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发表于 2014-8-4 23:07:54
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Part II: Speed
The addiction paradox
Drug dependence has two faces — as a chronic disease and a temporary failure to cope
BY BRUCE BOWER 2:30PM, MARCH 7, 2014
time2
Actor Philip Seymour Hoffman’s February death from a drug overdose triggered media reports blaming the terrible disease of addiction for claiming another life. But calling addiction a “disease” may be misguided, according to an alternative view with some scientific basis. Most people who are addicted to cigarette smoking, alcohol or other drugs manage to quit, usually on their own, after experiencing major attitude adjustments. Although relapses occur, successes ultimately outnumber fatalities. People can permanently walk away from addiction.
Evidence that addiction is a solvable coping problem rather than a chronic, recurring disease seems like encouraging news. But it’s highly controversial. Neuroscientists and many clinicians regard drug addictions as brain illnesses best vanquished with the help of medications that fight cravings and withdrawal. From this perspective, drug-induced brain changes increase a person’s thirst for artificial highs and make quitting progressively more difficult.
This conflict over addiction’s nature plays out in two lines of research: studies of remission and relapse among treated substance abusers and long-term studies of the general population.
Follow-up investigations of people who attend treatment programs report that addicts never completely shake an urge to snort, inject, guzzle or otherwise consume their poisons of choice. Ongoing treatment in psychotherapy, rehab centers or 12-step groups encourages temporary runs of sobriety, but it’s easier to kick the bucket than to kick the habit.
Surveys and long-term studies of the general population, however, observe that addicts typically spend their youth in a substance-induced haze but drastically cut back or quit using drugs altogether by early adulthood. Most of those who renounce the “high” life do so without formal treatment.
Each research approach has drawbacks. Treatment studies don’t include people who overcome addictions without seeking formal help, and thus underestimate overall recovery rates. Community surveys often overlook individuals with especially harsh drug problems, and thus overestimate recovery rates.
“There’s clearly disagreement in the field about the natural history of alcohol dependence and other substance use disorders,” says psychologist Madeline Meier of Arizona State University in Tempe. “Part of the reason is that clinic-based studies tend to find high rates of relapse but population-based studies don’t.” [352 words]
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New investigations aim to clarify how alcohol and drug addictions play out across the life span, at least in industrialized nations. A reanalysis of four national surveys in the United States concludes that issues such as getting married, fears of arrest, drug prices and health concerns can prompt individuals to quit drug addictions at any age, a finding at odds with the brain disease model of addiction. Related research suggests that life transitions and personality changes accompany remission from excessive drug use. Studies of New Zealand children tracked into adulthood suggest that individuals who break free of alcoholism suffer relapses less frequently than is often assumed.
Severe substance abusers, on the other hand, appear to face the most challenging future. Recent evidence highlights a near-universal tendency for people with multiple addictions and other mental ailments to relapse at least once within four years of completing treatment.
Scientists trying to untangle the life course of excessive, harmful consumption of mind-altering substances face challenges at every turn.
Maturing out
Psychologist Charles Winick grappled with those challenges in a controversial 1962 article titled “Maturing out of narcotic addiction.” More than 50 years later, new studies support and expand on key elements of his argument. Winick discovered that about three-quarters of those listed as heroin addicts in an annual federal tally disappeared from the rolls by age 36. He concluded that these young people had “matured out” of opiate dependence as they assumed adult responsibilities and resolved emotional conflicts that had driven them to drugs in the first place.
In line with most mental-health professionals at the time, Winick, affiliated with City University of New York, considered heroin addiction a disease. These findings suggested to him that addictions, like some infections, can be resisted successfully.
Winick assumed that police and hospital data collected by the government included nearly every U.S. heroin addict and that all of those dropped from the list had stopped using heroin. But some may have died without the government knowing, or continued using while managing to avoid the authorities. Today, arguments over Winick’s conclusions haven’t been fully resolved, says Boston College psychologist Gene Heyman.[354 words]
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Many people addicted to legal and illegal drugs end up quitting without formal treatment, just as Winick concluded, according to Heyman’s reanalysis of data from four national surveys of psychiatric disorders conducted in the 1980s, the 1990s and the early 2000s. Heyman’s work also indicates that people conquer their addictions at all ages, not just during young adulthood, as Winick thought.
Heyman’s findings, published in the 2013 Annual Review of Clinical Psychology, build on an argument he made in a 2009 book, Addiction: A Disorder of Choice. Everyday decisions influenced by deeply held values and goals push people toward or away from addictions, he wrote.
Heyman rejects the standard premise that alcoholism and drug abuse result either from brain diseases or moral failures.
