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Author: Justin Mckibben
This is arguably one of the most difficult questions to answer regarding drug addiction without being met with contention and passionate opposition. The troubling part is, despite the fact that the medical community, including the American Society of Addiction Medicine (ASAM) has taken a strong stance on classifying addiction as a disease, others still argue that it is a condition that only exists out of lack of personal responsibility or moral willpower. Stigma against addicts was the driving force behind the way the world understood addiction for so long that now it is an uphill battle at times trying to detach from those old ideas.
Beyond the assumptions most people adopt as fact, science and psychology have taught us that addiction is far more complex and misunderstood than most can imagine.
Still, the great question is the “why” of it all, which is a far more debatable way to ask the question than the “how” of it. Even more debate could surround the perceived motivations, and more controversy comes from the “addiction is a choice” conversation. At first, let us look at what the research tells us.
Why Do People Become Addicted to Drugs: The Brain
Now first, let us look at how addiction is defined according to medical science, offering the evidence from the ASAM.
The American Society of Addiction Medicine (ASAM) gave the most recent definition of addiction as a chronic brain disorder after a four-year process involving more than 80 experts. The ASAM definition notes that two decades of advancements in neuroscience convinced ASAM officials that addiction should be
defined by the activity present in the brain.
For instance, research has shown that addiction affects the brain’s reward circuitry to the point that memories of previous experiences with food, alcohol and other drugs or even sex can activate cravings and induce more addictive behaviors. Also, the brain circuitry that governs impulse control and judgment is altered in the brains of addicts.
Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition states:
“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,”
“Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”
Dr. Hajela did, however, add that the idea of choice is not completely off the table, but that it is not about choosing addiction, but choosing recovery.
To be fair, there are also neuro-scientists like Marc Lewis, a psychologist and former addict himself; author of a new book “The Biology of Desire: Why Addiction is Not a Disease” who believe that the brain is definitively reshaped by addiction, but do not think it should be classified as a ‘disease’. These scientists recommend cognitive behavioral therapy as a way to reshape the brain and redirect its systems into less self-destructive patterns. While they do disagree with the specifics of the ‘disease’ term, they stand by the neuroscience of addiction.
Why Do People Become Addicted to Drugs: Chronic Medical Condition
Further exploring the definition of addiction as presented by the medical and scientific communities, we find that the American College of Physicians (ACP) calls addiction a “substance use disorder” and states that addictions to drugs should be considered a serious public health issue. The ACP states that substance use disorder is a chronic medical condition.
Several agencies have supported this definition of addiction, including:
- The American Medical Association
- The American Psychiatric Association
- The Institute of Medicine
- The World Health Organization
And if we are going to get really technical, the basic definition of “disease” in the Merriam-Webster dictionary is:
-a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms
Examining this logic, it is clear that addiction meets all the criteria to be considered a disease. In fact, most definitions of disease are pretty spot-on with the nature of substance use disorder.
Why Do People Become Addicted to Drugs: The Formula
Now that we have explored how addiction can qualify as a disease, let us look into the “why” of it. Some insist there is an ‘addiction gene’ that dooms people to addiction. Others say the reason people become addicted is because of their circumstances in life.
One might say there is a kind of ‘formula’ for addiction, but it would be one like X+Y=Addiction.
Research has pointed toward biological differences that make people more or less susceptible to addiction. Certain genes, or combinations of genes, may result in someone’s brain and body developing dependence much faster than others with the same consumption.
So when someone says they drank the same as someone else, or did the same amount of drugs for the same amount of time, we need to understand that it doesn’t mean they will have the same reaction to those drugs. One of the main arguments people use to oppose the idea of addiction being a disease is comparing an addict to other people who drink and use drugs without being addicts… but science has shown us that is not how it works.
Then there is epigenetics, the study of functional, and sometimes inherited, changes in the regulation of gene activity that are not dependent on gene sequencing. In short, it means to examine how environmental exposures or choices people make can actually remodel (mark) the structure of DNA at the cell level or even at the level of the whole organism.
