DRHOOK- Gotta have it: Addictions often hard to eradicate

the handsome doctor John Hong of Charlottesville

"More" is not the last name of Mary Tyler Moore. "More" might be the mantra of the human race. Now, poor Oliver Twist requested, "Please, sir, I want some more," but he was starving. 

On the other end of the spectrum, Ponzi schemer Bernard Madoff definitely wanted more at the expense of everyone. Kayne West wanted more attention and to be more obnoxious when he unbelievably halted Taylor Swift's award speech at the Grammys.

 What happens when more leads to– well, more?

 Addiction to drugs leads to a path of wanting more: more drugs, more often. It is a chronic disease of impaired control of using drugs/alcohol despite the harm they cause. The repeated use of the substance comes from craving and/or the compulsive need to use it whether from physical or psychological dependence. 

 Physical dependence occurs when the body will actually go through withdrawal when the substance is not being used enough, or at all. You could say that the drugs/alcohol become a needed food for the body. When the person doesn't get the required food, withdrawal symptoms can occur such as pain, general discomfort, confusion, agitation, tremor, increased blood pressure, sweating, and even seizures. 

 Physical tolerance can lead to more physical dependence because the drug/alcohol users need higher doses of the substance to get the effects they want/need. 

Tolerance works like this. Let's say you own a bank, and what makes you happy is putting money in your safe. You start off with one bank teller, and she does ten transactions a day. However, after a month, she's doing 100 transactions a day. Hmm, wouldn't it make sense to get two tellers? You can get money in the safe faster! 

However, with two tellers, things run faster, so more customers come. Now there are 200 transactions a day. So you add a third teller, then a fourth, and before you know it, you have 10 tellers. But on some days, business is slow, so you become unhappy your cash deposits are going down. Also the tellers are starting to get burned out, so they start to work slower.

 In addiction, the brain is like the bank owner, the cash is the drugs/alcohol, and the bank tellers are the receptors of the brain. The more you use a drug, the more the brain will increase the receptors to bind to the drug. But in time, the brain will require more drugs to fill up all those receptors. Also, the receptors might become resistant to the drug and not work as well. Ergo, cravings and withdrawal symptoms occur. 

If you know a drug addict or alcoholic, they can consume doses that would kill you because they have built up such a tolerance. When I read how many medications Michael Jackson was taking, I nearly fainted.

 Psychological dependence is the sense of needing the drugs/alcohol to get the desired effect or to avoid the negative effects while not on the substance. People with mental illness are more susceptible to addiction. There's definitely a genetic factor in addiction, although environmental factors appear to influence the initiation of the substance use. 

Men are more at risk than women, although female alcohol abuse is on the rise. The good news is that alcohol abuse decreases as folks get older. Those with relationship problems and bad work histories have a higher risk of addiction. 

 Overdoing things to get a "high" or to suppress stress and escape reality can lead to trouble. Some people's brains are just wired to become addicted to drugs/alcohol. The best thing is to talk to your doctor, a therapist, or an addiction specialist to see if you're developing an addiction or already have one. Prevention and treatment can save your life!


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.