UofSC Psychiatry Resident || @TheHeadDocMD || MyStreetHealth Content Creator

Solving the Riddle of Addiction


Since addiction is a lifelong diagnosis, how do we prevent addiction from developing in those that are at a higher risk? In medical school, we learned how to treat disease, but one of the core principles that they teach you is how to educate patients. One of my mentors, the chief of trauma surgery, taught me a phrase I often find myself repeating. A doctor is three things, "a leader, a teacher, and a healer." In public health, you learn strategies, theories, and communication techniques to market to individuals through research on how to avoid preventable diseases. One of the most common marketing techniques in public health communication has been the use of fear tactics, behind which the basis is the hope that the individual who might be a sensation seeker or see such ads will be "scared straight." One of the most successful national strategies, truth campaign, had to do with smoking. 

However, recent research supports that those with addiction often lack a dopamine receptor that causes them in the youth to seek out opportunities, which will give them thrills, which they usually require due to the absence of this receptor. That said, the conversation then begins if we can't return in addiction patients to a non-addicted status; instead, how do we prevent the addiction from developing? I'll start this next part by talking about the health disparity of adverse childhood experiences (ACEs like the playing card), which has also received a lot of attention in the media in recent years. Unsurprisingly, individuals that experience six ACE qualifiers are nearly 5,000% more likely to be addicted to substances such as opioids. Please take the time to watch this short video from the landmark ACEs study out of Kaiser Permanente. 
In recent years more attention has been drawn to this health disparity and how to prevent ACEs. However, it's challenging to evade family members from having a mental illness, or parents going through a divorce, having a family member incarcerated, or the presence of sexual abuse. When these conditions lead to individuals having a positive ACE score that occurs during childhood, it is usually outside of the control of their parents. The CDC is focusing on how to prevent ACEs, which is a beautiful idea, but the Surgeon General Nadine Burke Harris of California has developed a better idea. The ACEs aware initiative seeks to implore physicians to screen the children to identify those that are at risk and by identifying these ACE categories, hopefully preventing the associated long-term adverse health outcomes.
One of the most frustrating things that I encountered as a medical student in downtown Los Angeles was the frequency of patients admitted for the symptoms of alcohol withdrawal. When drinking large quantities of alcohol over an extended time, the body builds up a tolerance to the depressant effects of the alcohol. Therefore, if the individual stops drinking, they experience excitation effects in symptoms like anxiousness, jitteriness, tremors in your hands, and can be extreme as seizures and death. As you can imagine, when we had a patient presenting with alcohol withdrawal, it was a serious complaint that required constant care. 
There was a young woman that came in, and when I say young, I mean the late 30s or early 40s. She was a career professional, a functional alcoholic, which is a colloquialism used to describe an individual that can carry on their daily activity while continuing to drink, which goes against the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for the diagnosis of alcohol use disorder. Yet I digress. I became familiar with this patient, she wasn't always on my caseload or under my assigned training physician, but I still recognized her on our patient list. Over my three-month internal medicine rotation, this patient presented three times for alcohol withdrawal. However, every time the care she received didn't match her described level of her symptoms, and so she would consistently leave against medical advice to seek out alcohol to self-treat her symptoms. This vicious cycle is something that we're familiar with in addiction. Substandard care for a complex neurochemical disease that results in the patient feeling frustrated with the medical system, with themselves and with the individual that took an oath to "first to do no harm."
Graphic: https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html
The medical system hasn't figured out a way to manage the treatment of addiction disorders, despite the current recommendations or even organize the etiology of its origin, despite the abundance of research. Therefore, we must focus our resources on preventing these brain pathways from maturing in adolescents that are at risk through the intricacies of the age-old conundrum that asks us "nature versus nurture." Regardless of the nature of a genetic predisposition due to a dopamine receptor or the lack of a nurturing environment of marginalized backgrounds or being born the wrong color, gender, or nation of origin, the exposures in childhood should not follow individuals throughout their lives.

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