Substance Abuse

What causes addiction?

The dictionary defines addiction as:  the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, such as narcotics, to such an extent that its cessation causes severe trauma.

In medicine, an addiction is considered an habitual psychological and physiological dependence on a substance or activity, such as gambling, or practice, such as sex, beyond one’s voluntary control.

To explore even further, science considers addiction physical or psychological need for a habit-forming substance, such as a drug or alcohol. In physical addiction to narcotics, the body adapts to the substance being used and gradually requires increased amounts to reproduce the effects originally produced by smaller doses.  The use of a medication in a manner different from how it is prescribed or recommended and use of an intravenous drug that is not medically required are considered substance abuse.

The pattern of substance abuse may lead to significant impairment or distress, reflected by one or more of the following:
• Failure to fulfill major role obligations at work,school, or home (e.g., substance-related absences from work, suspension from school, neglect of a child’s need for regular meals)
• Continued use in spite of physical hazards (e.g., driving under the influence)
• Trouble with the law (e.g., arrests for substance-related disorderly conduct)
• Interpersonal or social problems.
When addiction takes over the lives of parents, children ultimately pay the price.  The addiction becomes so great that children are exposed to danger and are often left to fend for themselves in every way.  When this occurs, the children may be removed from the home and placed into foster care until the parents can receive treatment.

Learning About Addiction

People experiment with drugs for many different reasons.  Many first try street drugs out of curiosity or peer pressure, while some drugs are consumed in an effort to improve athletic performance or ease another problem, such as stress, anxiety, or depression.  Use doesn’t automatically lead to abuse, and there is no specific level at which drug use moves from casual to problematic. It varies by individual.

Drug abuse and addiction is less about the amount of substance consumed or the frequency, and more to do with the consequences of drug use. Regardless of your consumption, if your drug use is causing problems in your life—at work, school, home, or in your relationships—you likely have a drug abuse or addiction problem.

It is a misconception that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior.  In reality, drug addiction is a complex disease, and quitting takes more than good intentions or a strong will.  Learning about the nature of drug abuse and addiction—how it develops, what it looks like, and why it can have such a powerful hold—will give you a better understanding of the problem and how to best deal with it.

What Is Drug Addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite the negative consequences that affect the user and everyone around them.  What begins as a voluntary choice to consume a drug will, over a period of time, become something very different.  Due to changes that occur in the brain, an addict will eventually have little-to-no self-control or ability to resist the intense impulses to take drugs.

Drugs abuse affects the brain much more dramatically than natural rewards, such as food and social interactions. To bring stimulation down to a more manageable level, the brain must try to adapt.  One way the brain compensates is to reduce the number of dopamine receptors at the synapse (a junction between two nerve cells). In addition, sending neurons increase their number of dopamine transporters, more quickly clearing dopamine from the synapse. These changes make the brain less responsive to the drug, but they also decrease the brain’s response to natural rewards.

Because of these changes, after the user has “come down,” they will need more of the drug next time they want to get high. This response is commonly referred to as “tolerance.”

As the brain continues to adapt to the presence of the drug, regions outside of the reward pathway are also affected. Over time, brain regions responsible for judgment, decision-making, learning, and memory begin to physically change, making certain behaviors “hard-wired.” In some brain regions, connections between neurons are pruned back. In others, neurons form more connections.

Once these changes take place, drug-seeking behavior becomes driven by habit, almost reflex. The drug user becomes a drug addict.

Stopping drug use doesn’t immediately return the brain to normal. Some drugs have toxic effects that can kill neurons—and most of these cells will not be replaced.  While changes to connections between neurons in the brain may not be permanent, some last for months. Some research suggests the changes may even last for years.

Long-lasting brain changes can make it challenging for addicts to stay drug-free.  They often experience intense cravings, leading to relapse.  Research has indicated that it could take up to 18 – 24 months for the brain to rewire itself back to normal.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal treatment failure—rather, it indicates that treatment should be reinstated or adjusted or that an alternative treatment is needed to help the individual regain control and recover.

When a child is placed in foster care due to substance abuse affecting one or both parents, the court system has little tolerance for relapse in spite of it being a common occurrence. A Relapse Prevention Plan is a crucial part of successful recovery.  Surrounding yourself with a network of people who are supportive in your journey to recover from drug addiction is another crucial element that will lead to success.

What Happens to Your Brain When You Take Drugs?

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: by imitating the brain’s natural chemical messengers and/or by overstimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers called neurotransmitters, which are naturally produced by the brain. This similarity allows the drugs to “fool” the brain’s receptors and activate nerve cells to send abnormal messages. Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or to prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The over-stimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the dopamine surges by producing less dopamine or reducing the number of dopamine receptors. The user must therefore keep abusing drugs to bring his or her dopamine function back to ”normal” or use more drugs to achieve a dopamine high.

Long-term drug abuse causes changes in other brain chemical systems and circuits, as well. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively —  in other words, to become addicted to drugs.

Why Do Some People Become Addicted While Others Do Not?

No single factor can predict whether a person will become addicted to drugs. Risk for addiction is influenced by a combination of factors that include individual biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

  • Biology. The genes that people are born with—in combination with environmental influences—account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.
  • Environment. A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life.
  • Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to more serious abuse, which poses a special challenge to adolescents. Because areas in their brains that govern decision-making, judgment, and self-control are still developing, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse.

Painkillers, Narcotic Abuse, and Addiction

One of the most frequent reasons people go to the doctor is for pain relief.  There are a number of different drugs that can ease pain. Opioids — also called opiates or narcotics — are pain relievers made from opium, which comes from the poppy plant.  Morphine and codeine are the two natural products of opium.  Synthetic modifications or imitations of morphine produce the other opioids:

  • Heroin (street drug)
  • Dilaudid (hydromorphone)
  • Percocet, Percodan, OxyContin (oxycodone)
  • Vicodin, Lorcet, Lortab (hydrocodone)
  • Demerol (pethidine)
  • Methadone
  • Duragesic (fentanyl)

When people use narcotics only to control pain, they are unlikely to become addicted to the drugs. However, opioids provide an intoxicating high when injected or taken orally in high doses.  Opioids are also powerful anxiety relievers.  For these reasons, narcotic abuse is one of the most common forms of drug abuse in the U.S.

Strictly speaking, most drugs referred to informally as narcotics really aren’t. However, two drug classes have some similar effects to opioids, when abused:

  • Benzodiazepines include Valium, Ativan, and Xanax. Benzodiazepine abuse results in sedation and calm, but tolerance develops rapidly. Withdrawal can result in seizures, unlike opioid withdrawal.
  • Barbiturates include Seconal, Amytal, Nembutal, and Luminal.  Barbiturates are also sedating and calming. Withdrawal after continued barbiturate abuse, like benzodiazepine abuse, is medically serious.

In general, benzodiazepines and barbiturates have less pain-relieving effects than opioids. All three drug classes are sedating and anxiety-relieving. Benzodiazepine abuse, barbiturate abuse, and narcotic abuse all produce tolerance and physical dependence over time, and withdrawal symptoms after sudden discontinuation.

Prevention Is the Key

Drug addiction is a preventable disease. Research has shown that prevention programs involving families, schools, communities, and the media are effective in reducing drug abuse.  Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking.  Thus, education and outreach are key in helping youth and the general public understand the risks of drugs and drug dependence.