Crav­ing in­sight into ad­dic­tion

The Guardian - Journal - - Letters -

I am a re­tired con­sul­tant psy­chi­a­trist who spe­cialised in the field of ad­dic­tion (Con­stant crav­ing: is ad­dic­tion on the rise?, G2, 9 Jan­uary). My con­clu­sion was that most, per­haps all, drugs of ad­dic­tion were very ef­fec­tive ways of pass­ing time with min­i­mum dis­tress – the anti-bore­dom ef­fect. Even “un­pleas­ant” ex­pe­ri­ences will pass time very ef­fec­tively. Sim­i­lar ex­pe­ri­ences are achieved by shop­ping, TV and sex­ual ac­tiv­ity etc. I thought that heroin and to­bacco were the best anti-bore­dom drugs. Nico­tine is not in­tox­i­cat­ing, the with­drawal symp­toms are se­vere but not ob­vi­ous to the ob­server, eas­ily re­lieved by the next fag, and dis­ease and death are de­layed un­til to­wards the end of work­ing life, thus sav­ing the pub­lic the ex­pense of a pen­sion. The ideal drug?

Dopamine is in­ci­den­tally in­volved in ad­dic­tion. The func­tion of dopamine ap­pears to be in a sys­tem or sys­tems for the ini­ti­a­tion and main­te­nance of our be­hav­iours – the way we think, feel and act. These sys­tems could be called sys­tems for it­er­a­tion. Lack of dopamine in the brain, Parkin­son’s dis­ease, shows up as a grad­ual loss of the abil­ity to ini­ti­ate ac­tions at will, so pro­gres­sively you are less and less able to will your move­ments – a fail­ure in the sys­tem of it­er­a­tion. Parkin­son­ism is of­ten ac­com­pa­nied by tremor or shak­ing; its other name is paral­y­sis ag­i­tans. The drug L-dopa in­creases the avail­abil­ity of dopamine in Parkin­son­ism and en­ables it­er­a­tion and move­ments to re­turn.

The in­crease in, and per­haps ex­cess of, dopamine in ad­dic­tions and some other be­hav­iours may as­sist their ini­ti­a­tion and use, of­ten overuse, but the up­stream ef­fect would be, in my eyes, that the drugs etc ac­ti­vate the anti-bore­dom ef­fect. You might say you take the drug etc and this relieves your bore­dom so you take or do it again, thus in­volv­ing the dopamine it­er­a­tion sys­tem lead­ing to ad­dic­tion by an as yet un­known mech­a­nism. We must es­cape from over­sim­pli­fi­ca­tion, even if the cur­rent dopamine story of­fers a sat­is­fy­ing moral­ity tale. Dr David Mar­jot

Wey­bridge, Sur­rey

Im­plicit in the ex­ten­sive anal­y­sis of cur­rent ad­dic­tions is a pos­si­ble way of see­ing the prob­lem in a light which might pro­mote co­or­di­nated and ef­fec­tive ac­tion. We are rightly con­cerned about the pos­si­ble con­se­quences of our phys­i­cal en­vi­ron­ment and its pol­lu­tants.

It is only a small step from this to un­der­stand that our men­tal, so­cial and cul­tural en­vi­ron­ment may have an equally dev­as­tat­ing ef­fect on our lives. If the cri­te­ria of hu­man well­be­ing are pre­dom­i­nantly re­duced to money and ma­te­ri­al­ism, our minds and per­sonal in­spi­ra­tions at­ro­phy or even van­ish. Drugs, gam­ing, porn or sex­ual ob­ses­sion sub­sti­tute as dis­trac­tions. Dr Ian Flintoff

Ox­ford

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