How to Beat Your Addictions.

"I didn't have my first drink until I was 29," the dentist said. "I had just received my acceptance letter from dental school and I thought I could finally relax and have an occasional drink."

"Same age as I was," the trauma surgeon and helicopter pilot stated. "The first time I drank was right before a mission. Unfortunately, I drank a pint of vodka, and my only recollection of the mission I flew was the moment I landed. I lost several soldiers on that mission, and I still feel guilty about it 30 years later."

"I remember from age 6 looking forward to Communion wine at my church because of the good feeling it gave me," the 30-year-old woman remarked as I obtained her history upon her admission to the alcohol treatment unit.

"From age 10 I drank purposely to get drunk," the 35-year-old nurse told me after entering treatment so she would not lose her nursing license.

addictions are unpredictable and predictable at the same time. There are risk factors that increase the chance of becoming addicted. Even being brought up in the "right" home, with the "right" parents, having the "right" education, and going to the "right" church will not necessarily protect you from becoming addicted to alcohol or any other drug.

What are the factors that increase your chances? Experts use a long made-up word to describe the factors: bio-psychosocial. What it means is that there is not one factor, but several.

"Bio" stands for biological, or the genetic factors that play a role. Rats can be bred over multiple generations to choose alcohol over water when given a free choice. If one identical twin with an alcoholic parent develops alcoholism, 60 percent of their identical twins will also develop alcoholism even if brought up by nonalcoholic adoptive parents.

Another biological factor influencing your disposition to addictions is that brain chemicals are in different proportions in different people. This causes alcohol to affect some people differently than others. For example, some people have more anxiety, which alcohol seemingly normalizes. Alcohol's calming effect in these people gives them more of an incentive to drink again. But continued use of alcohol eventually leads to a tolerance to it developing. Eventually this type of person requires more alcohol to achieve the same effect. This leads to an eventual downward spiral into addictive behavior and becoming trapped.

Sons of alcoholic fathers actually are less affected by alcohol when compared to sons of nonalcoholic fathers. Give both groups the same amount of alcohol, and the ones with alcoholic fathers feel less of a "buzz" and don't have as much imbalance.

Not one single gene, but many, contribute to addictive tendencies. But even if you have all the genes that contribute to susceptibility to becoming alcoholic, you don't necessarily become alcoholic. "Biology is not destiny" is important to remember. Knowing you have tendencies toward alcoholism because of your family history, you can choose not to drink even socially, thus avoiding the whole problem. You will still need to be aware of addictive tendencies, though, in other areas, such as gambling, sex, work, eating, and shopping.

"Psycho" refers to the psychological events that make it easier to become dependent on chemicals.

"I have always felt different from others, and when I had my first drink I felt as though that invisible wall between others and me had miraculously disappeared. I was ashamed of the light-colored patches on my skin, but after drinking it didn't seem to matter anymore."

The nurse who drank from age 10 actually had endured sexual abuse, and to her it made perfect sense to start drinking to numb the fear, anguish, and pain.

Many soldiers from Vietnam or any other war use alcohol or other drugs to numb the memories of what they experienced. "I drank in order to get to sleep. I couldn't sleep because I was terrified of what God would do to me in order to punish me for what I did during the war," one vet told me. Just one look at his face convinced me of the reality he felt. It took a year before he could smile, knowing that God could forgive him, but even longer before he could forgive himself. Not until he was able to forgive others did he finally experience forgiveness himself.

Some people are easily bored, always have to try something new, stir up some trouble, or check out trouble brewing. Punishments don't faze them, and rewards don't have much influence. This is the type of person who is most apt to experiment with alcohol or drugs and also to become addicted as a result.

"Social" refers to the social factors in your environment. You are not immune to influences around you. For example, researchers have proved that as the price for cigarettes increases fewer teenagers will begin smoking. The drugs that cause the most problems are the drugs that are the most available. Which drugs are these? The legal drugs alcohol and tobacco together cause more than 25 percent of all deaths each year in the U.S. Fewer than 20,000 deaths a year are caused by all other street drugs combined. The "drug war" is focused on the drugs that cause the fewest deaths!

Obviously the fact that some drugs are illegal will not prevent everyone from using them, but it does prevent some. More people use drugs that are legal, and as a result, if they have genetic tendencies they will then become addicted. Unfortunately the genetic makeup you inherit from your parents or even grandparents does not always predict your future. If teens can avoid smoking before they reach age 18, the chance of their ever using drugs or becoming addicted to drugs is very small. And using alcohol or smoking cigarettes or marijuana does not always mean you will go on to use cocaine or heroin. But those who end up using amphetamines, cocaine, and heroin usually began with the more available drugs such as alcohol and cigarettes.

Attitudes toward social drinking also influence how many become addicted. What some do under the influence: may be humorous, but it is also tragic. There aren't many jokes about those with diabetes or cancer, but we do have jokes about alcoholics. This reveals how permissive we as a society are to the problem of addiction. Instead of laughing at the results of excessive drinking, we should recognize it for what it is and help the person get help from those who understand the condition.

No one becomes alcoholic intentionally. Everyone rationalizes the process in the early stages. "I'm just having a little."

"It's just enough to feel good."

"I'm just having some fun!"

"Oh, just this once, just to be friendly."

Yet 17 percent of the population will end up having regrettable and often uncontrollable problems as a result.

