12% of UK Doctors are Addicts

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According to this site for sick doctors, 10% of the general population are estimated to be addicts. The figure rises to 12% for doctors in the UK. These figures refer to drug and alcohol addiction and do not include other addictions such a s gambling addiction. Both figures are probably highly surprising to most people. Addiction is certainly one of the most pervasive of all mental illnesses. The costs to individuals and those near them is huge in terms of grief and suffering; the cost to the nation runs into may billions of pounds.

Doctors and other front line health workers generally work under very stressful circumastances. One stressor must surely be that those they are helping or trying to help often turn against them, blame them, may be even physically violent. This may be true especially among addicts who ahve a tendency before they start on recovery to externalise their pain,  and blame whatever or whoever comes to hand. Doctors are often in a position where they can do little for a patient except refer them elsewhere. Often, when recovery from addiction has begun and the patient has gained some ownership of their own recovery, doctors can help with things like depression and anxiety.

However, going back to the figures at the top, if doctors themselves have such a high rate of addiction it seems reasonable to suggest that there is no easy medical ‘cure’ for addiction, no magic pill. If doctors cannot heal themselves, or not easily by use of medication, it follows they cannot offer easy solutions to anybody else. Doctors have to embark on recovery in the same ways as anyone else.

It’s the case that ‘addiction’ is classed as a ‘mental illness’, yet perhaps it’s true also that there is no straightforward and medication based treatment.

It may be that recovery is not a medical matter. Although medicine can help with the complexities of addiction on an individual case basis such as whether a comorbid mental health disorder needs treating initially or during recovery, by and large recovery takes place in non-medical contexts. 12 step programmes (AA,GA,NA etc.) is an obvious example (although as is well known, while some swear by the programme, some evidence regarding its efficacy suggests low success rates, and many people find it is not for them). Psychological therapies are used too, but accessing them can be very difficult, involving a long wait for treatment which is not necessarily successful.

A large number of people – in cases of alcohol addiction, for instance, maybe as many as a third of people – recover with no recourse to doctors, psychologists, 12-steps or any other agency. A well known example is that when soldiers became addicted to heroin fighting in Vietnam, 805 of them recovered without intervention on returning home to America where they were in the environment of family, home and friends. Inversely, studies show that drug addicts who stop using while in prison, sometimes for many years, resume upon release when they return to their old social networks. Environment in its broadest sense seems to play a big part in recovery.

Addiction Musings (2): THE SOUL OF ADDICTION

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Everyone’s an ‘addict’ these days if you believe everything you read in an ever increasing number of articles. People say jokingly, of course, things like they’re addicted to doughnuts or Facebook. Ingesting too much of anything or spending too much time on anything may be bad for your health and quality of life but that doesn’t make them addictions.

Certainly, some activities share things in common with addictions. Children whose life revolves around social media, who feel miserable and irritable if deprived of it, are said by some to be ‘addicted’. Yet heavy usage of a substance or activity does not in itself describe addiction. Many heavy drinkers, for instance, are giving a lot of time to drinking, damaging themselves and others, but that doesn’t make them alcohol addicts. A lot of people run into problems gambling: they run into money problems, and a host of other difficulties – but this doesn’t make them ‘gambling addicts’.

Heroin is used ‘sensibly’ by a surprisingly large number of general healthy and financially stable with good employment and quality of life. The substance itself does not contain a demon which guarantees addiction. On the other hand, cannabis which as a substance causes little or no physical dependence, may for some people lead to what is truly addictive behaviours. The characteristic which makes cannabis possibly addictive is its becoming the centre of a person’s life. All else is secondary. The days and weeks are spent ensuring supply, and being in a cannabis induced state (interestingly, one that need not be, and often is not, pleasurable). On the other hand, the vast majority of people who use cannabis represent a spectrum: like alcohol for instance, it may be used occasionally or regularly but without disrupting life: without it, life goes on pretty much as normal.

When it comes to fixed odds betting terminals, there’s a somewhat pointless debate about whether or not they are ‘addictive’. For most people they are not, that’s a fact. For a significant number of people they are. Their design make sthem so. In this respect they are electronically enticing the most vulnerable, which is the basis of campaigns against them. They are unfair and unjust. However, that is a separate issue from the question of what addiction is.

