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Dual Addictions

Dual Addictions This research paper will focus on the concept of dual addiction specifically, that of alcohol addiction and simultaneous nicotine addiction. I should make note at this point of my personal interest in the addictive process is a result of the existence of addiction in my family. I have experienced and observed the chaos, hardships and tragedies in my family as a result of the progressive nature of the addiction process. First, I would like to provide a general definition of addiction. Addiction is the repetition of a behavior or behaviors in a habitual or obsessive manner in the face of continued or progressively worsening consequences. Twelve step programs have labeled it as a disease of the mind, body and spirit. There is a general consensus among those who are addicted that to stop or cease the addiction process is not a difficult task. It is the “staying stopped” or continued abstinence that constitutes the difficulty. Relapsing, unfortunately, is not uncommon among alcoholics and addicts. Addiction does not only include the use of mind altering substances such as alcohol, street drugs, and prescription drugs, but can include an addiction to gambling, sex, work and compulsive spending. All of these in the light of continued practice may result in the impairment of physical, emotional, occupational as well as personal relationships. It is also possible if not probable, that many individuals experience an addiction to two or more behaviors or substances. The abstinence from one addiction may result in the usage of another addictive substance or behavior. This has also been called the cross addiction, or dual addiction. There are many definitions of alcoholism, none of which is entirely satisfactory. For the purpose of this research paper, the alcoholic is best defined as someone whose drinking causes a continuing and growing problem in any aspect of his or her life, more specifically someone whose drinking is causing an increasing problems in the lives closest to them. Alcohol addicts its victims both psychologically and physically. As the psychological addiction progresses, so does the physical dependency as well. Alcohol is consisted of both ethyl and methyl alcohol. The ethyl alcohol is what gives a person “feel good”. Ethyl alcohol is quickly absorbed into the blood stream. Methyl alcohol is similar to embalming fluid, takes longer to breakdown and is responsible for the morning after “hangover”. The traditional “cure” for a hangover is to have another drink. Drinking more slows down the methyl alcohol while the body absorbs the ethyl alcohol, resulting in the person feeling good temporarily. The research that has been reviewed for this paper has utilized the Vietnam Era Twin, (VET), Registry consisting 3356 pairs of male twins. These twins were born between January 1, 1939 and December 31, 1955 and served in the military on active duty during the Vietnam War era (1965-1975). This follows a previously published study by Swan, Carmelli & Cardon (1996), which reported a genetic correlation between smoking and alcohol consumption in male American World War Two veteran twins. In a study of female twins, Prescott and Kendler (1995) found that family system dynamics contributed modestly to nicotine and alcohol dependence with only small genetic influences common to both substances. Three sources of influence in this more recent study that accounted for individual difference are genetic effects or experiences and separate or different environmental effects. Shared environmental effects may be exposure family drinking and or smoking, going to same schools and living in the same neighborhood. These individuals who met criteria for nicotine and alcohol had an onset of this dependence at an average age of 17.1 years for nicotine and 20.4 years for alcohol. Those individuals with nicotine dependence, 50.9 percent met the criteria for alcohol dependence. Compared to those without nicotine, 20.8 percent had a diagnosis of alcohol dependence. In the study, genetic factors accounted for 59.6 percent and 51.5 percent of the risk for alcohol and nicotine dependence respectively. At the same time, shared family environmental experiences did not largely account for increased risk of nicotine or alcohol dependence. Even less significant was the correlation between separate or unique environmental factors as they contribute to the dual addiction of alcohol and nicotine. This study referenced the correlation between alcohol and nicotine dependence in male-male twins who may have had the extensive exposure of cigarettes and alcohol in the military as a major contributing factor. This would support a possible genetic predisposition as will as the shared environmental exposure factor. It is important to note that this research study did not focus on the dual addiction process as