ADDICTION: Obsession misdirected
The brain circuitry is hardwired for motivation when impinged with the stimuli of reward. The reward need not be materialistic or monetary, it could be temporary behavioural adjustments such as moments of pleasure, emotional deluge, startling boldness, perception of calmness & relaxation, intensified sensations, a heightened buzz, a surge of confidence, loss of inhibition and so forth.Over time there is a hankering and compulsion to seek these stimuli that invokes a repetition of behaviour in the head. For some this stimuli could be creative work, movies, interaction with people, sex, music, writing, sports, profession, electronic games, meditation etc. and for others it could be overindulgent eating, alcohol, gambling, prescription medicines, cigarettes, chocolates, drugs, substance usage, inordinate television etc. The first lot of stimuli is positive reinforcements as it doesn’t have any detrimental effects on the body but the second lot has adverse consequences.
Addiction is repetition of behaviour despite unfavourable aftereffects. Yes work can become a craving in which case we have workaholics and so can sex, resulting in sex addiction and both could have physiological irregularities but the quintessence of commonplace addiction is alcohol, smoking and drugs, which has distinctive signs of atrophy on the body. Obsession on the other hand is rooted in imaginary fear as in say obsessive ritualistic religious routine or using the same bat in cricket or inspecting the door locks multiple times before sleeping or it could be an act such as obsessive cleaning which may perhaps be due to either some past trauma or recent cognitive disturbances. Obsession could also be about preoccupation with people as in obsessing over a lover and so on. Addiction has substance dependence whereas obsession is reasonably devoid of any material dependence and more to do with feeling in the head. One can be filled with the need to become an extrovert at parties or the need to lose one’s inhibitions whilst dancing or need that extra bit of confidence to make a public speech and these could drive the person towards alcohol or an external boost but needing these substances to induce behavioural changes on a continuous basis is obsession and over time it becomes addiction.
Therefore obsession in a way is the root cause for addiction in conjunction with other factors such as:
- Recognition needs during teenage years could make one plunge into smoking to manifest masculinity. Peer pressure.
- Need to be cool or rebelling against societal conformity could drive one to alcohol.
- Physical abuse and molestation could drive people to drugs as a coping mechanism.
- Lack of care, erroneous parenting, wrong peer influence and environmental aspects.
- Wealth and accessibility could divert people into synthetic substance use.
- Career stress, business stress, anxiety about future, sports performance stress etc. (Armstrong case).
- Music that dissipate high energy as in rock or heavy metal music may seek a supplementing strategy hence use of substances at Woodstock and other concerts.
HOW DOES IT WORK :
Initially obsession triggers recurrence of habit which in turn progresses to addiction and soon the body is unable to stabilize without the addictive substance fed to it with impressive regularity. In the case of habit, one is still in control of one’s choices but in addiction one is enslaved by the choices. So what if it is addiction, why should it bother the society so much? It does for the simple fact that it results in debilitation of the body, affects the emotional and impulse regulation mechanisms of the brain which can cause impaired interaction with others hence it is a problem. What started merely as a psychological botheration has now, with addiction, become a physical imperative as body now seeks ingestion of the substance bereft of which one is distraught. Reformative approach therefore is not effective if one merely attempts to addresses addiction by presenting to the victim, grotesque images of ravaged lung cells as in cancer or heightening cognitive awareness by talking about heart ailments, throat grafts etc.
ALARMING THE SMOKER :
Try telling a smoker that there are about 600+ ingredients in cigarettes and when burnt it creates 7000 chemicals out of which 69 of them distinctly creates cancer. Throw in the names of chemicals such as acetone, acetic acid, arsenic, ammonia, benzene, carbon monoxide, formaldehyde, hexamine, nicotine, tar, toluene etc. and all these merely represent bizarre statistics for the ardent smoker. One has to go to the core of the smoker or alcoholic and address the obsession or misrepresentation of the worldview in their head. Detoxification and medicine is the quickest fix as reparation strategies in extreme cases but long-term cure can be effected with psychotherapy, CBT, hypnotherapy and groups such as Alcoholics Anonymous and many other support groups.
