Let's Talk Addiction - Author Jane McGregor discusses what addiction really means

Conceptualisations of ‘addiction’ change with the times. It is not an immoveable concept. The term ‘addict’ was first used in the sixteenth century. It came from the Latin ‘addictus’, of which the past participle ‘addicere’ had the sense of being obligated to someone else. Soon after, it took on a meaning of being attached to something through one’s own inclination, or of being devoted to some practice. Shakespeare was one of the first recorded writers to use the term ‘addiction’, and he used it to describe something akin to ‘strong inclination.’  Later examples include that used in the Oxford English Dictionary of 1790, which refers to the notions of gluttony, lust, and ‘superstitious ceremonies’.

Addiction can be an infrequent problem. It may disappear as a source of concern for centuries, but become almost universal at other times. Concern about addiction sometimes arises at times of significant change. In Europe and North America in the 19th and early 20th centuries for instance, a time of great political and economic upheaval, anxiety arose over excessive alcohol consumption and afterwards over illicit drug taking. In this period, concern about the problem led to renewed attempts to manage it by means of medical and penal management. Thereafter the concept of ‘addiction’ become narrowed, moralised and medicalised,  and when the problem persisted, led to a ‘war’ on illicit drugs.

Modern conventional wisdom has it that it is an individual problem; some people are addicted whilst others are not. As a consequence, the role of the caregiver is most often one of assisting the individual in the recovery process from ‘illness’ to ‘normalcy’. The standard line taken by the media, treatment agencies, and government is that the helpless addict has no power over his/her behaviour. However one of the difficulties with putting across messages like this is that, in reality, addiction is far more complicated than this. The scope of the term has expanded and a plethora of new behaviours and activities have been added to the list. These activities are diverse and include gambling, sex, food, exercise, shopping, internet use, and the inventory is growing, leading to an increasingly diluted and looser sense of the term more akin to its original, non-medical meaning. As used today ‘addiction’ means behaviour that is excessive and overwhelming, and/or deeply entrenched. The problem may take over all aspects of someone’s life – intellectual, spiritual, emotional, behavioural and social and may involve an apparent blindness to the harms of the addictive behaviour.

An important discovery for those working in the UK health arena, and one that is not that surprising given the term has broadened so much in recent years, is that the prevalence of addictive behaviour, as currently understood, is on the increase. A sign of this is the huge increase in the prevalence of clinical depression, and other psychological states with depressive components that develop around, or develop as, a consequence of addiction. Further evidence of a growing problem has been the spawning and rapid growth of the ‘recovery’ industry, which has become a monumental global business.

Today a vast array of literature on recovery from addiction exists, a huge amount being ‘recovery stories’. Readily available from bookshops and the internet, often these are written by people belonging to mutual aid groups like SMART , and Alcoholics Anonymous or the many 12-step groups that are derived from it (Bloggers Anonymous, Gamblers/Gamers Anonymous etc.). In addition, online materials and groups are available to help the addict - self-help courses in overcoming Bulimia, binge-eating, handling gambling problems and so on. The plethora of self-help material does not mean that caregivers should sit back and leave individuals with addiction problems to fend for themselves. No, what it suggests is that caregivers need to look afresh at ways of working and reorganise their practices within a much larger social frame in order to help people with problems of addiction wend their way up the path of recovery.

Jane McGregor is a lecturer in substance misuse at the School of Nursing, Midwifery and Physiotherapy. University of Nottingham.


 i Quinion, M. (1998) ‘World Wide Words’. Online resource available from http://www.worldwidewords.org/topicalwords/tw-add1.htm [cited March 27th 2012]
 ii The social nature of addiction is powerfully put across by Bruce Alexander in Alexander, B.K (2010) ‘The Globalisation of Addiction: a study in poverty of the spirit,’ Oxford, Oxford University Press. 
 iii SMART is an organisation that supports peer led mutual aid groups for individuals seeking abstinence from addictive behaviours.  Its programme is based on methods derived from Motivational Enhancement Therapy, Cognitive Behaviour Therapy and Rational Emotive Behaviour Therapy.

Author Kevin Lee discusses Early Detection of Mental Illness

Indeed, I believe early detection and treatment is the best way to heal mental illnesses like schizophrenia.  Currently there are a few websites designed to promote basic mental health awareness for our children.

