The disease that
every woman should
be able to discuss
By ANNE M. FELTON,RN, ND
Ihat do you really know
about addiction? The
term “addiction” conjures
different meanings
and images for many. Many two-packs-a-day smokers are willing to call themselves “smokers,” yet less likely to identify
with the term “addict.”
The term addict is often reserved for
what are referred to as the illicit or hard
drugs, such as heroin, cocaine, methamphetamine
and marijuana. There is also
the increasing misuse of prescription opiates — pain pills. Yet every individual
who continually misuses any of these
substances
despite negative consequences
suffers from addiction.
Addiction is basically separated out
diagnostically into two categories: substance
abuse — a pattern over time of
continued misuse of a substance despite
significant negative life consequences —
and substance dependence. Substance
dependence is marked by the continued
need to use increasing amounts to feel
the same positive response from the substance
(tolerance), as well as uncomfortable,
sometimes seriously harmful physical
symptoms (withdrawal). These are the
highlights, not the exclusive criteria, for
substance dependence and abuse.
Addiction is a simple and appropriate
term that fits both disorders and is useful
to describe the entire disease process and
not just the diagnostic criteria.
Many still believe that addiction is
simply about moral aptitude and poor
social choices. But would you suggest to
a friend who loves the sun and outdoor
sports and was recently diagnosed with
aggressive melanoma (skin cancer) that
the fact that she did not always wear
sunscreen and often enjoyed long hikes
without skin protection was responsible
for her disease? I doubt it.
The fact is that while we know that
sun exposure is the strongest link to skin
cancer, there is someone else out there
with equal or greater exposure and similar
skin type without skin cancer.
Addiction is similar. Not everyone who
uses or even abuses a substance will
become addicted to it. Because everyone’s
brain is different, our “switching”
point is different as well.
All addictive substances have the
potential to create a “reward pathway”
in the brain that ultimately leads to
brain dysfunction and what we talk
about as addiction.
I have worked with some addicts who
said they were addicted after only one
drink. Others say it took years and years
of misuse of substances to become
addicted. Yet the pathway in the brain is
the same for all.
Just as with cancer, there is likely a
strong genetic predisposition to addiction,
yet this alone is unlikely to cause
the expression of addiction. The cause
of addiction is a subject of great interest.
Why does one addict choose alcohol
and another, cocaine? Why do
addicts experience euphoria when
using opiates, yet non-addicts generally
report feelings of sedation?
Trauma, the co-occurrence of psychiatric
disorders such as depression and
anxiety, and isolation in the elderly are all
strong contributing factors for addiction.
Here is the bad news. In 2002, estimates
taken from DAWN (Drug Abuse
Warning Network) showed 553,874
women visits to Emergency Departments
were drug-related. In 2001, there were
7,439 reported deaths of women in
Emergency Departments that were druginduced.
These 7,000-plus deaths are
separated out from those that may have
been drug-related, such as traffic accidents,
assaults, etc., which would bring
this number up several thousand more.
Also, it’s important to note about these
DAWN statistics that all the participating
Emergency Departments are from larger
metropolitan areas. These are low estimates.
A 2004 study found that 30 percent
of outpatients screened by their primary
care providers had a substance abuse
problem. Of that 30 percent, only a third
were provided any treatment or resources.
All chronic illnesses, when out of
remission and left untreated, can wreak
havoc with all our body systems.
Addiction is no different and may be
one of the more deadly. The short- and
long-lasting effects of alcohol are experienced
by women more rapidly and
with more devastation than by men.
Liver disease is more common in
woman drinkers, as are the long-term
and debilitating cognitive deficits that
may result as a consequence of liver
disease. A woman with alcoholism can
expect to die 15 years earlier than her
non-addicted counterpart.
Yet early warning signs are frequently
ignored. Primary care providers are often
remiss in making appropriate referrals
and performing screening exams. It is
absolutely essential that we take control
and responsibility for our health. Defining
addiction as a disease process does not
excuse behavior, nor does it suggest that
one is at the mercy of her genes.
WARNING SIGNS
It should come as no surprise that
women ignore the early warning signs of
addiction just as many women have historically
ignored warning signs of other
illnesses. To be sick takes a tremendous
amount of time away from a busy schedule
and a family.
It is terrifying to discover a lump in
your breast or a changing mole on your
skin. What would it be like for your family
to watch you struggle with a possible
chronic terminal illness? What would you
do if the small glass of red wine you
drank a few nights a week grew into a
large glass? What if the large nightly
glass turned into several glasses a night
and you began to snap at your children
and were no longer able to effectively help them with their homework? What
would you do?
HOW TO GET HELP
The acceptance of addiction as a disease
is a huge beginning. Still, it is only the
beginning. Women especially need to be
willing to acknowledge that they are no
good to their families when they cannot
take care of themselves. Women more so
than men have developed their addictions
in isolation and attempted to manage
them alone as well. Do not wait until your
life is unrecognizable to you and your
loved ones to reach out for help.
First, be open and honest with your
physician. When you are lucky enough to
have probing questions asked, don’t feel
insulted by them; be glad you have a primary
care or specialty physician who
does not ignore the warning signs of
addiction and gives it the thought it
deserves as a disease process.
Next, utilize your resources and take
action. You may be powerless over drugs
and alcohol, but you are not powerless
over your life. Many addicts have
obtained sobriety by not so simply walking
through the doors of their first 12-
step meeting.
Twelve-step meetings are powerful
self-help groups that offer acceptance
and support in a nonjudgmental environment,
but they do not replace the need
for medical and psychiatric care.
Most addicts are not lucky enough to
recognize their substance abuse in time
to work with the primary care provider
and find outpatient treatment and 12-
step meetings to be beneficial. While it is
possible with an excellent primary care
provider or psychiatrist to detox — go
through supported withdrawal as an
outpatient — it is safest and most comfortable
in a treatment facility.
Inpatient programs (also referred to as residential treatment programs), such
as the University of Colorado Hospital’s
Center for Dependency, Addiction and
Rehabilitation, offer comprehensive,
individually structured treatment that
begins with the management of withdrawal.
There are many benefits to inpatient
treatment. The length of stay generally
varies from 30 to 90-plus days.
The problem with treatment for
addiction is the complexity of the disease.
Many seeking treatment have
already experienced multiple relapses —
what I prefer to call progressions — in
their disease. This may be an obvious
cycle of misuse/sobriety/re-use, or one
not so obvious: Perhaps you have
thought you should drink a little less,
stopped for a couple of weeks and then
gone on a binge followed by heavier
drinking than before. Withdrawal at this
point may be as long as three to five
days, sometimes longer. At this point,
effective treatment programs will allow
the patient to do much more than detox;
they will provide the patient with the
skills and knowledge to continue to fight
the illness and a place to begin to heal.
Without doubt, science and medicine
are now ready to better define and tackle
addiction, more precisely describing
the physiology and brain of the addict.
And while I certainly agree with this, I
would caution that it is crucial not to lose
sight of the human being and the story
that the addict tells us.
As is true with any deadly and progressive
illness, science and medicine will
only get us so far — the human experience
and sense of spirituality is what survival
is all about! Maybe this is
euphemistic. I know it is sincere.
Anne M. Felton, RN, ND, is nurse
manager of the University of Colorado
Hospital Center for Dependency,
Addiction and Rehabilitation.
