NOTE: This is the second article in our series on The Addicted Cop. If you have not yet read Part I, we recommend clicking on the attached link below.
Whether addiction should be considered a disease, a psychologically-based behavior disorder, the result of low character or poor morals, something learned and socialized into an individual, a bad habit derived from unchecked pleasure-seeking, or some other personal defect altogether has been the source of much debate. Among medical professionals and addiction specialists, treating addiction as a disease has become an increasingly common modality; that addiction is a disease is something many if not most of these professionals accept as a matter of fact.
To a layperson, especially if not intimately close to addiction, this may seem counterintuitive. Cancer is a disease. Diabetes is a disease. Getting addicted to something and remaining in its clutches is a matter of behavior, right? Well, consider this: It is true a lot of diseases we have absolutely no control over. A chromosomal glitch here, a toxic waste mishap there, and anyone can be at the mercy of the fates. However, many diseases are absolutely our own doing and even if the behavior that contributed to its formation is stopped before or once the disease is found, the disease itself remains. A lot of us, maybe even most of us, are born into this world and immediately start the decades-long process of rigging the time bomb that is going to send us right back out of it.
What you eat has a direct impact on your body and your wellness. Too much of an unhealthy diet (a choice and a behavior) can cause irreparable harm to the body (a disease). Once the disease is established it must be confronted both behaviorally and medically. Addiction is no different.
So let us start by reviewing just what an addiction is, using the definition cited in last month's article. An addiction is a chronic neurobiological disorder that has genetic, psychosocial, and environmental dimensions and is characterized by one or more of the following:
- the continued use of a substance despite its detrimental effects;
- impaired control over the use of a drug (compulsive behavior);
- and/or preoccupation with a drug's use for non-therapeutic purposes (i.e. craving the drug)
Now, while this is a very good starting point for understanding addiction, it is really only a very basic outline. First, it focuses on addiction to a substance, for instance alcohol, nicotine, or opiates. Some sort of drug. When we have usually considered the concept of addiction these traditional substances have been the culprits behind the cravings. As addiction has become better understood, it is apparent we may need to redefine exactly what we consider to be the addicting substances, and there are a couple different ways to do that redefinition. A bit more on that later.
Next, the definition does not really address the issue of withdrawal, long considered a an identifying characteristic of addiction. Anyone who has tried to break out of a true addiction knows the pain of withdrawal and how easy it is to just give in and go back, no matter the consequence. Why is something so potentially harmful so compelling, even after the harmful effects are being experienced? When we take away the addicts source of pleasure, why is the response not just a lack of pleasure but one of physical pain?
Finally, our definition does not answer the question Why? Why are certain things addictive? Why does an addiction develop in some people but not in all? Why are humans so often seemingly drawn to their own self-destruction?
The Reward System
Built into all of our brains is an elaborate collection of physical and chemical structures that make up our Reward System. The reward system is nature's design to regulate and control behavior by rewarding pleasurable experiences that promote the continued well-being and survival of the individual on the micro level, and the proliferation of the species on the macro level. Eating is an example of an individual survival imperative, and one that can be both practical and pleasurable. Shelter-seeking may not come to mind as something pleasurable, but being warm, dry and safe, the benefits of having shelter, are both practical (they increase the odds of survival) and pleasurable (a reward for shelter-seeking). Sex is not necessary for the survival of an individual but it is absolutely essential for survival of a species. Engaging in sex, then, offers great rewards in terms of physical pleasure (for humans and higher primates) and social status (humans and other mammals).
Central to the functioning of this reward system are an array of chemical neurotransmitters that relay information between the cells of the brain, with two of particular importance, dopamine and serotonin. When an individual is engaged in something causing pleasure, i.e. eating, sex, play, etc. there is a boost in the levels of these two chemicals in the brain. Increasing the level of dopamine and serotonin rewards the brain and creates an overall sense of emotional contentment and well-being in the moment, and a likeliness of returning to the activity later to duplicate the feelings associated with it.
To illustrate, many Law Enforcement Officers are dedicated to outdoor sports such as hunting, fishing, skiing, etc. Maybe you or a close colleague is. Take the hunter who thoroughly enjoys the excitement and strategy of the hunt while in the midst of it, and who leaves the field with a deep sense of contentment and well-being afterward. Both are the rewards system at work and ensure the hunters eventual return to the field.
Trouble in Paradise, or When the Reward System Goes Awry
Although the reward system is designed to reward the individual for engaging in appropriate and productive activities that increase well-being, there are really no safeguards against misappropriating it, and not everything that can give pleasure and boost dopamine and serotonin are good for us. Searching for a buzz by fermenting grains and fruit for consumption, or harvesting certain non-food crops for creative ingestion, is certainly nothing new in human history. Alcohol, tobacco, cannabis, opiates and coca have been used by humans for thousands of years of recorded human history, and probably tens of thousands before that. All of these, and more modern intoxicants, offer very dramatic boosts to our reward system that maybe far greater than what it is typically asked to manage. The intensity of the pleasure they offer is so great, and the corresponding chemical bump is as well, that they can begin to rewire the reward system.
Remember, the reward from the neurochemical boost reinforces the behavior that caused it and subsequently prompts us to seek it again. A big reward and our brain wants more of the same, so naturally we replicate the behavior. Do it enough and behavior begets repetitive pleasure-seeking begets habit begets addiction.
Doctors Wilkie Wilson and Cynthia Kuhn describe addiction as a hijacking of the brain's reward system. The addiction overrides its normal function, rewiring it and altering the essential chemistry. Remove what the body wants and dopamine and serotonin levels drop depriving the brain of what it craves to feel well. Food, sex, and other normal pursuits that should provide the chemical boost become inadequate, at least in normal amounts, and only the desired drug can provide relief. Think of an opiate addict you have known or worked with in the middle of a serious Jones. It is not necessarily even the high they are looking for anymore, they need their dope just to feel normal. Their reward system has been hijacked.
Like the man whose overeating behavior has led to heart disease, a maladaptive physical change in his body, the addicts behavior has led to a maladaptive physical change in his brain. His addiction has become a disease.
A New Definition of Drug
Maybe you are asking yourselves But what has this got to do with cops? Sure, I might know a few that drink too much, but drugs..? Much has been learned about the science and nature of addiction and its physical impact. We are going to ask you to shift your thinking on the definition of drug. To truly understand addiction, as it relates to our reward systems, definitions must be broadened to include a far wider array of drugs, some of which you cannot drink, smoke, snort or shoot. They are every bit as addictive - and destructive - as those you can, and almost all are completely legal.
Next month we will look at some of the new drugs, the expanding face of addiction, and how cops are as vulnerable as anyone. Please join us.