Pubdate: Sat, 28 May 2011 Source: Victoria Times-Colonist (CN BC) Copyright: 2011 Times Colonist Contact: http://www2.canada.com/victoriatimescolonist/letters.html Website: http://www.timescolonist.com/ Details: http://www.mapinc.org/media/481 Author: Bill Cleverley And Richard Watts, Times Colonist MOST AREN'T TREATED FOR ILLNESS, DOCTORS SAY For doctors, an addiction is an illness. It comes with identifiable symptoms like an illness and it responds to specified and well-documented treatments like an illness. And it also comes with a strong genetic component. "Addiction is a broad spectrum illness," says Victoria addiction specialist Dr. Chris Fraser, medical director of the Cool Aid Community Health Centre on Johnson Street. "It is analogous to cancer in terms of the varieties and heterogeneity of causes and heterogeneity of treatment approaches." Medically speaking, he says, addiction can be regarded as a disorder of the functioning of the brain. The substance's mood-altering properties hijack the brain's ability to discriminate and make sound choices. "The choice to use a substance is lost and it becomes a compulsion," says Fraser. "We speak in addiction medicine of the Cs of addiction: The Compulsiveness of it, the loss of Control over it, the Consequences of it." And those consequences -loss of career, family, health and dignity - -will worsen as the illness progresses, making treatment more difficult. Unfortunately, most people suffering don't get treatment, says Dr. Mel Vincent, director of psychiatric services for the Edgewood, a private treatment centre in Nanaimo. They just get sicker and sicker. "They may not even realize they have a problem -denial being what it is. Most addicts hope that they can change it, or think at some point they'll get it under control, but they keep going until some crisis comes along that is the wake-up call. They lose a job. The wife leaves. They're bankrupt. They get charged legally or something happens and they say: 'Whoa! Hold it we have a problem here,' " Vincent says. "Before that they continue to get sicker and sicker and sicker, and their denial goes up in parallel with that so they actually have a blind spot for how sick they are actually becoming." Often they aren't the only ones in denial. If a man is diagnosed with multiple sclerosis or cancer, his spouse might turn to neighbours for help and support. With alcoholism or addiction, however, the spouse would more likely keep it a secret, says Neal Berger, executive director of the private Cedars treatment facility in Cobble Hill. The reaction is not necessarily unjustified. In its national report card on health care in 2008, the Canadian Medical Association cited survey results that only 32 per cent of Canadians say they would be likely to socialize with a friend who has an alcohol addiction; that falls to 26 per cent for a drug addiction. Only four per cent would hire someone who has an alcohol addiction, and only two per cent would hire someone with a known drug addiction. Yet, as Berger points out: "No one that I knew ever decided to be an alcoholic or to develop an addiction disorder." According to the B.C. Medical Association and the Canadian Centre for Addiction and Mental Health, people usually develop an addiction due to factors such as genetics, health, the age of first use, family history and social network. These people find the behaviour of consuming alcohol or doing drugs extremely rewarding -perhap for the excitement or the pleasure, or perhaps to numb them to other physical or emotional suffering. Fraser says he often sees street-level substance abusers, people who have lost everything and live from hand to mouth. A diagnosis of addiction is easy for these people, but the treatment will often be hugely complex. Fraser said severe addicts who have been abusing substances for several years are probably abusing more than one substance. They also have a high risk of other chronic illnesses, such as hepatitis C, transmitted though sharing needles. And if they are living on the street or close to it, they will not have supportive families or friends. Street-level addicts are also more likely to have mental illnesses, such as bipolar disorder, which will require diagnosis and treatment. Schizophrenics, for example, can often be easy victims for stimulant substances like cocaine or methamphetamine. Meanwhile, addicts in the middle-class or with high incomes can be much more difficult to diagnose, although ultimately easier to treat, says Fraser. These addicts are more adept at hiding or disguising an addiction, but then show up at the doctor's office with gastro-intestinal disorders. High-functioning addicts are typically habitual abusers of alcohol or marijuana. "It's a rare early morning jogger or exerciser in the city of Victoria who hasn't smelled cannabis coming off the cars of construction workers who are headed for the trade sites," says Fraser. "Anybody who uses cannabis at 8 a.m. as their 'get you going' is definitely showing signs of addiction." Higher income addicts, once diagnosed, are motivated to get help. They have more to lose in terms of income and social status, and they tend to have better support systems and fewer social problems. "They often have access to paid counselling, paid treatment and recovery programs; they have supportive family members, supportive partners, children," says Fraser. "They have people who are going to be there and take the extra steps and extra efforts." B.C. has far more middle-class addicts than street-level ones. The 2009 B.C. Medical Association report, Stepping Forward: Improving Addiction Care in British Columbia, said about 400,000 British Columbians have some form of substance addiction or dependence problem, not including tobacco. Estimates peg B.C.'s homeless population at about 12,000 people. Of the 400,000, only about 33,000 have a serious dependence on illicit drugs. Most suffer from a dependence on alcohol -and our use of alcohol seems to be rising. In 2008, the provincial health officer estimated health and enforcement costs exceeded revenues from alcohol sales by $61 million in 2002-03. That report showed consumption had increased about eight per cent since 2002, with consumption rates growing in particular on Vancouver Island and in the Interior. Still, the percentage of those with a substance dependence seems to be holding steady, says Rob DeClark, director of programming for Cedars. A disturbing trend, however, is the younger age of people with addiction issues. "What we're seeing now is earlier onset. We're getting phone calls now about 14-, 15-, 16-year-olds who have been using hard drugs for three years," DeClark says. THE SERIES Sunday Public vs. private treatment: If ever there's been a clear example of two-tiered health care in B.C., it's in treating alcoholism and drug addiction. Tuesday The rise of harm reduction: From a safe injection site in Vancouver's Downtown Eastside to Victoria's former troubled needle exchange on Cormorant Street. - --- MAP posted-by: Richard R Smith Jr.