the female-female twin population experiences it. To date there is no substantial data for the female population. It is also important to note that this data may not be generalized to non-military individuals or populations. The study exhibits a number of strengths in terms of reliability. The data was collected from a structured interview and the diagnoses were derived from standardized DSM-III-R criteria. Estimates of the reliability of the estimates were good to excellent. Data was collected from a large nationally distributed, non-clinical population. The combined use of alcohol and nicotine constitutes serious and chronic problems. The use of tobacco products causes throat and lung cancer as well as emphysema and heart disease. About four hundred thousand deaths in the United States are tobacco related. Hurt and colleagues (1996) found that tobacco related health problems were associated with 50.9 percent of deaths among addicted people and were twice those anticipated for the general population. Alcohol related health problems were associated with 36 percent of deaths and were more than four times of those expected in the general population. Hurt and colleagues stressed the importance of the nicotine-alcohol relationship as a serious risk factor for increased mortality substance-dependent people. They also noted that these two dependencies may be inherited and for those people with both addictions, smoking may be a trait co-inherited with alcoholism. The studies suggest that abstinence from smoking may benefit the cessation of alcoholic activity and that the focus on nicotine abstinence not hinder the success rate for treatment of alcohol. Possible mechanisms suggest by other researchers include cross-tolerance to nicotine and alcohol, neural reward pathways and cued responding. Others studies have repeated that smoking onset and alcohol use have similar risk factors in common that are in many times due to heredity influences, especially in adolescents and young adults. The data this study unlike other studies on alcohol and nicotine strongly suggests that not only is the threat of addiction to each of these substances a heredity factor, but that the concept of cross addiction, or dual addition is, itself a matter of genetics. It would indicate that teenagers, or young adults who are at an experimental stage of their life are especially vulnerable to this kind of genetic dual addiction. While schools and community programs in the past have focused on education, as a means to prevent the use of alcohol, tobacco and drugs and it is evident that dual addiction should be allotted an equal time in education as prevention as with the genetic predisposition to this condition. This study does have its caveats, in that the research is only limited to male twins born between 1939 and 1955. It is also confined to Vietnam era veterans. In the Pentagon has in the past provided cigarettes to its soldiers and thus might of had influences on the outcomes of this study. The study does not account for female statistics in the process of dual addiction. Females constitute the fastest growing segment of alcohol abusers in the United States. Young adults and adolescents were also not accounted in this survey as they are at the crossroads of substance use or abuse. The study neglected to take statistics from various demographics from all aspects of the population. The benefits of this research study outweigh the drawbacks in the fact that it lays the groundwork for future studies in the dual addiction process, as previous work was instrumental to this one. It provides schools the background it needs to educate its students on the dangers of dual addictions. Bibliography: Brick, John & Erickson, Carlton. Drugs, the brain, and behavior. Binghamton: Haworth Medical Press. (1998). Hurt, R.D., Offord, K.P. ,Croghan , I.T., Gomez-Dahl, L., Kottke, T.E., Morse, R.M., & Melton, L.J. Mortality following inpatient addictions treatment: role of tobacco use in a community based cohort. JAMA,275, 1097-1103. (1996). Keller, John E. Alcohol. a family affair. San Diego: Kroc Foundation. (1977). Prescott, C.A. & Kendler, K.S. Genetic and environmental influences on tobacco dependence among women. Alcohol and Tobacco: From basic Science to Clinical Practice, 59-87. (1995). Swan, G.E., Carmelli, D., & Cardon, L.R. The consumption of tobacco, alcohol, and coffee in Caucasian male twins; a multivariate analysis. Journal of Substance Abuse,8, 19-31. (1996). True, W.R., Xian, Hong, Scherrer, H.F., Madden, Pamela, Bucholz, K.K., Heath, A.C., Eisen, S.A., Lyons, M.J., Goldberg, J., Tsuang, Ming,. Common Genetic Vulnerability for Nicotine and Alcohol Dependence in Men. JAMA,56, No.7. (1999). Woititz, Janet Geringer. Marriage on the rocks: learning to live with yourself and an alcoholic. Pompano Beach: Heath Communication. (1979).

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