Here is where we openly admit to the actions (i.e. choices) of individuals to influence the development of addiction. Someone’s environment and the way they react to it does contribute to developing an addiction. In general, research has shown that an individual’s health is the result of interactions between their genes and their environment. Of course the likelihood of addiction can be increased by factors like:
Studies from the Nation Institute on Drug Addiction (NIDA) support that an individual’s surroundings also have a particular impact on drug use. According to the NIDA,
“Exposure to drugs or stress in a person’s social or cultural environment can alter both gene expression and gene function, which, in some cases, may persist throughout a person’s life. Research also suggests that genes can play a part in how a person responds to his or her environment, placing some people at higher risk for disease than others.”
When someone starts addressing external issues with drugs or alcohol, it magnifies the problem. Those who are exposed to a different life-style will also have a different risk of developing a substance use disorder. This impacts those epigenetics we were talking about.
In the end, we can say that people use drugs and alcohol as a solution. It is the resource they turned to for escape, for excitement or for a feeling of ease and contentment. It was a powerful element they were able to reach to, that ultimately rewired their brain and changed their DNA.
Why Do People Become Addicted to Drugs?
Some people will say that the Y of X+Y=Addiction model proves that addiction is a choice, not a disease. Well, to argue that choices can still create diseases, we can point out that in 2014 it was noted for the first time in history, “lifestyle diseases” killed more people than communicable diseases. Health care providers and public health officials have recognized for a very long time that unhealthy lifestyle behaviors are the root cause of several diseases, including:
- Type 2 diabetes
- Cardiovascular disease
- Chronic obstructive pulmonary disease (COPD)
- Some forms of cancer
Choices influence these conditions, which the medical community categorized as modifiable risk factors, including:
- Poor dietary habits
- Physical inactivity
- Alcohol overuse
People would argue still that someone who uses hard drugs knows the high risk and chooses. Well, don’t people who eat foods with low nutritional value and over-indulge in smoking while never exercising know the risks?
Why do people become addicted to drugs? There are so many factors unique to the individual with that formula. Genetics, environment, actions, along with physical and mental health all play a part in how a substance use disorder develops, just like numerous other conditions. That is precisely why it is so important we start to recognize addiction as a disease; as a chronic medical condition and one that people should not be shamed and stigmatized for. All these elements of substance use disorder literally rewire the brain and rewrite the DNA.
Though this may seem like a lot of information, it covers barely a fraction of the research on this subject. There is no easy “why” to it, but there is enough to know why recovery is so important. Real recovery is not just removing the drugs, but also working to create new coping skills. Recovery takes work, and a great foundation can make all the difference.
Understanding addiction is one thing. But learning how to make the life in recovery that you deserve takes a strong beginning. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now.
CALL NOW 1-800-951-6135
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Author: Justin Mckibben
Sadness is a part of life, and every once in a while we all experience the slump that comes with a bad case of the blues. Our troubles are often what make our joys more special, but depression is a much more serious side of sadness that can be debilitating and even lethal. Far too many people suffer from depression that goes on untreated until they resort to implosive behaviors such as substance abuse, self-harm or even suicide.
Suicide claims a life every 14 minutes in the U.S., and the situation is only getting worse.
That means in the time it takes me to write this article, edit and post it, more than a dozen men and women will have taken their own lives. I had to let that sink in for a second…
The Center for Disease Control and Prevention (CDC) has tallied up more than 41,000 people who die by suicide each year in the United States. Suicide is actually the second-leading cause of death in people aged 15 to 34 years. Over 90% of the people who take their lives suffer from some form of mental illness. Primarily the most common factor is depression.
Depression and Gender Differences
Women and men experience many things differently, for reasons both biological and environmental, so it is no surprise serious depression affects men and women differently.
Now a new study is saying there are numerous genes regulating the activity of a neurotransmitter in the brain which have been found to be abundant in brain tissue of depressed females, suggesting a genetic diversity between men and women with depression.
According to the research conducted at the University of Illinois at Chicago this new discovery could be one of the underlying causes of the higher frequency of suicides among women, giving experts new information to change what we know about depression treatment.
Gender to Glutamate
If we are going to talk gender in terms of depression and suicide, statistically we should note:
- Women are 2 to 3 times more likely to attempt suicide
- Men are 4 times more likely to actually die by suicide
The risk of suicide is associated with changes in several neurotransmitter systems.
Monsheel Sodhi, assistant professor of pharmacy practice at UIC, studied the autopsy tissue from brains of psychiatric patients who had passed away. Sodhi noted that female patients with depression had abnormally high expression levels of many genes that regulate the glutamate system.
Glutamate is the major excitatory neurotransmitter in the brain, and the glutamate system is widely distributed in the brain. Many abnormalities in this part of the brain have been linked to several other issues, including:
- Alzheimer’s disease
Sodhi and her colleagues were intrigued by recent studies that found that methods of treatment aimed at altering the glutamate system activity can rapidly eliminate depression in 2/3 of patients who do not react to conventional antidepressant treatments.
Conventional antidepressants target the monoamine systems, which secrete the neurotransmitters:
So of course this makes sense since these neurotransmitters are typically closely related to pleasure sensors and such, so the research team was of course interested in why a different aspect of the brain would have even more of a reaction.
The Suicidal Mind
In the new study, published in the journal Molecular Psychiatry, Sodhi and the team compared both females and males with depression to subjects who had never experienced psychiatric illness. Even more specifically Sodhi noted that many of the depressed patients had actually died by suicide.
What the team found was that females with depression had the highest levels of expression of several glutamate receptor genes. This may be an indicator as to why women are more prone to depression.
In addition, three of these genes were found to be elevated in both male and female patients who had died by suicide, which according to Sodhi indicates that females with major depression who are at high risk of suicide may get the greatest benefit from antidepressant drugs that act on the glutamate system. The study also suggested:
- New glutamate receptor targets for development of treatments for depression
- Identifiers of biochemical markers that could be used to assess suicide risk
Only one-third of patients achieve any form of considerable remission from conventional treatments for depression, and many of these methods take some time; time which Sodhi and others believe is too likely to run out.
Hopefully with information like this pointing at genetics and brain chemistry for clues and causes we can see some new revolutions in how the world both views suicide as a stigma, and how we as a society are able to identify and treat mental illness like depression.
Suicide is never the answer, it is only a permanent escape from temporary problems we all have the ability to get through, and I say this as a suicide survivor. But far too many people struggling with depression, addiction and other compulsions that push them to that place of hopelessness. But there is always hope. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135
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Author: Justin Mckibben
There is a school of thought that is based on the concept of mental illness not being like the old fashioned concepts of a broken or defective brain, and even straying away from the conceptions of having developed by trauma or stress in adolescences, and more closely linked to bacteria and infections. What makes this such an intriguing idea is that if this is correct, that means mental illness could not only be contagious, but it could also be more easily treated.
One example is the diagnosis of Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS), which is a condition that was first proposed in 1998 that linked the sudden onset of psychiatric symptoms to strep infections. PANDAS represents a remarkable branch of medical exploration that has been gaining acceptance in the past few years, though not without controversy.
With PANDAS a strep infection causes parts of the brain that help regulate motion and behavior to get caught up when the body reacts to the infection, mistaken for bacterial invaders by cells that try to destroy them to protect the body. This leads some doctors to believe that if you can eradicate the inflammation it will signal the immune system to stand down, restoring normal brain function.
In 1994, Susan Swedo, a researcher at the National Institute of Mental Health (NIMH) in Bethesda, Maryland, had a hunch that there might be an immunological explanation for obsessive-compulsive disorder (OCD) and through her research about the connection between basal ganglia and mental illness she developed the premise of PANDAS. Much remains mysterious, Swedo says, about the symptoms of PANDAS in a paper she wrote that actually first put a name to PANDAS. Children are typically those afflicted, and some kids actually hear voices or experience what is called “Alice in Wonderland” syndrome, which is described as wildly distorted perceptions of size and distance some liken to waking nightmares.
But obviously not all kids with strep get PANDAS. The average grade school student comes down with strep twice a year, according to the National Institutes of Health. Yet 1,999 out of 2,000 don’t develop PANDAS. So while Swedo’s research suggests the definite connection between the two, it does not seem to be the end-all-be-all.
Now researchers are exploring the possibility that inflammation, or an overactive immune system, can actually be related to mental disorders that include:
- Alzheimers’ disease
According to Golam Khandaker a host of recent genetic and epidemiological studies have shown inflammatory markers are found in the blood of people who are depressed or who experience psychotic episodes. Khandaker studies inflammation and the brain, and is a senior clinical research associate at the University of Cambridge, in England.
History of Immunopsychiatry
Immunopsychiatry states that infection and inflammation can have a profound impact on the brain, and immunopsychiatry has been an abstract concept in the history mental health treatment over the last century. In the 19th century, mental illness and infectious disease were closely linked, but in the 20th century that connection has been outcast and struggled against psychiatric and neurological dogma. Now new comprehensions uniting the brain, body, and environment help doctors and therapists to understand the idea.
In the 1880s, German psychiatrist Emil Kraepelin argued that mental illness and insanity were biological or genetic conditions, classifying a wide range of conditions under the umbrella term dementia praecox, or “premature dementia.” These classifications were tremendously influential at one point.
Then there was syphilis, something so common it was called “the disease of a century”. It’s a sexually transmitted disease caused by the bacterium Treponema pallidum that represented this idea of the body and brain being linked in mental illness because beyond ravaging the body, late-stage syphilis victims often experienced what doctors at the time called neurosyphilis.
Neurosyphilis was a state described as manic and delusional, before paralysis and death. Right there was suspected proof of an infection causing psychosis.10% of patients in turn-of-the-century asylums were there because of neurosyphilis. An Austrian psychiatrist named Julius Wagner-Jauregg became the first psychiatrist ever awarded a Nobel Prize in Medicine in 1927 for an unconventional syphilis treatment that would be condemned as unethical today, but hinged on the idea of infection and the immune system being related to mental illness.
How it Happens
When you think about the big picture, behavioral responses to physical ailments make sense. When we have the flu, we feel it physically and emotionally. High fevers, usually signs of extreme inflammation, can cloud thinking and induce hallucinations, and our “sickness behavior” is just the body and brain working together to combat an infection.
But when inflammation persists, depression can become chronic. Over time, inflammation can do real damage to the brain. Other models for the link to inflammation, infection, and mental illness are Autoimmune diseases like:
- Type 1 diabetes
- Celiac disease
In these cases immune cells take aim at the body’s tissues and organs instead of fighting disease, attacking and destroying the organs with devastating consequences.
Epidemiological studies have begun to link autoimmune disease to mental illness, supporting the idea that misguided immune reactions can influence the brain. For example:
- Schizophrenics often have celiac disease
- Lupus sometimes leads to psychotic episodes
Everything from Parkinson’s and cerebral palsy to attention deficit hyperactivity disorder (ADHD) have been connected to damaged basal ganglia, which are referred to as the gatekeeper between the brain stem and motor function and the upper brain, and when they are afflicted, it effects our control of some basic impulses.
Critics of PANDAS agree with the advocates in the idea that mental disorders like OCD, depression, or schizophrenia should be looked at as a set of symptoms with a variety of possible causes… and possible treatments. Factors like genes, environment, and immunity all contribute in a way that medical professionals are just beginning to understand and explore further.
Yet today, simply by knowing that some mental illness is caused by infections, doctors and scientists are returning to a holistic understanding of the relationship between body and brain. With this new holistic view of mental illness, there is the potential for amazing new treatments that could overcome crippling mental disorders.
The stigma surrounding mental health only holds people back from truly understanding what it means to suffer from a mental illness. People who are bound by a mental disorder are not outright mental defects, they are sometimes just at the mercy of a mind that has been weakened by physical infection, and there is always treatment out there. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135
Author: Justin Mckibben
It’s pretty common knowledge that consuming alcohol takes a toll on your body, and especially the liver. If you’re a drinker the longer you drink will consistently up the chances of developing a serious liver disease, and there are other risk factors that come into play besides drinking alcoholically. Being aware of these factors can help you in trying to curb your chances of serious liver complications, and for those who are struggling these factors may ultimately assist you in understanding the best treatment options for you.
