Overcoming AddictionByCharles Atkins, MD

"Wouldn't it be great if youcould love me first and let the bottle wait?"--Dolly Parton"They tried to make me go torehab, I said, 'No no no.'"--Amy Winehouse
You know it's killing you. The alcohol, cigarettes, pain pills, illegal drugs whatever the habit isthat you've tried to change—repeatedly—but without success.  Your conversations with yourself are familiaras a favorite tee shirt, "I've got to stop…I'll do it tomorrow."  And then tomorrow comes, and with it the urgeto drink/smoke/use illicit drugs and despite your best intentions you give in.  "Okay, tomorrow then.  I'll really stop tomorrow."  So what's wrong with us that we persist inbehaviors that harm us?  And mostimportantly, how does someone finally make the needed change?As a psychiatrist who works withpeople with drug and alcohol dependence I spend a lot of time on these questions.  While the answers can be complex, I'm drawnto some basic truths.  First, thedestructive habit--whatever it is--serves a purpose, at least initially.  The "why" someone begins to drinkor use drugs varies from person to person. Alcohol provides a sense of relaxation and well being.  For people who are anxious or sociallyawkward it helps lubricate their tongues and makes them feel at ease in socialsituations.  Opiates (pain pills toheroin) induce a state of euphoria and relieve not only physical pain, butemotional suffering, as well.  It's nocoincidence that so many survivors of abuse and trauma become addicted to heroinand prescription opiates.  For teens experimentation with drugsand alcohol has become a passage rite.  Thenot-fully wired adolescent brain doesn't register the danger in the behavior,and it's during these young years where most pick up habits that turn ugly intime.  The magnitude of this is followedby annual surveys that monitor high-risk behavior in teens.  In 2009 24% of high-school students engagedin binge drinking, nearly ten percent had driven in the past month when they'd hadalcohol, roughly 30% had been passengers in a car where the driver had beendrinking, 20% smoked cigarettes, 20% had used prescription drugs without adoctor's order, over six percent had tried cocaine and/or Ecstasy, and 2.5% hadtried heroin.  Once established, negative behaviorstake on a rhythm and turn into a habit. A smoker hears the phone and lights up, the morning cup of coffee isaccompanied by a smoke, and every work break includes a quick cigarette or two.  A drinker anticipates the weekend, or the endof the workday as the time for the first beer or cocktail.  Passing a liquor store they think aboutwhether or not there's enough booze in the house, or who they'll meet up withfor drinks at a favorite watering hole.  Depending on the drug of choice,problems start to develop and can damage any and all aspects of a person'slife--physical and/or mental health, relationships, job, finance.  An arrest for Driving under the Influence(DUI) starts a cascade of losses and legal problems.  Physical effects of excessive drinkingemerge, and dependence--the body's need for the continued presence of asubstance--takes hold.  An opiate addictno longer gets the euphoric high, but instead is chased by the physical andemotional agony of withdrawal "Jonesing" that turns her life into anunending search for the next fix.  Thealcoholic becomes shaky in the morning, starts to drink throughout the day, hasunbearable anxiety, poor sleep, and somewhere around the 20-year mark of heavydrinking heads into serious alcohol-related diseases such as cirrhosis and certaincancers.  A dangerous and potentiallyfatal withdrawal syndrome--delirium tremens (The DTs)—traps the drinker andtheir ability to "just go cold turkey" is no longer a safe option.  As for cigarettes, there's little doubt thatthey represent the number one cause of preventable death in this country fromheart disease, cancer and stroke.What's remarkable is that even in theface of terrible losses--job, health, family--the destructive behavior persists.  Deceit and minimization of the problem iscommon, and attempts to quit or cut back are frequent and short lived.  Motivation to do something about the behavioris mercurial, changing from moment to moment. Yet people can and do change.  And just as the reasons why someone starts adestructive habit are varied, the paths that lead someone to put down a badhabit are particular to them.  At somepoint there is an awakening and with it a call to action.  "This is killing me and I've got tostop."  For others it may be anexternal force, a spouse threatening to leave, a child who can no longer bearto see you drunk and cuts you out of their life, an illness or serious legalproblem that's a direct result of the addiction.  Regardless, something in the equation shiftsand motivation moves into action: throwing away the cigarettes, dumping thebooze down the drain, checking into a detoxification program, attending a12-step meeting.  Again, there are manypaths and depending on the behavior, the severity of the addiction and theperson these vary from "going cold turkey" on your own to intensive treatment.  Some will require the services of medicalprofessionals to get them through potentially dangerous withdrawals (alcoholand certain Valium-family drugs), and many will turn to rehabilitationprograms, drug counselors and well-established self-help groups such as AA andNA.  The first days are the hardest aswell-worn patterns of behavior, and cravings have to be resisted andchanged.  This is where familiar slogansfrom 12-step groups such as AA become life savers, "One day at a time".  "Today I'm not going to drink or drug, I'lldeal with tomorrow when it comes."     What is clear for everyone who has successfullyput aside a destructive habit is that they've transformed a desire to changeinto action.  In time, the olddestructive behavior is replaced with newer and healthier ones.  As I often tell my patients, putting down abad habit is both easy and hard.  The hardpart is "just don't drink" and the easy part is, "just don't drink".