For example:

• Am I ok?
• Mind check

Websites such as the 'Mayo Clinic' may offer a more compressive account regarding all forms of mental illness.  Yet, reading the technical definitions of a mental illness can often be confusing, especially for the younger generation.

The illness of depression may be easier to understand, since most people have experienced feelings of sadness.  However, in the case of schizophrenia, the symptoms may be easily misunderstood.  Persons with schizophrenia may experience hallucinations or delusions.  But what exactly are these symptoms?  Delusions may be defined as the misinterpretation of experience, while hallucinations may be defined as seeing or hearing things that do not really exist.

However, as a patient with schizophrenia, I know that realizing the fact that I am delusional or hallucinating can be difficult.  Patients with schizophrenia may sometimes believe that their delusions and hallucinations are “normal”, and not the symptoms of any form of illness.  In my case, I experienced delusions on a periodic basis throughout my childhood, and although I did possess some recognition that these thoughts may have been “extraordinary”, I never conceived the possibility that I may have been sick.  It was only after I reached adulthood, when my delusions became increasingly frequent, where I pondered the possibility that I could have been affected by some kind of illness.

I remember that in grade 6, I received sexual education for a short period of that school year.  Perhaps we can create a similar program based on mental illness awareness.  If I was educated on the nature of schizophrenic delusions, maybe I could have realized that the belief that I was God was not “normal” and perhaps the symptom of some kind of disease.

I think a mental illness awareness program could help some children, before they become overwhelmed with the symptoms of some disease.  If our children possessed the awareness that some of their thoughts are indeed “strange”, maybe they will seek some kind of further counsel, and this could encourage the early detection and treatment process.  I think it is important to educate our children on the subject of mental illness before they become overwhelmingly symptomatic.

The goal that we should all work towards is the self-identification of the early stages of mental illness, and all other illnesses for that matter, because this is the best time to start the treatment process.

Kevin Alan Lee

(All views and opinions are that of the Author)

Treating Back Problems in Athletes Versus Non-Athletes

Most of us have had a ‘bad back’ as some stage and will know how when it hits, every movement, step, lift or sneeze can be excruciating, with few positions being comfortable. If we were lucky it will have only lasted a few hours our a few days, however the reality is that back pain is one of the biggest causes of ‘time off work’ and many people will have prolonged and recurrent episodes.

A recent article in the British Journal of Sports Medicine [1] points out that amongst the general population, psycho-social links to low back pain along with the complexity of the back's structure make specific patho-anatomical diagnosis of back injury difficult. On the back of this the majority of patients within health services are labeled as having ‘non-specific back pain’ (NSBP). That being the case, the author, a respected back pain researcher and practitioner, advocates a bio-psycho-social model of care addressing behavioral as well as physical issues.

In the last 10 years I’ve been working in international cricket, athletics and now rugby, sports where back injury is always in the top three problems resulting in lost training and competition time. My belief is that the influence of psycho-social risk factors linked to back pain such as low levels of job satisfaction, psychological distress, smoking, obesity and heightened fear of activity are much less of an influence on back injury in the athletic population.

If a sports person has significant injury then it can usually be attributed to a specific mechanism with identifiable structural damage. For example, fast bowlers in cricket are prone to lower back stress fractures due to repeated extreme bending of the spine during the delivery stride, and front-row forwards in rugby have a very high rate of neck pain attributable to disc damage, associated with flexing and compressing the spine in the scrum.

Rare is the athlete who will accept a diagnosis of ‘non-specific lower back or neck, pain’ and those managing their care will be expected to provide a clear diagnosis and treatment plan. The danger of an approach that doesn’t prioritise relevant anatomical injury is that it can, and has, led to a shift away from the use of some valuable diagnostic tests and interventions. Rather than simply not offering what could well be very useful types of scans, therapies, injection procedures and even surgeries to wrongly homogenized groups of NSBP patients, better outcomes might be obtained by researching and providing specialist services based around practitioners who are able to recognize both psycho-social and patho-anatomical factors in order to direct patients to the most appropriate investigation and treatment.

As pointed out in another recent paper, [2] as the name suggests, ‘bio’ should be at the forefront of a bio-psycho-social approach to managing back injury, particularly in athletes.

