is faced with the compulsion to use. An addict who continues to use doesn't necessarily imply the addict is "weak-willed" as much as the addict has made the decision that they *want* to continue to use over not using.

Ric's picture

Addiction: Disease or choice

Thanks for the positive debate.

There are elements of will power in any choice for the sake of justifying a particular orientation in this discussion. There is also ignorance and willful denial in many of the choices one makes during a lifetime. When someone lights up they are not considered anything- addicted or otherwise. Social smokers, casual smokers closet smokers or all the other smokers are breathing cancer-laden substances together with nicotine, whether they know it or acknowledge it.

Nicotine is clinically proven to cause addiction and physical dependence and can even cause death if taken in the right amount or interacting with other substances. The powerful and persuasive tobacco lobby is not interested in disclosing negative data about their products even when they cause death. Big Tobacco lied under oath in open congressional inquiries about the danger and health hazards of their products. Clinically there is no difference between addiction to tobacco, alcohol, meth, etc.

Nearly all addictive chemicals exhibit a wide range of risks and timetables but the chemical footprint of addiction to any substance whether legal or not is the same.
I disagree that addiction to tobacco is not as devastating as other substances. On the contrary, tobacco kills just as many people, costs probably more to treat as a public health issue, and affects the entire family as it relates to second-hand smoke and its harmful health effects. You may not have to deal with DUIs but try paying for lung cancer chemo, drugs to treat artheriosclerosis and a list of pulmonary diseases, not to mention EMT visits for cardiac arrest, long term care, and the list goes on. Drug dealer scares? try the government, who deals and profits legally in these substances. They may be cheaper than other drugs, but they are still drugs nonetheless.

You totally miss my point regarding choice. Arresting any behavior is not as simple as stopping, but rather continuing after arresting. Lets focus the discussion to addiction itself, not clinical diseases, genetic correlations, and a long list of human disorders. The twenty-year alcoholic can stop and probably continue sober, but the damage to his liver,heart and pancreas is irreversible.
The plant worker for asarco can quit his job and leave the premises, but the permanent damage from exposure to lead is real.

There is biochemical evidence in detailed studies which determines which dopamine receptors are actually overridden in the brain and at which part in the timeline of use it actually happens. At this point the user has no control or will power to stop. The longer the user stays addicted, the harder it is to quit. And quitting is about completely rebuilding a life and continuing to live it willfully without returning to that destructive cycle. "Addiction" is a behavior-altering bio-cellular process which can be triggered by a number of things- Be it gambling, engaging in risky behavior, using amphetamines or alcohol, practicing extreme sports, engaging in war, even willfully thinking about using.

The tragedy here is that tens of thousands of kids living in poverty and adverse environments never really have a choice to begin with. They are raised without family, safety, life-enhancing role models,etc. Some babies are born already addicted to crack. Choice? arresting behavior? my ass.

Anonymous's picture

I totally agree with those

I totally agree with those who say that addiction is NOT a disease but a choice. My ex/husband started taking cocaine from the age of 42 (we didnt find out until 5 years later)!!! It all started when he decided to leave the UK to go and work in Spain where he started to work for a company where there were loads of much younger people and he probably revived a second yought. 5 years later, me and the children joined him (leaving everything behind) and we hit reality almost immediately after arriving! I can assure you that we have suffered so much in every single aspect because the man had turned into a cruel, secretive, enraged monster. He went eventually into rehab which made us all really happy. When he came back we were to be avoided as we were the "enablers" and he went back to the same friends, moved in one of the flats of a serious addict and, our nightmare - although different - started all over again! Since then he has relapsed 3 times, we are divorced, one child is now also experimenting with drugs and I attend every co-anon meeting I can. Our lives are in tatters although I am determined that this is going to be a momentary situation. All I can say about cocaine addiction is that it is a vile, self-inflicted act of uber-selfishness which not only rots the user, but also his family and friends. Although I feel sorry for the state they end up with I feel more sorry for those who care for that person. They are the victims and the user becomes the disease. Sorry for my rant.

Dave Ebert's picture

I sympathize completely.

I sympathize completely. There are individuals who are not only addicted, but are also borderline personalities- sociopathic, self centered creeps who cannot empathize with their victims. These people become incorrigible addicts. They never recover. I realize it has been a long while since you posted this note. I hope since then you have placed a continent between you and that user.

RozNor's picture

Enabling and co-dependency

Enabling and co-dependency are funny things. Just because someone is involved with or is close to an addict does not mean they are automatically enablers or co-dependent like the 12-step programs seem to love to pin on the non-addicts involved; it’s as if the non-addict is given 50% of the blame for the addict's addiction.

There are "harm reduction" programs out there, like methadone clinics and needle exchange, that we don’t look at as "enabling", however, a loved one of an addict who stays with an addict, and runs through all the options available for the addict to get recovery is considered just as "sick" as the addict.

With co-dependency, you are looking at a *pattern* of behavior, controlling behavior, by the non-addicted party. True co-dependents have a *history* of involving themselves in bad relationships, intimate relationships and friendships. One relationship with an addict DOES NOT make someone co-dependent.

If there’s anything most non-addicts are "guilty" of is purely not truly understanding the depth and dangerousness of addiction. Everyone has been fed this idea that addiction is a brain disease, and if addiction is a disease like cancer is a disease, most people won’t turn their backs on someone they love because they have a disease. They will support and encourage the addict to get help.

The other issue is non-addicts need to understand is that binge users with a job are far more dangerous than the daily user in the shelter. Non-addicts are more likely to remain with the binge user because it’s more that the addict has a “problem” than an addiction; the addict is teetering on a full-blown addiction and has a better chance of being "saved from themselves". Binge users in mid-life who have yet to feel any real consequences of their addiction, and jump from relationship to relationship are MASTERS at manipulating people. They are charming and put on a wonderful show in order to have their cake and eat it too. These are the types who go to 12-step meetings just to make it seem as though they are getting help, yet still remain on their 60 day cycle.

So, be careful when you hear enabling and co-dependency being tossed around.

Serendip Visitor's picture

destructive obsession DEVILS DUST

iv done alot of drugs in my life, when i was 11 i decided i wanted 2 smoke weed, possibly because of the DR DRE 2001 CD,, after i got into high school i saw some older friends trippin on ecstacy, i decided i wanted 2 do that, i lived in a bad neighborhood and my neighbor across the hall in the apartment sold the drug, so i spent 10$ canadian and bought the pill,,i started doing E every weekend and even at school before,,this whole time i always smoked weed, i wound up moving 2 a new town,,stopped using E,,kept smoking weed,,then i started sellin alot of weed and decided i wanted 2 sell coke 2,,after a couple lines i was sniffin all the time,, next thing u know im sniffin the shit every day,,my nose had chunks of shit blowin out it bigger than goetz, then i got locked up,, got out on bail,,,sniffed alot of coke still,,went back 2 jail,,got out and have stayed away from it,,i think i just got into it that summer cuz i was sellin it,,but iunno sometimes i still think about getting some,,but i havent,,maybe ill buy an 8 ball 2nite ;) jk