Monday, October 20, 1997 Anatomy of a disease: 'It's more than ... willpower' By Meredith Goad Staff Writer ©Copyright 1997 Guy Gannett Communications Wounded by alcohol Rebuilding a shattered life Fetuses especially vulnerable to harm from alcohol Alcohol's heavy toll on the brain Alcohol-related deaths in 1992 Caption here Staff art Jean Fisher couldn't understand what was happening. She and her husband, Bud, had been social drinkers for many years. Then, when Bud was in his late 50s, he crossed some invisible line and began drinking more and more. Gradually, his behavior changed. He became emotionally abusive. He gave up household responsibilities to Jean. He broke promises. His children stopped bringing friends to their home in Cape Elizabeth, and sometimes had to help their father to bed. More than once, Jean said to him, ''If you love me, you won't do this.'' But as much as he wanted to, Bud couldn't stop. For the families of people with alcohol dependencies, it's often difficult to comprehend why their loved ones can't look at a beer or bottle of liquor and just say no. The answer lies in the brain and the chemicals that course through it whenever we take a sip of alcohol. ''There's really a biology to what the drug does to your brain that causes people to crave the drug, to have withdrawal, that makes it very difficult for them to stop,'' says Dr. Scott Treworgy, medical director of the chemical dependency unit at St. Mary's Regional Medical Center in Lewiston. ''It's more than just about willpower.'' The National Institute on Alcohol Abuse and Alcoholism defines alcoholism as a disease that has these characteristics: Craving, or a strong compulsion to drink. Loss of control. There's an inability to stop once drinking has begun. Physical dependence. When the person stops drinking, he starts experiencing symptoms of withdrawal, which include nausea, sweating, shakiness and anxiety. These symptoms can be relieved by taking a drink. Tolerance. Over time, an alcoholic needs more and more alcohol to get high. At the heart of addiction is that intense craving. Some people develop it right away. Others may drink for years before getting hooked. But because alcohol is a drug that changes the way the brain works, no one is invulnerable to alcoholism if they put enough of it into their system. ''If you put it in there too long and in too high amounts, you get hooked,'' says Dr. Bill Clark of the Addiction Resource Center. ''That's just a fact of life. It doesn't have to do with whether you're a nice guy or a bad guy or a doctor or a laborer. It has to do with putting too much booze into your system.'' It may start innocently enough. ''People who don't develop very good coping skills and ways to self-soothe, they find chemicals an easy way out,'' says Dr. George Dreher, a psychiatrist at Maine Medical Center. ''For a lot of people, the chemical meets some sort of initial need, and it probably doesn't meet it in a good way, but it's a quick way.'' Alcohol excites one of the main pleasure centers of the brain, the nucleus accumbens. The nucleus accumbens is a primitive structure that is important for survival; when we satisfy our instinctive cravings for food, water and sex, it's this part of the brain that we're stimulating. A sip of whiskey comforts us in much the same way we get comfort from a kiss or a piece of chocolate. All of these pleasures release in the nucleus accumbens a burst of dopamine. Dopamine is a neurotransmitter, a molecule that carries messages from one brain cell to another. In the case of booze, that message is an alcohol high. Alcohol produces a powerful and persistent dopamine reward. When a person drinks, it reinforces pleasure-seeking behavior and leads to more drinking. As a person drinks more, the brain has to adapt so that it can continue to function while bathed in larger and larger amounts of alcohol. Eventually it takes even more alcohol to get the same euphoric effect. Remove the alcohol, and the altered brain cries out in protest. ''The more you use, the more tolerance you get, so over time you will get less and less positive results but a greater withdrawal,'' Dreher says. ''After a while people will be using just to feel normal, when in fact what they're doing is using to keep from withdrawing.'' The answer to why some people become hooked right away and others take years to slide into alcoholism may lie in genetics. Researchers have found through adoption and twins studies that some vulnerability to alcoholism is inherited. They have already identified spots on several chromosomes that are associated with alcoholism, notes Dr. Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism. In some cases, Gordis says, genes are the strongest influence on a person's future. But even in those cases, there's still some hope for avoiding trouble. Research has shown that only about 15 percent of the daughters and 30 percent of the sons of alcoholics go on to become alcoholics themselves. ''You're inheriting a risk, you're not inheriting a disease,'' Gordis said. ''The phrase that I like to use is that the genes that we're going to find are for risk and not destiny.'' Both neuroscience research and genetics research are leading the way to better weapons to fight alcoholism. Researchers are using sophisticated imaging techniques to learn more about the neurochemistry of alcoholism, hoping to develop medications that can interfere with alcohol's effects on the brain. One such drug, naltrexone, came on the market in 1995 and is used to help prevent relapse in recovering alcoholics. Many people have trouble seeing alcoholism as a complex disease that has a biological component because of the sometimes offensive behaviors of people with alcohol dependencies. Dr. Stanley Evans, an addictions specialist at Jackson Brook Institute, says he thinks a lot of people pay lip service to the concept of alcoholism as a disease, but when it strikes their own families that concept goes out the window. ''They see them as bad, weak, inadequate people who don't deserve any help,'' he says. Evans and other physicians like to compare alcoholism to other complex diseases that have a genetic component - illnesses like diabetes and heart disease. Like people with these diseases, people with alcoholism can develop the problem early or late in life. They can have a milder or more severe case. And when they get treatment, they can have trouble sticking to their therapy and relapse, just as a person recovering from a heart attack can have trouble following a diet and exercise regimen. Some physicians have even begun dividing alcoholism into two types, just as they do diabetes. Early-onset alcoholism develops at a young age, may be more severe, have a much greater genetic component and be more resistant to treatment. This typically would be the person who starts drinking as a teen-ager and quickly develops alcohol-related problems. In late-onset alcoholism, genetics plays less of a role and the disease may be less severe and more treatable. This typically would be a person who grows depressed and starts drinking heavily after retirement or after a spouse dies. Learning more about alcoholism helped Jean Fisher deal with her husband, who has now been sober for about 16 years. With help from Al-Anon, she discovered she wasn't the only person living with someone who was alcohol-dependent. She learned to say, ''This is the person I love, but I don't love the behavior.'' ''It's a place to learn about detachment; that's what you do when you separate the person from the disease,'' she said. ''It's very hard to do, but you learn how to do it. You also learn to have compassion for this person who is ill.'' Questions or comments on this site? E-mail us. to top of page © 1997 Guy Gannett Communications HOME | News | Business | Sports | Arts | Viewpoints | Classified | Obituaries | News Archive