Craig Ranson

1.  O'Sullivan, P., It's time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 2011.
2.  Hancock, M.J., C.G. Maher, M. Laslett, E. Hay, and B. Koes, Discussion paper: what happened to the 'bio' in the bio-psycho-social model of low back pain? European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2011.

Ron Michaelis Talks Personalised Medicine

We are entering an era in which both you and your doctors will use your genetic information to better maintain your health. The information that will be provided by genetic and other tests will enable you and your doctor to better estimate your risk for both rare and common diseases. This information may help you maintain your own health better, by adjusting your diet, environment and lifestyle to avoid the non-genetic factors that increase your risk for the diseases for which you have the greatest genetic risk. In addition, this information will help your doctor choose the safest and most effective drugs and treatments for you when you do get sick, minimizing harmful side effects and ensuring more successful outcomes.

In time, personalised medicine tests will not only include tests of genes, but also tests of proteins, RNAs and other important biomolecules. Currently, however, most of the attention is focused on developing genetic tests. These tests are based on the fact that the sequence of a typical human gene is as variable as any other human trait. Just like heights and hair colors, different people often have slightly different sequences for any given gene. Because your genes make your proteins, when two people have different sequences for a gene, they may also have different levels of activity in the protein that gene makes. One reason you possess your unique combination of physical, emotional, intellectual and medical characteristics is that you possess a unique pattern of high activity in some proteins, typical level of activity in others, and low level of activity in others.

Because your genes make your proteins, you can often estimate the level of activity the person will have in a protein by analyzing the sequence of the corresponding gene. Further, because your proteins regulate all your body's systems and processes, if you know the level of activity in the critical proteins, you can estimate how well a particular system works in the individual. This in turn enables you to estimate that person's risk for the diseases that result if the system in question is not working well. For example, if you know the sequence of the genes that make the proteins that act as ion channels in heart muscle, you may be able to estimate the individual's risk for certain cardiovascular (heart) diseases more accurately than you could otherwise. Alternatively, if you can estimate the level of activity in the proteins that break down a specific drug and clear it from our bodies, you can better predict the probability that a particular person will accumulate too high a concentration of the drug and have an adverse reaction to the drug if he/she is given the dose of that drug that most people are given.

This approach to medicine is referred to as Personalised Medicine (PM), because it allows the doctor to consider the individual patient according to his/her personal characteristics, rather than treat everyone who has a particular disease with the same drug and dose. PM does not only aim to allow doctors to treat patients more safely and effectively. PM also expects people to play a more active role in maintaining their own health than most of us are accustomed to playing. Dr. Leroy Hood helped coin the term "P4 Medicine".  The four "Ps" refer to PM being personal, predictive, preventive and participatory.  One of the cornerstones of this approach is the understanding that our genetic risk factors interact with risk factors we encounter from our diet, environment and lifestyle to determine our overall risk for a disease. Knowing what diseases you have the highest genetic risk for enables you and your doctor to estimate your risk for diseases more accurately (personal and predictive). In addition, it may help some people tailor their diet, environment and lifestyle, to actively “participate” in maintaining their own health and well being (preventing disease) and try to avoid some of the factors that may further increase their risks for these diseases.

People's access to genetic/genomic information and the role it can play in their lives will continue to expand.  At present the cost of many genome sequence tests remains high enough to be out of many people's reach.  The cost, though, will continue to drop dramatically, and it will soon be possible to obtain a person's entire DNA sequence for less than $1,000.  This of course does not come without its own set of challenges. At present, we do not understand exactly how to translate most of the information that is obtained through genetic tests into risk predictions or treatment recommendations. Because of the sheer number of genes that influence our risks for most diseases, and the complex nature with which they interact with each other and with nongenetic factors, there is still a great deal of research that needs to be done in order to enable doctors to use our genetic information to improve the practice of medicine. The genetic information must be considered in the context of one’s personal and family history, as well as one’s age, sex and medical data (such as blood sugar level).

The ability to obtain this kind of information also carries with it substantial psychological challenges. Some people would rather not know the results of a genetic test if the result may indicate that they have an increased risk for a disease for which there is no effective treatment, such as Alzheimer disease. Genetic counselors help with all aspects of the genetic testing process. A genetic counselor can inform you about the tests that are available, discuss the benefits and limitations of the available tests, help you interpret the information provided by the test and help you cope with the psychological and family issues that may arise.