There are thousands of ways of asking and answering this question. One thing that seems agreed is that addiction seems to seriously impact on every area of life. Breakdowns of various kinds, physical and mental health deterioration, misery and so on. Yet what about the concept of the ‘highly functioning’ addict? Somebody who is successful on most measures, thriving, healthy, and so on.

Questions, answers, theories and explainations go round and round ending up in a tangle and a mess. But what follows suggests a description of addiction which many may recognise. It’s not a medical or psychological or other expert viewpoint. It’s abot the being and meaning of addiction in an addict’s life. (In philosophy, questions about being and meaning are ‘existential’ questions). This description applies to both those who have not admitted or realised that they are addicts, and to those who know too well that they are in addiction’s grip, those who feel trapped, enslaved.

Enslavement is actually the original meaning of addiction. In Roman times, a formal legal contract would addict a slave to a master. A slave, of course, has no freedom; his or her identity is simply being a slave. Everything the do, everyhting they think, everything they are is in terms of the master, has the master at the centre. The slave’s life revolves around the master.

Interestingly, in mediaeval times, this meaning was tweaked slightly with monks who ‘enslaved’  themselves to God. This voluntary giving over of one’s whole being to God was also called addiction.

Through metaphor, addictio has come to signify the state of enslavement. Just as a Roman slave’s life was totally determined by the master and the condition of enslavement, and the mediaeval monk’s life revolved around God with all else subsidiary, so the modern addict’s whole life and being revolves around the object of their compulsion. The object may be a substance or a behaviour. While the addict functions in many areas of life or not – employment, family, relationships etc. – these areas are always secondary to the object of addiction. An addict may lie, cheat, steal, do things that they utterly detest doing because their whole being revolves around the object of compulsion.

If this description is on the right lines it offers the intriguing possibility that a ruinous addiction may be defeated not by will power but simply by replacing what is important to being and meaning in life. Certainly there is much evidence that many severely addicted people come to ‘recovery’ not by any method or treatment but by finding meanings and values in life that are more positive. So, for instance, 80% of military heroin addicts in Viet Nam stopped using when they returned home to their families, the latter being the positive meaning and values system that defeated the destructive one. Evidence shows that many young people with addictions ‘mature out’ of them without treatment when they find richer meanings to life, for instance throughs tarting a family or a career.

To employ a somewhat hackneyed word, addiction is holistic. It is a state of being that involves every single part of a person’s life.

 

Ade Johnston

A Life Pervaded by Addiction: an interview with Joe

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The common phrase ‘problem gambler’ is thrown about very casually as if the compulsive gambling behaviour that so many experience (about 5% of the UK polulation including the 0.7% of life threatening cases). Too often a person is defined as an ‘addict’ or a ‘problem’. People do have problems and addictions but to identify them buy labellig them only in these terms is dehumanising and wrong.

The way we all too often label people needs challenging. Hence we have anti-stigma campaigns. There are many such campaigns around mental health. People should not be labelled for many reasons: one is that it lessens or belittles them; another is that it isolates people by their being seen as ‘different’; a third is that negative labelling deters people from seeking help and support.

This interview with Joe reveals a life of suffering from compulsive gambling. Rather than facts and statistics, academic studies, medical discourses, we think it is essential and in many ways more powerful and relevant to listen to the unique, individual voices of people who face the danger of being boxed into a dehumanising label and stereotype.

What’s also brought out in this interview is that problem gambling involves far more than individuals who gamble. It includes the environment and culture. It also includes the design of gambling machines in our digital age – specifically, in Joe’s case, fixed odds betting terminals and online gambling.

How prevalent is addiction?

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Following on from the previous post, our coffee discussion turned to the prevalence of addiction in the UK. We were both coming from a belief that it reveals an astonishingly large number of people in trouble. We believe it is a massive social problem that is not getting the attention it requires.

