Bdrug Abuse Research In Historical Perspective
David F. Musto, M.D.
Attempts to understand the nature of illicit drug abuse and addiction can be traced back for centuries, however, the search has always been limited by the scientific theories and social attitudes available or dominant at any one time. Dr. Benjamin Rush, a founder of the first medical school in the United States and a signer of the Declaration of Independence, was one of the pioneers of U.S. drug abuse research. However, he had few scientific resources available to attack the problem. The intricacies of cellular response to a drug could not be understood until tools were developed to measure the response and to integrate this knowledge with complex cellular biochemistrya technology that has been developed only in the past decade. One can compare this situation with that of pneumonia. A myriad of treatments and partially effective remedies were used until the discovery of penicillin, when the old treatments became a part of medical history. It is now possible, however, to be optimistic that the tools needed to resolve the addiction problem are at hand.
New Insights Into A Common Problem
Nobody starts out intending to develop an addiction, but many people get caught in its snare. Consider the latest government statistics:
- Nearly 23 million Americansalmost one in 10are addicted to alcohol or other drugs.
- More than two-thirds of people with addiction abuse alcohol.
- The top three drugs causing addiction are marijuana, opioid pain relievers, and cocaine.
In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit.
The scientific consensus has changed since then. Today we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.
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How Does Drug Abuse Become An Addiction
When a person takes drugs, it interferes with the communication system in the brain. This system is made up of neurons which communicate through chemicals called neurotransmitters.
Upon first taking a drug, a person usually feels good, often referred to as high. This is because the reward center of the brain has been activated and levels of dopamine, a neurotransmitter that affects emotions and pleasure, increase. Naturally, people seek to repeat that which brings them such immense pleasure. This could mean eating or being with people they love, but it may also mean using drugs. Over time, as drug use continues, the brain adjusts accordingly. It gets used to the drug, and therefore requires more of the drug in order to achieve the same amount of pleasure from the substance. This cycle leads to a person using more and more of a drug in order to reach the same level of pleasure as they achieved when they started using a drug.
According to the National Institute on Drug Abuse, All drugs of abuse excite the parts of the brain that make you feel good. But, after you take a drug for a while, the feel-good parts of your brain get used to it. Then you need to take more of the drug to get the same good feeling. Soon, your brain and body must have the drug to just feel normal. You feel sick and awful without the drug. You no longer have the good feelings that you had when you first used the drug.
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How Long Does It Take The Brain To Recover From Addiction
The brain has billions of neurons, which connect via neural pathways. As children develop and learn, their brains create and change these pathways, a process known as neuroplasticity, with relative ease. At approximately age twenty-five, the brain has developed the majority of its neural pathways its plasticity is significantly reduced.
The brain uses neural pathways as efficiently as possible, allowing repetitive tasks to become automatic or habitual. The frequent use of the same circuits embeds them deeper into the brain, making it more difficult to alter their routes. Imagine dragging a scissors blade across cardboard along the same line over and over the groove gets more pronounced. Fortunately, the brain is more flexible than cardboard. Although adults need more time and effort to change neural pathways than a child does, adults can change their brains.
Changing the adult brain is essential for individuals who engage in addictive behaviors. Even in a high-tech society, humans still behave on the pleasure-reward system our early ancestors used for survival. The brain releases dopamine, the feel-good neurotransmitter when an action, event, or emotion is satisfying or pleasurable. To get more of that good feeling, humans repeat that stimulating action or thought.
Areas Of The Brain Affected By Substance Use
While alcohol and drugs affect the entire brain, some regions are more involved with SUD than others. The National Institute on Drug Abuse explains the effects of drugs on the brain in the article Drugs, Brains, and Behavior: The Science of Addiction, which focuses on the overstimulation of three key brain areas: the basal ganglia, the extended amygdala, and the pre-frontal cortex.
- The basal ganglia, associated with the brains reward system, recognizes pleasurable activities such as enjoying a good meal or having fun with friends. When overstimulated by drug use, though, it loses sensitivity to natural neurotransmitters, such as dopamine. With continued drug use, drugs become the only stimulus that activates this reward center.
- The extended amygdala is associated with negative emotions such as stress, anxiety, and irritability. These are symptoms a person experiences when a substance leaves the bloodstream. To avoid the negative symptoms of withdrawal, individuals often take more drugs, creating a feedback loop.
- The pre-frontal cortex is the area of the brain that governs decision making, logic, problem-solving, self-control, and impulse control. When this area of the brain is affected by drugs, confusion and poor decisions dominate the cognitive process.
Several drugs, including alcohol, affect the cerebellum. The cerebellum assists with muscle control and coordination, which is why people who have had too many drinks may stumble and weave when they walk.
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How Drug Use Starts
For some individuals, substance abuse begins when they start socially experimenting with various substances. This can be the case with drugs such as amphetamines, alcohol, marijuana and prescription drugs.
Opioid abuse can begin differently. People who become addicted to opioids are often prescribed prescription drugs, such as painkillers, often following something like an accident or surgery. They can then start taking higher doses of those prescription drugs, which can lead to abuse. They may also seek cheaper forms of opioids, such as heroin. Overall, 75% of heroin users report that the first opioid they took was a prescription drug.
When someone begins using drugs of any kind, they may start feeling as if they need larger and more frequent doses to get the same effects, even with something that started as social experimentation. This is called tolerance.
