Synopsis
"The Addiction Solution" introduces a revolutionary scientific breakthrough in treating addiction based on a new medical paradigm that finally frees patients from the treadmill of addiction. Written in plain language with engaging illustrations and easy-to-read charts and graphs, this book clarifies and explains everything anyone ever touched by the disease of addiction needs to know. In recent years, an explosion in biomedical technology allowed scientists to both "read" DNA and "see" brain chemistry in ways never before possible. It's now been scientifically proven that addiction is an inherited, neuro-chemical disease originating in brain chemistry, determined by genetics, and triggered by stress. "The Addiction Solution" moves step-by-step through the most basic levels of the new paradigm and all the other issues surrounding addiction. As such, it's the new starting point for unlocking the puzzle of how addiction really works and how it can be successfully treated. It draws composite case histories to illustrate how the innovative Personal Recovery Program works in practice, customizing treatment for each of a diverse group of addicts abusing a wide variety of different substances - from the first day of treatment to its successful resolution.
Extrait
1
Origins and Triggers
HOMEOSTASIS
The concept of homeostasis is at the core of any discussion, diagnosis, or treatment of addiction.
What is homeostasis? It is the process of maintaining the body's natural balance to achieve stability (or a norm), not just in critical moments, but throughout a lifetime ... one day at a time, one minute at a time, and one second at a time. Homeostasis is the central regulating system for the entire body, and it plays a crucial role in good health and bad.
In the mid-19th century, French physiologist Claude Bernard conceptualized the need for a constant (a condition or process that does not change) that regulates the body's "internal milieu" (internal environment) to make life both possible and sustainable. If that constant was lost--if the internal milieu was destabilized or thrown out of balance--life itself was threatened.
Over the following decades, the idea of a self-regulating constant at the center of life was applied to all biological systems: plants, animals, humans, and microorganisms.
This constant was given a name in the early 1930s by Walter Bradford Cannon, an American who joined two Greek words--homos, meaning "equal," and histemi, meaning "to stand." Homeostasis literally means "to stand equally" or "to remain the same." As it specifically relates to addiction, it means "to maintain a balanced state."
The term constant does not imply something unyielding. In fact, homeostasis is remarkably fluid and flexible in adapting to internal and external threats.
Think of a surfer on a board, riding a long wave to shore, expertly adjusting her balance and posture to counter each dip and swell of the ocean's current. Riding the waves of life, homeostasis does essentially the same thing--bending, countering, and adapting to each change or danger while maintaining the body's tenuous balance.
Homeostasis is a dynamic concept in continual flux, maintaining stability by moving fluidly within a narrow field, a constant range of normalcy.
For example, 98.6° Fahrenheit (37° Celsius) is commonly accepted as normal body temperature. But individual body temperature may vary. For some people, "normal" might be 98.4°F; for others, 98.9°F. Your normal temperature actually lies in a fluid range of about plus or minus 1 degree-- in this case, from about 98.1°F to around 99.1°F.
Homeostasis strives to maintain the body's internal temperature within each person's normal range. A signal (like extremely hot or cold temperature) is picked up by a sensor and sent to a control center (the brain), which immediately sends back a response appropriate to restoring homeostasis. Three fast steps: input, processing, response.
A response can be an involuntary (or automatic) reaction. For instance, if it's warm outside, your body sweats, helping to cool the skin. If it's cool, you shiver or get goose bumps, both of which help warm the skin. Those involuntary reactions to external conditions are called homeostatic compensations.
A response can also be voluntary. Let's say it's a real scorcher outside, and you're sweating like Niagara Falls but you can't cool down. This is when the survival instinct--part of homeostasis--prompts a voluntary response: You fan yourself, jump in a swimming pool, sit in the shade with a cold drink, or walk inside where the air-conditioning is set at a comfortable 72°F.
Now imagine you're outside in the dead of winter. It's bitterly cold, and snow cascades from the sky. Standing there shivering is not going to keep you warm ... so you put on a parka and gloves, stand under an outdoor heat lamp, or walk back inside where the heating system maintains a cozy temperature.
In any extreme condition, voluntary action is needed to maintain homeostasis--otherwise heatstroke or hypothermia would result. Yet whatever physical action is taken, it is automatically cued by an imbalance in homeostasis. Think of it as a red flag alerting the systems to impending trouble.
