Vol. 12. No. 4
Spring 2003

Chantelle works as a trouble-shooter at a Salt Lake City software company. Attractive and stylishly dressed, the 32-year-old looks every bit the successful career woman as she sips coffee in a downtown Starbucks and tells her story. She’s a former prescription painkiller and heroin addict whose nine-year free fall into drugs cost Chantelle her children, ended her marriage, and left her living in a junkyard sharing needles with other users.

Clean for three years, Chantelle believes the root of her addiction lurks in her genes. “I was born addictive,” she says. “It runs in my family.”

Medical research indicates she may be right: as scientists learn more about chemical addiction, many believe the disease is genetically based. For those who carry the genes, all it takes is the first drink, or cigarette, or line of cocaine, and chances are, like Chantelle, they’ll become addicted.

Research into genetics, pharmacology, neuroscience, and other areas is providing new insight into how addiction affects the brain and which genes may predispose people to the disease. Eventually, this research may produce new drugs and therapies for addiction.

But as medical researchers gain new understanding of addiction as a disease, the social perception of those who are addicted remains clouded in ignorance. Many people still hold the long-standing belief that addicts are weak-willed, morally defective people who choose to live the way they do.

That misapprehension is based on a lack of knowledge, says Barbara Hardy MSW’83 PhD’01, associate director of the Utah Addiction Center. Addiction has many contributing factors—biological, environmental, psychological, and social—and if people knew more about it, they’d view the disease differently, according to Hardy.

“More than anything it’s a lack of understanding that addiction is a chronic, relapsing disease,” she says. “We need people to make the shift from thinking, ‘These are bad people,’ to thinking, ‘These are people who need help.’”

The Utah Addiction Center was established to facilitate that shift in thinking. The center, located in Research Park, was founded three years ago under the aegis of A. Lorris Betz, the U’s senior vice president for health sciences. The center’s mission is to promote the understanding of chemical addiction by addressing the issue on three major fronts: fostering research to find better ways to treat and, one day, perhaps, prevent addiction; providing clinical training so doctors and other professionals can recognize and help addicted patients; educating the health-care community and public about addiction.

If the stigma of addiction stems from a lack of knowledge, the only way to address that is through education. To that end, the center sponsored a “Recovery Day” in September to bring the issue into the open and to show that addicts are people “just like you and me,” Hardy says. About 400 people attended the event at the Gallivan Center in downtown Salt Lake City, and Hardy is already planning another Recovery Day, along with other community programs and initiatives, to begin reshaping perceptions of addiction.

Unfortunately, the lack of understanding surrounding addiction extends beyond the general public to those in health care, according to Hardy. It’s estimated that one person in 10 has a substance abuse problem, yet the U.S. medical education system doesn'train physicians to recognize the signs. If they could see the symptoms early, doctors could refer addicts to the appropriate help and lessen, perhaps substantially, the financial and social tolls of the disease.

For example, a patient may repeatedly see a doctor for stomach problems that are diagnosed as an ulcer. But the underlying cause of the ulcer may be alcoholism, and if the doctor recognizes that, he or she can get the patient help. Many home and car accidents, assaults, and incidents of child abuse have a chemical addiction component that goes undiagnosed, too, according to Hardy.

As a first step to fill that educational void, the Utah Addiction Center is joining with the U’s medical school to start a pilot residency program to formally train new doctors to recognize the signs of chemical addiction. The program, funded with the help of a $50,000 grant from the Callister Foundation (See “And Finally...”), begins in July for residents in the fields of pediatrics, internal medicine, obstetrics and gynecology, and family and preventive medicine.

While educating the public and training doctors can have an impact in a relatively short time, research offers the most fundamental level of impact.

The center is committed to expanding research in genetics, pharmacology, neuroscience, and the behavioral and social sciences, Hardy says. The center’s role entails everything from writing research grant proposals to initiating joint ventures among different groups researching addiction. The center, in time, may hire its own researchers, but Hardy doesn't anticipate ever having a large staff. She wants to build on the considerable resources available at the U’s Health Sciences Center. University scientists are already researching addiction in numerous ways, including two of the most promising areas—pharmacology and genetics.

