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The discussion about drug addiction exists everywhere: in our politics, in our schools, and in our homes. Drugs strike at everything we hold dear: our self-image, our relationships, and the people we love. But addiction is a vastly complex spectrum, a process that is seeded long before the first hit, and recovery continues long after the last therapy session. Having a guide to drug addiction, understanding how addiction works and what it looks like, goes a very long way in helping families cope with the cost of substance abuse.
An addiction describes a mental and physical health condition where a person has a physical and psychological dependence on a substance that changes how that person thinks. People may initially depend on this substance (usually a drug, but also alcohol, or anything that has an effect on how the brain functions) to help them cope with difficult situations, like chronic pain or anxiety, but they eventually start using the substance to simply get through the day. People may look forward to the effects of the substance so much that it starts to consume their other thoughts, becoming the focal point of their everyday lives. They may divert their resources and energy to securing more of the substance (lying to their doctors to get a bigger prescription or dipping into their savings account to buy alcohol), going so far as to lie to their friends and family about their problems. Their academic or professional lives will likely suffer as they become less interested in social obligations, and more concerned about feeling the effects of the substance, even as the world around them fractures.
In drastic situations, people may refute the suggestion that they are using the substance too much, or that their behavior is having a negative impact on the people around them. They may try to justify their consumption, deny the problem exists, or otherwise try to get out of the situation without giving up their intake.
However, even trying to stop taking the substance doesn’t work, because their bodies and brains have become so used to it. They experience unpleasant and violent reactions (nausea, muscle pain, insomnia, and fever) when they go a few days or weeks without drugs or alcohol, eventually giving in and indulging in even larger doses just to feel some semblance of relief.
The Substance Abuse and Mental Health Services Administration explains that this is what an addiction (also known as a substance abuse disorder) really is. Medical News Today goes further, explaining that a drug addiction deprives individuals of the ability to control their cravings for the substance. What they get, however, is an increased tolerance, meaning that they have to consume larger and larger amounts of the drug in order to experience the same effects they did when they first started taking it. If, for example, a person needs numerous drinks to feel the pleasant buzz usually associated with one or two drinks for a moderate drinker, that can be a sign of addiction.
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It is important not to conflate the conditions of addiction and abuse, as the two terms are distinct, although related to different degrees, depending on the person. Those who abuse drugs or alcohol retain a level of control over their behavior, to the point where a doctor speaking to Everyday Health describes abuse as a “milder” form of addiction.
Another doctor cautions that the difference between drug abuse and a drug addiction is small enough that abuse should be seen as a warning sign for addiction;
even if people can consume more drugs or alcohol than what is healthy for them, and still hold their lives together, they are almost certainly developing a full-blown addiction unless an intervention is secured as soon as possible.
Broadly speaking, the abuse of drugs or alcohol revolves around how a person uses them. Psychology Today explains that those who abuse controlled substances displays an ability to either maintain their consumption (albeit at heightened levels) or abstain completely. This is insidious, because people can claim that since they successfully exert a level of control over their intake, they are not in danger of overdosing, or that any negative effects are aberrations or not related to their habits. Consequences of abuse are inevitable, but those in the abuse stage of the spectrum might still be able to cut back on their drinking or drug use enough to allay the concerns of family members. If people do not (or choose not to) learn from their experiences, the transition from drug abuse to drug addiction is inevitable.
Neurotransmitters, found in the brain, are chemicals that pass information from one nerve cell to another. It is through neurotransmitters that the brain tells the heart to beat, the stomach to digest food, the lungs to breathe, and so on. Neurotransmitters are also responsible for regulating functions like mood, sleep, appetite, and concentration, among others. Stress, poor diet, unhealthy lifestyles, genes, and drug consumption can deplete some neurotransmitters and boost others out of their optimal range, causing any number of negative effects.
One such neurotransmitter is known as dopamine, which The Guardian called “the celebrity among brain chemicals.” Dopamine plays a number of roles in the brain, but it has become infamous for the complex way it stimulates pleasure, rewards, and the anticipation thereof.
According to Psychology Today, the brain releases dopamine when we experience something good, like consuming food, having sex, or doing something that is otherwise agreeable. In a healthy brain, the brain reabsorbs the dopamine, which is why we eventually lose the desire to keep engaging in the activity, no matter how good it initially was. Crucially, however, we remember how those activities made us feel, and we want to feel them again. Dopamine drives the anticipation of rewards; for example, compelling us to not just eat food to survive, but to eat food we will actively derive pleasure from consuming.
But this is where drugs come in. Quoting the National Institute on Drug Abuse, Slate magazine writes that all drugs, from alcohol to heroin to Valium, force the dopamine neurotransmitters to keep transmitting dopamine throughout the brain and central nervous system, for longer periods of time than any natural activity can do.