Stages of Alcoholic Liver Disease
There are different stages of alcoholic liver disease:
- Fatty liver
- Alcoholic hepatitis (inflammation of the liver)
- Cirrhosis (fibrosis, or scarring, of the liver)
Dr. Pam Peeke is the author of “The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction” as well as the senior science advisor to Elements Behavioral Health. According to this expert, fatty liver and alcoholic hepatitis are “fairly prevalent,” but cirrhosis is a very different problem. Peeke states,
“One in five people who are alcoholics develop [alcoholic] hepatitis, and one in four develop cirrhosis. You’ll be at higher risk if you also have fatty liver—it’s those people who tend to be at higher risk for cirrhosis if they continue to drink.”
Data suggests that:
- About 90% of heavy drinkers develop fatty liver
- 10 to 35% of heavy drinkers will develop alcoholic hepatitis
- Up to 20% of heavy drinkers will develop cirrhosis
The good news is, some elements of cirrhosis are reversible, but in order for this to be possible Peeke says there has to be 100% abstinence in order to facilitate this kind of recovery. In the experience of most alcoholics, abstinence from consuming alcohol is an essential part of recovery, period.
These are 7 elements of alcoholic liver disease, and it is important to take these things into consideration when evaluating your drinking habits, because for those struggling to stop drinking, this may open your mind to the risks you run.
- How Much You Drink
This one is pretty obvious. Alcoholic liver disease typically occurs after years of heavy drinking. Not all alcoholics will get it, but the longer you drink and the more you drink, the more your chances increase.
- Consistency of Drinking
Consistently drinking heavily on a regular basis is actually a higher risk than drinking irregularly throughout the week, or even binge drinking on weekends and holidays.
Research has found that five drinks or more per day raised the risk of developing cirrhosis according. The risk of both hepatitis and cirrhosis is increased when consumption for 20 years or more is around:
- 60g or more per day for men
- 20g per day for women
The damage caused by alcohol happens more acutely in women, so women are more likely to develop liver disease. For women it is more severe, happens much faster, and takes less alcohol to develop.
Women are more vulnerable than men for various reasons, including:
- Women secrete less alcohol dehydrogenase (which breaks down alcohol)
- Have a greater proportion of body fat (alcohol is soluble in water)
- Experience changes in fat absorption due to their menstrual cycles
Beyond gender, the full extent of the role genetics play in alcoholic liver disease is not yet understood, but more is being learned. It is believed that gene mutations actually predispose someone to both developing alcoholism and alcoholic liver disease. Some mutations in genes that may explain this genetic link are:
- ADH (alcohol dehydrogenase)
- ALDH (aldehyde dehydrogenase)
- CYP4502E1 (one of the many cytochrome P450 enzymes)
This is also connected to individual differences in the metabolism of alcohol.
- Immune System
A stronger immune system will of course have a better chance at surviving and fighting off liver disease. However a compromised immune system cannot, and thus increases the risk factor of liver disease.
Research has found that people with HIV or hepatitis C, or both, have an increased risk of advanced liver disease. It is known that these diseases increase death rate of liver cells.
Drinking in excess only compounds this problem and accelerates the process of weakening the immune system.
Anything that makes it harder on the body to maintain its health increases the risk for developing liver disease, especially for drinkers. 2 big ones are:
Many alcoholics have a habit of poor nutrition. Now more data on gut bacteria or the gut microbiome is just beginning to discover how these things are affected by alcohol, which can change gut permeability and lead to problems absorbing and digesting food.
Malnutrition also increases oxidative stress, which is known to promote liver disease by the depletion of circulating antioxidants, including vitamins A, C, and E, and glutathione. Ultimately poor dieting and nutrition continues to weaken the immune system, which opens you up to infections and complications.
- Physical Fitness
In addition to abstinence, regular physical activity is an essential factor in the continued health or the required treatment for the recovery of the liver. On top of the mental and emotional fitness that goes into recovery for alcoholics, physical fitness can co-exist with nutrition in a way that helps to nurture recovery, and revitalize the immune system for someone whose body has been suffering.