Marijuana and cocaine addiction mainly afflicted young people in the national surveys. An average of about three-quarters of those who at some point had heavily consumed either of these two drugs had cut back markedly or stopped using completely by age 30. Just 5 percent of cocaine addicts remained hooked into their 40s and 8 percent of marijuana addicts remained devoted pot smokers into their 50s.
Alcoholics and cigarette smokers held on tighter to their habits. It took an average of 27 years for two-thirds of alcoholics to quit or dramatically curtail their drinking and a whopping 49 years for two-thirds of tobacco users to give up their smokes. Cocaine and marijuana addicts quit sooner; two-thirds had quit within seven years and nine years, respectively.
It’s especially tough to break the addictive grip of substances that are glamorized in ads and can be legally purchased at local stores, Heyman suspects.
[273 words]
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Never too late
Most provocatively, he calculates that the likelihood of recovery stayed constant over time. A disease that turns the brain into an increasingly insatiable drug-seeker would make aging addicts the least likely to recover. Yet, heavy alcohol users in the study were as likely to give up the bottle or revert to occasional use at age 40 or 50 as at 30. That means that people whose addictions lasted into their 50s and beyond still had the potential to turn their lives around, Heyman concludes.
Being married, having a college degree, fearing arrest, facing high drug prices and developing drug-related health concerns made heavy cocaine, marijuana and alcohol users more apt to quit or substantially cut back.
Heavy smokers took a different road to recovery. Most who gave up nicotine did so after age 75. Government data suggest that antismoking campaigns have influenced increasing numbers of heavy smokers, many of them older, to quit using cigarettes, Heyman argues. From 1965 to 1995, smokers who had graduated from high school or college quit at higher rates than those with less education, apparently in reaction to information about health dangers of their habit, he says. Cigarette sales began a steady downward slide shortly after the 1964 Surgeon General’s report on smoking and illness, which was followed by increased cigarette taxes, prohibitions on public smoking and the appearance of warning labels on packs of cigarettes.
“Whether or not drug use persists depends on factors that influence decision making, particularly values related to family, the future and one’s reputation,” Heyman says.
Short-term, self-focused decisions — such as wanting to numb the emotional pain of childhood abuse — can eventually lead to drug addiction, he argues. Switching to a long-term focus on others — say, choosing to be a better parent and to make family members proud — triggers the hard work of getting sober and improving one’s lot in life.[311 words]
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Providers of addiction treatments differ on whether a positive perspective shift banishes bad habits or temporarily controls illnesses that can’t be cured. Studies of how people kick addictions on their own are rare. Intensive investigations of addicts who quit without formal treatment would help in designing treatments that produce long-lasting improvement, Heyman suggests.
Sobering changes
Major personal transitions throughout life, as suggested by Heyman’s findings, shape the course of alcohol and drug addictions, says psychologist Kenneth Sher of the University of Missouri in Columbia.
“People mature out of addictions at all ages,” Sher says, echoing Heyman’s expansion of Winick’s 1962 proposal.
Sher and his colleagues have analyzed data from one of the U.S. population surveys of alcohol and drug use that Heyman consulted. In that project, more than 34,000 adults, ages 18 and older, completed face-to-face interviews in 2001 or 2002 and again three years later.
At the second interviews, past-year rates of drug dependence and abuse — defined in the survey as full-blown addiction accompanied by painful withdrawal reactions, as well as lesser but still serious drug problems — peaked at 9.3 percent among 18- to 20-year-olds but gradually fell in older age groups, reaching a low of 0.5 percent among those older than 50.
In particular, rates of new drug addictions and relapses among those who had kicked past substance problems declined sharply as participants got older, Sher’s group reports in the December 2013 American Journal of Public Health. From young adulthood to old age, those who started out with drug problems were most likely to get better over the three-year span if they got married, had children or landed a job after being unemployed, in line with Heyman’s results.
Cases of drug dependence and abuse that originated between interviews clustered among people who were at least 34 years old and got divorced in that window of time.
Alcoholics in the sample displayed an intriguing gender difference, Sher’s team reported in the May 2012 Journal of Abnormal Psychology. Men, but not women, who were at least 38 years old and got jobs or had a child after the first interview displayed marked declines in alcoholism by round two of the interviews. About 50 percent of alcoholic women in that age bracket who had children during the study remained heavy alcohol drinkers after three years, versus 40 percent of alcoholic women who didn’t give birth during the study.
Life transitions mean different things to different people, Sher says. For instance, parenthood may more often instill a sense of responsibility in middle-aged men and a sense of despair in middle-aged women.[429 words]
source: science news
https://www.sciencenews.org/article/addiction-paradox
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