Later reflection considers the following:

  • There is a problem understanding what may be referred to as addiction. There is a very large number of people whose addictions have resulted in actual or potential life ruin involving finance, employment, social status, relationship breakdowns, a range of severe physical and metal health problems, and death.
  • However, there are many more cases where people are nearing these severe states. There are many whose drinking or other substance dependence are working slowly to take years off their lives. Nicotine addiction is an an obvious case. This applies to behavioural addictions such as gambling also, and statistics for these groups are hard to achieve if at all.
  • Unknown numbers of people are addicted to over the counter painkillers or prescribed medicines. Unknown again is the number of people illegally ordering prescription only addictive medication online.
  • There is a range of other addictions which are now taken seriously by researchers and treatment providers such as eating disorders, sex addiction and internet addictions.
  • Many ‘normal’ behaviours share characteristically common features of addictions. Compulsive shopping, perfectionism, workaholism for instance have similar neural substrates to all addictions.
  • A research paper has suggested that 47% of Americans are addicts in some sense.
  • Statistics for all addictions taken together in the UK are hard to come by. Limited statistics are available separately, e.g. for alcohol, opiates, marijuana (usually treated as psychological dependence),  gambling, amphetamines, heroin, cocaine.
  • It is extremely difficult to gather statistics. Since many addictions are to illegal substances and do not get reflected in medical interventions for instance, the true scale of actual addictions to a substance or behaviour can only be estimated.
  • Nevertheless, what figures there are contribute to an understanding of the prevalence of addiction. 9% of men and 4% of women are dependent upon alcohol. In Scotland there are 50% higher rates. The Gambling Commission also reflects geographical variation:

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  • Such figures cannot disclose current trends nor the breakdown of specifics of for instance, types of alcohol behaviour, methods of gambling. As for gambling, since it is increasingly done at home using online technology, only sources such as publicised personal catastrophes, some suicides, treatment statistics are available. The stigma associated with addiction is that even many severe cases will be attributed to financial ruin or depression etc.
  • For every addict at the extreme negative end of the spectrum, many more people will be affected, especially children and families. The problems of addiction therefore affect very large swathes of the population.
  • Besides the immense personal costs and suffering, society as a whole spends many billions of pounds because of addiction. These costs relate to health, crime, lost productivity and the welfare bill.
  • We aren’t remotely expert or knowledgeable but believe the true rate of addiction is extremely high. It needs much more urgent focus by policy makers across government services and within government, especially:
  1. Researching and acknowledging the scale of the issue as a whole rather than by reference to particular addictions.
  2. Identifying social, environmental, business contributions to addiction and curtailing them. For instance, prohibiting products designed to entice vulnerable people or induce people towards addictive behaviour, such as fixed odds betting terminals, advertising, online design; minimum unit pricing for alcohol.
  3. Raising awareness among professionals and ancillaries; ensuring destigmatisation among support providers and workers.
  4. Not allowing loss of government revenues to be used as an excuse to prevent public harm.
  5. Acknowledge once and for all that addictions represent one of the nation’s main mental health disorders. Integrate metal health services, educate staff, resource much greater treatment provision.
  6. Roll out public health promotion and advertising.
  7. Rethink drugs policy. Seek best practices globally for decriminalisation or legalisation. Emphasise treatment over punishment.
  8. Immediately produce policies and strategies to support the many people who suffer dual diagnosis disorders.

Addiction. Mental Health. Which?

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We were enjoying cappuccino and chatting about the somewhat ambiguous relationship between ‘mental health’ and ‘addiction’. Not being experts, the questions we raised only represent the view from the bottom – or, more precisely, they only represent our own coffee time discussion.

  • Why do campaign groups big support organisations, medical and government sources seem very reluctant to include addiction as a mental health issue? Certainly they all mention addiction but it seems to us that it is put in a box of its own and not given anything like the prominence of, for instance, depression and anxiety.
  • This seems odd especially because it is well known that depression and anxiety alone are very closely related with substance and behavioural addictions. They may lead to addictions via ‘self medication’ or the impulse to escape intolerable pain; both are likely consequences of addiction. It’s a cycle.
  • We are aware of the concept of  ‘dual diagnosis’ or ‘comorbidity’ where addiction is often accompanied by another mental health disorder. We are aware too that this is well known among professionals and has been researched and discussed for decades. There are organisations dedicated to researching and promoting discussion around dual diagnosis, such as Progress and many others but in practice we believe on the ground support and awareness is patchy geographically or non-existent.
  • Give that some mental health disorders such as gambling addiction and bipolar have high rates of comorbid substance abuse we find it odd that publicity around the issue is very feeble.
  • Anti-stigma campaigns around mental health issues are to be celebrated if they are evidenced as effective. Stigma is a huge barrier to recovery, seeking treatment and engaging socially. Yet we are not aware of any ongoing, well-resourced anti-stigma campaigns relating to addiction.
  • In our next post we consider the prevalence of addiction in the UK. We are concerned that a great deal of suffering is not being as adequately addressed as it could and should be.