We are on the brink of a remarkable revolution that promises truly personalised medicine. PM tests will help you better understand your genetic risks, and allow you to become more involved in maintaining your own health and well being by focusing on the environmental and lifestyle factors that are most likely to make your sick. There will also be a change in focus, from an emphasis on treating disease to an emphasis on maintaining health.  Before the end of this decade, people will have access to a great deal more information than they have access to now. In order to reap the greatest benefit from these new medical advances, it is critical that you understand how to interpret your genetic information, and what the potential benefits and limitations of the available genetic/genomic tests are.

Ron Michaelis

Kurt Gilliland talks about the Importance of Remembering the Past

What's in a name?  How do physicians really communicate?  How does the history of medicine compare to its future?

Meredith Browne, an artist and faculty member at John Abbott College in Montreal, Quebec, who has portrayed many famous physicians writes...

“While most of us are probably familiar with the fact that some parts of our bodies, such as the Fallopian tubes or the Islets of Langerhans on the pancreas, are named for the doctors and scientists who first described them, it is not widely recognized just how many eponyms appear in the study of human anatomy.  Like explorers who claimed geographical features in the names of their kings, queens, countries or selves, clinicians and anatomists have left their names on many of our physical features.”

Some of Meredith Brown’s work is featured in Anatomists and Eponyms: Spirit of Anatomy Past.  Each of her paintings represents symbolic, narrative, or historical aspects of a body part named for its “discoverer.” Her project addresses a number of questions including what it means that, whether we know it or not, we all carry these honorific references to now long-dead men with us all the time. It is also an experiment in the use of the visual arts as a means of uncovering and interrogating ways of understanding the body and its meanings which come to us from previous iterations of scientific and medical practice.

The small scale of the paintings (like the cover of a book) was chosen to create a resonance with the familiar and intimate act of reading, encouraging the viewer to think about what it means to read the body through the history of medicine and anatomical study.  Her paintings required both text-based research into the lives and histories of the men who named these parts of our bodies, and visual research looking for images of historical figures and depictions of anatomical features. She identifies her practice as being a kind of research creation—rather than merely illustrating the famous man and the part of the body he named, each painting represents symbolic, narrative, or historical aspects of a body part named for its “discoverer.”

Eponyms are not just a thing of the past new structures and processes are being named to this day! See what Ole Daniel Enerson has collected on the topic.

Kurt Gilliland

NUP is Moving Office

We are delighted to advise that we will shortly be moving our offices and warehouse to enable closer contact with our parent University.

Please update your administration and any accounts records,  as shown below:

With effect from Tuesday 1^st November 2011 our new contact information will be as follows:

Nottingham University Press

University of Nottingham

King's Meadow Campus

Lenton Lane

Nottingham NG7 2NR

Telephone: +44 (0)115 7484090

Fax:  +44 (0)115 7484099

Calls made to our old direct lines and general phone numbers will be forwarded for a limited period of time, but please ensure that you use our new number when possible.  This will enable ease of communication until the switch is complete.   Personal contact email addresses will not change for the time being.

New E-mail addresses and Direct Line numbers will be notified at a later date.    

No changes will be made to our website (www.nup.com) and we hope that you will continue shopping with us.  There may be a small period of down-time during the actual move, but please refer back frequently for updates.

We look forward to continuing our excellent service to our customers and colleagues, and to working with you in the future.

NUP

Lawrence Fagg Takes a Look at the World Beneath

I live on a small farm in the Shenandoah Valley of Virginia. Although quite modest in size, it is agreeably balanced with some patches of woods and some gently rolling pasture. Thus there is enough variety so that, before she died, my wife, Mary, and I were never bored taking short walks to different parts of the farm.

One time, shortly before sunset, while we were walking just below a gradual rise in the pasture, I happened to look over at the setting sun as its rays grazed the broad crest of the rise and was amazed at what I saw. The sun’s rays had highlighted myriads of spider web strands that linked blades of pasture grass with a golden iridescence. The strands linking the grass blades pointed in every which direction so that the entire surface of the pasture was in effect covered with a soft gossamer blanket of spider web strands we never knew were there. It was a serendipitous glance at the vibrant mini-jungle that thrived right under our feet.

