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Distilling Fact from Fiction: Scientist debunks myths about alcohol dependence to reduce stigma of complex disease

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Isn’t alcoholism simply a matter of “too much too often”? Are certain groups, like the Irish, more likely than other people to become alcoholics? Is caffeine addictive like alcohol is? What about the Internet? Shoe shopping?

When it comes to alcohol and addiction, it can be hard to sort fact from fiction.

Dr. Carl Erickson stands in front of a drawing indicating the location of the Medial Forebrain Bundle (MFB), also called the Mesolimbic Dopamine System (MDS).
Dr. Carl Erickson is Pfizer Centennal Professor in the College of Pharmacy. His drawing indicates the location of the Medial Forebrain Bundle (MFB), also called the Mesolimbic Dopamine System (MDS). Popularly known as the reward pathway or pleasure pathway, this is the area of the brain where chemical dependency occurs.

That’s the work Dr. Carl Erickson, distinguished professor in the College of Pharmacy and director of the Addiction Science Research and Education Center, has set out to do. He’s become something of an alcohol and addiction myth buster.

“The problem is that people don’t understand what addiction is, and they sometimes resist learning about it,” Erickson says. “This arises from stigma, prejudice and misunderstanding, all of which lead to more myths or widely held inaccurate beliefs.”

About a dozen years ago Erickson, a pharmacologist who has spent 40 years studying the effects of alcohol on the brain, hung up his lab coat. He began dedicating himself entirely to educating professionals and the public about alcohol dependency. He pairs a solid background in the science of addiction with an easygoing manner and energetic delivery.

In other words, he’s a scientist who knows how to make science accessible to the average person. His approach has garnered a lot of acclaim, including his being named one of the first recipients of a Betty Ford Center Visionary Award.

The first thing Erickson wants people to understand is that dependency is not a matter of loose morals or bad choices or ethnic backgrounds. Dependency is a brain chemistry disease.

“The fact that alcohol dependence is a disease is now backed by more research than we’ve ever had,” Erickson says. “The problem with alcohol dependence is not in the bottle and it’s not in the glass. The disease is in the brain. The uncontrolled drinking is just the symptom.”

Debunking Myths about Dependence

MYTH: All someone has to do to overcome alcoholism is go to Alcoholics Anonymous (A.A.).

FACT: A.A. doesn’t work for everyone (even for many people who truly want to stop drinking). For most people, A.A. is a gut-wrenching, lifelong working of the 12 steps. Scientists theorize that people who “get better” in A.A. are somehow learning how to overcome (or compensate for) their brain disease.

MYTH: Nicotine and marijuana are not addicting.

FACT: Nicotine is one of the most dependence-producing chemicals in existence and marijuana has also been proven to create a dependence in a percentage of people who smoke it regularly.

MYTH: Anyone who drinks or uses drugs too often will become “addicted.”

FACT: We know this doesn’t occur in everyone, any more than diabetes occurs in everyone who eats too much sugar or food. It now appears that a person must “have what it takes” to become dependent on drugs. In many cases, genetics is the main risk factor for determining who develops the disease.

MYTH: All addicts are criminals.

FACT: Evolving research is demonstrating that “addicts” (people who are dependent on drugs or alcohol) are not bad people who need to get good, crazy people who need to get sane or stupid people who need education. “Addicts” have a brain disease that goes beyond their use of drugs.

While the symptom is one that’s easily stigmatized, alcohol dependence is chronic, and it requires lifetime care, just as other chronic illnesses like hypertension, asthma and diabetes require lifetime care. Short-term treatment programs and 12-step programs can be helpful, but unless they provide consistent, long-term treatment, the symptoms of the disease are likely to return.

One reason it’s hard to get people to understand that dependence is a brain disease is because they don’t understand that there are actually two major drug and alcohol problems. One is willful drug abuse. The other is the brain disease of chemical dependence. People assume they are one and the same, but they aren’t.

“There’s no way that you can stand and look at an abuser and a dependent person and see any difference,” Erickson says. “They look the same. But one has the ability to stop on his own and one doesn’t. The latter will drink until he dies if he’s not intervened upon.

“Clinicians now have the tools to tell the difference. It’s an important fact to have out there.”