 

Addiction Musings (1) Introduction

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We’re beginning a series of posts ‘musing’ about addiction. Musing rather than thinking too hard, as the subject is so vast and split into thousands of specialist research specialities. Not to metioned the all too often ignored experiences and ideas of people who have personal acquaintance with addictions.

Words – any words – can be highly misleading. The word ‘addiction’ does not refer to a thing that can be seen or otherwise sensed, weighed, measured. It is helpful to think of it as just a signpost to hundreds of different states which are often barely understood by addicts themselves or expert specialists. No one has, and no one ever will, come up with a unified ‘theory of addiction’ because unlike, for instance, things that can be weighed or measured or seen in a microscope, there are no tight borders around the term. Everything is blurred. In everyday life people talk about being ‘addicted’ to such-and-such a television series or type of biscuit. Such usage of the word belittles the suffering of  severe addiction states.

On the other hand, it is accepted as a fact that not only substance dependence but behaviours can be characterised medically as addictions. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition which is one of the main diagnostic manuals used by psychiatrists identifies ‘gambling disorder’ as a clear-cut case of addiction.

Increasingly mentioned in the media are things like ‘internet addiction’, ‘smartphone addiction’ and ‘social media addiction’. Serious research has yet to suggest whether these are ‘true’ addictions – but they certainly have many of the characteristics of addictions.

An interesting case of possible addiction relates to climbers for whom climbing is one of the most, if not the most, important part of their lives. They have reported ‘withdrawl symptoms’ of depression and anxiety if injury prevents their activity. It’s well known too, that many love exercise and the gym so much that they would feel bereft without them. Activities such as exercise and climbing are known to relese chemicals i the brain which produce a ‘feel good’ factor and in some cases, especially when combined with risk, a definite high or ‘buzz’.

On this site we mean by addiction a condition which involves compulsive activity over which an indidual feels they have little or no control, and which produces extremely negative consequences. Negative consequences involve physical and mental health, financial problems, relationship breakdowns and other serious problems – including, of course, death. In some cases, people suffering with addiction will be ‘in denial’ and not realise or admit the devestating consequences of their behaviour; equally, many are only too aware yet feel they cannot stop the compulsion. Invariably, the lives of those close to somebody suffering from addiction are seriously affected too.

More people than today used to talk of a ‘demon’ within, such as ‘the demon drink’. Interestingly, the word addiction in mediaeval times was used to describle priests’ giving themselves up to God. Addiction was a contract, and in Roman times a slave would be ‘addicted’ to a master. We still talk about being enslaved by addiction.

There is still a great deal of stigma around those suffering with addiction (and other mental health ailments too). It is seen by some uninformed people as a character weakness or a moral flaw. In reality addiction is a mental health condition that requires every bit as much understanding, research and treatment as, for instance, depression or anxiety.

In fact, depression and anxiety are often the primary disorders which lead people to ‘self medicate’ or take part in risky behaviours in an attempt to alleviate suffering: addiction may follow (and when it does it usually makes the original conditions worse).

Addiction can strike anybody irrespective of age, gender or social class. While it is true that some addictions correlate with factors such as deprivation, poverty and social exclusion, many addictions do not. There are plenty of teachers, police officers, doctors, nurses, politicians, judges who succumb to alcohol. Online gambling prevalence is highly correlated with middle class professionals. Away from ‘skid row’ stereotypes, thousands of ‘respectable’ people are becoming addicted to over the counter painkillers and prescription only drugs obtained illegally (mainly online).

Current research shows that 9% of men and 4% of women are physically dependent upon alcohol. That is a staggeringly high figure and it may well increase.

Addiction is not, then, something which happens to a few unfortunates or degenerates. It is almost certain that somebody reading this now is on the road to addiction if not already there. And it is completely certain that everybody knows someone suffering from addiction be it at home, at work, among friends. And for each of these people, many more will be suffering too – from their addiction.

 

Children Learning to Gamble

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In the digital environment – where some toddlers learn to use a digital device before they can talk – bright and cheerful interactive apps and games are the norm for children.