For example, while the dopamine neurotransmitter is normally recycled back into a neuron (the reabsorption mentioned above), cocaine binds to the dopamine, preventing it from being recycled. This causes the brain to be flooded with intense sensations of euphoria, exhilaration, and pleasure, for much longer than any other activity or hobby could hope to achieve; depending on how cocaine is consumed, anywhere from 3-90 minutes.
High-resolution images produced by laser scanning microscopy show that drugs actually change the chemical functioning of the brain, to the point where other sources of pleasure have no physiological or neurological effect.
Psych Central explains that people receiving treatment for alcoholism are often victims of childhood abuse (whether physical, sexual, or emotional). The journal of Alcoholism: Clinical and Experimental Research paints the picture in numbers: While 8.4 percent of the general population of the United States has experienced physical abuse, this rate increased to 24 percent of alcoholic men and 33 percent of alcoholic women. With regards to sexual abuse (any act of a sexual nature performed without informed consent), 6 percent of the general population has been mistreated; when looking at alcoholic men, 12 percent were sexually abused during their childhoods, and 49 percent of alcoholic women were sexually abused during their childhoods.
Similarly, the journal Depression and Anxiety found that physical, sexual, and emotional abuse during childhood was associated with higher-than-average rates of substance abuse. A study of 587 participants, all from a “highly traumatized population,” had addiction rates of 39 percent for alcohol, 34.1 percent to cocaine, and 44.8 percent to marijuana.
“Childhood trauma creates lifelong adult addicts,” says The Fix, speaking of the “massive increase” of risk in turning to controlled substances to cope with the stress and strain of enduring distressing or violent events that occurred early in life.
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While abuse in childhood plays a huge factor in determining the chances of a person becoming addicted to drugs or alcohol, it is not the only piece of the puzzle. Mayo Clinic lists a number of other factors that can influence people’s behavior and mental health, to the point where they seek out controlled substance. In addition to childhood abuse, these factors play a role:
A Psychology Today blog looks at both physical and environmental causes of addiction, saying that substance abuse is “one possible outcome” of the alignment and combination of risk factors. Another article points to the “genetic component” being a “huge component” in the development of the personality to become a substance abuser.
Drug addiction, therefore, is an incredibly complex spectrum. Whether it is childhood abuse, a family history of addiction, the availability of drugs from peers (and the pressure to use), or a stressful home situation, any number of causes can line up that make a person inclined to start using drugs. Whether that person continues to use drugs is similarly dependent on that kaleidoscope of conditions.
To that effect, the American Journal of Psychology wrote that adolescents using marijuana was partially influenced by the availability of drugs in their respective neighborhoods. A study of 311 pairs of twins in Australia found that a sibling who used marijuana was at least two times more than likely to use a number of other drugs, when compared to the sober twin. The authors of the study wrote that the connection between using marijuana early and “graduating” to harder drugs in adulthood may be a result of a combination of peer pressure and social context (such as the availability of drugs) while controlling for genes and home environment.
However, Reason magazine pointed out that the joint American-Australian study did not discuss whether or not there was a direct, drug-related effect between the smoking of marijuana and the use of other illegal drugs later in life. Effectively, says Reason, a marijuana user may be tempted to experiment with other drugs, but the twin study did not conclusively suggest that the experimentation was solely the result of the marijuana.
Whatever the reasons behind addiction, what drugs are people actually using? Tabulating that list has proven difficult, because addiction rates vary across social contexts and psychological characteristics. For example, The Fix claims that crack cocaine has one of the highest rates of abuse, but Canada’s CBCwrites that saying one drug is more addictive than another does not take into account the different thresholds of addiction that different people have – thresholds that are determined by the many risk factors mentioned above.
Nonetheless, there’s little disagreement as to the addictiveness of certain drugs. The Fix placed heroin at the top of its own list of the “10 hardest drugs to kick”. With its “legendary” addictiveness, the Centers for Disease Control and Prevention say that the United States has seen an increase of heroin usage across genders, age groups, income levels, and demographics. The year 2013 saw more than 8,200 heroin-related deaths.
In all the discussion about cocaine and heroin, it’s easy to forget that alcohol is a drug and a very addictive one at that. The National Council on Alcoholism and Drug Dependence calls alcohol the most commonly consumed substance of addiction in the United States, with 17.6 million people (1 in 12 adults) suffering from some form of physical or psychological dependence on alcohol. The CDC found that young adults consume an average of 9 drinks when they get drunk, when the definition of binge drinking is an average of four drinks for women and five drinks for men in less than two hours.
BBC News explains that alcohol, like other drugs, derives its addictiveness from its stimulation of dopamine in the brain. Like with other drugs, individual drinkers have unique psychological and genetic traits that determine whether or not a single drink can expose them to the same element of risk as a line of cocaine or a hit of heroin.
Addiction can be confusing. It is not always easy (or even possible) to join the dots from causes to mediums to effects. Knowing more about the various aspects that can cause it, and understanding why people can react to stress and substances in such different ways, can help concerned family members or friends to recognize a warning sign, or know what to look for, if they are worried that a loved one is abusing drugs or alcohol.
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