American actor and addiction-awareness activist Matthew Perry and journalist Peter Hitchens traded blows in a televised interview last week,  with the latter questioning the reality of drug addiction. Hitchens questions how Perry has suffered in his ‘battle with addiction’ and for his motives in supporting special courts for people who buy and use illegal drugs.  Hitchens has gone further to question if in fact ‘addiction’ actually exists at all.  Not surprisingly this has resulted in one hell of a row.

Over the past two decades I have visited high schools and colleges to talk on how addictive drugs affect the brain and to explain the many theories about why certain people become addicted.

What is an addictive drug?

All addictive drugs release the neurotransmitter dopamine in the brain and this is thought to contribute to their addictive properties. Dopamine is carried in a nerve pathway called the reward pathway which controls the brain’s reward and pleasure centers. The reward pathway does this by regulating emotional responses that enable us not only to see rewards but also to take action to move toward them.  Addictive drugs hijack the reward pathway by causing it to release dopamine and this leads to the compulsive behavior including the loss of control in limiting intake found in addiction.

Are some drugs more addictive than others?

Yes. The type of drug taken is important as some drugs are more addictive than others.  This is because drugs differ in their ability to release dopamine in the reward pathway.  How a drug is taken is also very important. Nicotine is very addictive because it is smoked.  Smoking is the quickest way to get a substance into the brain and this makes it more addictive.

Don’t forget the buzz

The initial use of addictive drugs such as cocaine, heroin, alcohol and marijuana is often driven by the immediate euphoria – the buzz – that accompanies it and because their brains are so rich in dopamine this is of great importance to adolescents and young adults.  In this way drug addiction is predominantly a disease of the young.

Why do people take addictive drugs?

People dabble in addictive drugs for all sorts of reasons  – availability, affluence, to rebel, to seek attention, for a sense of adventure, naivety, the pressure to conform  or just plain boredom.

Who becomes an addict?

Addiction is complex and there are as many reasons why someone becomes addicted as there are addicts. This situation is not helped by the fact that we cannot yet predict who will become addicted, or how to cure it.

Addiction is a three-legged stool

The problem is that not everyone who takes addictive drugs becomes addicted. In fact, most drug users can with a little effort, drop their habit.  In order to explain who becomes addicted it is best to think of addiction as a three-legged stool and just as a stool needs all three legs in place- all three legs must also be in place for addiction to take hold. The three legs of addiction are

• Biological.  For instance, children of alcoholics are four times more likely to become addicted to drink, even if they’re brought up away from their natural parents.
• Psychological.  For instance, chronic, inescapable stress including the stress of boredom contributes to addictive behavior.
• Social.  For instance, the availability of a drug is important – it’s harder to become an alcoholic in Saudi Arabia where the sale of alcohol is forbidden.

Hitchens is right – addiction doesn’t exist – that is, until you become an addict.

So, in one way Hitchens is right- addiction doesn’t exist – that is, until you become an addict. Then it controls your every waking and sleeping moment, it can destroy your life and those of your loved ones, shatter talent and ambition, wreck communities and economies.

Drug taking as a way of coping

The row between Perry and Hitchens over the nature of addiction might not be in vain if it opens up a debate on how we as a society deal with stress. We all know of, or have heard of someone suffering from chronic addiction and we are led to surmise that alcohol and drug taking is their way of coping.  In this we are not alone. As the world economy continues on its downward slide, and unemployment and financial worries beset us, are we going to turn more and more to these quick fixes to handle our dis-stress?

Probably the most important lesson to be taken from this row is the realization that the stresses of life and how we manage them IS the difference between life and death. I look forward to developing this theme in greater detail including drug-free tips on how to avoid worry and stress in future posts, but in the meantime, I salute both Perry and Hitchens for bringing addiction back into the spotlight.