Born with a glass in your hand

New research says that addiction is all in the head - literally. CHERRY NORTON on the chemistry that keeps us hooked

Why can one person drink like fish for years and yet never become alcoholic, while for another a tipple or ten can begin the slide into dependency? It is a question that has dogged professionals working with alcoholics for decades and the answers have been diverse: childhood problems; current problems; personality. It's not so long ago that addicts were seen as no more than weak-willed individuals who gave in to their cravings - the cure was to try harder, to toughen up.

Those days are long-gone, however. Recent research, which has led to major breakthroughs in terms of treatment, has focused on the brain and the chemicals within it. Scientists are gaining a new understanding of the causes of addiction. They are able to show that some of us are born with genes that makes us more susceptible to addictive behaviour; that some people have more addictive personalities; that some have a brain chemistry that means that they get more out of drinking, smoking or taking drugs and this encourages them to repeat the experience.

Another change in research terms is that instead of looking specifically at alcohol abuse, what is being studied is addiction. It does not matter whether the addiction is to alcohol, cigarettes, sex or food - research suggests that they have enough in common to be treated in a similar way.

"Research in the 1990s has been proving that all addiction is related to the chemicals in the brain," says Deidre Boyd, editor of Addiction Today, and author of Addiction: Your Questions answered. "Serotonin and dopamine are the main ones. These are the feel-good chemicals - they make people feel happy. Levels can be reduced by any traumatic event - bereavement, divorce or abuse - and the neurochemistry can change forever. People who become addicted to certain substances are subconsciously trying to boost the levels of these feel-good chemicals."

It was only at the end of the 1980s that people started treating drug and alcohol addicts together, she says. "Research has shown that alcohol acts like a drug. If you have a particular chemical imbalance then alcohol can mimic heroin, morphine or valium - taking alcohol gives you a range of drugs in your brain chemistry. Food and sex addiction are also related to the levels of serotonin. At one level all addictions are the same."

By combining clinical and neuroscientific research, doctors have opened up a new era of treatment that looks at addiction, how it is reinforced, dependence and the affect it has on the brain, and attempts a more holistic approach. Instead of being forced to go cold turkey with a sudden withdrawal of the drug, addicts are being given replacement chemicals. Drugs have been developed to block cravings, and behavioural as well as psychological therapy is used.

The market for nicotine patches, gum and inhalers has grown dramatically - it is no longer seen as essential for smokers to go through a gut-wrenching withdrawal. Scientists have made similar breakthroughs in treating alcoholism by mimicking natural chemicals in the brain in order to control cravings and reduce the pleasure induced by a gin and tonic.

But addiction is not just about a chemical or physical susceptibility to certain drugs. Addiction counsellors believe people also abuse drugs for emotional or psychological reasons that may not be obvious. "It can be to hide or suppress a pain or memory such as grief that you are not aware of or have forgotten," says Ms Boyd. "Injecting someone with a drug that will stop them craving alcohol only partly helps. Unless you address the psychological and emotional side, the person will look for some other addiction to fulfil the same purpose. Until it gets out of hand and starts destroying the person, addiction does serve a purpose."

In Britain, alcohol is second only to smoking as the biggest cause of avoidable death, with an estimated one in 25 addicted to it. Nearly one in 10 male drinkers and one in 20 female drinkers has an alcohol problem, showing at least two physical or psychological symptoms of alcohol dependence.

Research published last month showed that some people might have a natural chemical in the brain that promotes alcohol addiction. Without the chemical, the mice in the study showed 75 per cent less interest in drinking alcohol compared to ordinary mice, which like humans can become habitually dependent on drink. The finding paves the way for new drugs that could prevent the initial addiction.

Last year a pill that takes the buzz out of drinking alcohol was launched in Britain. Naltrexone, which the manufacturers claim has a 80 per cent success rate, is designed to help heavy drinkers control their alcohol intake as well as help those who want to give up drinking completely. The once-a-day pill works by blocking the effects of alcohol on the pleasure receptors in the brain. When someone taking the drug drinks alcohol, the effects are not as pleasurable and so cravings for it are weakened, thereby preventing repeat behaviour that could reinforce the habit.

"No one is born an alcoholic," says a spokesman for the ContrAl Clinic, which has introduced the new treatment. "Drinking is gradually learned. Each time you drink, endorphins, chemicals that give you pleasure, are released, reinforcing the drinking behaviour. This happens to everyone but in some people, because of their genetic make-up and life experiences, it gets so much reinforcement that their drinking gets too strong."

Professor Griffith Edwards of the National Addiction Centre, in London, says that addiction is a strong habit that is reinforced by social deprivation, poverty and supply. "The more the drug is available the more people will use it and the more they will use it continuously and heavily," he says. "Addiction is both a biological and psychological dependence. It represents the coming together of body and mind. But some drugs are more addictive than others. Nicotine is highly addictive - someone only needs to be exposed to it for a short amount of time to become dependent."

Amanda Sandford of Action for Smoking for Health says that after a report by the Surgeon General in the US - the equivalent to Britain's chief medical officer - methods used to stop smoking were radically changed. The report, which looks at the pharmacological basis of tobacco addiction, found that tobacco usage was similar to drug addiction. People who stopped smoking experienced sudden withdrawal and neuroscientific research began to show the effects of nicotine in the brain and showed why it was so difficult for people to give up smoking.

"Before, people just thought will-power was required," says Ms Sandford. "It was not accepted that smoking was addictive. However the emerging research has shown that it is not just physically but also behaviourally addictive. At a simple level, people who give up smoking are often at a loss of what to do with their hands. Those who give up smoking using nicotine replacement patches or gum, are twice as likely to succeed to those who just stop."

In Britain 12m to 13m people smoke and at any one time three quarters express a wish to stop, but only 2 per cent a year manage it. Perhaps the best measure of these breakthroughs in research will come when that figure improves.