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Heroin addiction and dependence on other narcotics, or substances such as alcohol, cannabis, amphetamines, cocaine and prescribed medications, are almost never primary conditions. They are nearly always secondary conditions, the result of Pre-existing, Underlying, physical, chemical, mental or social problems.

To talk about alcoholism or heroin addiction and the treatment of alcoholism or heroin addiction, without discussing the Pre-existing Underlying Factors that lead to the abuse of these substances, is very common and totally counterproductive. Success in detoxification is much less likely, and relapse back to substance abuse is much more likely, if the Underlying Factors are not discovered and successfully treated. Substance abuse is like any other health problem - its treatment must be determined by the diagnosis. "Heroin Addiction" is not a complete diagnosis. The Pre-existing Underlying Factors/ Conditions are the main diagnosis. They must be discovered so that they can then be treated appropriately. To be effective, the diagnosis of the Underlying Factors and their treatment, must commence at the same time as the assessment and treatment of the addiction.

Seeing 50 or 60 patients a week in my drug and alcohol practice has led me to the conclusion that The Pre-existing Underlying Factors/ Conditions in the vast majority of heroin addicts, alcoholics, amphetamine, cannabis and prescribed medication abusers, in order of frequency, are:

1. ADD (Attention Deficit Disorder) is very common.

2. Unresolved Traumas and Stresses are very common. e.g. verbal, physical or sexual abuse in childhood, deaths in the family, family breakdowns, horrendous motor vehicle accidents, immigration, moving house and school too often, war experiences, serious illness etc.

3. Depression is very common. Manic Depressive (Bipolar) Disorder.

4. Anxiety and Panic Disorders are common. Social Phobia and Agoraphobia

5. Insomnia and other Sleep Disorders.

6. Chronic Pain Including Headache, Painful Diseases (e.g. Pancreatitis), Motor Vehicle, Industrial and Sporting Accident Induced Pain.

7. Intolerable Circumstances in the present (violence, relationship breakdowns, financial disasters, accidents, unemployment, problems in the family, at school or at work and collisions with the law, including court appearances and jail.)

8. Being often in a Drug Environment in which there is exposure to people using drugs, easy availability of drugs, exposure to drug pushers, peer pressure or an addicted partner.

9. Lack of Purpose in life, boredom.

10. An Unstructured Life, lack of boundaries, responsibilities or work.

11. Social Slackness or weakness in the individual, the family or the environment he grew up in. Self-indulgent people who will try anything or do anything that might gratify them, regardless of possible consequences. This is an uncommon cause of addiction, even though it is often thought to be the main cause.

12. Serious Sexual Problems, including Sexual Identity Conflict and the fear of "coming out".

the commonest cause of substance abuse and addiction is ADD banner

ADD is the main cause of someone's addiction, but the ADD is not discovered and treated, the health care professionals involved might almost as well not start to treat the addiction. The addiction will keep recurring again and again. If the addiction is to heroin, overdosing will be a danger during these repeated treatments. Each time the addict gets off the heroin, which has been controlling the ADD suffering, that suffering will flare up again, causing the addict to again seek relief through cannabis, street amphetamines and then heroin.

It is a chemical disorder of the brain. We have approximately 140 different chemicals in our brain and it is believed that ADD is caused by inheriting faulty genes, which result in faulty regulation of the supply of four of the most important brain chemicals. They are Dopamine, Adrenalin, Noradrenaline and Serotonin.

These abnormalities give rise to a vicious cycle of poor functioning, discomfort and distress and the use of drugs to try to boost performance and relieve distress. Those drugs usually cause more problems than they solve, thus putting the ADD sufferer into ever increasing distress and trouble.

Although the different aspects of ADD vary in degree from person to person, the common pattern is as follows.

There is poor attention, focusing or concentration. This leads to learning difficulties and a poor education.

There is a disturbance of activity, usually overactivity and hurrying (Attention Deficit Hyperactivity Disorder, or Attention Deficit Hurry Disorder, or ADHD); but sometimes resulting in underactivity, boredom, daydreaming, slowness, dawdling and lack of motivation, with difficulty in getting started and a tendency to procrastinate (Attention Deficit Daydreaming Disorder or ADDD). This activity disorder may result in problems in the classroom. The child cannot stop talking, fidgeting or moving around, distracting his classmates, aggravating his teachers and perhaps becoming the class clown; or he/she may sit quietly in the corner of the class daydreaming, be neglected and fall behind. The family may be driven mad, and relationships be strained or damaged, because of the hyperactivity and impatience, or because of failure to achieve and to contribute. Employment is very difficult, with poor performance, friction with employers and workmates and frequent dismissals, resignations and periods of unemployment.

There may be a strong tendency to impulsivity, with knee jerk reactions and snap decisions, some of which are too quick to be the best.

There may be a strong tendency to impulsivity, with knee jerk reactions and snap decisions the norm, often resulting in mistakes, regrets & overuse of credit cards or even shoplifting.