This experience set off a train of thought that in some indefinable way brought a sense of integration and completion to my view of the world around me. This was because, first, I realized that there was a still deeper realm of activity underlying this blanketing mini ecosystem. It was the micro world of the electromagnetically interacting atoms and molecules that are the fundamental ingredients of the spider web strands and the blades of grass. There was a ceaseless atomic activity “underneath” this blanket on which we were treading. Second, the sunlight that nourished the grass by photosynthesis and made it possible to observe this phenomenon was electromagnetic radiation from the sun’s intensely hot surface.

Thus in one cohesive realization I was able to sense the micro-world of atoms and molecules, the macro-world of the spider web blanket, and the cosmic world of the sun, each involving the electromagnetic force in one way or another. So this was an encompassing view of how, of the four forces of physical nature, it is the electromagnetic force that activates all of the nature around us. In fact, it has been harnessed throughout biologic evolution.

This evolution has depended on a multitude of electromagnetic quantum interactions, largely of exquisite sensitivity. They are put into service for the incessant probing, trial-and-error process of communicating, attracting, and repelling that has made possible each new level of chemical and biologic complexity. Indeed all of chemistry and biology depend on electromagnetic interactions. Atoms whose electrons orbit around the nucleus and molecules, however complex, that in turn bind together atoms, are activated by the electromagnetic force. It is highly complex electro-molecular activity that makes possible the life of the blood cells in our bodies and the neurons in our brains.

This wondrous activity is not only to be seen in the fecundity of the living nature that surrounds us, the plants, flowers, and trees, but also in the vibrant stasis of solid objects. It is the electromagnetic force along with certain quantum effects that empowers this stasis to keep the table lamp from falling through the table and the table from falling through the floor.

This pervasiveness of electromagnetism’s role in all of earthly nature extends to include virtually all of modern technology. Indeed the electromagnetic force is the work horse that in one way or another that powers almost all of the tools of modern living. It provides the electric power that runs our factories, lights our homes, and operates our washers and refrigerators. It is a wealth of often subtle electromagnetic interactions that activate the functioning of the computers and cell phones that are such an integral part of today’s life.

It is electromagnetic radiation that carries the messages of our cell phones as well as the signals that give us radio and television programs. Without the use of the properties of this radiation we would have no knowledge of the stars and galaxies in the cosmos. Astronomers have observed galaxies whose light took 13 billion years to arrive here. So, when we look out to the heavens, the entire history of the universe is spread out before our eyes, and it is electromagnetic radiation that tells the story.

 However, whether I am reflecting on the world of atoms and molecules or the world of stars and galaxies, I always seem to have my most focused reaction to the encompassing nature of the electromagnetic force in April when I go outside and look at the deep pink blooms on the peach and almond trees as well as the blanketing whiteness of the plum trees. These trees are a source of joy and wonder to me. While I know intellectually that it is the electromagnetic activity that underlies the presence of the blooms and all of the surrounding nature and virtually all of the technology that keeps our world churning on, it is my wonder that abides.

L Fagg

New NUP Online Catalogue for 2012

Our new Online Digital Catalogue for 2012 is now available for viewing, simply click the catalogue cover. For more information about any of the titles or services please see our website: www.nup.com.

NUP

Peter Altman discusses Answerable Questions Vs Unanswerable Questions

Over a period of about 3 years I have put together a book on various aspects of Life and the Universe.  These are subjects that have interested me, as a scientist, for many years.  How did everything start?  Where did it all come from?  How did life begin, and does it exist anywhere else?  UFOs, travel to other planets and galaxies, time travel, the end of the World, is there a divine Creator, what happens when we die?…the potential questions are almost endless. 

Questions can be categorised in many ways – by subject matter, by degree of difficulty, and by whether they can be answered at all.  Subject matter is straightforward: science, literature, history, general knowledge etc.  Degree of difficulty is more subjective, since what is perceived as hard by one person may be very easy for someone else if they happen to know the answer.  But answerability is the most intriguing.  Consider, for example, the question ‘Does alien life exist?’  There are only two possibilities – either it does or it doesn’t.  We have no evidence one way or the other so at the present time all we can do is to make a Best Guess based on what we do know.  Or, ‘How did the Universe begin?’  It’s here so it had to come from somewhere.  But how did this work?  Again, we don’t know – yet.  The tantalising aspect of such questions is that they do have answers but we don’t know what they are.

