Addiction: Do You Need Help? -- Drew Pinsky, MD -- 11/06/03

Last Editorial Review: 10/19/2004

By Drew Pinsky
WebMD Live Events Transcript

Addiction has many guises. From drugs and alcohol to gambling and sex, you may wonder if you or someone you know has fallen into addiction. Drew Pinsky, MD, from the popular radio show, Loveline, and author of the new book, Cracked: Putting Broken Lives Together Again, joined us to help us understand and define addiction.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Member question: Hi, Dr. Drew, thanks for being here today! There seems to be an increase in the prescribing of many new SSRI drugs for depression and anxiety. Do you know of any instances of people becoming addicted to these types of medications? I have heard conflicting arguments that your body will naturally wean you off of SSRIs as you get "better" -- yet I have also heard of negative side effects as people stop taking the medications, causing people to stay on the medication and creating a dependency on the drug. Any insight would be appreciated.

Dr. Drew: First, let's understand what addiction is, if you're going to decide whether something is or is not an addiction. Addiction is a specific biological disorder of the reward systems of the brain that permanently alters the survival system and thus the motivational priorities.

SSRIs have absolutely no potential for triggering this mechanism; they are never addictive. The question you are asking, though, is whether using SSRIs creates a biological change that results in a continued need for their use, and I know of no evidence that suggests this. Fifty percent of depressions recur; therefore, if you needed SSRIs, the probability is you will need them again.

Moderator: Let's talk more about the definition of addiction. Is any behavior that we lose control over considered an addiction, in your mind? Or have we gone "addiction crazy" in the last few years, tagging all vices as addictive?

Dr. Drew: We have gone a little addiction crazy. We use the term very sloppily and inaccurately. One of the most common definitions used in the addiction field is: a biological disorder with a genetic basis. Its hallmark is progressive use in the face of adverse consequence (effects on school or work, health, finance, legal, relationships). There is also a component of denial.

And if one is to look at a behavior as an addictive behavior, in the majority of cases, the addictive process is first triggered by a pharmacological agent.

Member question: Is addiction a result of an unresolved issue or fear? How do your emotions play a part in addictions?

Dr. Drew: Addiction is a biological switch having been thrown in the deep regions of the brain. For the most part emotional disregulation is why people go to drugs in the first place: Difficulty regulating feelings, trying to feel better, seeking solutions to emotional states, and inadvertently throwing that switch.

Member question: Hi, Dr. Drew. How do you help a loved one who is addicted to video gambling that refuses to get help? He goes for long periods of time without gambling, has a great paying job, and has never stolen to feed his addiction. Where can I go from here to help him?

Dr. Drew: These are very tough problems. If he is completely unmotivated, there is a not a lot you can do for him, other than try to find ways to leverage him into treatment. Create consequences for his behavior. Or you can leave. Loss is the many times the only thing to catch the attention of an addict in their disease.

The other things you can do are to go to a co-dependency recovery program or get therapy yourself. This will help you set limits on his behavior and hopefully motivate him into treatment. You might also contact gamblers anonymous yourself and see what resources are available in your community.

Member question: What are symptoms of a sexual addiction?

Dr. Drew: Sexual addiction is a model of any other addiction. You need to see a family history of alcoholism or addiction, i.e., a genetic predisposition. And again, the hallmark will be ongoing sexual acting out in the face of adverse consequence. The vast majority of these patients will have had a history of sexual abuse/trauma in childhood.

Member question: Can a person with alcohol addiction pass the gene to their offspring to be an alcoholic or will the offspring have a addiction to something else such as sex, drugs etc.?

Dr. Drew: The same gene or genes are responsible for all forms of addiction. Regardless of your manifestation of the addiction gene, you will have about a 50% probability of passing that on to your children. But remember, genes are not destiny, and what you are passing is the predisposition.

Member question: What if no one in your family history has had any of those addictions: prescription drug abuse, gambling, etc.? Is this just something we pick up on our own?

Dr. Drew: You don't have addiction if you don't have the gene. You can have bad habits and you can manifest abuse and you can hurt yourself. But you may not have the progressive disorder of addiction. Look carefully at your family history, however. There can be hidden clues: Were you adopted? Are your ancestors from Ireland, Scotland, Central Europe, or North American Indian? If so, beware.

Member question: If you do not have the addiction gene, and become addicted to something, is it then easier for you to break the addiction, or does the addiction run a similar course to those who carry the gene?

Dr. Drew: No gene, no addiction. You may become dependent on a drug and have withdrawal, but once you have completed withdrawal you will leave the drug and have no desire to return. Addicts don't do that, regardless of their wish or beliefs to the contrary.

Member question: Is there any way to be tested for these genes?

Dr. Drew: Not yet. I expect there will be within 10 years.

Moderator: What will insurance companies do with that info?

