SPECIAL REPORT

THE BATTLEFIELD OF ADDICTION

Science and treatment offer some hope for people trapped by alcohol and drugs

D'ARCY JENISH July 19 1993
SPECIAL REPORT

THE BATTLEFIELD OF ADDICTION

Science and treatment offer some hope for people trapped by alcohol and drugs

D'ARCY JENISH July 19 1993

He is polite, articulate and well-dressed. He has a job at city hall in Toronto and money in the bank. He and his girlfriend share an apartment and a close relationship. For 41-year-old Eric, the job, the savings and the relationship are major accomplishments, if not minor miracles. Three years ago, after half a lifetime of smoking, drinking and injecting drugs daily—and using morphine and alcohol to endure withdrawal—Eric had become severely addicted. For years, he had distributed drugs, hung around with prostitutes and pushers, and carried a gun to protect himself. “Of all the drugs I did over 23 or 24 years, cocaine took me to my bottom,” he said. “I could never get enough of it. I was totally morally bankrupt.”

On his harrowing downhill slide, Eric had plenty of company. Year after year, thousands of Canadians cross the line between social drinking and alcoholism, between taking an occasional sleeping pill and handfuls of them, between normal living and the endless nightmare of addiction to mood-altering chemicals of one kind or another. But at the same time, medical researchers in Canada and the United States are beginning to understand how chemical addiction affects the brain—findings that one day may have clinical application. Rehabilitation centres are employing new and promising methods of treatment for substance abuse. But perhaps even more significant in the battle against alcohol abuse are recent surveys showing declines in the number of Canadians who drink, how many are categorized as alcoholics and the nation’s overall consumption.

Although most Canadians do not become hooked on alcohol or drugs, those who do, like Eric, inflict incalculable damage on themselves, their families, their employers and the nation’s health and social services. Addicts out of control usually wind up sooner or later in hospital emergency departments, detox or treatment centres, jails or mental institutions. Every year, thousands die—by suicide, on highways, from exposure, of alcohol-induced cirrhosis of the liver or drug-induced brain seizures. Yet hundreds more, prepared to seek help, do recover. For many, the road back has led them to Alcoholics Anonymous, which this year is celebrating its 50th anniversary in Canada, to Narcotics Anonymous or elsewhere in the panorama of self-help groups. Some respond to psychotherapy, some to religion.

Still others, also like Eric, combine professional treatment and selfdiscipline. But like every addict who overcomes dependence, Eric first had to hit a personal bottom—physically, emotionally, psychologically and spiritually. He reached that bottom, he recalls, in the fall of 1990 during a tearful conversation with his younger sister, who convinced him that either cocaine or his companions in the drug trade were going to kill him. “I was totally out of control,” says Eric. “It was only a matter of time before I was dead.”

Despite the well-publicized notoriety surrounding such drugs as cocaine, and its lethal derivative known as crack, alcohol abuse remains a far larger problem than addiction to street drugs or to such prescription medications as barbiturates and sedatives. A national drug and alcohol survey, done for Health and Welfare Canada by Statistics Canada and published in 1990, showed that Canadians spend about $10 billion a year on alcohol. The survey also estimated that almost 80 per cent of Canadians aged 15 and over drink alcohol. In 1989, Ontario’s Addiction Research Foundation (ARF) estimated on the basis of trends in deaths from cirrhosis that there were close to 477,000 alcoholics in Canada, down from nearly 623,000 a decade earlier. Other estimates range as high as two million.

Nobody knows even roughly how many Canadians may be addicted to illicit and prescription drugs. The Health and Welfare survey found that cannabis (marijuana and hashish) remains the most popular street drug among Canadians. Almost one-quarter of 11,634 people aged 15 and over who took part in the national survey had used the drug at some time during their lives, and 6.5 per cent were current users. The survey reported that only 1.4 per cent of the respondents currently used cocaine or crack. Less than one per cent were using the hallucinogenic chemical LSD, amphetamines or heroin. But at the same time, almost 21 per cent of those surveyed had recently used mood-altering prescription drugs.

By almost any measure, the social costs of excessive alcohol and drug consumption are enormous. Every year, substance abuse directly or indirectly leads to thousands of deaths. The ARF reported that in 1989, the latest year for which national figures were available, 3,062 people died from diseases directly related to alcohol consumption, such as cirrhosis. Alcohol was also involved in almost 16,000 other deaths in fires, motor vehicle accidents, acts of violence and other incidents. There were 428 deaths directly attributable to drug use. In Alberta, the Alcohol and Drug Abuse Commission (AADAC) reports that alcohol is a factor in about 80 per cent of the province’s domestic disputes. Moreover, substance abuse imposes a huge financial burden on the Canadian economy—according to the ARF, almost $34 billion annually (or five cents out of every dollar of wealth generated by the entire country) in extra health care, policing and lost productivity.

In an attempt to address the consequences of active addiction, companies across the country are introducing what have come to be known as employee assistance programs. Shell Canada Ltd. established a full-scale program at its Calgary headquarters in 1983 and four years ago, in defining its alcohol and drug policy, rejected employee testing and assured workers with dependency problems that they could expect assistance “without fear of discrimination.” Shell’s consultants have found that alcohol abuse ranks second behind work-related stress as the most common problem among 5,500 employees.

