Addiction…Reality vs Mythology

Prairie Doc® Perspectives for week of April 11, 2021

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Bacchus was a member of the Roman pantheon of gods. In ancient times he had a variety of attributes, but modern culture primarily remembers him as a god of wine and debauchery. Perhaps the image of his followers, or Bacchantes, as individuals who have abandoned society to live in a raucous state of perpetual inebriation has contributed to our perception of alcoholism and addiction.

When I talk to my patients about their use of substances, be it alcohol, prescription medications, or street drugs, I find that most believe they don’t have a problem. They tell me they aren’t using every day, or they still make it to work in the morning, or they haven’t been arrested, or, my personal favorite, they only drink beer.

There are many substances that people can misuse, and to which people can become addicted. If one peruses the current handbook that guides diagnosis in psychiatry, it is easy to see the similarities between alcohol use disorder, and opioid use disorder, and cannabis use disorder, and a myriad of other addictions.

Sufferers may use more, or more often, than they intended. They may want to cut back but be unsuccessful when they try. They may spend unusual amounts of time seeking, using, or recovering from the use of their preferred substance. They may have strong cravings. They may give up other activities in favor of using. Their performance at work or school may suffer, or they may fail to meet family commitments. They may find themselves needing a greater quantity to achieve the same effect or having withdrawal symptoms. They may continue to use, despite knowing their use is detrimental to their relationships, or that it is dangerous and damaging their health.

It is important to recognize that a person does not need to have all the above-mentioned experiences to have a substance use disorder. Indeed, the diagnosis can be made in the absence of most these criteria. Most who suffer from addiction are not souls lost on skid row. They are our neighbors, our friends, our family.

Genetics is an important predictor of who will develop a substance use disorder, but it is not the only factor. Life experiences, particularly trauma experienced in childhood, personality traits, and the social environment all affect risk.

Addiction is a common disease. Drugs and alcohol kill hundreds of Americans every day. The same is true for heart disease and cancer, and we don’t criticize the patient for these diseases. It’s time we show the same compassion for people diagnosed with addiction and consign the image of the Bacchantes to mythology.

Debra Johnston, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streamed most Thursdays at 7 p.m. central.

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