Dr. Drew: Don't worry. They already don't pay for the treatment of an addiction. Read my book, Cracked, if you want to see how frustrating it can be.

Member question: My ex is worried I am overdoing my sex stuff, from cyber to masturbation to sex with others. I tell her it's my life. What is normal or not? Who is right/wrong?

Dr. Drew: I think to apply terms like right or wrong will only serve to confuse these matters. Clearly there is a problem when behaviors progress in the face of consequences. When a normal person has an adverse affect from a behavior they will curtail the behavior. An addict will not. If you are able to have stable relationships, you are not putting your health in harm's way, or creating financial or legal liabilities, then you are probably in the normal range.

There is, of course, the more subtle issue of being able to be empathic with the people with whom you are having these flings. And if you are not, and you are being exploitative, that is another reason to look at things.

Member question: I know that it's not as big as being addicted to alcohol or drugs, but I am unable to stop overeating and I don't know where to turn. My doctor thinks Weight Watchers is the answer, but as I try, I fail and am nearing 300 pounds (at 5'3''). The problem is binge eating. Is there somewhere else I can turn?

Dr. Drew: This is an amazingly common problem. It is not addiction, but it is a manifestation of a problem that is poorly addressed by our culture. Our culture would have you believe that you merely haven't found the right diet, when the reality is this may be a manifestation of an extraordinary biological disorder.

Researchers are actively looking into how the brain modulates appetites. There may one day be a pill you take to restore normal hunger drive mechanisms. Presently I think most experts would advise you into looking into surgical intervention for your condition.

Member question: I have smoked pot for a number of years as an antistressor. Currently I'm having thick sinus congestion and very bad headaches and sore throat. I also have ulcerative colitis. What treatments can help me regain my health as I am very tired and in a lot of discomfort? I want to quit the smoke altogether.

Dr. Drew: You no longer use marijuana as a stress reducer. You are an addict and this addiction will not stop without treatment. I would suggest you look into Marijuana Anonymous. You need careful supervision when you stop this drug. There is an extraordinarily high incident of suicide in the first six months of marijuana abstinence.

The syndrome of marijuana addiction is always the same: A profound euphoria is experienced, usually after the second or third exposure to it, and from that moment on the addict pursues, preoccupies, or uses that drug every day. Somewhere down the line, exactly what you are experiencing develops; the addict gets depressed, has trouble sleeping and being motivated. Of course, the addict's response is to smoke more or better pot to deal with "the stress," which only accelerates the decline into depression.

Member question: Dr. Drew, I have a suggestion: This person can also join a support group such as the ones here on WebMD. They have been extremely helpful to me and to others.

Moderator: Not to toot our own horn, but what's your take on online support for addicts, Dr. Drew?

Dr. Drew: Any form of support is useful for people with compulsive or addictive behaviors. Twelve-step models for overeaters definitely work. Whether the support is merely to help with the feelings of having to contend with this condition or in an attempt to intervene therapeutically, it is helpful, but it is never a substitute for face-to-face interaction.

Member question: Is it possible to be too intelligent to work a plausible program within AA?

Dr. Drew: Intelligence can get in the way of any emotional therapeutic process. The first step in recovery requires one to trust others and to merely follow directions, not to over think things. Remember, the addictive biology will color everything, especially thinking or how one thinks.

Member question: My husband had an addiction to painkillers. He stopped taking them about seven months ago without any treatment. Does an addict need treatment or can he actually conquer the addiction on his own? This addiction was enough for him to lose everything.

Dr. Drew: I have never seen somebody with advanced forms of addiction successfully stay stopped without treatment. There is something referred to as "natural recovery," which basically is the spontaneous remission of addictive behaviors. I am of the opinion that this only occurs in earlier, less-progressed manifestation of the disease, and I believe most of these people will return to substances eventually.

Member question: How do you support a sister addicted to drugs that lives 2,400 miles away, and only calls when she needs something?

Dr. Drew: You go to Al-Anon. Your participation in a co-dependency 12-step process with a sponsor will have a positive affect on her disease. Try it and you will be amazed.

Member question: Is there anything new and promising in the medical field for treatment of alcoholism, as in new drugs?

Dr. Drew: There is always active research in this field. It will not be long before we can turn back the biology to a more predisposed state. In other words, perhaps turning the switch off of the addictive drive. That will never, however, be curative, since this is a disease that also includes complex emotional and spiritual pathologies.

Member question: Can you tell me if the drug Neurontin is addicting?

Dr. Drew: Neurontin is categorically not addictive. However, I rarely have had patients escalate and abuse it somewhat. Be cautious with it if you are an addict. Follow directions carefully.

Member question: Are there such things as positive addictions? Can people become addicted to things that are actually good for them?

