Addictionology: The Science of Addiction
By Rey Ximenes, M.D.
An addiction is a chronic disease. It is considered a chronic relapsing brain disease where the brain, particularly the pleasure/survival center, is being hijacked to consider the addiction or addictive behavior integral to your very own survival. This area of your brain is responsible for your “fight or flight” response. Addictive substances and/or behavior, such as sex, gambling, or over eating, stimulates that area of the brain and can increase dopamine sent to your brain receptors. These substances can actually stimulate this area of your brain as much as 1800% more than your usual behaviors necessary for your survival. This can trick the brain into seeking out those substances or addictive behaviors because it feels good; and then increases the brain’s need to rely on the addiction so much that without the addiction, your body will shut down, and feel as if it may die.
What do addictionologists do?
Addictionology is the study of this phenomenon. Addictionologists look at the physiological, biochemical, psychological, as well as societal and social effects of addiction. We provide a knowledge base for what addiction is and how to tackle it. We take the time to understand each substance that can be highly addictive, to understand their effects; in order to help a person wean off that addictive substance. If a patient decides to stop taking that substance, they will likely go into withdrawals, i.e. physical or even psychological symptoms of the body’s dependence on the substance. These withdrawals can include: hallucinations, body spasms or pain, diarrhea, nausea, vomiting, fatigue, depression, and/or restlessness. We try to understand the withdrawal process so we can possibly prescribe the patient with medication that can help them wean off the substance, while easing their withdrawal symptoms at the same time.
We also provide patients with coping strategies, either at an in-house rehabilitation facility, or in an out-patient capacity, depending on their personal circumstances. We may also provide more holistic strategies that help patients cope with their addictions, such as acupuncture, meditation, or some sort of counseling and/or therapy.
It is also important to note, we work closely with patients to understand them better, in order to help them heal from their addiction. We approach our patients openly and with curiosity. We cannot assume our patients are “bad people” who need to be taught how to be “good people”. In my personal experience, I’ve met good people, who happen to be addicts and I’ve met some bad. I’ve also met non-addicts who are good people and some who are bad people. Therefore, having an addiction does not automatically make a person a “bad” person.
Because we study the societal and social effects of addiction, we understand that the addiction came as a result of patients hiding from their trauma, or hiding from an uncomfortable situation that they do not want to, or don’t have the coping skills to deal with. Addictionologists understand that if, as a society, we understand the why behind someone’s addiction, we can solve their addiction issues. When we are studying addiction and the patients’ individual struggles, we subsequently help them understand what they are hiding from, their triggers, and behaviors that help them cope better with their circumstances.
How can we understand addictions better?
Societally, addictions have such a negative connotation because people usually look down on addicts. A lot of times we see addicts as “those people”; and we refuse to have an open and honest perspective towards our own vices.
The truth is addiction is everywhere. You could have an addiction to things that are more readily available than opioids, cocaine, or even fentanyl. Sugar is one of the most highly addictive substances and one of the most prevalent. In fact, 75% of Americans have some form of a sugar addiction. Sugar is in the majority of our foods even though sucrose has no nutritional value. That is the majority of people in the States who have an addiction; and sugar adversely affects more people’s lives, because it is so readily available. It also kills more people.
To understand addiction, you must understand why that person would turn to that substance or behavior to “feel better” or “self sooth”. It’s more than likely that person hasn’t been taught coping mechanisms to help them confront and deal with their traumas. Therefore, they are using the drug or an addictive behavior to give them a sense of wellbeing and aid in their survival. And, when it comes down to it, addiction is really another way to survive.
It is usually not the substance itself that is hard to withdraw from. It tends to be harder to quit the routine of seeking out that substance or that addictive behavior, in order to deal with times of great pain. A person can usually stop taking the substance pretty easily because they can see the correlation between the continued use of the substance having adverse effects on their physical and mental wellbeing. However, if they do stop, they usually think, now what? How do I cope with the trauma that I have been running away from? That’s the hardest part.
This is exactly the point we have to understand for most addicts. The focus should not be on the substance or addictive behavior. It should be on the “why” behind how they got there in the first place. When we start looking at the bigger picture, we can have a lot more empathy and understanding for their circumstances because we all have pain, or some kind of discomfort we are trying to cope with. And, like most addicts, we are not taught how to cope or understand our problems fully.
How do addictionologists support their patients?
First, and foremost, we help our patients on an individual level. Every patient is different, even if their substance of choice, or addictive behavior is similar to someone else’s. That substance or addictive behavior may be affecting that particular person very differently both physiologically and psychologically. We have to be mindful of that person’s individual struggle with addiction and the impact of the addiction on their particular bodies. Of course there are addiction programs and facilities that are designed to help a group of patients simultaneously for a varied number of days (usually 30-90 days). But we do assess and treat each patient based on their experiences with the drug, length of taking the drug, and overall health.
From a physical approach, we do have a number of chemicals that we can use, in loo of the substance, to wean patients off the substance, such as buprenorphine or methadone for opioid addicted patients. From a psychological approach, we teach our patients coping skills to help them confront their trauma. We help them uncover what type of pain they are dealing with, and what they may be hiding from, and why.
We provide our patients with comprehensive treatment plans so we can support our patients long beyond our direct care. Addiction is like any other chronic disorder; it lasts. Relapse is also very common. We help patients focus on managing their disease, rather than on “curing” it.
I have a three pronged approach to supporting my patients. I teach them to improve their: diet, movements, and how they think. Nutrition and exercise can improve patients’ overall wellbeing and increase their energy. Also, healthy coping mechanisms can assist them when their world gets difficult and they must confront things that trigger them.
How does APC support their patients?
We primarily help our patients in an out-patient capacity. We offer support groups, counseling, and medication that can support their withdrawals. There are some substances where patients cannot just stop immediately without danger to their health, or their lives. These drugs are: alcohol, benzos, and barbiturates, though we don’t commonly deal with the latter anymore.
It’s important to shift our understanding of addiction from a “them” problem, to an all of us problem. We can say to people, just stop taking these substances or doing these behaviors; but there is so much more than that. We have to get to the root of why they are doing these things. If we can tackle stress and poor coping mechanisms in childhood, we may see less addicts later in life. Understanding the problem and all the physiological, social, and biochemical effects of that problem and reasons why that problem came to be, is why addictionalists study addiction from such a holistic perspective.