“We can all be Addicts”

Interview with Dr. Hugo España, addiction specialist and toxicologist by Amalia del Cid (first published on La Prensa.com.ni ) –

Addiction is a risk of everyday life, but sometimes we do not understand it. As human beings, almost any human behavior can turn into an addiction, even a passion for soccer, Dr. España explains. In his opinion, this process is not only influenced by our genes but also by our experiences, our emotional voids, as well as certain substances called neurotransmitters, responsible for opening and closing specific "gates" in our brain.

At what point can you call someone an addict?

Obsession, compulsion and denial are the basic elements of the addiction process.

Can you become addicted to something other than drugs?

Of course, addiction can involve almost anything from work to purchasing, including sex, pornography, TV, gambling. To anything and to any situation.

What about Facebook ?

Of course. One can even be addicted to religion! One can fail his own family because of religion. When you can no longer control and mark boundaries , it is a sign of a possible addiction.

Are we all addicts ?

In my opinion yes. But not all of them are considered to be harmful. Sometimes we even manage to control them. When talking to a regular sportsman or woman, one may call his practice a "vice", but he or she is not necessarily addicted . He feels no obsession or craving to buy the latest model of Nike, to watch a Real Madrid game, or to purchase Ronaldo’s latest jersey.

Can one become addicted to the Real Madrid ?

Well, when I lived in Europe, some of my fellow students used to purchase some of the players’ underwear! One day, I was offered a shirt of the Barça soccer club. After I put it on, the first thing I heard was a friend of mine yelling at me from a window, asking if I was not scared to be beaten up should I continue to wear it (laughs). If you can’t control your emotions , you can be addicted to anything.

And how do we know what is our specific addiction?

In the first place, you must consider the compulsion aspect of your behavior. Is it something that wracks your brain on an ongoing basis or not? The second element is compulsion; are you craving for this thing, and does this compulsion translate into reality. Third, is your behavior harmful to you or to the people you love, and do you tend to ignore it (denial)? It may not necessarily be physical damages, it may also be emotional,  financial and even legal damages.

Are there genetic influences on addiction?

Yes, there are, but we don’t want to label people. If someone had told my parents when I was born: "This child will be addicted to alcohol ," my parents would have probably been wary of alcohol, and I could have ended up addicted to cannabis. In general, one should be wary of all possible addictions. Human beings are exposed to it , simply because we all live.

If my father was an alcoholic , can I become an alcoholic too?

It is said that we have, genetically, a ten percent chance to become addicted to the same substances as our parents. Well, it leaves us 90 percent. This ten percent risk is a reality, but actually becoming an addict or not will largely depend on how I grew up, how I’ve been educated, the experiences I had at home, the friends I had etc.  Of course there is a risk , but that does not mean it will become a reality.

And if my mother was a shopaholic ?

Well, there is some chances you will too develop a compulsive buying disorder. Parents teach their children their own habits, their own ways. If my children have never seen me drink, If have endeavored to educate them about alcohol related risks, or about safe sex for example, it will decrease the likeliness to see them engage in such behaviors. Although there still is a possibility for them to become addicts. Ultimately, these decisions will belong to them, but at least they’ll be able to rely on what we taught them.

Can we all become addicts?

Yes we all can.

On what basis ?

On emotional voids. You may feel that there’s something in your life, at home or deep inside of you that does not satisfy you. This void leads you to an ongoing search for pleasure and happiness. Drug users do not necessarily seek self-destruction – although some do, in particular those facing severe mental or psychological problems – most people desperately seek a better, wonderful self.

How does this work?

Our brain function is regulated by molecules called neurotransmitters. These molecules can accentuate thought processes, joy, elation, but also fear and anxiety.  If you are told: “You will soon get an increase”, our brain will release specific neurotransmitters increasing a feeling of joy. On the contrary when you are told bad news (“Your car’s been stolen”), another type of neurotransmitter will be liberated, boosting a feeling of sadness.

And …?

Your brain will open additional valves. If I’m happy, my brain will open a number of “valves”, which will then close again, naturally. In contrast, drugs over-stimulate and flood your brain with excess chemicals, forcing “valves” to remain wide open even when you stop using for a few hours. The addicted brain will order you to fill out these valves again with the chemicals they need. This is compulsion, or craving.

What about substance-free addictions, such as sex?

It works in the same way. People seek something that gives them pleasure, just like receiving a flogging for sadomasochists.

Addiction happens when one’s life is focused on something?

Addiction is mostly about losing control. Everything can turn into an addiction. Being able to enjoy something without turning it into an addiction requires moderation. As the saying goes in toxicology: “Everything is toxic, nothing is toxic, it all depends on the dose.”

Should people seek professional help?

Definitely.

Do we all have emotional voids?

We all do. But all of us don’t fill these voids adequately. They can be filled with love, understanding, car , respect, healthy family relationships, God if you need it, or even one’s favorite books. All you need is a strategy. Otherwise we'd all be crazy!

But you said that anything can become an addiction…

Yes, if you don’t react in the appropriate manner. For example, I can go out with my family,  I can go for a walk in the woods, or I can wander around in a mall without necessarily make compulsive purchases… the pleasure of being with them is enough for me. You may also watch a movie at home, play a board game with your children.. All of this will fill your voids and make you happy.

Are some substances more dangerous than others ?

Some of them are more addictive. Alcohol has a very high addictive potential,  you don’t feel this potential right away. On the opposite, cocaine and crack create an almost immediate addiction.

What about coffee?