Dr. Drew: I get that question all the time, and so far I haven't found one. I guess the closest thing would be a selfless workaholism, but remember this is a disease defined by the consequences, and consequences mean negative results. Therefore, even a positive behavior would have to have escalated to the point that it becomes destructive in order to be considered an addiction.

Member question: I have indulged in the addiction of masturbation since 1992. How can I give it up?

Dr. Drew: The most common manifestation of this phenomenon results from the technological assault delivered by the Internet. The Internet and the sexual content that flows into people's homes is literally a stress on biological systems. And for those with a tendency to sexual addiction or compulsion, it's like having a crack pipe in your house 24/7.

There are now many books on this topic and people specifically trained in this disease. The best centers I know of are The Meadows, in Arizona, and del Amo Treatment Center in Southern California. There are thought to be roughly 600,000 Americans each year newly manifesting this compulsion. Take care of it.

Member question: What if you are addicted to something such as self-injury?

Dr. Drew: Cutting can become part of an addictive syndrome. It does activate thrill mechanisms and cause a powerful surge of central nervous system endorphins. But it is not the initial manifestation of an addiction. It can be a compulsion, and it is a sign of very serious psychiatric disturbances, but if it becomes an addictive behavior there almost always was first an addiction to a pharmacological agent.

Member question: What about recidivism from people who are children of alcoholics and who had a flirt with 15 years of cocaine abuse, but haven't used it in 12 years after a rehab program? Do they revert when put into stressful situations? What causes them to lose it? Can they become "normal,"" conventional folks?

Dr. Drew: Once the switch has been thrown on this disease, it is forever active. It is a chronic disease marked by relapse. Unless they remain connected to a treatment process chronically, they are at risk for future relapse. Whether triggered by life stressors or the result of re-exposure to an addictive chemical, there is once again a need for treatment.

Member question: We all know that cigarettes are addicting. How to stop, other than cold turkey, is the question.

Dr. Drew: Nicotine is a complex topic. Other than cold turkey, you can taper nicotine with nicotine replacement devices such as the patch, and/or use medication that decreases craving, such as Zyban. The more attempts at stopping, the higher the probability of success.

Member question: Several family members of my mom's generation were alcoholics (but not my parents). Several family members of my generation, including my sister, have had alcohol and/or drug addictions. My husband's father drank quite heavily, although he said it was social. My husband smokes weed on a very regular basis. I can't do anything about any of them. But it makes me think that my son, who is in high school, may have a genetic predisposition to addiction. On top of that, he has ADHD and impulse issues and he never seems to do things half way. What can I do to help him avoid substance abuse? I've talked to him a lot about how other teens may experiment a little and then stop, but he has to be concerned about getting addicted. Am I on the right track?

Dr. Drew: You are definitely on the right track. The most important thing is to keep him as emotionally healthy as possible and to seek mental health professionals if there is any kind of trouble. Earlier intervention yields better outcome. You also raise an interesting issue in that recent research is showing a genetic biological link between ADD/ADHD and addictive, genetic predisposition.

Member question: My daughter has chronic pancreatitis very bad. She is constantly on medication for pain. At this time she has been in the hospital three weeks and will be in at least one more week. How do I explain this to people that keep telling me she is a drug addict?

Dr. Drew: Well, she probably is a drug addict in that the vast majority of chronic pancreatitis develops in alcoholics, and alcoholics in chronic pain who are exposed to opiates become addicted to those drugs, perpetuating the pain and obviously perpetuating their addiction. It is a very difficult situation. She may be someone who will need what is called chronic replacement therapy, such as methadone.

Member question: Can people be addicted to treatment? I know people who are always trying to quit smoking.

Dr. Drew: There is no real addiction to stopping. But there can be a chronic dependency upon treatment. Not everyone becomes completely dependent on the treatment process, but if that is what is necessary to stay sober and to survive this disease, it is a small price to pay. You don't think of people with hypertension being dependant on their treatment or diabetes being dependant on their treatment. The same should apply to addiction.

Member question: Dr. Drew, in your book, Cracked, you talked about the problems concerning the limitations of health insurance on mental health and prolonged treatment. Are there motions to deal with these issues?

Dr. Drew: God, I hope so. But, at present, the tail is wagging the dog, and there seems to be no one to advocate on behalf of people with this disease, and it is a travesty.

Moderator: Any final comments for us before we let you run, Dr. Drew?

Dr. Drew: Please read my book, Cracked, if you are interested in this topic. In this book, I am trying to teach about the disease through giving the reader a caretaker's-eye-view of the experience of contending with this illness. The cases were carefully selected. I believe it is an efficient way to learn about a complex condition that can teach us all a great deal about the human being.

Moderator: Thanks to Drew Pinsky, MD, for sharing his addiction expertise with us today. For more information, please read his new book, Cracked: Putting Broken Lives Together Again. You can also visit our message boards for information and support. You'll find a safe and welcoming place to discuss your concerns and ask more questions.

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