Homeostasis is not limited to controlling body temperature. It also maintains blood glucose balance and regulates the body's water level (thirst causes you to drink water; the body absorbs what it needs and releases the excess through evaporation and urination). In fact, homeostasis regulates the entire body and all its systems--millions of internal equilibriums (or balances) affecting everything from the smallest brain cells to the largest bones. At the same time, it reacts to every change and threat by making alterations of equal size and in opposing directions to those that created the disturbance. For instance, when physical danger threatens, homeostasis releases adrenaline to help the body combat it. During vigorous exercise, homeostasis cues the heart and respiration to race faster to keep the body's internal balance.
Whenever stability is at risk, the process of homeostasis takes steps to ensure that balance is restored so life may continue.
Homeostasis and Disease
Sometimes the body cannot restore balance on its own, and medical intervention is needed.
For example, homeostasis efficiently helps the body resist some viruses, like the common cold: The virus attacks, the immune system receives the signal to respond, and you get better. More virulent strains, like hepatitis, overwhelm the homeostatic process, and medical assistance is thus needed. Toxins and drugs can also overwhelm the system: Homeostasis can fight small amounts of mercury or lead or cocaine, but larger or concentrated doses of these and other poisons require medical treatment.
Many illnesses and diseases result from homeostatic imbalance, including diabetes, hypoglycemia, dehydration, gout, any malady caused by a foreign chemical or substance in the bloodstream--and the disease of addiction. These problems usually occur when there's a flaw in the homeostatic mechanism or when an increased amount of a specific substance (a toxin, a drug, or a metabolite like uric acid that leads to gout) engulfs one or more of the body's operating systems. These situations require medical intervention.
In every case of medical intervention, the goal is to restore the body's chemical balance--its homeostasis.
Homeostasis and Emotions
Our internal balance can be threatened not only by the physical world but also by our emotions. Feelings and emotional upheavals disrupt homeostasis by changing our brain chemistry. These emotional fluctuations play a central role in the disease of addiction.
The homeostatic process can usually handle minor emotional disappointments and hurts, but a large dose of stress fuels a roller coaster of emotion that wreaks havoc with equilibrium. By releasing chemicals that change our body and brain chemistries, stress applies pressure to all our systems, including the immune system, which in turn makes us vulnerable to myriad emotional and physical maladies.
In such cases, medication is often needed to restore homeostasis.
THE ROLE OF GENETICS
You hear it all the time:
"She's got her mother's eyes."
"Poor kid, he's got his father's nose."
"Baldness runs in their family."
On the simplest level, genetics--the science of heredity and variation in all living things--is the medical record of family trees.
Both external (physical) and internal (chemical) features are determined by genetic traits passed down through family lines.
If your bloodlines are filled with tall and trim predecessors, chances are you will be tall and trim. Likewise, if your family has historically been short and overweight, you could develop the same physical features. However, genetic predisposition does not translate to inevitability. Weight, for instance, can be altered through choices about exercise and nutrition. Say a man with "trim genes" is a couch potato who swills beer and eats chips and fries. Genetics alone will not keep him trim. After years of sloth, he'll have a beer gut and 40 additional £ds.
At best, predisposition is a diagnostic tool to help prevent or treat genetically based pitfalls. If people have heart disease running through their family trees, it's advisable that they lower their cholesterol, stop smoking, and engage in regular exercise. Children of a parent with diabetes should have their blood glucose levels routinely checked and be counseled on good eating habits. These examples underscore an important point about genetics--so important that it's worth repeating: Predisposition does not translate to inevitability. With knowledge, foresight, and healthy behaviors, anyone can defy much of their genetic fingerprint.
A New View of the Family Tree
For centuries, family trees could be viewed only from the outside. Your ancestors sat at the very top of the tree, and you (or your children) were placed at the lowest level. The few genetic traits we could track at that time were external (things like hair and eye color, height, and weight) and historical (ancestors who had died of heart attacks; cancers that appeared to run through the family line).
In the past decade, research scientists have begun to map the human genome, which stores all our hereditary information and largely defines who we are. As scientists crack the genome code, it's as if they are cutting a cross- section of the human family tree and looking inside that slice to discover the chemical fingerprints embedded in our lines of heredity.
Thanks to this inside view, we've discovered that genetics not only transmits physical traits but also plays an important role in determining brain chemistry ... and it shows itself in inherited behaviors like chronic depression, bipolar disorders, anxiety, hyperactivity, sleep disorders, and many other so-called psychological and behavioral conditions.
The new family tree: a cross-section readout of a gene
These chronic problems are created by inherited homeostatic imbalances, and these imbalances constantly affect our brain chemistry and therefore our emotions, behaviors, and everyday functioning. Even under minor stress, these imbalances can cause emotional or mental instability that directly influences addictive tendencies.