The genre of Popular Science has had a real surge of interest recently so I think that this is a timely topic.  There’s been a lot of science in the media and this is a good thing.  By and large, science works.  The remote control turns on the TV; antibiotics kill bacteria; eclipses happen as predicted, etc.  But there’s lots of pseudoscience as well, which is a bad thing.  Why do so many people still believe in things for which there is clearly no good evidence that they work.  You wouldn’t convict a suspect because he looked like a villain – you would expect to see some evidence that he actually committed the crime. 

It’s certainly not my intention to upset anyone, and we’re all entitled to our own beliefs and opinions.  It is my belief however, that people should weigh up evidence before accepting fantastic ideas, and the more fantastic the idea, the better the evidence needs to be.  For example, if someone told me that they could foretell the future, I would certainly ask for some good evidence before accepting their claim. 

Some older readers may remember football pools and a man called Horace Batchelor.  The ‘pools’ were the forerunner of the National Lottery where punters could win thousands of pounds by predicting the results of football matches.   Horace Batchelor developed his infra-draw method and advertised it widely on Radio Luxembourg in the 1950s and 1960s. Listeners were asked to send him their stake money and he would bet this on the pools according to his system.  He would take a percentage of every win but took nothing if the bet lost.  In his heyday, he was receiving as many as 5,000 cash stakes every day.  He eventually won about £12 million for himself and was for a time banned from betting by some pools companies.  This of course only served to increase his popularity.

So how did he do it?  Could he predict the match results?  No.  It was a simple mathematical system.  He received so much stake money that he could afford to cover very many, and in some cases all, of the possible outcomes.  This meant that he often had winning lines but as far as his punters were concerned, their individual chances of winning were no better than if they had placed he bets themselves.  He took his commission from the winners and sent them the balance.  He invested no money himself. 

The modern day equivalent would be to advertise a lottery-winning scheme and place the money sent in to cover every one of the approximately 14 million combinations.  You’d be guaranteed a win every week.

Science is everywhere, and it works.  It’s best that we adopt a cautious approach before believing that all sorts of amazing things that appear to defy science are actually possible.  Everything isn’t always what it seems.

Nottingham University Press In Collaboration with Science Reviews 2000

From July 2011, Nottingham University Press (NUP) and Science Reviews 2000 will be working together on a joint venture to promote each other’s services. Both companies’ titles target similar markets in the academic field and it was felt this was a natural fit for collaboration.

As part of this collaboration all six of Science Reviews Journals are now featured on NUP’s e-commerce site, available to purchase directly for one year print-only subscriptions. Links are also available to access on-line purchases/subscriptions. Science Reviews will be featuring NUP’s titles and services within their Journals and also online.

Sara, SR2000, comments, “Finding a partner for our Journals was an important task for us. NUP offered us a great fit for our company, as well as offering a high quality service and a good business relationship.”

Sarah Keeling, NUP, comments: “Working together has been a rewarding and informative experience as this is a brand new business model for NUP. We are delighted to be expanding our range of experience and hope to expand more in this area in the near future.”

About Science Reviews 2000
Science Reviews 2000 Ltd is an independent, family owned academic publisher founded by Dr Peter and Professor Margaret Farago. It currently publishes six Journal titles: Chemical Speciation and Bioavailability, Science Progress, Avian Biology Research, Journal of Chemical Research, Materials at High Temperatures and Progress in Reaction Kinetics and Mechanism. Together with its international team of editors and advisory board members, Science Reviews 2000 Ltd continues with its primary objective of providing affordable world class information to all scientific disciplines in both industry and academia. See website for more information.

About NUP
Nottingham University Press is a dynamic and rapidly expanding independent university press - and has gained international recognition as a publisher of high quality scientific and technical publications.

From humble beginnings with the publication of "Recent Developments in Pig Nutrition 2" in August 1992 and "Recent Advances in Animal Nutrition 1993" in June of 1993, NUP has grown into an internationally recognised University Press with representation in over 90 countries. NUP specialises in the publication of Conference proceedings, alongside its normal publishing programme. See our website for more information about NUP.