So how do Addicts Break Their Habits?

Back in the 60's and 70's, there was a popular model of heroin addiction. It was based on the observation that there were few hard-core street addicts in their 40's or older. When this population was looked at in more detail, they found that approximately a third of them had died as a result of their criminal activities or of the medical complications of their addiction! Another third were in prison for a long time, due to their criminal activities. And only a third of them successfully "kicked the habit." Yet, when interviewed, they still fondly recalled the ecstasy of the heroin high and, if opiates were legalized, would gladly return to opiates.

How to explain these findings? That was where the 'Hustle/Hassle" hypothesis arose. The hypothesis went something like this:
At first, Heroin was Heaven. It was easy to get as the pushers lowered the price in order to hook you. But, once hooked, the prices went up. Or perhaps a big drug bust temporarily reduced the supply. Now the addict had to work harder to get his supply - he had to Hustle. As time went by, he had to hustle even more. He had to lie, beg, borrow - and steal. He acquired a reputation and people started to avoid him, making it even harder to score a dose. The Hustle Factor started to increase. And he experienced "Hassles." Eventually, he came into sight of the police and the criminal justice system. Now the hassles really began to escalate. Police recognized him and started checking him for stolen goods or drugs And he may go to prison for short periods of time and be forced to quit "cold turkey". Eventually, the Hassle Factor became so great that, even when he was able to get his heroin, he was unable to experience Heaven. At that point, he "burned out" and "kicked the habit."

This bleak outlook held that there was no easy way to rehabilitate the addict. He had to "hit bottom" and burn out first. This led to some brutal rehab programs, like Synanon. There "counselors" (recovered addicts, themselves) relentlessly hammered the addict in order to hasten his progression towards burnout. This was before our improved knowledge of opiate receptors and neurobiology gave us other models of addiction - and other treatment regimens.

So how do we help addicts recover now? Well, first of all, there is not just one, but a series of nadirs at which the addict may temporarily burn out and seek help. At that time, the addict is entered into an inpatient treatment facility. Why inpatient? Officially, it is to remove him from the stimuli and temptations of his addictive environment. But recall that that was an extremely stressful environment, full of hassles. A biologist might observe that by sequestering him from the constant temptations and the stress of having to "just say no", that his chronic stress and therefore his Cortisol levels would decline. And at that point, with his brain returning to normal functioning, he would then be able to learn new behaviors!

There, in a comfortable, nurturing environment, therapists and counselors would be able to teach and coach him in new behaviors. Only when he had begun to internalize these new behaviors, would he be returned to his home environment and given outpatient therapy. There, the coaching would continue until the addict had successfully incorporated these new behaviors. Then, he would have an alternative behavior to addiction. And by continually choosing the non-addictive behavior, he would reinforce it (remember LTP requires repetition) and the old, addictive behavior would wane. But it would not disappear. That's why addicts "fall off the wagon."

And there you have a biological view of AODA Rehab. (Alcohol and Other Drugs of Abuse) Like any behavior, it takes time, effort, and a lot of repetitions to successfully change a behavior. But there are hundreds of thousands of ex-alcoholics, ex-drug addicts, ex-smokers out there. All of them proving that it can be done.

And now, I'm going to get on my soapbox and preach a bit. Insurance companies HATE AODA treatment facilities. Many insurance companies refuse to cover alcohol or drug treatment. And many refuse to cover ANY disease or medical bill that even hints at a psychiatric disease - like stress, anxiety, PTSD, phobia, depression, ADD, autism, schizophrenia and, of course, anything suggestive of an addiction. They know that there are costs associated with treatment and that relapses are common. And so they try to reduce their costs and push the costs onto society as a whole. Even when they call themselves Health Maintenance Organizations (HMOs.) This might be a good time to think about writing your Congressman or Senator.

And I'm going to take a further leap and look at sex offenders. There is a common belief out there that once a sex offender, always a sex offender. And yet, we've been looking at behavior from a biological viewpoint and we now know that, yes, behavior can be persistent. But it can be changed. I predict that, in time, treatment modalities and facilities will be available even for these tortured souls.

Well, that's enough for now. In my next post, I will discuss in further detail the process of behavior change. So GL & GT.