CELEBRITY ADDICTION :
Are all forms of addiction due to childhood abuse, lack of care, improper education, need for an identity and impaired value system? Perhaps it may have started with a combination of the above. What about celebrities taking cocaine, heroin, methamphetamine etc. Fame, money, respectability, and success you name it and they have it. How is it then that Philip Seymour Hoffman, 46 yrs., died with a syringe stuck to his arm and five empty packets of heroin in the trash? Just 2 days back Robbin Williams committed suicide and he was stated to have been battling depression. He too was on cocaine and alcohol excesses in the 80’s. What about Cory Monteith, Charlie Sheen, Heath Ledger, Lindsay Lohan, Robert Downey Jr., Amy Winehouse, Jim Morrison, Michael Jackson, Kurt Cobain, Jimi Hendrix, and 100’s of others, all victims of drugs at one point. Perhaps a high sense of invulnerability is what these substances create for them from their daily performance stress. The collective wisdom of the entertainment industry wasn’t enough to keep them in sobriety.
WHAT DOES ALCOHOL DO?
Does alcohol lower inhibitions? Shy persons become exuberant, conversational diffidence dissolves, laughter triggers an infectious trend, people break into a song, it can invoke violence, fearless behavior and certain drugs induce invincibility. Cannot imagine spectators going to football games and rock concerts sober, it is kind of sanctioned convention. The prefrontal cortex, which is located at the anterior end of the frontal lobes, normally controls our impulses and damage to this can lead to loss of inhibitions. Alcohol or drugs affect the prefrontal cortex thereby impairing our judgment . Examples of people attaining focus, dexterity, concentration, decision-making and entwining risk after consumption of alcohol exist but these are inadmissible as a strategy to emulate.
To statistically explicate, alcohol levels of 0.01 to 0.05 g/ 100 ml of blood results in normal behavior. 0.03 to 0.12g/ 100 ml results in mild euphoria, sociability, talkativeness, increased self-confidence, decreased inhibitions. A good annual bonus also has this effect on the body. At this level of alcohol in the blood, the beginning of sensory- motor impairment happens and there is loss of efficiency in performance tests. 0.09 to 0.25 g/100 ml results in emotional instability, loss of critical judgment, deterioration of perception, memory and comprehension, impaired balance and drowsiness. 0.18 to 0.30 g/100 ml results in disorientation, dizziness, exaggerated emotional states, increased pain threshold, increased muscular incoordination and slurred speech. 0.25 to 0.40-g/100 ml results in approaching loss of motor functions, decreased response to stimuli, inability to stand or walk, vomiting and impaired consciousness. Alcohol levels of 0.35 to 0.50 g/ 100 ml of blood result in complete unconsciousness, depressed or abolished reflexes, subnormal body temperature, incontinence, impairment of circulation and respiration, possible coma and death.
People drink to excess for various reasons; to unwind during a date, to relax after a hard day, part of cultural upbringing (say wine in France), to alter their moods for an event, appear happy to others, the person may be an inebriant, peer pressure, sheer addiction, to insulate themselves from past constraints, genuine celebration after intense accomplishment (sports, music, academics, relationship, marriage and so on), political etiquette, produce excessive energy at concerts and binge drinking (Munich Oktoberfest, 6.4 million visitors and 6.9 million liters of beer is chugged every year. 638 people drank themselves into a stupor last year which Germans call Bierleichen or “beer corpses”). High risk gambling and its association with drinking are highly suggestive hence people fuel two addictions with one act.
WHAT DOES SMOKING DO?
Balance of chemicals in the brain can be altered and nicotine is a catalyst. Dopamine is a neurotransmitter and a chemical that is responsible for transmitting signals in between the nerve cells (neurons) of the brain and when there is unexpected elation e.g. chocolate, ice-cream, food, sex, smoking, drinks, drugs etc. Smoking causes this release of dopamine hence smoking is addictive. It mainly affects the production of dopamine and noradrenaline and upon a change in the levels and concentration of these chemicals, the smoker gets a feeling of a short burst of euphoria and there is a feeling of peace and calm. Over a period of time the brain decreases the natural secretion of dopamine and serotonin as it senses an extraneous trigger. When the smoker attempts to quit, the natural dopamine generation capability of the brain is shut down temporarily hence it takes weeks perhaps months for the brain to reactivate the dopamine generation and during this time there is withdrawal of elation and desertion of ‘wellbeing feeling’. Body starts craving for the substance and this could lead to desperation. With passage of time the intensity of drugs or cigarettes have to be kept up to retain the same feeling and effect.
