If psychiatry is the Cinderella of medicine, addiction medicine is the Cinderella of psychiatry.
These were the words of a local psychiatrist mentioned during a course I attended several years ago that just stuck in my mind because indeed, almost nobody wants to deal with these problems and these patients.
I am a non-smoker and given how annoyed I was throughout my life by smokers who lit cigarettes in the classroom (as teachers!), on the hallways of universities (as colleagues and teachers when smoking was not forbidden yet in such places), in patient rooms (especially during winter), in trains, in restaurants and many other public places, I thought that nicotine was such an addictive substance that these people don’t realize anymore how weirdly they behave. Now imagine my surprise when I encountered long-lived people who smoked 1-2 cigarettes every couple of days. And then imagine my surprise when I encountered very addicted people who smoked 2 packs a day during the last 10 years. Maybe nicotine was one substance only but the way these people reacted to it seemed very different. What I noticed in my years of clinical practice is that the people who aged gracefully were also the ones who may have consumed alcohol, but never got drunk. They were the kind of people who rarely drank more than one glass of wine per day. They weren’t the typical coffee addicts either, drinking a cup of coffee every other day if that. They were the kind of people who ate variedly and in small quantities. It dawned on me that the longest-lived patients I saw – the kind of people who aged like wine and not like vinegar – seemed less prone to addictions than the general population.
It’s tempting for tabloid journalists to notice such consumption and write a huge headline that so and so also smoked, drank alcohol, ate bacon etc and lived to be a centenarian and people will buy that kind of ‘news’ because it makes them feel OK about their habits. But quantity is never mentioned and that may be the difference between an occasional indulgence and chronic consumption. Enjoying a variety of pleasures in small quantities could also dilute any toxic after-effect of such substances and/or behaviors similar to how hormesis works.
Addiction is a disease which hacks the memory and the learning process. Searching for certain rewards is certainly important for survival, but what happens during addiction is that this search takes place at a disproportionate level for only one kind of pleasure to the detriment of others and in severe cases even to the detriment of basic survival. That reward can be provided by a substance like nicotine, alcohol, any illicit drugs or it can be a non-substance like gambling, sex or food.
Addiction is no fun and even when it is overcome, lifespan may still be reduced compared to the general population. Long-term addiction accelerates aging both internally and externally.
Having said that, people vary widely in their vulnerability to becoming addicted and this vulnerability may show up in different lifespans in the population.
The highest risk factor for addiction I saw quoted in scientific literature in humans as well as in animal models is the genetic one – if you’re interested in which genes increase the risk of several types of addiction, this review is a good paper to begin with.
Of course, you can’t (yet) control the genes you’re born with, but there is one stage in life when addiction is likely to be most damaging over the whole life course and that is while being a teenager. That is the time when people are most prone to peer pressure and any addictive substance can be more damaging than the norm because the brain has not yet fully developed. Neurodegenerative diseases come with aging anyway, but if aging sets on a brain affected by other non-aging-related diseases the damage may be more extended. The worst cases of Alzheimer’s I saw were in alcohol addicts.
And while the worst period in life in terms of long-term addiction effects comes during the teenager years, the one in which addiction is more likely to occur and also to be disguised is old age. A nice old lady you see in the morning during commuting could consume way too much alcohol in the evenings; she could be your patient one day and it wouldn’t even cross your mind to ask her whether she consumes any alcohol. But people die gradually and the old age is a time of loss: of physical abilities, of social identity, of spouses and friends, sometimes of children too. It’s also a period of life when it’s tempting to become bitter about disillusions and failures. It’s a period of life when people tend to live alone as well. As you can see, the elderly have all the reasons to become addicted – especially to opioid painkillers and socially accepted/legal drugs like alcohol – and addiction vulnerability can tilt the balance towards a shorter lifespan.
A third risk factor for addiction is the occurrence of other mental diseases. The causes of mental diseases are multiple, but there’s no denial that they are influenced by – not necessarily caused by – the external environment and how resilient people are to mental stress.
The very old people I encountered in my clinical practice had to overcome many obstacles throughout their long lives, but it is my impression that they learned well how to be happy and/or how to minimize suffering. These were the rare people who loved to read philosophy and literature and such books may have taught them how to cope with life in general. These were the people who usually married only once and the ones who had 1-2 children instead of 10. These were the rare people who were spiritual without being fanatically attached to dogmas and without trying to impose their views on you. It seemed like they were moderate in everything they did. I don’t know whether this moderation could be linked to a resistance towards addiction since I couldn’t find any scientific paper on the topic, but if you can find one, please mention it in a comment below!
In terms of personality traits, conscientiousness can favor longevity and this could make these people less prone to try addictive substances in the first place or more likely to detect deviations and control themselves faster as in stopping themselves at one glass of wine only. But one more thing I noticed in the long-lived people who aged gracefully is that they learned the art of balancing being social with rejecting peer pressure. Being too social puts you at risk of embracing unhealthy behaviors. Being too lonely can increase your risk of death, especially during advanced age. Neither of these extremes is conducive to a long lifespan. The moderate path in being open to ideas and people without losing your critical thinking skills and without being afraid of spending time alone could provide the best of both worlds.
Anca Ioviţă is the author of Eat Less Live Longer: Your Practical Guide to Calorie Restriction with Optimal Nutrition ,The Aging Gap Between Species and What Is Your Legacy? 101Ways on Getting Started to Create and Build One available on Amazon and several other places. If you enjoyed this article, don’t forget to sign up to receive updates on longevity news and novel book projects!
Don’t miss out on the Pinterest board on calorie restriction with optimal nutrition where she pins new recipes every day.
https://www.pinterest.com/IovitaAnca/eat-less-live-longer/
Or the Comparative Gerontology Facebook Group where you can join the discussions on how species age at different speeds and what could be the mechanisms underlining these differences!
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It probably works both ways:
– people who, by virtue of their mental skills, know how to be moderate and resilient, in consequence learn to avoid extremes and to become addicted, and thus live longer lives.
– people who are lucky not to possess the addiction-favoring genes are also less likely to get addicted and again can live longer.
The converses of the above 2 statements seem to apply as well.