Why it is so easy for humans to become addicted? The area of the brain that is affected controls what is called the reward system. Often special cells in the brain are activated when you feel pleasure. Addictive drugs activate these brain cells and pathways. But normal, healthy behaviors can activate these same areas too. It's as if God is trying to make it easier for you to do the right thing. For example, if you get a good grade on the test after studying hard, you feel a surge of pleasure. This helps you remember what it took to feel good, and therefore you'll study hard for the next test. If you act unselfishly toward someone you love and they respond in a way that makes you feel good, you say to yourself "I'm going to act unselfishly again in the future, since I like feeling this way." Catch a touchdown pass or get a compliment about how you look, and you're going to repeat that behavior, since it feels good. Unfortunately, if you take a shortcut and use a drug to obtain this same feeling, then you will more likely remember the shortcut and repeat the act in order to feel good again. This causes a surge of feeling to become the goal rather than the process, and eventually you will become addicted to the shortcut.

The dentist who did not have the first drink until acceptance into dental school became addicted to pain pills and stole medications from patients before finally entering treatment. The nurse who drank from age 10 eventually lost her ability to function as a nurse, even with treatment.

Early signs of addiction are not hard to spot. It is easier for the onlooker to detect, though, than for the person using the chemicals. Initially a feeling of embarrassment, followed by guilt, is felt. This leads to a tendency to minimize or avoid the topic, to blame something or someone else. Because admitting the truth would cause an addicted person to feel terrible, they often describe their lives as overwhelmed by stress, fatigue, a lousy job, a nagging spouse, bad luck, or judgmental friends. If avoiding the topic doesn't work and others still bring up their drinking, then the addicted person will use anger to frighten off their friend. Then the alcoholic and the family become isolated, dropping out of the social scene, even going as far as avoiding family gatherings or church activities.

Outrageous techniques are utilized to hide the substance abuse. One of my patients would pour alcohol into a drinking hose. Telling his wife he was going to work in the yard, he would then make multiple trips to the hose to get "a drink of water." Another patient who was an elderly grandmother would drink her alcohol only from a thermos so her family would think it was just coffee.

Eventually financial problems begin to develop, with more money being spent on the chemicals and not enough on life's necessities. Additional money is spent on the resulting problems, such as accidents and drunk driving violations. A spouse now has to assume more and more responsibilities, which eventually cause fatigue, depression, insomnia, hypertension, or headaches or backaches. To avoid the embarrassing, unpredictable encounters, children do not bring friends home anymore. Eventually problems develop on the job and in the physical health of the substance user. Not all doctors or counselors are comfortable confronting the problem, and so the problem persists until it can no longer be ignored. Often this results in serious medical problems, divorce, or death.

Family members become trapped to the same degree that the chemical traps their loved ones. "My son is using heroin, and he won't stop," said one woman. I turned to the son, but he wasn't sure why his mom was so upset. I continued talking to his mother.

"Yes, he lives at home with me still," she said. "He won't take care of himself, so I end up doing the cooking for him and cleaning his clothes. Sometimes I find myself lending him money, knowing he will use it to buy drugs. I've even found myself driving him into Los Angeles in order for him to buy more heroin. I know I shouldn't, and I promise myself it will be only this once, but it isn't. I'm hoping that he will see how much I love him when I make these sacrifices and that seeing this love will motivate him to change." Unfortunately, it wasn't working, and she needed help to practice tough love, not permissive love. She needed new ways of thinking, just as the patient did.

It used to be believed that an addict had to "hit bottom" before being willing to receive help. Hitting bottom meant losing self-respect, friends, family, home, money, job, and health. We now know that it needn't become this severe if the right techniques are applied early enough in the course of the addiction's progression. It is unusual for the patient to wake up one day and say, "Today I will get help." Generally it takes some external pressure either from the family, concerned colleagues at work, the doctor, or the legal system before one chooses to make changes. A diabetic or someone with hypertension is not able to think their way to health. In the same way, a person with alcohol- or drug-related problems needs to follow directions and a plan of recovery in order to achieve success. It is usually an ongoing process that requires vigilance, new ways of thinking, spiritual renewal, and guidance from experienced helpers.

Even if a person is not seemingly willing to receive help, there are caring and supportive ways to encourage their seeking help. For professionals such as doctors, dentists, nurses, and pharmacists there are professional programs of help referred to as "Diversion."

Many insurance companies will reimburse the cost of treating the withdrawal from various chemicals. Just getting through withdrawal, though, is not enough, and more treatment will be needed to educate the patient on how not to relapse. A person does not have to be an inpatient; there are many outpatient programs that are effective. Some people will need to stay in a recovery home because of being homeless or jobless. Many counties have programs for those without medical insurance. Such self-help groups as Alcoholics Anonymous (and for family members, Al-Anon). Narcotics Anonymous and Nar-Anon, Cocaine Anonymous, Sex and Love Addicts Anonymous, and Gamblers Anonymous exist.

The bad news is that humans will always be prone to addiction. This problem will never go away. The good news is that recovery is possible. I see miracles occur every week in the treatment program I work with. I've seen lives changed from hopelessness to hopefulness, from degradation to re-creation, and from being a slave to chemicals to being a child of God. If you are concerned about a loved one, do not wait. You be the one to begin the process of healing.

Mickey Ask, M.D., is medical director of the Addictions Treatment Unit at the Jerry L. Pettis Memorial VA Medical Center in Loma Linda, California, and on the faculty of the Loma Linda University School of Medicine.