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THE DOCTOR IS IN! – Thoughts on Addiction

addictionBy: Dr. Frank MacMillan, MD
June, 2015

Human beings are hardwired towards addiction. Modern society has evolved a mind-boggling number of traps that ensnare members of the human family in all sorts of compulsions or addictions. Compulsion drives a large part of our economy.

Think about it.

Advertisers and marketers want to know what buttons to push to make us buy their products, and then buy them again and again. The human brain’s reward center can be triggered in any number of ways, but always producing the same result, the desire for more of what makes us feel good.

Let’s face it. We are pleasure-seeking creatures. Some of us are more sensitive to this drive than others, but we are all susceptible. Historically, cultures have defined as virtuous such social constructs as prudence, thrift, sobriety, fidelity and others. Over time, the pendulum of what society considers to be virtuous swings back and forth from permissiveness to social and legal prohibition.

I was going to originally write this column on the problem of opiate addiction, and this includes prescription drugs but also illegal drugs like heroin. These compounds are useful as medicines as they suppress pain. If abused as intoxicants, they are highly addictive and actually remodel the brain to need progressively more to relieve pain or get high. Cannabis may similarly turn out to have significant value as a medicine, but we are seeing more serious problems with extracts, concentrates and synthetics. We are also seeing new syndromes in habitual, experienced users including cannabis hyper-emesis syndrome, an intractable vomiting condition that occurs as a result of the cannabinoid receptors in the intestines becoming over stimulated.

We are susceptible to addiction to not only substances, but also to behaviors as well. Compulsive behaviors are all around us. People laughed when they heard former Boston Red Sox player Wade Boggs saying he was addicted to sex, but is it really so difficult to imagine a professional athlete with disposable income and availability would have an endless supply of opportunity, and get caught up in destructive behaviors? How many of us know problem gamblers who repeatedly double down, knowing the next score will come their way? Just today, I ran across an article relating compulsive eating to the same brain changes that occur with major depression. Think about it, not only substances, but behaviors can induce chemical changes in our brain that may be lasting.

I don’t think the answer to our addictive nature is necessarily prohibition. We tried that in the 1930s with alcohol and know it doesn’t work. Access control is one tool, but also education, social and cultural levers, and public health are tools that are really underutilized. Getting tobacco out of restaurants and public buildings made smoking much less cool and easier for the public to resist, a great example of negative peer pressure. There is a legitimate public health reason that celebrities who glorify drug use should be called out. I was at an Eric Clapton concert as a teenager, and the song that got everyone on their feet singing was “Cocaine.” There is something so wrong about that.

We have a serious problem with addiction in this country. Addiction not only threatens individuals, but also affects families, and entire communities. We need to shine a light, get the word out, inoculate our children with the facts, and show good examples in our own behavior. Our political, social, cultural and religious leaders also need to show courage, step up and be heard. Prevention is always much easier than cure, but we also need to be ready and able to help those who cannot help themselves.

mACmILLANDr. MacMillan specializes in Gastroenterology and Liver disease and is a member of the North Andover Board of Health. Dr. Macmillan was recently elected by his peers to be vice Speaker of the House of Delegates at the Massachusetts Medical Society and alternate Delegate from Massachusetts to the American Medical Association. Dr.

MacMillan is on staff at Holy Family Hospital Haverhill and Methuen, Anna Jaques Hospital in Newburyport, Lawrence General Hospital, and Parkland Hospital in Derry, NH and is the President of the Massachusetts Gastroenterology Association. Dr. MacMillan also serves as Massachusetts Governor of the American College of Gastroenterology and is a Fellow of the College.

ValleyPatriot

ValleyPatriot

The Valley Patriot is a free monthly print newspaper serving Northern Massachusetts, and Southern New Hampshire. The print edition is published by the 10th of each month and is distributed to 51 cities and towns.

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