The Disease of Addiction and Other Mental Illnesses
The Disease of Addiction and Other Mental Illnesses
Understanding the complex nature of the disease of addiction is critical to an attorney, member of the judiciary, or members of government who protect our citizens.
by Roger A. Goetz, M.D
Addiction appears voluntary, spiteful, pathetic, frightening. The behavior that it causes surrounds its victims with violence, degradation, guilt, anger, hopelessness and death. Until the advent of technology that permitted the study of the internal mechanisms of brain cells and neurological tracks, the disease of addiction had been called sinful, possession by the devil, a character weakness, a symptom of serious psychiatric disorders, or the result of stupidity.
The devastating effects of intoxication were recorded by Moses in ancient times, yet the difference between episodic intoxication and the chronic debilitating nature of addiction was not recognized until the 17th century. Unfortunately, as we prepare to enter into the 21st century, the attitudes of the 18th and 19th centuries persist. The myths of history have hindered the proper management of the disorders of addiction and remain an emotional issue to this day.
As with most mental disorders, even intelligent and educated people are taken aback by the associated violence. They are often confused by the paradox of rigid control of the affected person to protect society while simultaneously providing care and protection to the victims who have the disease. To protect society and control the disease, the physician and the lawyer must be a team to provide leadership and guidance to society. Understanding the complex nature of the diseases of addiction is critical to an attorney, member of the judiciary, or members of government who protect our citizens.
The intense governmental and research efforts exerted during the epidemic of substance abuse and addiction during the last half of the 20th century have led to clarification of the differences between intermittent intoxication and the disease of addiction. According to studies by the National Institutes of Health, addiction is a multi-factorial biogenetic disorder that affects approximately 14 percent of the United States population. It is as involuntary as other medical conditions.
The addition of certain chemicals (i.e., alcohol, narcotics) to the genetic substructure permits the activation of the illness of addiction. As in many illnesses with a genetic substrate, such as diabetes, some forms of heart disease and arteriosclerosis, the genetic potential to develop the disease is enhanced by adding chemicals. Examples of this phenomena include giving fatty substances to the susceptible heart patient and altering dietary intake of carbohydrates in Type II diabetics. Since little can be done to alter the potential for addiction in people who have the genetic structure, it is important to identify high-risk populations. Individuals who drink excessively to the point of intoxication and still function are different from many who drink less and are seen daily on the street corners. Their addiction totally interferes with their ability to survive successfully in society. By the time society identifies the individuals with the genetic potential, though, it is often too late to alter the course of their lives.
For many years medical and legal efforts focused on types of drugs and the differences between various drugs, such as alcohol, cocaine, tranquilizers, or other sedatives. It is now known that addiction is not drug-specific. Alcoholism is drug addiction. The cocaine addict has the same disease, requires the same treatment, and requires the same abstinence as the alcoholic. A basic tenet of recovery is total abstinence from all mood-altering substances.
An understanding of the nature of addiction requires an understanding of neurotransmitters and related interactions in the human brain stem. Although an article of this nature is not intended to be scientifically detailed, it is necessary to understand the primitive nature of the disorder and to have an understanding of the phenomena of denial.
Mood-altering substances affect the cerebral cortex (intellect), cerebellum (balance), frontal lobe (emotion), and mid-brain (instincts) in all humans. In those with potential for addiction, however, far more happens within the brain. Those deviations result in addiction.
In laymen's terms, the brain is a structure which reacts to internally produced chemicals. These chemicals, called neurotransmitters, are the mediators of the instincts for survival, reproduction, and interpreting the external environment through impulses from sensory organs. These chemicals produce the familiar "fight or flight" response, panic, sexual arousal, or hunger, and interact to produce mood, including depression, and elation. The addition of "addicting" chemicals into the human brain mimics or alters these normal chemical processes in specific areas of the brain.
In the case of substance abuse and addiction, the removal of external chemicals through abstinence, after detoxification, is essential in treatment and recovery. In the disease of addiction, after exposure to external chemicals, the complex processes are permanently distorted and thus the return to normal drinking, drug use, or other chemical use is impossible. All drugs and chemicals used in addicted individuals must be thoroughly supervised by some healthcare worker who knows the biochemical interactions involved.
Denial is the hallmark symptom of addiction. As one can see, the normal chemical responses in the brain are synchronous with external circumstances. The sight or sensing of an approaching train at high speed produces fright and ultimately flight, hopefully. If the internal chemical environment and the external environment no longer correlate, that is, for example, the brain is bathed in a sedative drug such as alcohol, it fails to identify the danger of the approaching train and the entire organism reacts in denial of the impending danger and disruption. Since denial is an internally mediated chemical reaction, it is different from lying, and it is not a voluntary response. "Breaking" the denial by proper treatment is the keystone to the therapeutic process. It is as important as total abstinence from all mind-altering drugs in recovery. A person in denial is honestly unaware of the etiology of the life's problems. The belief that the problem (substances) is really the solution is astonishingly persistent.
The treatment of the chemically dependent professional is very successful. All properly managed treatment systems, such as FLA, have recovery rates which are phenomenally higher than those seen in the general population. The reported statistical recovery rate is approximately 80 percent, plus or minus one standard deviation of 10.4 percent.
The treatment of the professional must proceed with an understanding of the highly emotionally charged, chemically induced primitive mid-brain responses that will be encountered in the process. This results in the helping professional often being the focus of anger, revenge, deviant behavior, and violence. This corresponds to the altered internal brain chemistry of the victim of addiction.
Addiction and substance abuse problems are the most frequently referred to any organized statewide health program, usually accounting for between 60 percent and 70 percent of all referrals. The second most common referred condition is depression as either chronic, recurring depression, or bi-polar disorder. Although the circumstances resulting from addiction and abuse often produce depression which disappears after detoxification, abstinence, and treatment, there are a significant number of cases in which depression exists independently of substance abuse or as a concurrent medical condition.
As with substance abuse, depression in its various forms including bi-polar disorder (formerly called manic-depressive syndrome), is a chemical phenomena. When modern anti-depressive drugs are used in conjunction with proper medical and psychological management, depression is highly responsive to treatment. It is not a matter to be dealt with independently. Depression requires observation, medication, guidance, activities involved toward recovery and environmental adaptions.
Self-destructive activities and changes in mood, just as changes in physical function, require evaluation by experienced professionals. There is little controversy over the successful treatment of mental illness. The success rates in illnesses which commonly occur in attorneys and other professionals exceed recovery rates associated with most chronic medical conditions. However, inadequate treatment, non-traditional methods, and self-treatment are as fatal in mental illness as they are in diabetes, cancer, and heart disease.
At a time when mental health care is being denied for financial reasons to many ill people and mental health treatment resources sacrificed, it is extremely important that lawyers and other professional workers receive immediate, extensive care to preserve society's investment in their profession. Over the years, this task has been efficiently, economically and compassionately accomplished by Florida Lawyers Assistance, Inc. The judiciary, the Bar and individual attorneys who have struggled with this dilemma, are to be congratulated on their success.
Dr. Roger A. Goetz was a certified addictionologist who until the time of his death in March 1998 acted as the director of the Florida Impaired Practitioners Program. In addition to his work with the PRN, Dr. Goetz sat on the Florida Lawyers Assistance board of directors from its inception in 1986 until the time of his death.