For some strange reason, my previous column dealing with The Addictive Personality received almost 20,000 hits. Since this is roughly 50 times the average, it suggests great interest in what should be a common sense topic. For that reason, some follow-up seems in order.
By way of personal qualifications, I've had a very long, up-close relationship with drugs and addiction. It began when psychopharmacology was just getting started and I was still very excited about the possibility of taking pills for mental ills. At that time, when I was designing test protocols at big pharma, it was considered noble (ala Walter Reed) to personally experiment with the different agents. An advantage of doing this legally in a clinical setting is that you know exactly what you're taking and how much. As a result, I've tried most drugs, several (such as amphetamines) for months at a time. I was never addicted because I don't have an addictive personality.
There is a list of generally agreed upon addictive characteristics (depression, insecurity, compulsiveness, etc.) but not all people who have them become addicted and vice versa. Then too, different drugs can have different effects on the same individual because of variations in metabolic function...as in oriental flushing syndrome.
One popular notion is that there are two different kinds addiction...behavioral and chemical. This is open to some debate because behaviors and chemicals are entwined and almost impossible to separate. Jumping from a plane provides an adrenalin rush while oxytocin will create a lifelong mother/baby bond. Smoking is an obvious example of this connection when the act of lighting up becomes joined with the sensation of a nicotine hit and forms a single pattern. As for withdrawal, giving up a chemical and giving up a loved one can be equally devastating.
Of course you can find a plethora of studies showing chemical/physical interactions. You can also find "proof" that putting a magnet in your shoe will cure arthritis. The fact is that somebody has to pay for the study. Last week margarine was better than butter and this week it's just the opposite. I do hope this is not too great a dose of reality. But don't get me wrong, I'll bet on science every time. It's by far the best we have but it's not a religion demanding unquestioned faith. A few years ago, even JAMA admitted that as much as a third of what it printed might be less than wholly unbiased. How many researchers have heard the story of the lab fire that consumed the original data you just requested?
I don't think I need to dwell on a second notion...that there's a difference between legal dependencies and illegal ones. There isn't. During a radio interview, a caller said Rush Limbaugh's addiction was acceptable because it was for a prescription drug. When I asked if Rush had a prescription, the caller hung up.
A third notion says that certain drugs are so powerful they can hook anyone...absolutely, positively. If this were so, why is it that not all people using those drugs become addicted? Indeed, one wonders why water boarding would be necessary if you could simply addict a terrorist and then withhold his fix as a means of gaining information. This is an example of magical thinking and the same as saying that totems, crosses and jujus - all by themselves - have the power to bewitch.
However, make no mistake when comparing something like chewing coca leaves to snorting cocaine. A large dose of a concentrated substance will certainly create a bigger bang for the buck and those who are mentally or physically susceptible are far more likely to be swept away. This is no joke and saying it's just in your head misses the overwhelming power of things "just in your head."
Look At It This Way
The sad part is that while savvy researchers already know all this, the layperson that would benefit from a few facts is content with confirmation bias and wouldn't know whom to trust even if he/she were willing to entertain a new idea. Thus, despite great interest, the topic appears destined to remain mired in emotional rants and useless anecdotal accounts. This is unfortunate because the judicious use of many drugs can serve to provide valuable insights and to significantly improve one's quality of life.