Thus, if two young men both decide to sow their proverbial wild oats for a while, frequenting bars and drinking heavily, one of the men might simply abuse alcohol and stop when his oats are sown or when the costs associated with drinking outweigh the perceived benefits. The other might end up with a lifelong dependence on alcohol.

“That’s because one has what it takes to become dependent and the other one doesn’t have what it takes,” Erickson explains. “What’s involved in having what it takes is mainly genetics, but there’s a 40 percent fudge factor in there that we call ‘triggering factors’ or ‘environmental factors’ that we have not yet identified that make some people more vulnerable when they have genetics and some people less vulnerable.”

The move from abuser to dependent happens in the brain in one of two ways. In some cases, genetics are so ingrained in an individual that dependence is almost ordained.

“Sometimes we see people who say, ‘I knew I was an alcoholic from the very first drink,’” Erickson says.

Such people experience what scientists call “instant dependence.” They’re so heavily genetically loaded that unless they avoided all alcohol their entire lives, it would be difficult for them not to become dependent.

About 32 percent of those who smoke become dependent on nicotine, while 23 percent of those who use heroin and 17 percent of those who use cocaine become dependent on the drugs. By comparison, about 10 to 12 percent of people who drink become dependent on alcohol.Others experience what’s called “neuroadaptation,” in which the brain adapts to the presence of the drug to the point where there is no turning back. This may happen in people with a genetic predisposition and also in those without one. Scientists are still trying to understand why.

What they do understand is that certain pathways in the brain, often called pleasure pathways, are where dependency occurs. Erickson likes to tell people where they can find them.

“Go like this,” he says, pointing a finger to a spot directly in the middle of his forehead. “Now, go like this,” he adds, pointing with his other hand to a spot above his ear.

“Where those lines cross in the middle of your brain is where this disease occurs. It’s called the reward pathway to the brain. It’s also called the mesolimbic dopamine system. Scientifically, this tells us that it runs on dopamine, the ‘pleasure transmitter.’”

When we experience pleasure—whether from alcohol, exercise, the birth of a grandchild, or, for some, shoe shopping—a burst of dopamine travels down that pathway. When a dependency occurs, the dopamine and some other neurotransmitters are changed to go along a different pathway. It’s kind of like a train switching tracks. Pleasure is no longer a major factor, and the person’s life is changed forever.

“We hear about people who become dependent just like a switch went off in their brain and suddenly they couldn’t stop,” Erickson says. “So maybe the switch has gone to a different biological track. Science suggests that more and more of those pathways get recruited as the dependence process occurs.”

Brain imaging studies are beginning to be used to identify the pathways of the brain, and they may some day be able to see what happens to the brain when an alcohol dependent person stops drinking. Today, however, there are no tests that can predict dependency. And support for that and other research is limited, according to Erickson.

So that's been a driving force for me--to try to educate the public to reduce the stigma and prejudice so that we can get more money to study addiction science and alcoholism. Dr. Carl Erickson“There’s not enough money to study addiction medicine, addiction science and alcoholism,” he says. “There’s not enough money at the federal level based on the importance of the problem in society.”

Research for alcohol and other drug problems gets about one-tenth the dollars that cancer research gets and one-eighth the dollars of heart disease research. It gets about one-eighth the dollars that AIDS research gets.

“So that’s been a driving force for me—to try to educate the public to reduce the stigma and prejudice so that we can get more money to study addiction science and alcoholism,” Erickson says.

That means busting the myths wide open. The Irish are not more likely to become alcohol dependent than other groups. Caffeine is not addictive, and neither is the Internet nor shoe shopping. They activate the pleasure pathways but don’t create a dependence.

And alcohol dependence is not a matter of “too much too often.” It’s a matter of “I can’t stop without help.”

For Erickson, the best way to help ensure that help is available is to keep sharing the facts. In 2007 his latest book, “”The Science of Addiction: From Neurobiology to Treatment” will be published by W.W. Norton. And Erickson is in front of audiences nearly every week of the year. He recently returned to the Betty Ford Center.

“When I talk to 80 patients at the Betty Ford Center, that’s 80 more people who will have the right information,” he says, “rather than the misinformation that permeates the people in recovery and those who treat them.”

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  Updated 17 April 2006
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