David Chisholm, manager of Shell’s occupational and environmental health department, said that “we believe alcohol is a bigger problem than all other drugs.” Although mandatory drug screening is uncommon in Canada, Transport Canada has prepared draft legislation to require compulsory drug testing in four federally regulated transportation sectors: marine, aviation, rail and trucking.

Drugs and alcohol also play a major role in the commission of crime. Since 1990, the Correctional Service of Canada, the federal agency that runs the country’s penitentiaries, has studied the pre-prison living habits of every inmate entering the system. John Weekes, a research manager for the Correctional Service, said that the studies show that more than half of the 5,500 individuals given penitentiary sentences since 1990 used drugs or alcohol on the day they committed their crime. More than two-thirds entered prison with drug and alcohol problems that required professional treatment.

Addiction can develop from prolonged use of alcohol or experimentation with street drugs. It can also begin with a visit to a doctor’s office. Norma, a forty-something mother of two and the wife of a small-town Ontario doctor, began suffering severe migraine headaches after an operation in 1970. Her doctor prescribed Fiorinal, a painkiller containing codeine. Fiorinal relieved her headaches but it made her feel overly energetic and euphoric. Norma said that she began taking the drug even before she experienced any migraine symptoms. Her consumption grew from the prescribed three pills a day to 14. She developed a dependence on the drug that lasted for 20 years.

According to many experts in the field of addiction research and counselling, female dependence on drugs or alcohol is a huge but largely hidden problem. Treatment centres have only begun in the past decade to design programs for women. Women are more likely to keep their alcoholism or drug addiction hidden for a number of reasons. For one thing, the experts say, they tend to experience more fear, shame and guilt than men. Many are also afraid that social service agencies or the courts will take their children away. “There’s a lot more female alcoholism out there than we think there is,” said Lucille Toth, director of development and public relations for the Renascent Centres, an organization that operates three treatment facilities in the Toronto area. “We just don’t know about it.”

A woman called Amy is perhaps typical. For almost 20 years, she was a closet alcoholic who concealed her drinking from everyone but her immediate family. A former teacher and the mother of two grown children, Amy lives in a suburban community west of Toronto. She took her first drink in her early 20s, then gradually progressed from social drinking to occasional binges to daily consumption—as much as a 26-ounce bottle of vodka and a dozen bottles of beer—most of it at home. “I had to have the drink,” she recalls, “no matter about the fights with my husband and children.”

One of Amy’s few public displays of drunkenness convinced her she had hit bottom and had to quit drinking. At mid-morning on a chilly fall day in 1990, while supervising six children in the school kindergarten, she became desperate for a drink. She got the youngsters dressed and took them to a nearby shopping centre where there was a liquor store. She bought them snacks at a fast-food restaurant and left them at a food-court table while she slipped into the liquor store for a bottle of vodka. By noon, she was visibly drunk and had to be removed from the school by her daughter. She subsequently spent a month in a treatment centre and has been a sober member of AA ever since.

But the emergence of more female addicts is only one of the shifts that have occurred in the ranks of those entering treatment programs. Addiction counsellors say that over the past decade they have been seeing more young people and more patients generally who are addicted to both drugs and alcohol. Dennis James, director of the health recovery program at the Donwood Institute in Toronto—the first publicly funded hospital in Canada devoted solely to treating substance abuse—said that, in that time, the average age of patients has dropped to 35 from 42. Ten years ago, 75 per cent of Donwood’s patients were exclusively alcoholics; now, only 45 per cent are. The rest are addicted to other substances as well.

Characteristic of that trend is a construction company supervisor named Geoff, who lives in a medium-sized Ontario manufacturing city east of Toronto, who was addicted to both alcohol and cocaine. In his early 30s and the father of two preschool children, he had become what addiction experts define as a “poly user.” Geoff, who spent 28 days in a Toronto-area treatment centre in the spring, started drinking at age 15 and four years ago began using cocaine. Geoff’s final binge occurred shortly before he entered treatment. He got up on a Thursday morning, phoned his employer to complain of illness and by noon was in a local bar. He and a couple of friends woke up in jail on Saturday morning in a small town in New York state across the St. Lawrence River from Gananoque, Ont. They were escorted to the border and were back in a bar on the Canadian side by early afternoon. “I didn’t know how I’d got there or what had happened,” he said.

For every alcoholic and drug addict who overcomes his or her problem, several others fail and many never even try. And those who seek treatment represent only a small minority of the addicted population. Brian Rush, the ARF’s head of treatment systems research and development, said that U.S. surveys have consistently shown that only 10 to 15 per cent of those with alcohol or drug problems come forward asking for help. Applied to Ontario, where about 75,000 people seek some form of treatment each year, those percentages would suggest that the province has as many as 750,000 people with addictions—more than seven per cent of the total population. Those determined to overcome their dependence generally apply for admission to a structured program, which can involve weekly counselling sessions, or a 28- to 40-day stay in a treatment centre.

