Dependence and Addiction
by Duncan Vere
Taking drugs may seem exciting to begin with. It may be seen as a means of rebellion against, or escape from, a person’s current circumstances. However, it carries a real risk because anyone can become a powerless passenger when a drug habit becomes the driver.
It’s easy to buy drugs from illegal suppliers. However some drugs not only cause serious harm, but also make the user crave future doses.
The need for repeated doses of a a drug can occur with drugs prescribed by a doctor, as well as those bought illegally. Such dependence can be benign, as happens with drugs that assist a person with a heart condition, or it can have harmful side-effects. People are said to be addicted when their need to take a drug adversely affects them or their social environments.
The most commonly bought illegal drugs are those that alter a person’s mood or perception of the world. So-called ‘soft’ or ‘recreational’ drugs like Ecstasy do not lead to dependence, but others like heroin or crack-cocaine rapidly lock people onto needing repeated doses.
Even so, recreational drugs do have their dangers. To start with they carry side-effects that can be lethal. On top if this, using recreational drugs can encourage people to start taking addictive drugs. Many people find that once the ‘high’ experience of a recreational drug has worn off, they are left with a general dissatisfaction within themselves. They then try to relieve this by taking a stronger drug.
The dangers do not just stop at loss of health. People who become addicted find it difficult to maintain jobs, but need to find large sums of money to buy drugs and feed their addiction. Some drugs users in the UK spend between £350 and £2,000 per week on a mixture of heroine and crack. Most of the money was raised by shoplifting, burglary, fraud, drug dealing and prostitution.1
The Push to Try Drugs
People start to use illicit drugs for a variety of reasons. Some do it simply to have the experience, and to have a good time.
Others want to test their limits. For some there is a need to prove themselves or join in with their friends and peers.
Some start to use drugs to escape from emotional or physical pain. In other situations, drug use is linked to particular pubs or clubs. The combination of social pressure and availability means that going to these places increases a person’s chance of starting to use them.
A Historical Review
Attitudes to dependence and addiction have changed. For centuries most people drank heavily. Many were addicted to alcohol. Water was unsafe and the ‘measure of a man’ was how much liquor he could hold. In the 18th and early 19th centuries political leaders were 12-pint men. Clive, Wilberforce, Coleridge and Wordsworth all took opium for part of their lives2. Drug dependence, including snuff tobacco, was usual, and babies and children were quietened with opium or gin.
In the later 19th century the social problems caused by excess drinking led to the Temperance Movement. Christian brewers like the Barclay and Buxton families aimed to popularise beer instead of spirits, because it seemed less harmful.
Alcohol intake fell on average to sixth of previous levels, but today it is rising. One in 25 children aged 11-15 drinks more than the safe limit for adults3. One in 25 adult drinkers is thought to be addicted to alcohol4.
The trend repeats for tobacco consumption. In 1996, 13% of young people aged 11-15 regularly smoked cigarettes, and in a reversal of previous figures, more girls than boys now smoke (15% vs 11%)5.
Since 1987 there has been a fivefold increase in drug abuse among 12 to 13 year olds and an eightfold increase among 14 to 15 year olds6. In addition, around 45 per cent of 16 to 19 year olds admit to having tried illegal drugs at some point in their lives7.
Illegal drug use is not confined to young people or those who are already disadvantage. One study showed that 10 per cent of medical students smoke tobacco, 17 per cent drink excessive alcohol, 37 per cent have used illegal drugs and 9 per cent currently use them8.
Among adults, dangerous drinking and drug abuse is rising. In 1989, some 4,000 additional people became addicted to heroin9, but by 1992 this had risen to 7,658 new addicts per year10. A recent report indicates that there are now 130,000 drug users in England and Wales.1
The risks to any drug user are very real. According to the most recent survey by the Office for National Statistics, ‘drug related mortality among men in their twenties has increased three-fold over the last ten years’11.
- Dependence – A compulsion to take a drug to satisfy a psychological or physical reliance on it.
- Addiction – Severe dependence that results in socially damaging patterns of behaviour. People can be addicted to drugs, alcohol, food, shopping, praise, etc.
- Tolerance – The need to take more and more of a drug to attain in the same physical or mental effect. Tolerance develops over a period of time, as either the liver becomes more efficient at breaking down the drug of the body’s tissues become less sensitive to it.
- Withdrawal symptoms – A group of distressing mental and physical effects experienced by a person who stops using a drug.
Leading to Addiction
Initial use and subsequent addiction can have several roots:
Pleasure is the most common reason given for dabbling with drugs as they give extreme sensations and break the monotony of life. No-one believes that they will get caught out by getting addicted to them.
In a world where image is everything it is easy for individuals to become convinced that they can’t live up to these ideals. Drugs seem to give an extra boost.
Low self-worth can be compounded by rejection. This could be real, as in the case of a child abandoned by his or her parents, or imagined.
People need to feel as if they fit in with their friends. The resulting peer pressure can be very powerful, and can strongly influence behaviour.
Children living in homes where smoking or drug taking is considered normal, are more likely to adopt similar habits. The majority of people learn their alcohol habits from their parents.
Availability of Drugs
Research by the Scottish Health Education Unit revealed a simple rule: the more readily available a drug, the greater the number of people who become addicted to it12. When the street price of a drug falls, its use increases.
There is evidence for common biochemical factors in some alcohol and opium dependencies (eg dopaminergic pathways) and alcohol breakdown products (tetrahydroisoquinolines in the brain)13.
Genetics and Gender
As scientists learn about how genes contribute to our behaviour, some claim that looking for particular genes can identify people who may have an increased risk of becoming addicted to particular drugs14. However, there is no indication that anyone is genetically compelled to become addicted.
In addition, whether a person is male or female does not affect their susceptibility to becoming addicted to a particular drug.
All this suggests that the chief cause of addiction is not the drug itself, but social attitudes, pressures and desires that lie within, or play on, the mind of the taker.
Behaviour and Habit
The process of taking a drug can become very important to the user.
In some cases you can slowly reduce the amount of heroin that an addict is taking without the suffering the acute ‘cold turkey’ symptoms. This is because they are continuing the rituals of their habit, even though the dose is decreasing. However, remove their syringe and the symptoms are triggered.
Read more: (Part 2) ….Chief social issues…
- Home Office Drugs Prevention Initiative Paper 23, Arrest Referral: Emerging Lessons from Research (1998)
- Golding AM (1993). Two hundred years of drug abuse. J. Roy. Soc. Med., 86: 282-28
- Alcohol and the young: a report of the Joint Working Party of the BPA and RCP (1995)
- Measures for measure: A framework for alcohol policy. (1997) Alcohol Concern, p3
- Statistics on Smoking: England, 1976 to 1996. Department of Health (1998)
- Standing Conference on Drug Abuse and Children’s Legal Centre, Young People and Drugs – policy guidance for drug intervention (1999)
- Parker H, Bury C, Eggington R. (1998) New heroin outbreaks among young people in England. Police Research Group: Crime Detection and Prevention Series, Paper 92
- Ghodse AH, Howse K (1994) Health trends, 26: 85-88
- Social trends (1989) p124
- Social trends (1994) p100-101
- Population trends (1998) 93: 37
- Scottish Health Education Unit (1975) Understanding alcohol and alcoholism in Scotland
- Blum F (1982) Naloxone ad ethanol poisoning. Ed. Usdin E. Published by Allen R Liss, New York
- True WE (1999) Archives of General Psychiatry 56: 655 – 661
Christian Medical Fellowship (CMF) Files No. 08, 1999