Go to an online gambling site for adults and you see the same sort of bright and cheerful apps and ‘games’. Roulette? You can play for free using virtual credits. Just a click of a button and you can play for real money. Children are no different from adults in enjoying risk, winning and losing chances, and are likely to be drawn to these games of chance.

In addition, the format of children’s games and gambling screens is blurred. A child who learns to love screen games is already primed to love online adult ‘games’.

The Australian Gambling Research Centre has published a worrying report:

According to the report, the fact that gambling and gaming have been mixed together means that gambling has been normalised for children. 

Young people are effectively being taught the basics of gambling at a younger age than ever before. 

But from making one click on your Facebook page, to one simple swipe on your smartphone, simulated gambling games are everywhere and they can be difficult to avoid.

Since television and online advertising for gambling is on the increase, and children today grow up in a world where televised football, for example, equals televised gambling, there is cause for concern.

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What treatment for gambling addiction?

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There are many profit making facilities for recovery from every kind of addiction – substances, alcohol, increasingly ‘digital addiction’. Some offer expensive promises for recovery from gambling addiction. There’s Gamblers Anonymous too, a 12-step programme which may or may not work for some people, but many don’t like the approach. Figures suggest only 5% of problem gamblers seek help and only 1% receive it.

What’s available on the NHS? Gambling addiction is recognised as a psychiatric disorder and described in detail in the DSM, one of the psychiatrists’ ‘bibles’. So if you go say to your GP what’ll happen? A lot will  depend on your GP but she may recommend cognitive behavioural therapy (though you may have to wait a long time before you get it). Truth to tell, CBT has not been proven to be universally effective. A GP may offer meds for concurrent depression or anxiety. Very rarely will you be referred to a NHS psychiatrist.

I was talking to a psychiatrist today and asked what treatment was available. He said possibly CBT but the condition is under-researched. It’s true though that some medication trials and research are promising, but the overall situation is very thin and patchy.

Given that gambling addiction carries with it a much higher suicide risk than the general population, various mental ailments such as anxiety, depression or obsessive compulsive disorder, and in 70% of cases parallel substance abuse disorders, you’d think research and treatment would be much more advanced by now.

There are hundreds of thousands of gambling addicts just in the UK, an dtheir addiction has a ripple effect on families and society as a whole. Gambling addiction is a case of awful individual suffering. And it’s likely to become a greater problem as gambling seeps into the DNA of our culture where even children are becoming problem gamblers.

 

 

 

 

Fixed odds betting online and on the high street

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An article in The Guardian argues that the age old distinction between gaming and betting has been eroded by the advent of digital gambling machines in high street bookmakers and online. Many people who enjoy or provide betting are upset that an element of skill and genuine odds based on probabilities of outcome are taken away by fixed odds machines.

 

If Lionel Messi gets injured in the warm-up, for instance, the odds about a Barcelona win will immediately start to drift. And because the odds fluctuate and come down to a matter of judgment, shrewd gamblers – and there are plenty – can make a longterm profit from their betting.

In gaming, the odds are fixed, because the chance of every possible outcome is known, and also fixed. The maths which governs the payouts and probabilities is as immutable and well-understood as the laws of planetary motion. For as long as we live in a universe where an apple falls down and not up, no gambler can win at gaming in the long run.

For 200 years in Britain, from the birth of both bookmaking and roulette in the last decade of the 18th century until the arrival of internet gambling, betting and gaming knew their place. Betting took place on racecourses and, since the early 1960s, in high-street betting shops. Gaming was restricted to casinos. Its availability, in other words, was more tightly regulated.

The internet has changed all that, and it is betting firms, both online and on the high street, that have been doing their utmost to blur the centuries-old dividing line. The “B” in FOBT stands for “betting”, for instance, but these are gaming machines, pure and simple. The FOBTs produce guaranteed profits – an average of more than £50,000 per machine per year – and never ask for a pay rise or phone in sick.

Addiction by Design

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Natasha Dow Schüll is an anthropologist who spent 15 years studying machine gambling in Las Vegas. Her resulting book is a close examination of the people, the machines and the several contexts that interact to produce gambling addiction. The idea that a machine’s design interacts with a user (not one or the other but both) is a core theme. The book is something of a page turner, full of deeply human insights into the people she met whose lives have fallen prey to addiction.

There is a growing awareness both in and beyond academia that the design of gambling machines is crucial to understanding addiction. The book is highly recommended. For a good overview, watch her lecture: