Of Dreams and Reality

“BIOLOGICAL MODEL OF ADDICTION"

Introduction

The results of excessive drinking are well known.
What makes the individuals who constantly drink too much ignore them is to a great extent a mystery.

In “Invitation to Psychology” the two co-authors C. Wade and C. Tavris (1999) (Addison-Wesley Educational Publishers) discuss the two dominant approaches to understanding addiction which they refer to as “Biological Model” and “Learning Model” respectively.
They also attempt to integrate the contributions of both “models”.

Here in Alcohol II are listed the key points of the “Biological Model of Addiction” (as stated by Wade and Tavris).

[Note: It is for you to decide how ambiguous (if at all) they are!!!!]

Biological Model of Addiction (key points)

A. Genetic Involvement

1) It is possible that several genes in combination affect:
a) The response to alcohol (including the metabolism of alcohol by the liver)
b) The compulsive use of alcohol
c) The progression of alcohol-related diseases (including cirrhosis)

2) It is possible that genes contribute to temperament or traits that predispose some people to become alcoholics (alcohol dependent).

3) It is also possible that:
a) “…genes have little to do with alcoholism…” and
b) “…alcoholism results, basically from alcohol!”

Alcohol Involvement

1) Heavy drinking:
a) Alters brain function
b) Reduces the level of pain-killing endorphins
c) Produces nerve damage
d) Shrinks the cerebral cortex
e) Damages the liver

2) “In the view of some researchers, these changes then “create”:
a) “… biological dependence ..”
b) “... inability to metabolize alcohol..”
c) “…psychological problems …”

I WONDER IF ‘ANY OF THE ABOVE’ HAS CAUSED YOU TO STOP*, PAUSE AND THINK (IF BUT FOR A BRIEF MOMENT)!!!!!!!!

Many ambiguities surround alcohol and the drinking of it. One of the most interesting ones is whether or not it is a drug of true addiction.

This brief introduction to alcohol related ambiguities leans heavily (if not solely) on the following statements made by Robert Kemp, T.D., M.D., F.R.C.P. (circa 1972) in ‘Drinking And Alcoholism’ (A Family Doctor booklet published by the British Medical Association):

1) Alcohol is “not a true drug of addiction as are morphia, heroin or cocaine.”
[Note: R. Kemp refers to morphia (morphine), heroin and cocaine as “hard drugs”.]

2) “Anyone who systematically takes any of these “hard” drugs will quickly become a true addict. The tissues develop a real craving with serious withdrawal symptoms if the drug is not forthcoming so that a drugless life is almost impossible and recovery rare.”

3) The drinker “can live perfectly normally without alcohol though naturally he misses its effects and prefers life with it to life without.”

4) Dependence on alcohol is “on an emotional basis rather than on a physical level. This means that those who drink excessively do not do so because their tissues are craving drink and they themselves have become physically dependent on this substance.”

5) “The fact that there is no true addiction makes treatment possible and recovery likely.”

I WONDER WHAT YOUR VIEWS ARE ON THE ABOVE STATEMENTS.

Exfoliation (known biologically as desquamation) is a normal feature (activity) of the skin surface (superficial dead and keratinised cells of the outermost horny layer).
It is the process of shedding worn out horny cells in the form of invisible scales (collections of small numbers of cells).

Products (e.g. creams) and treatments associated with it, together with its abnormalities (due to disease) can be said to constitute another set of bodily ambiguities.

[Note:
Disease aspects will only be mentioned in passing].

The skin (as a whole) is the ultimate barrier and connection between the body and the environment.

Its ability to protect against the entry by many harmful environmental agents (including microbes) depends to a great deal on the chemical composition and physical construction (nature) of its very surface (made of the outermost cells of the horny layer of the epidermis).

[Note:
Various substances (produced mostly by the epidermis itself) help the cells of the horny (outermost and dead) layer of the epidermis to carry out some of their barrier functions].

The skin surface is best described as transient because the cells of which it is made are continuously being shed (desquamated or exfoliated) and replaced. Such a constantly ‘renewed’ surface offers the best possible protection to the rest of the skin (including the deeper living layers of the epidermis) and the body as a whole.

[Note:
1) There are limitations to the protection a thin layer of biological materials which constitutes the skin surface (outermost rows of the horny layer) can offer.
2) Nevertheless it has kept human kind in existence for a long time!].

Cells migrate from the layers immediately below to take the place of those (‘worn out’ ones) that are desquamated (exfoliated in everyday language).

The cells that move upwards (or outwards) from row to row until they are exfoliated all originate from the deepest layer of the epidermis which is called the basal layer.

[Note:
1) During the migration from the basal layer to the horny layer each epidermal cell undergoes differentiation (over about 14 days) which changes it from a soft and living structure to a dead and toughened (keratinised) one.
2) Horny cells spend about another 14 days in their 'dedicated' layer and then are desquamated (exfoliated)].
3) Skin scales make up most of ordinary household dust.

Shedding of visible scales (collections of larger numbers of horny cells) is abnormal. This can occur in infectious conditions (e.g. ring worm) and non-infectious conditions (e.g. sunburn, eczema, psoriasis, etc.)].

Additional to the normal desquamation that follows epidermal cell differentiation (and migration) is the desquamation that is facilitated (accelerated) by routine skin-centred activities. These include washing, shaving, make-up application and removal, etc. Friction against clothing, bedding, etc. has the same effect.

Thus for the normal (healthy) skin, treatments and products designed or aimed specifically to bring it about (exfoliation) could be said to be unnecessary and perhaps in some cases excessive.

Note of Caution:
Excessive exfoliation can have detrimental effects in the long run, especially if epidermal differentiation and replacement cannot keep pace with it.
A good example of ‘swings and roundabouts’, I would be inclined to say!

Cellulite I (Introduction).
Cellulite (also referred to as “so-called cellulite”) is a very good example of bodily ambiguities.
[Note:
a) It should not be confused for cellulitis (a bacterial infection of the skin and subcutaneous tissues by Streptococcus pyogenes).
b) However both cellulite and cellulitis can affect (although differently) the same tissues].

In this introductory part (for cellulite), mainly quotations {with my notes in ( ) and [ ]} from the Journal of Dermatologic Surgery and Oncology (March 1978) will be used to illustrate this.

1) From Morris Leider.
The French word cellulite was suddenly thrust upon the lay public in the country (US) some years ago in commercial advertisements of “beauty” parlors and other agencies that offered treatment for a certain dimpled appearance of the ordinarily well –covered skin of mature women.
[Note:
a) The dimpled appearance of the skin (referred to above) has been described in much earlier French publications as resembling the skin of an orange or the surface of a mattress.
b) Reasons for the two different appearances will be discussed at some other time].

2) From Earle W. Brauer.
(A) Cellulite is a cosmetic “defect that consumes and tortures millions of European women.
[Note:
a) The term cellulite made its entry in French medical literature in 1816. However it is not certain that it was applied precisely to same condition that we discuss here].
b) It was not until 1978 that two papers about so-called cellulite (or cellulite for short) were published in English (in the journal mentioned above)].

( It is a normal “abnormality” that has spawned a billion-dollar industry of futile treatment both within the legitimate medical/surgical collegium and in that fringe of lay persons who call themselves “estheticians”.
[Note:
a) “Estheticians” as referred to above is a direct translation from the French “estheticiennes”.
b) In modern terms they would be referred to in the US as cosmetologists and in the UK as beauty therapists.]

3) From F. Nurnberger and G. Muller
A) It has been claimed but never proven that so-called cellulite is attributable to internal illnesses, birth-control pills, environmental pollutants and miniskirts.
[Note:
The more likely causes will be discussed at some other time]
It is an important obligation of physicians to teach the fact that so-called cellulite is not a disease but is the result of the sex-typical structure of the skin of women and a natural sequence of ageing.
[Note: Involvement of the sex hormones in skin structure will be discussed at some later time].

4) From C. Scherwitz and O. Braun-Falco
A) Since so-called cellulite is not a real illness, there is no meaningful or effective therapy by medications
[Note: Therapy proposed by the above authors will be discussed at some later time].