Men and addiction
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.
Alcohol
Nicotine
Gambling
Legal drugs
Men and addiction
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.
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 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:
The causes of addiction
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).
Type II or 'male limited'
The cognitive model of addiction
The cognitive approach to addiction assumes that:
Is there an addictive personality?
Personality is complex and the role of personality in addiction is uncertain. It is difficult to disentangle the effects of personality on addiction from the effects of addiction on personality. There is no single addictive personality. However, there are a number of personality types that have been associated with addiction and they are outlined below. The strongest evidence exists for 'antisocial personality'.
The anti-social personality
The self-punitive personality
The stressed or anxious personality
The passive-aggressive personality
Does psychiatric illness lead to addiction?
Society and addiction
Cultural factors and addiction
Is addiction a disease or illness?
Professionals mostly feel that the situation is more complex than this. It must be recognised that viewing addiction as a disease helps many people to overcome their problem. Unfortunately, some people see themselves as passive victims of their illness, believing that 'there is nothing I can do'.
The AA approach is to accept that one is 'powerless over alcohol' and to put oneself in the hands of 'God, as we understand him'. The evidence for biological and genetic factors being important in addiction bolsters the illness argument, but there is also evidence for social and psychological factors being important.
Low levels of serotonin - a brain chemical - appear to be an important cause of addiction. 'Drugs of solace' may increase serotonin levels and depressed people take them for this reason. Alcohol raises serotonin levels in the short term but the levels fall in chronic alcoholics. Ecstasy produces the same effect. Cigarettes may increase serotonin levels, adding to their addictive properties. Gambling also seems to be associated with low levels of serotonin.
Low levels of serotonin may be the result of inheritance, but low status in society also seems to reduce serotonin levels. Drug and alcohol abuse is more common in people from lower socio-economic backgrounds.
Studies in animals demonstrate that they will self-administer substances such as alcohol, cocaine, amphetamines, nicotine, barbiturates and some benzodiazepines. Therefore, these drugs are described as rewarding or reinforcing. The fact that drugs and alcohol are rewarding does not explain why some people become addicted but not others, but it does lend weight to the argument that addiction is an illness or disease.
How to recognise if you have an alcohol dependence problem
If you answer 'yes' to two or more of these questions then it is possible that you are drinking too much and should seek help.
Treatment for addiction problems
Someone who has been consuming alcohol very heavily may require admission to the medical ward of a local hospital in order to ensure safe withdrawal. Coming off alcohol quickly can result in delirium tremens, which can be a fatal condition and must be treated carefully. A drug called chlordiazepoxide can be given to help with withdrawal.
Those who are not drinking as heavily may be able to reduce their intake at home with or without chlordiazepoxide. But while stopping drinking is relatively easy, staying off drink is much more difficult.
In most parts of the country Community Addiction Teams now exist. Nurses visit people in their own homes or see them in a local clinic and provide support and advice.
A number of new types of medication are now available that reduce the craving for substances such as alcohol and nicotine, and can be helpful for those who are already determined to give up. Without this motivation to change, tablets will not help.
There is a range of other self-help groups and support groups throughout the country. The numbers of these groups can be found in the phone book.
Treatment for drug dependence
If you are injecting heroin you should seek help immediately through your local GP. In most parts of the country methadone
can be prescribed as a substitute for heroin. In some parts of the country needle exchange schemes are available so that even if you continue to inject heroin you can at least do so in some safety. Good treatment services are available in many regions, which help people to come off drugs.
Self-help groups such as Narcotics Anonymous play the same role as Alcoholics Anonymous.
Whether you consider your addiction to be a disease or simply a manifestation of your character, it is important to realise that you have options; you are not doomed to a life of addiction simply because you've been an addict in the past. You should also remember that you don't have to face your addiction alone - your GP is there to help you get over it.
Useful telephone numbers
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.
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.
Approximately 3 per cent of the British adult population has a gambling problem. Of these, about 500,000 are 'pathologically compulsive'.
Some estimates put the number of Britons addicted to over-the-counter drugs and prescription drugs to be around 2 million.
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).
'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.
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.
Cognition is the process by which we attain knowledge and awareness of the world, and it has been argued that addiction is not inherited but is a learned behaviour. The more one consumes the more likely one is to be become addicted. Addiction can thus happen to anyone.
The phrase 'addictive personality' is used so commonly in our culture that few of us question whether an addictive personality type really exists, yet many doctors and psychiatrists believe that the term means nothing. Certainly, there is little evidence for an addictive personality as such.
These people are unable to accept frustration. They live for, expect and must have easy and continuous gratification. They often eat a lot, chew sweets and smoke as well as drink heavily. They drink for two reasons - to reduce the personal discomfort that results from frustration and to provide instant and dependable gratification. They are impulsive and do not learn from their mistakes.
Some outwardly docile people are actually repressing aggressive tendencies. This results in inner tension and alcohol helps to relieve this tension. Often alcohol releases the aggression.
Some people find stress more difficult to deal with than others. They may use alcohol in an attempt to cope.
This term refers to someone with an outwardly calm and acquiescent shell that hides inner anger. They find it impossible to deal with anger-inducing situations.
Psychiatric factors can be important. Addiction causes psychiatric problems but, at least in some cases, psychiatric problems can come first. Many alcoholics state that they drink because they are depressed. If one goes into their life history the opposite is generally the case: they are depressed because they drink. There is a sub-group, however, who do indeed start to drink heavily to ward off depression.
Societal or environmental factors are important. Factors that increase or reduce the availability of alcohol may influence the incidence of alcoholism, eg if the cost of alcohol is increased or alcohol is made more difficult to purchase the rates of alcoholism usually go down.
Cultural factors are also important. In some societies consuming alcohol or other substances is less acceptable than in others. People in some occupations are more likely to develop alcohol problems, eg publicans, seamen, barmen and those in the armed forces. Many of these occupations are more likely to involve men than women. Drug addiction is particularly associated with unemployment, poverty and urban decay. It is more common in men than women.
Most people with addiction problems feel that they have a disease. Alcoholics Anonymous (AA), Narcotics Anonymous and Gamblers Anonymous all see addiction as a disease.
Ask yourself the following four questions (the CAGE questionnaire).
The obvious answer to addiction is to stop taking the consumed substance, but of course this is far from easy. If you have any concerns consult your doctor, who has a range of treatment options at his disposal. The important thing to remember is that help is available. Probably the most important source of help (it reaches the greatest number of people) is Alcoholics Anonymous. The 12-step approach of AA is useful for many people though not for everyone.
Dependence on opiate drugs, such as heroin, is a serious problem. There is a high risk of contracting a serious illness such as hepatitis B or AIDS, and a high risk of death by overdose or through accidental injection of toxins that have found their way into the heroin supply.
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