Imagine a keg of nitroglycerin, the main ingredient of dynamite. Nitroglycerin is highly unstable and extremely volatile, yet it can sit without incident for days, weeks, and years. But as time passes, it degrades bit by bit, becoming more unstable. Then, one day, it receives a shock--say, pressure or heat--and it explodes.
Now picture an inherited imbalance in brain chemistry. It, too, may be highly unstable and extremely volatile, yet it can function marginally for years, attracting little if any notice. One day, it receives a shock in the form of a major stress and detonates in an explosion of dysfunctional emotions and feelings that can trigger addiction.
Like fingerprints, brain chemistry is unique. That's why we all behave differently. Similarly, no one's brain chemistry is perfectly balanced. All of us are born with different combinations of "flaws" that reflect our individual homeostatic imbalances. These flaws can be reflected in emotional instability. The more off-balance your individual brain chemistry, the more vulnerable (or at risk) you are to addiction.
Every day, newspapers and medical journals report newly discovered genetic links to smoking, drinking, behavioral addictions, and drug abuse. With an estimated 20,000 to 30,000 genes contained in our DNA, and billions of possible combinations of those genes, new scientific studies clearly confirm the genetic influence on homeostasis and inherited diseases. Here are just a few of thousands of examples.
. Mice mutated with a defective Per2 gene drink three times more alcohol than normal. . Nonsmokers are more likely than smokers to carry a protective gene, CYP2A6, which causes them to feel more nausea and dizziness from smoking. . People with two copies of the ALDH*2 gene variation rarely drink alcohol and more rarely develop alcoholism. . In a study at the University of Southern Florida, 95 percent of the participants who abused alcohol and illicit drugs and smoked shared a double A variation of the mu-opioid gene.
As the human genome is mapped precisely, more genetic links to addiction will be confirmed.
But let's be clear: No one has discovered any single gene for addiction. Rather, addiction is the result of combinations of genes that, when stressed, cause myriad destructive homeostatic imbalances.
The chemical imbalances that lead to addiction are not discernable through casual observation. You cannot spot an addict by his or her physical features (although physical behaviors--like raiding a medicine cabinet at a house party--are telling). Instead, the hereditary imbalances that cause addiction are found in the brain and its chemistry.
Of course, some genetic traits are more clearly expressed than others within different family trees, so degrees of vulnerability to addiction vary widely. That's all the more reason you should research and review your own family history. If it's filled with addiction and alcoholism, you can take steps to avoid the land mines that may trigger the disease, just as you would take precautions if you were predisposed to another disease.
Genetically speaking, your addiction may not be your fault, but from both a social and human perspective, prevention and treatment is your responsibility.
ENVIRONMENT, IMPRINTING, STRESS, AND ADDICTION RISK
In addiction medicine, environment is defined simply as the world in which you live. It has little to do with climate change and a lot to do with the people close to you who may put you at risk of addiction by adding to your stress. These relationships are grouped in four categories.
Community environment. In terms of addiction risk, does it make a difference whether you live in a small town or a big city? Not really. What is important is the cohesiveness of your community (or lack of it) and how you connect (or don't) to it.
A dysfunctional community poses a greater risk to addiction than a community that operates harmoniously. If your community has favorable or lax views of drug use, you've got a better than average chance of trying drugs. Statistically, if your town or city has positive or lax views on firearms and crime, your risk of addiction is raised.
If your town or city has a healthy ambience but you don't fit in, or you withdraw or detach yourself from the community, then you run a greater risk of addiction. Conversely, if you are an active participant in a robust, well-organized, and welcoming community, your risk for addiction is decreased.
Family environment. Through a process called imprinting, infants and toddlers learn and establish patterns of behavior by observing and imitating those closest to them. At that early stage, their central nervous systems soak up almost every stimulus within reach. This "imprinted data" is expressed years later as feelings and behaviors, both good and bad, when events in our lives reflexively recall these imprinted messages. For that reason alone, families--their interactions, cohesiveness, and attitudes-- have the earliest and most lasting impact on children. In terms of preventing addiction, the importance of a good, stable family environment cannot be overstated.
If the family is conflicted or dysfunctional, the risk of addiction is increased. The greater and more hurtful the conflict, the greater at risk the children are for future addiction. Divorce harms children on many levels by creating fierce conflict within a dysfunctional family environment. Physical, psychological, and sexual abuse place children at risk for addiction in their l...
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