Pharmacology researchers are learning that neurobiological factors of addiction compromise the brain’s ability to function in key areas, such as decision-making and compulsive behavior, says Glen R. Hanson PhD’78, professor of pharmacology and toxicology at the U. “We believe addiction is a brain disease,” says Hanson, who is just finishing a two year stint as interim director of the National Institute on Drug Abuse, National Institutes of Health, in Washington, D.C., and plans to return to the U this spring.

Stress appears to play a role in addiction by releasing chemicals in the brain. Smokers, for example, often increase their nicotine intake when they’re under stress, so researchers are looking for drugs that block stress and its consequences. Some antidepressants, such as buproprion (Zyban), can be effective treatments, and Hanson believes it’s possible that within 10 years more medications may be available to help addicts. But Hanson doubts there will ever be a pill that will eliminate addiction entirely, the way antibiotics stop infection. Drugs will have to be accompanied with behavior modification therapy, he says.

Hanson believes genetics plays a large role in addiction, with up to 60 percent of the propensity to become addicted having a genetic root. In alcoholism, that percentage may be even higher, while with heroin it might be a little lower. This doesn't mean people are predetermined to become addicted, says Hanson, but it increases the odds when they’re exposed to certain environments.

The genetic component of addiction, particularly in nicotine, is the focus of a five-year, $11 million grant U researchers just received from the National Institutes of Health. The researchers, from the School of Medicine and
Eccles Institute of Human Genetics, are pursuing the hypothesis that nicotine addicts have a receptor gene in their brains that predisposes them to addiction and the physical consequences of smoking. These receptors, the researchers theorize, are critical in determining susceptibility to Chronic Obstructive Pulmonary Disease(COPD), one of the most devastating consequences of smoking cigarettes for long periods.

Although smoking doesn'typically cause the same sort of behavior as other chemical addictions, the consequences of it are staggering. An estimated 50 million Americans smoke, with 450,000 deaths annually attributed to cigarettes, according to John Hoidal, professor and interim chair of the medical school’s internal medicine department and principal investigator of the study. (Raymond Gesteland, the U’s vice president for research, is co-principal investigator.) Smoking is also a tremendous drain on the economy, costing nearly $100 billion a year in medical expenses and lost productivity.

Data show a strong genetic component in COPD, emphysema, and even atherosclerosis, a vascular disease that is the leading cause of smoking-related deaths, according to Hoidal. The risk of developing illnesses caused by smoking seems to cluster in some families, and the study will examine genetic causes of addiction in both people and mice.

And, according to Hoidal, whose medical specialty is the lungs and their related systems, the study may provide information on the broader field of addiction. “The hope is it will have wider implications,” he says.

For Chantelle and other addicts, research that zeroes in on the roots of addiction cannot come fast enough. Chantelle started using painkillers to escape an unhappy marriage and, in the depths of her drug abuse, exhibited every form of bad judgment possible. She stole painkillers meant for her husband’s 90- year-old grandmother who was slowly dying. She convinced her dentist to perform root canals on healthy teeth so she could get Percoset, a prescription painkiller. She even made one-day trips to Tijuana and back to Salt Lake City to obtain a pain reliever not legal in the United States. Finally, her addiction led to heroin and a life on the street that endangered her in many ways.

Her husband took their children and filed for divorce. After a number of attempts to get clean through various programs, Chantelle, with the help of drug counselors and therapists, finally found the way three years ago, and today takes life day to day. She has re-established contact with her children, who now live in Florida with their father and his new wife, and speaks with them daily.

Despite all that happened, Chantelle was lucky in a couple of ways.

Her parents and siblings—a close Mormon family—never deserted Chantelle, and today she has good relations with them, although she no longer practices the LDS religion. And, in what may be just pure luck, even after sharing needles with strangers, Chantelle did not contract HIV or hepatitis C.

Not a day passes when Chantelle doesn'think of her bout with addiction and how the disease ruled her life. That’s fine with her—some things should not be forgotten.

“I don’t want to forget it,” she says. “I have to remember what happened.”

—Phil Sahm BS’78 is a writer in the Office of Public Affairs for the Health Sciences Center.

Utah Addiction Center 801-581-8216 www.uuhsc.utah.edu/uac

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