There is no formulaic approach to effect a cure rather rehabilitation is a collective attempt from the following methods:
- Heightening individual awareness
- Distracting tactics
- Intervention approaches
- Replacement techniques
- Societal contribution to addiction
1. Heightening individual awareness
The gist of whatever we presented above thus far is categorized under the realm of individual awareness. Intensification of this, periodic messages, affirmations and subliminal intrusions must be an ongoing process. Reading this article with interest and diligence may heighten awareness and perhaps alleviate an addict’s obstinacy for a very brief period but serious addiction cannot be placated with this mode. It is a protracted undertaking.
2. Distracting tactics:
Getting up and going for a job, swimming, remaining active, creatively absorbed, intensifying one’s life and engagement within a positive environment, remaining active. To put it as distraction is incorrect, these are in fact plugging back to life strategies. One of the aims of raising awareness is to bring into visualization the positive merits of distracting tactics.
3. Intervention approaches
Excessive smoking and drinking to cope with stress, anxiety, panic, and trauma may appear as an unhinging coping mechanism to a non addict but to understand the mind of an addict one has to be far more sensitive and delve deeper. CBT, psychotherapy, hypnotherapy, acupuncture, group therapy, relapse strategies, behavioural and motivational techniques also are known to have produced good results.
4. Replacement techniques
- Nicotine Patch
- Electronic Cigarettes
- Gum (Nicorette) for withdrawal period
- Non-nicotine medications (Varenicline works by blocking nicotine receptors in the brain)
Some of these have given moderate success. In essence nicotine patch and electronic cigarettes continue to induce nicotine into the body albeit in lower dosages hence may not be a sustaining or rather successful endeavour. Success has been recorded in pockets. Moreover there seems to be some kind of legislation brewing as regards to e-cigarettes may probably be discontinued in public places.
5. Societal contribution to addiction:
a. Ban Cigarettes:
Most powerful method to effect a long-term permanent cure. Why not ban cigarettes completely, discourage its manufacture, in fact eradicate the product. Yes it infringes upon civil liberties of people, stifles free spirit, freedom of choice and arguments such as ‘mature people have the right to exercise their orientation of intoxication’ and so forth emerge but smoking causes about 109,164 deaths in the UK alone in a year. It costs the UK NHS in excess of £ 5.7 billion a year in spite of such a huge abatement in smoking since 1950’s. Cardiovascular disease due to smoking itself cost £ 205 million. 6 million people are killed worldwide due to tobacco, 5 million of these are due to direct tobacco use and 600,000 are due to non-smokers getting exposed to it. Don’t these statistics mean something. Why then a tenderness to civil liberties, free spirit and maturity. Shouldn’t this charade stop? Shouldn’t someone take an outright executive decision and enforce a ban. Why not curb it at the inception and governments ban the very manufacture and import of cigarettes.
Astonishingly this is where the anomalies begin. The United States receives $ 15.58 Billion from tobacco tax, the UK treasury earned £ 9.5 billion in 2011-12. On the price of a pack of 20 cigarettes 77% is tax hence there is tremendous government earning from it. The tobacco lobby is extremely powerful, sponsor’s elections, influence federal policies. Insurance companies don’t want to ban tobacco as they profit from it. The combined profits of the six leading tobacco companies in 2010 were $35 billion, which was equal to the combined profits of Coca-Cola, Microsoft, and McDonald’s in 2010. Global tobacco industry revenues are approaching half a trillion dollars, annually!! All the top cigarette companies are notorious lobbyists with a very deep cash cistern. Which sane government would ban cigarettes! The same is the case with alcohol. Drugs, well it being a distinctive social evil, luckily meet with a purgatory treatment in most countries.