An alternative is the 12-step recovery program offered by Alcoholics Anonymous. Indeed, most residential treatment centres now encourage clients to regularly attend meetings of AA or similar organizations. Patients are strongly urged to continue those affiliations after they are released. AA, the oldest of the self-help groups, was founded in Akron, Ohio, in 1935, following an encounter between a hard-drinking physician and a recently sober New York stockbroker—who, although deceased, remain anonymous in keeping with the philosophy of the program. The broker had discovered that his compulsion to drink was overcome so long as he tried to help other alcoholics by sharing his experiences with them. AA now estimates that it has about 2.2 million members worldwide. The first AA group in Canada was formed in Toronto in 1943. There are now 5,275 groups across the nation, with a total membership of about 95,000.

A loosely structured fellowship, AA has only one requirement for membership: a desire to stop drinking. Members are encouraged to attend AA meetings and follow a program of 12 steps, the first of which is to admit that “we admitted we were powerless over alcohol, that our lives had become unmanageable.” The steps also suggest that members make “a searching and fearless moral inventory of ourselves,” and make amends directly to all those harmed by their drinking. Joe C., a 73-year-old retired Toronto businessman, said that he joined AA 48 years ago and still attends meetings, for “peace of mind and serenity.” Associated with AA, but functioning independently of it, are two organizations devoted to helping family members cope with the emotional turmoil of having lived with an alcoholic. The Al-Anon Family Groups for spouses were first organized by the wife of one of AA’s co-founders. Alateen, formed more recently, offers help to the children of alcoholics. Members of both groups apply AA’s 12 steps as a way to deal with what the science of addiction calls “co-dependency”—the pervasive and victimizing compulsion among family members to shield an alcoholic in their midst, often for years, from the consequences of his or her actions.

AA makes no claims about its success, and professional addiction counsellors are equally reserved about how well their techniques work. They contend that it is difficult to assess the effectiveness of treatment because many patients fail to complete prescribed courses, others only achieve temporary sobriety and some lapse back into their addictions several months or even years afterward. Garth Martin, assistant director of the ARF’s Clinical Research and Treatment Institute, claimed that, as a rule, one-third of those who enter a program will achieve complete abstinence or sharply reduce their use of drugs or alcohol. Another third will cut back but continue to have problems. And one-third, said Martin, show no improvement at all.

Most counsellors agree that treatment works best when an individual recognizes his problem early in his addiction. They also claim that a middle-aged alcoholic with a stable family, job and community life is more likely to overcome a dependence than someone younger from a disrupted social background. Dr. David Korn, president of Toronto’s Donwood Institute, said that many youthful drug addicts must be taught basic life skills because they are poorly educated, unemployed and have never formed lasting relationships. However, Dr. Graeme Cunningham, director of alcohol and drug services at the Homewood Health Centre in Guelph, Ont., said that the results of short-term treatment among people addicted mainly to street drugs “are abysmal.”

People addicted to street drugs, particularly those who began using them in their early teens, have social and emotional problems that must be addressed along with their substance abuse. Donwood’s James said that they usually have difficulty resolving conflicts, tolerating criticism or expressing feelings. “If someone starts using chemicals early, it influences their learning capacity and ability to form relationships,” said James. “Many have limited social skills and a limited ability to tolerate differences in other people. They become angry and frustrated easily.”

In the scores of treatment programs across the country, the central element in most is to have the alcoholic or drug addict talk candidly about his dependence, either with a counsellor, or with fellow addicts. AA also emphasizes the healing power of open, honest disclosure. In addition to closed meetings for members only, the organization holds some meetings that are open to the public, at which a recovered alcoholic talks about his or her experiences.

Group therapy sessions, led by a treatment centre addiction counsellor who guides the conversation, can be a powerful experience for an individual addict, said Cunningham. Many addicts spend years feeling lonely and isolated, he said. They usually abandon social and recreational pursuits because alcohol or drugs have come to dominate their lives. They alienate spouses and children and become consumed by fear and shame. “Isolation is the core of addiction,” Cunningham said. “The key to beating the addiction is to smash that isolation. It takes incredible courage for many of these people to speak publicly for the first time about themselves in front of a room full of strangers.” If there is one reason for optimism in the shadow of addiction, it is that Canadians are drinking less than they were a decade ago. Some of the havoc caused by excessive drinking is also declining. Figures published by Statistics Canada reveal that although 111,300 people were charged with impaired driving in 1991, that total was a 31-per-cent decrease from 1981. During the same period, drug use among young Canadians also showed a sharp decline.

Still, thousands of Canadians remain tormented by their addictions. For many, life is a vious cycle of consumption, sickness and depression and renewed craving for alcohol or drugs, or both. Experts concede that, despite all the research on the subject and the prevalence of treatment programs, addiction remains a baffling phenomenon. There is no reliable way of determining who is likely to become an alcoholic or drug addict. And most addiction counsellors readily admit that they can never predict who will beat the problem and who will succumb to it. For those who don’t make it, addiction to chemicals—in bottles, pills or needles—promises an inevitable downward slide to an institution. Or oblivion.