The Science of Addiction: Implications for Elders
O'Brien, Terence, Aging Today
Scientific discoveries in the last 10 years have provided a new understanding of addictions and led to the development of improved treatment approaches that significantly increase the promise of long-term sobriety. New tomography techniques using PET-scan technology display pictures that allow practitioners and scientists to see the adult human brain in ways that were inconceivable only 20 years ago. The implications for intervention are dramatic, especially for older adults.
This technology has pinpointed the location of the addiction process in the brain's ventral-tegmental area (VTA). Located at midbrain, this cluster of cells controls memories of so-called reward experiences and regulates the emotions centered on these experiences. (See "Addiction Science," adjacent to this article on page 8.) What research has demonstrated is that, essentially, all addictions are the same: It doesn't matter whether the addiction is a process type, like compulsive gambling, or a substance type, such as alcoholism.
GOOD NEWS, BAD NEWS
The good news is that the treatment for every type of addiction is also similar. Successful treatment involves either stopping the behavior (alcohol abuse, compulsive gambling) or altering the addict's approach and attitude toward the addiction (food or sex addictions).
The bad news is that because all addictions are essentially the same, to the brain, one addiction can be used to moderate, relieve or help avoid withdrawal from a second addiction. On the one hand, if compulsive gambling is stopped, an increase in overeating behavior may serve to alleviate the gambling withdrawal. On the other hand, one addiction can be used to intensify another. In some cases, a primary addiction may be triggered and emerge only after a period of abstinence from some other, preexisting addictive behavior. For example, going to the market for a quart of milk may turn into a stop at the liquor store, which in turn could lead to the purchasing of alcohol and drinking to the point of lowered inhibition. Only then might the person engage in a bout of compulsive gambling at a casino or online.
Science and practice have long shown that most addictions are compounded by a secondary, coexisting psychiatric problem, even though such problems are not directly related to the operations of the VTA. Kenneth Minkoff, a respected expert on addiction, wrote in 1991 that "dual diagnosis is an expectation, not an exception."
Because of this addiction connection, treating professionals or concerned family members should not be surprised if a second addiction flares up 6-12 months after the first addiction had been extinguished. Also, they should anticipate the possibility of a secondary mental health problem, such as depression, either following or coexisting with the addictive behavior. Failing to develop a treatment plan that looks at both of these issues is a recipe for failure.
STAGES OF CHANGE
Any successful treatment plan should first take into account the individualized approach established by James O. Prochaska and Carlo C. DiClemente in their groundbreaking Stages of Change model. They determined that an individual in a precontemplative stage may be unable to heed a message that suggests stopping the addictive behavior. In other words, loved ones or professionals will find it impossible, at this stage, to break through a person's denial because precontemplative individuals are not yet ready to acknowledge that a problem exists.
At a later stage of change, treatment can begin with the goal of initially working toward stabilization. One of the most effective stabilizing strategies is connecting an addicted person with a group of like-minded individuals committed to their own recovery. …