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Dr. Quirion: Unfortunately, it is still not possible to visualize clear differences between such conditions in a given individual. A large group of individuals must be studied and an 'average' image generated. Individual differences are great as they are in term of genetic predisposition. However, it is rather clear that crack interacts with the brain dopaminergic system, hence altering the effectiveness of the medication.
bruce weaver from Canada writes: I have always thought if you can quit something how can it be an illness? I know people who were alcoholics who quit. I knew someone addicted to crack cocaine who quit. My uncle was a schizophrenic. He couldn't quit he was like that the rest of his life. Surely there is a difference between an addict and someone with a true mental illness?
Dr. Quirion: Good question. Schizophrenia is an extremely difficult disorder to manage. As to quitting, yes one can 'quit' the habit of smoking, drinking alcohol, etc..but often such a person is highly at risk and often only considered in remission having to refrain himself from social conditions associated with substance use potential.
Scary Fundamentalist from Vancouver, Canada writes: If people are really predisposed towards a particular addiction (believe it or not, I actually agree with this), would the addiction never happen if they were never exposed to the substance in question?
Dr. Quirion: Hmmmm, I like fundamentalists, especially if they are from beautiful Vancouver! Well hard to tell for sure but likely yes..but of course, rare that a given person is only predisposed to one addiction. Often, it is overall sensitivity to various forms of addiction that is increased, not to a single addiction making it much more difficult to avoid exposure.
lindapc foothills rocky mountains from Canada writes: This is not a shocker to the average parent that has watched their child spiral on a course of insanity while being addicted to alcohol, drugs, sex and or gambling. For a great many years, I have been hearing how addictions are a result of mental illness, now it comes out that that is the reality.
So, what can anyone do for the people that have genuine mental illness, documented, quantified by a physician; in regards to the addictions?
Will there be more facilities built to supply help to those individuals that may require more intense treatment in the area of mental health/addictions?
Dr. Quirion: This question relates to a lot of discussion and exchanges over the past week in the G&M. Canada must ensure better access to care for all suffering from mental illness, addiction, etc. Much work ahead of us all.
Sue City from Canada writes: Another excuse for people to not take control of their lives. I've dealt with an addiction and I worked hard to overcome it. If I could've leaned on the 'I am sick, therefore, I am helpless' idea, I might not have beaten it. Though, chronic and abusive addiction (ie. hard-core junkies, binge drinkers) may not have the required willpower as they are truly living inside the allegory.
But, are we only talking substance addiction here? What about sex addicts, pedophiles, rapists? Will they use this as a defense? 'I couldn't help myself. It's in my genes.'
Dr. Quirion:Well one can argue that this could apply to heart diseases, diabetes, and even cancer! We often do know what we need to do (exercise everyday, eat well, etc) but we do not do it..some are better than others at that and can beat it but certainly not all. A lot is in our genes but in most cases this is only part of the story.. environment being the real trigger leading to the disease. Again, I would argue that in most cases of addicted behaviours, one can manage it, but it not really cured, it is only in remission.
haron wickman from Winnipeg Canada writes: I am interested in Dr. Quirion's view on harm reduction and addiction.
Dr. Quirion: Harm reduction is not a magic bullet and through innovative research we hope to be able to find more effective means to treat various addictions in the future (vaccines, etc). However, harm reduction programs have often proven to be effective particularly to reduce risky behaviours associated with certain forms of addiction (needle exchanges spreading the risk of HIV transmission).
Christine Diemert, globeandmail.com: Should all addicts be treated as some with a mental illness, or are there exceptions?
Dr. Quirion: Good question and no easy answer..what we can say is that addictions are brain disorders. Some addictions are much stronger than others but apparently all act by stimulating what is known as the reward pathway of the brain. The reward pathway is critically important to promote normal food intake, sexual behaviors etc..but this pathway is apparently highjacked, in varying degress, by rewarding substances and behaviors from gambling to heroin!