There are often problems with time. ADD people are often very impatient and 5 minutes may seem or be an impossible length of time for them to wait. On the other hand they may get so involved in things that they don't notice the hours going by, miss meals, neglect other duties and forget appointments. Appointments are very hard for ADD sufferers to make and to keep. They often can't come to grips with making an appointment with a psychiatrist who has a six week waiting list. They often have difficulty with things that require planning ahead.

The net result of all this is that education and performance is poor, relationships are strained, there may be difficulty in getting or keeping a job and certainly in developing a satisfactory career, and the suffering and distress involved may mean that the person seeks relief in various types of social, prescribed or illegal drugs. This tendency to substance abuse is so common that ADD sufferers are sometimes said to have an "addictive brain". Research recently showed that treatment of primary school ADD children with Dexamphetamine or Ritalin, reduces their chances of substance abuse in adolescence by 85%.

It is our finding, confirmed by independent psychiatric assessment in most cases, that at least 60% of the heroin addicts I see in my clinic are ADD sufferers, mostly ADHD sufferers, but also a significant number of ADD sufferers.

1. Reducing the chemical abnormalities by the use of Dexamphetamine or Ritalin, which have a normalising effect rather than a stimulating effect on ADD sufferers. Dexamphetamine and Ritalin are difficult to obtain because both the public and the authorities have tended to lump them together with other dangerous black market amphetamines such as Speed and Methamphetamine and to overlook the fact that ADD sufferers have unusual chemistry. One man's poison is literally another man's medicine with ADD. In most developed countries the baby has been thrown out with the bath water. Much damage is being done to innocent people by regulations which were introduced to protect the population against addiction, but which are based on faulty generalisations that cause a very vulnerable section of the population, who don't have the resources or the capabilities to get proper medical attention and pharmaceuticals, to use dangerous and unsatisfactory alternatives from drug dealers.

2. E.E.G. Biofeedback if available and affordable.

3. Any other concurrent substance abuse must be effectively diagnosed and treated.

4. Any other disturbances such as depression, anxiety, social phobia or relationship or family breakdowns, that coexist with or have been brought on by the ADD, must be dealt with.

5. Assessments should be done to define the gaps in the sufferer's education, caused by their inattention and inability to focus/concentrate and their behaviour problems and strained classroom relationships, during their school years. Supplementary education should be used to fill in the gaps and complete their education.

6. Training will be needed to make use of their new ability to focus/concentrate, read and study and their normalized energy/activity, in preparing for employment and a career.

7. If legal Dexamphetamine or Ritalin is not available (which is the scandalous situation that exists in Perth for any adult who cannot afford to consult a private psychiatrist) then Epilim (Sodium Valproate), serotonin boosters and tricyclics will usually have some beneficial effect. The alternative is black market Dexamphetamine or Ritalin, taken in the morning by mouth, regularly and in small amounts. Black market Dexamphetamine or Ritalin is a far safer and better choice than intravenous street amphetamines, heroin or cocaine, if a sufferer has to make do with self medication for a period.

In Western Australia the only free public clinic that diagnoses and treats ADD is the children's hospital. Family doctors, even if they are experts in drug and alcohol medicine, cannot prescribe stimulant therapy. This means that penniless addicts have to go without proper treatment and usually self medicate dangerously, using cannabis, intravenous street amphetamines, heroin, morphine, or cocaine, at a cost that causes poverty and crime and brings the risks of Hepatitis B and C and HIV.

Because of some of the genes many of us carry, a proportion of our babies are born with genes that inevitably lead to unusual chemistry, which almost inevitably leads to conditions (ADD, depression, anxiety etc.) that in turn almost inevitably lead to distress, poor performance, social problems, substance abuse and dependence and great social cost. Fortunately today we have the capability to correctly diagnose & treat those conditions, although unfortunately it often doesn't happen.

Until the healthcare professionals, the public generally and the authorities in this field, understand and act on ADD, this whole sequence will continue to occur and drug addiction, the drug world and the drug lords will grow and prosper.

We must provide reasonable availability of chemicals that relieve these chemically unusual and afflicted people of their distress and disability, without giving rise to the side effects and dangers of the drugs and methods pushed by the criminal world.

We already have the chemicals we need - buprenorphine, valproate, serotonin boosters, naltrexone, dexamphetamine, ritalin, and occasionally lithium, but so far we lack the wisdom and systems to make them reasonably available. Available in ways that are accessible even to people who suffer from the disabilities, dysfunctions and lack of resources of ADD sufferers.

Despite anything anyone may tell you, none of these types of medicine is any more dangerous than dozens of other chemicals your family doctor writes prescriptions for every week. If they were reasonably available, in a way that was accessible to people with the disabilities and dysfunctions ADD sufferers have, there would be very little street trade in any of them. The criminal market for speed, methamphetamine, ecstasy, heroin, morphine, cocaine and cannabis would contract sharply. The pushers and the Mr. Bigs would have to find something else to do. The Criminal Justice, Education and Public Hospital systems would have the pressure taken off them. We would be able to get on with building up the people we are presently causing untold misery and chopping to pieces.