b. Ban Cigarette Advertising:
There is progressive success in ban on cigarette advertising in almost all countries. Australia further path broke in their legislation when in Dec 2012 they stipulated, “All cigarettes must be sold in uniform drab olive-green packets with graphic health warnings.” The differentiating marker on products will be the brand name, which will be written on the packet in a uniform style. The cigarette companies were up in arms and filed multiple litigations, reason being ‘an act against free enterprise and trademarks’ but the ban stands and cigarette packaging has been stripped of its image, logo and identity in Australia, thus far. Standardized packing is the new concept and big graphic health warning is quite a deterrent. New Zealand has promised to follow the Australian lead with other countries evaluating the model (France, Ireland, South Africa, India, Britain). This is quite a powerful stance by Australian government.
The fight continues but unless we as a society show more intent, the improvements would remain marginal. People with addiction and obsession are not directionless, they seem to have a goal and are remarkably resolute when it comes to substance usage. This resoluteness of theirs has to be redirected and utilized for their own good and they ought to replace a positive habit into their repertoire as against such negative one’s. Amongst the various strategies individuals could embrace for smoking cessation, societal support is paramount. Cigarette companies need to slowly pull back such products that can only attenuate health and wisely replace it with alternate products and branding strategies.
Ironical, Philip Morris’s website posts this information:
“ILLICIT TRADE: Illicit cigarettes enter or are sold in a market in violation of fiscal laws, custom laws, and other regulations, e.g., without payment of import duties, excise tax, or VAT, and in noncompliance with regulatory measures. The illicit trade in cigarettes harms governments, consumers, and manufacturers. According to World Health Organization (WHO) estimates, the illegal, unregulated black market in cigarettes amounts to 600 billion cigarettes a year or 11% of global consumption. A report conducted by KPMG found that in the EU alone 65.5 billion illegal cigarettes were consumed in 2012. This equates to annual losses to national and EU revenues of approximately 12.5 billion Euros. We are undertaking a broad series of measures to fight illegal cigarettes, to ensure our brands are protected and consumers get the genuine product they expect. We are also working with a number of governments around the world on specific agreements and memoranda of understanding to address the illegal trade in cigarettes.”
What a brazen rendering of impressive statistics and usage of well-substantiated numbers from WHO, KPMG etc. Such fervor they demonstrate to protect their brand when it comes to illegal cigarettes. How about communicating the death related statistics or health related costs to the community and government? What a ridiculous and juvenile thought indeed! Why would these top cigarette companies do so and sound their own death knell. It is up to others to contest and reveal. Why pick Philip Morris and single them out, they had entered this business a long time back as have others including alcohol companies. They abandoning their core business cannot ever happen as a voluntary act, they can only be dislodged with government and societal intent and as long as smoking related deaths are spread over a large span of time (i.e. decades), no one anticipates any cataclysmic smoking eventualities hence the flourish of these firms continue. These companies aren’t evil or malfeasant as they continue to operate within the strictures of law and contribute significantly towards taxation. They aren’t pumping in anything more toxic than whatever already exists in the cigarettes to keep people addicted. Sadly even for them, it is just the way the product is and they are saddled with this line of business. The idea is not to seek a closure of their ‘going concern’ status, rather the yearning is for a total industry stoppage itself to the line of products i.e. cigarettes.
Perhaps the focal point has to be government who has the power to stop this at the very source and ban the manufacture of cigarette’s as against euphemistically attempting to assuage the public with statements such as ‘Cigarette taxation will be above inflation rate each year’ or ‘duties to skyrocket on alcohol and cigarette products’. These statements express lack of a strong will. One can administer a bit of leniency when it comes to alcohol as, in moderation, it could be a social drink and perhaps the gory statistics aren’t as pronounced as cigarettes and drugs though the reparation costs are substantial to rehabilitate alcohol addicts. A lot has happened since the 1950’s in smoking cessation arena and Australia has taken a tougher stance. Let us hope this mission remains free from bureaucratic interventions in all the countries. Meanwhile, non-addicts, do preserve your category status with the same discipline with which you have remained in this category, an experimentation with addiction just isn’t worth it. As for the addicts, please evaluate whether the obsession can be redirected to something more healthy.