This is a minor drug. It may cause an addiction, but one should drink about a hundred cups to achieve an effect similar to a line of coke . It is not comparable. Of course I’ve never heard of anybody taking a hundred cups of coffee…

All of us won’t become addict to the same substances…

Of course not. We are all different. The Alcoholics Anonymous, for example, tend to consider drug addicts as rubbish even though some of them are still drinking. “We are alcoholics, nothing to do with drugs”. Some might have used marijuana without ever being addicted to it. It’s like falling in love. You may sleep with twenty women but you’ll fall in love with one. You could try a number of substances without ever becoming addicted… You’d better not do it though.

Speaking of love, can you become addicted to love?

You can be addicted to sex. When you like sex and pleasure you’ll be seeking this pleasure again and again. It has nothing to do with falling in love. You’re only dedicated to giving and taking pleasure, and this can lead to addiction.

You’re talking about sex, but what about real love?

In any romantic relationships, some people can show signs of codependency. They will need more attention, gentleness, they desperately want their spouse to care for them. These people can become addicted to specific, conflicting relationships. Some addicted people can be both mushy and possessive and their relationships can be explosive!

Do emotional needs put people at risk of conflicting relationships?

They do. In particular when your lover or spouse starts to manipulate you in relation to the way you live this relationship. On the contrary, if you have the chance to be with someone who shares your values ??and principles and who’s in love with you, well then, congratulations!

Could you elaborate?

Let’s suppose you’re in love. Let’s suppose you’re with someone who is in love too. Then you realize that this person drinks, or is a compulsive shopper, or has any other type of severe and damaging addiction. However your need of this person makes you stay. Then you start becoming a codependent. And the conflict starts on, because you are far too exposed because your love doesn’t allow you to liberate yourself from this person. You’ll then develop a guardian angel syndrome. The one who will provide care and comfort. It’s the “he needs me” situation. You’ll stay with your spouse because of a genuine emotional need.

What about domestic violence?

I don’t really know. It is a very different theme which does not necessarily imply an addiction. There is a need for affects, but what your culture has taught you is also influential. There are a number of factors for a woman to continue to stay with a violent spouse. Codependency is only one of these factors.

How can we determine that someone is addicted to Facebook ?

Parameters are the same. Obsession, compulsion and denial. You’re attending a lesson while thinking about Facebook again and again. Or you engage in chatting with your friends almost 24 hours a day. This is an addiction and addiction can cause accidents.

What are modern addictions ?

Everything that has to do with technology . For example when you feel compelled to purchase the latest things , when you connect to Facebook  or Netflix all day long, when you’ve got to have the best TV set , the latest smart phone, change your car every year, etc. All of this can become an addiction. People buy what they don’t need. If you see a friend with pants you don’t have in your wardrobe, you'll run out and buy them. In fact, You’re just filling a void, a void made of poor self-esteem or lack of recognition.

Are some people more vulnerable than others ?

Of course! some have larger voids than ours and those that are empty are more prone to become addicts.

What are the strangest cases you’ve ever seen ?

I once had a patient who felt compelled to smell and to eat soap. This is quite rare though. Another rare dependence is that of Diogenes, that is people who stack up junk, magazines, papers, etc. they fill up their house with things that are useless, and they end up with a useless life themselves. Those cases were among the most bizarre I’ve ever seen.

What do you think of collectors ?

Well, in my opinion it is not so weird. It may even be positive, because after a while, people may sell their collections and make some profit out of them. It all depends on how you do it. If you're obsessed with buying a jacket one thousand pesos when you have only one thousand pesos to make your children eat, your addiction may make them starve. This would obviously would not be very productive. It depends. We cannot say that Mr. so-and so is addicted or not without an in-depth appraisal of his situation. A therapist should sit down and talk to each person, study each individual situation to determine whether or not there is addiction .

How thin is the line?

Very, very thin.

Are there minor addictions?

It all depends on how we consider them. I have known people who used to hang out with gang members, who were using drugs, who committed robberies and so on. Those people eventually turned to religion. They now go to church every day and spend the rest of their time praying. Well, we might say that they’ve changed an addiction for another. But what about their wife, their mother or their son,  what do they think of it, what do they prefer? Seeing them hanging out with gangs and stealing again, or spending their time in church? They may be addicts, but it is a lesser evil.

Can I replace a harmful addiction with a minor one?

Of course, we, physicians, prescribe medications to calm down people, to make them stop using a specific substance by taking a more controlled drug. This is called substitution maintenance therapy.

Do all addictions require pharmacological treatment ?

Not all of them.  Nonetheless, being followed up by a skilled psychotherapist appears to be necessary and even mandatory. And it is often a life-long treatment.

A life-long treatment, really?

Yes. Simply because addiction is a chronic disease. It cannot be cured but only controlled. It's just like hypertension or diabetes. Anyone who has consumed keep this consumption in memory. This applies to all addictions.

And what is your addiction?

(Laughs) Work , I think. You can call me any time, and I’ll be ready to work.

Is it especially harmful?

If they call me at two o'clock in the morning it is! (laughs)

At age 40, Dr. Hugo Mauricio España pursues a medical career which began in 1995 when he obtained his doctorate at the National Autonomous University of Nicaragua (UNAN ) in Managua. In 2003, he specialized in toxicology and addiction, and later in forensic sciences. Dr. España has worked successively for the Dianova foundation, for the CARA center in Nicaragua and for the Remar Foundation, for  a total of thirteen years of experience in the addiction treatment area. Dr. España is now working for the Institute of Legal Medicine of Nicaragua.

Dr. Hugo España has worked with the Dianova Nicaragua Foundation as a physician, addiction specialist and toxicologist at the Pasarela office and in Malinche and Roma rehabilitation centers. From 2001 to 2006 he also led numerous discussions on the problem of addiction. Following the closure of those two rehabilitation centers, Dr. España began working at the Foundation’s main office until 2007. He continues his involvement as a member of Dianova ‘s board of directors in Nicaragua and as a physician attached to the Hotel Europeo.