Men and addiction
Written by Dr. Ciaran Mulholland, consultant psychiatrist/senior lecturer in mental health
A global problem
You won't be surprised to learn that the use of addictive drugs of all types is a global problem. What is surprising, however, is that few experts agree on what addiction really is, or what causes it.
Some doctors and healthcare workers view addiction as a disease whereas outside the profession many people think in terms of having an 'addictive personality', and yet the evidence for both concepts is inconclusive. As we will see, our attitude to addiction is just as much shaped by cultural attitudes as by the medical evidence. But before we look at the nature of addiction, and why it affects men more than women, we should remind ourselves of the scale of the problem.
Drugs of abuse
The United Nations estimates that the world is host to 8 million heroin users, 13 million cocaine users, 30 million users of amphetamines, 141 million cannabis users, 227 million sedative users and 1100 million tobacco smokers. Over 100 million people are dependent on the tobacco trade for their livelihood.
Alcohol
Alcohol is thought to cause around 33,000 deaths per year in Britain, with one in four hospital admissions being related to alcohol. Drinking is implicated in 60 per cent of suicides, 40 per cent of domestic violence cases and 39 per cent of domestic fires.
Nicotine
Probably the most common and problematic substance with potential for abuse, nicotine is highly addictive. The various toxins in cigarette smoke kill many thousands of people annually.
Gambling
Approximately 3 per cent of the British adult population has a gambling problem. Of these, about 500,000 are 'pathologically compulsive'.
Legal drugs
Some estimates put the number of Britons addicted to over-the-counter drugs and prescription drugs to be around 2 million.
Men and addiction
Men are much more likely to be addicted to alcohol and other substances than women. Two thirds of attendees at Alcoholics Anonymous are men (although this figure was 80 per cent in 1972).
A large American study has found that men are twice as likely as women to have a substance dependence disorder, with a lifetime prevalence of almost 36 per cent for men and 18 per cent for women. In other words, over one third of the male population of the US have been dependent on alcohol or drugs at some stage of their lives.
Men in the 25 to 34 year age group were twice as likely as those in the 45 to 50 year old age group to report substance dependency. Alcohol and drug abuse are strongly associated with an increased suicide rate in men.
In a large British study men were three times more likely than women to be alcohol dependent and twice as likely to be drug dependent.
Almost 8 per cent of British men and almost 5 per cent of women said that they had been drug dependent at some time in their lives, 3 per cent of men and 1 per cent of women reporting dependence during the previous year. Marriage appears to protect men from addiction problems.
Never being married or becoming single is associated with increased alcohol consumption, while getting married is associated with a drop in alcohol consumption.
Substance misuse
'Substance misuse' is used to describe a drug user who experiences mental or physical harm as a result of their habit without necessarily being addicted to the substance in question.
Substance misuse needs to be contrasted with substance dependence (also known as addiction). Dependence occurs at a more advanced stage of the addiction process. Doctors make a diagnosis of addiction if three or more of the following features are present:
- a strong desire or sense of compulsion to take the substance.
- difficulties controlling the substance-taking behaviour in terms of when it occurs, being able to stop or the amount consumed.
- a physically unpleasant withdrawal state when not consuming the substance.
- further substance use to relieve or avoid the withdrawal state.
- evidence of increased tolerance (increased doses are required in order to achieve effects originally produced by lower doses).
- progressive neglect of alternative pleasures or interests because of the substance use.
- persisting with substance use despite clear evidence of harmful consequences.
- narrowing of a person's personal repertoire; ie taking the substance becomes more important than anything else.
. The causes of addiction
There is much controversy as to the causes of addiction, not least because the exact biology of addiction is unknown. There are a number of theories, briefly explained below, but none should be considered to be the definitive account nor is any one theory mutually exclusive of any other. It appears that characteristics of the individual (including their personality), the properties of alcohol and drugs, and environmental factors interact to produce addiction, but it is difficult to determine whether the individual's personality or their environment is the primary factor in causing addiction.
Is alcoholism inherited?
A considerable body of research suggests that a tendency to alcoholism may be inherited. Alcoholism seems to be much more common in some families and this inherited type of alcoholism particularly affects men.
Individuals may inherit a higher tolerance for alcohol (they need more drink than others to achieve the same effect), or they may inherit an increased chance of becoming dependent.
One author has described two types of alcoholism, one of which specifically affects men and may be inherited (though this idea is not accepted by everyone).
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