So many things factor into the gradual development of liver disease through excessive drinking or alcohol abuse, and so many people ignore the signs that their life-style has exposed them to these risks. Alcoholism is deadly in many ways, and many find that in order to change their health and preserve their future, they must change their lives, today! If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135
Author: Justin Mckibben
The link between our genetics and our addictions has long been pondered, studied, and speculated as a major factor in how we can trace and treat mental health issues, behavioral impulses, and even problems with substance abuse. Now some suggest that changing the way that a gene in the brain region operates may actually offer a new solution to reducing addictive cravings and depression at the source.
Studying the Science of Substance Abuse
According to the findings in a recent study conducted at the Icahn School of Medicine at Mount Sinai that has been published in the journal Nature Neuroscience, reducing the addictive cravings and the symptoms of depression is a matter of controlling the genetics. This study focuses on changes shaped in human genes by transcription factors. It centers on the concept of manipulating proteins that bind to specific DNA sequences and influence the function of a person’s individual genes.
DNA is in everyone, and contains genes and the instructions needed for an organism to develop and survive. To carry out these functions, DNA sequences are adapted into messages that essentially “tell” the cells which proteins to make or how to react. That message dictates the response of a given cell when the body needs it to carry out a specific function.
While all cells contain the DNA that codes for every gene, most of these genes are not activate at all times. The expression or activity of a gene depends on the action of transcription factors, allowing some genes to be active and others to be repressed until the body calls upon them whenever needed.
The transcription factors can be transformed by contact to certain chemicals or by stress that will produce a response, which can make the genes more susceptible to stress or addiction. In the recent study, the research team introduced synthetic transcription factors called Zinc Finger Proteins (ZFPs) into a single gene. That FosB gene was located in the nucleus accumbens.
The nucleus accumbens certainly plays an essential part in the reward circuit. Its central function is based chiefly on two essential neurotransmitters:
- Dopamine- which promotes desire
- Serotonin- which promotes inhibition
Several studies done on test animals in the past have shown that all drugs increase the production of dopamine in the nucleus accumbens. Drugs also reduce the production of serotonin in the nucleus accumbens. That should come as no surprise, as drugs are commonly known as mood or mind altering substances. The synthetic transcription ZFPs were introduced into the FosB gene of mice as test subjects.
Exciting Evidence of Innovation
When FosB is stimulated and effectively activated in the brain, the individual typically experiences a more increased sensitivity to drug interaction and less resilience to stressors. Basically when this gene is expressed, it makes a person more likely to seek drugs to fulfill their needs and less capable to cope with stress or emotional compromises.
The combination of the FosB gene and the synthetic transcription (ZFPs) caused chemical modifications that actually produced the opposite effect on the test subjects. The test mice appeared to be more resilient to stress and less susceptible to cocaine dependency, suggesting that by manipulating this gene, depression as a major factor in both mental illness and substance abuse can be combated at a cellular level, and chemical dependency can possibly be something we are able to alleviate by the same means.
The authors of this study have indicated that their research is the first step in developing not only therapeutic alternatives to positively and effectively diagnosing and treating the diseases of depression and addiction, but this new data could also help to greatly improve on treatment of other genetic-based conditions.
The study’s lead author, Elizabeth A. Heller, PhD claimed,
“The use of engineered transcription factors has broad implications outside of neuroscience, because gene regulation underlies many diseases, including most forms of cancer.”
So as scientists and researchers look further into how genetics play their role in depression and addiction, they are beginning to understand how using synthetic proteins can actually trick a person’s DNA into reacting differently to stress, and become less dependent on drugs to produce dopamine. Training the body to combat mental illness and substance abuse at a cellular level may actually change everything we know one day about addiction and addiction treatment.
The future may hold new hope for a better understanding and awareness of addiction and depression, and we may be opened up to a new world of possibilities for identifying and addressing these and other health and behavioral issues. Too many people have too little understanding of the disease of addiction and how intricate and deeply rooted it can be, and because of that they never seek the help that could save their lives. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135