Drug use can start at any age. However, starting during childhood or adolescence is linked to an increased risk of dependence on the substance, where they feel like they need the drug to function normally.
What Are Drugs Of Abuse
Drugs that are commonly misused include:
- Alcohol.
- Synthetic cannabinoids .
- Synthetic cathinones .
- Tobacco/nicotine and electronic cigarettes .
While these drugs are very different from each other, they all strongly activate the addiction center of the brain. That is what makes these substances habit-forming, while others are not.
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Where Does Drug Addiction Start
It is true that not everyone who uses drugs will go on to develop a drug addiction, but there are many whose lives end up crippled by their obsession for substances such as heroin, cocaine, and even prescription medication. So where does drug addiction start? Why do some individuals end up in real trouble while others are able to use illegal drugs recreationally with seemingly no issues?
How Is Substance Use Disorder Diagnosed
The first step to diagnosing a drug addiction is recognizing the problem and wanting help. This initial step may start with an intervention from friends or loved ones. Once someone decides to seek help for addiction, the next steps include:
- Complete exam by a healthcare provider.
- Individualized treatment, either inpatient or outpatient.
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What Can I Do To Support My Recovery From Addiction
Recovery means different things to different people. There is no one definition and, like most things, one size does not fit all. It can be helpful to think of recovery as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
There are four major areas that support recovery:
- Health overcoming or managing health conditions and making informed, healthy choices that support physical and emotional well-being.
- Home having a stable and safe place to live.
- Purpose carrying out meaningful daily activities and having the independence, income, and resources to participate in society.
- Community having relationships and social networks that provide support, friendship, love and hope.
Hope, the belief that these challenges and conditions can be overcome, is the foundation of recovery. The process of recovery is highly personal and occurs through many pathways. The following may help you in your recovery:
- attending medical and therapeutic appointments
- creating a network of people who can support you while you overcome addiction
- learning about the addiction and its treatment
- taking medication as prescribed
From: DSM-5 criteria for substance use disorders verywellmind.com
There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders.
Are Some Drugs More Addictive Than Others
In short, the answer to this question is yes. But how addictive a drug is may depend on numerous factors, such as a persons environment, the type of drug, and the frequency with which it is used. Certain drugs carry a higher rate of addiction than others, but this doesnt necessarily mean they are more addictive. For example, this higher addiction rate for certain drugs could be due to how easily a drug can be obtained and how affordable it is.
The following are five of the drugs with the highest addiction rate in the world, according to The Independent.
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Help Is Available For The Families Of Addicts
Having a family member with an addiction problem is painful, confusing, and overwhelming. The situation is not hopeless, though. Treatment facilities can help people with substance abuse problems and the families who love them.
If you want to know how to get someone into rehab, we can help you. Peace Valley Recovery provides well-rounded, comprehensive addiction treatment programs. If your loved one wants to stop using drugs and alcohol, we can help.
We know the pain of caring for someone who cant stay clean and sober and we are here for you. Call us today to speak with an admissions counselor who can answer any questions. You dont have to walk this path alone!
What Are The Signs Of Addiction
The main sign of addiction is a problematic pattern of use that has a negative impact on day to day life.
Choosing an action, behaviour or substance to the exclusion or detriment of other parts of your life is a sign of addiction.
Additions are often associated with the following feelings and behaviours:
- craving and fixation
- sacrificing other commitments so you can continue your addiction
- continuing addiction in spite of negative consequences.
The strain of managing an addiction can seriously damage your work life and relationships.
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Behavioral Manifestations Of Addiction
When friends and family members are dealing with a loved one who is addicted, it is usually the outward behaviors of the person that are the obvious symptoms of addiction.
Those behaviors are primarily centered around the addict’s impaired control:
- The excessive frequency of drug use in spite of attempts to control
- Increased time using or recovering from drug effects
- Continued use in spite of persistent problems
- A narrowing of focus on rewards linked to addiction
- An inability to take steps to address the problems
How Does Having A Chronic Disease Contribute To The Effects And Dangers Of Drug Use
Living with a persisting or recurring disease often means attending to a number of medical details, including:
- Doctor and lab appointments
- synthetic cathinones
- tobacco/nicotine
Unfortunately, some of the damage caused by these drugs can be permanent. Any substance with respiratory depressing effects could lead to a dose-dependent increased risk of respiratory arrest and starve the brain of enough oxygen that it could lead to brain injury and permanent brain damage.
Other brain cell issues, however, can be treated with medications and diet changes. Much of that depends on the amount of time the brain cells have been exposed to drugs, along with the type of drugs people have taken.
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How Does Drug Addiction Start
People who have never experienced addiction often wonder why someone would want to become addicted to a substance. They ask themselves why anyone would use a substance that could potentially lead them down that path. Many of these questions dont have simple answers, and the questions that do have answers, are not easy to understand. The best way to explore the way addiction begins is to peel back the complex issues layer by layer and examine the way each component relates to the overall matter.
How the Cycle Begins
While humans are the most intelligent species, we are also the most hedonistic, or pleasure-seeking. We pursue and enjoy things that make us feel good like tasty food and drinks, fun activities, comfortable environments and much more. Every time the brain learns of something pleasurable as we develop from infants into adults, it stores the memory and the source of that good feeling, also known as a rush of dopamine. Healthy brains can store that good feeling away and move on with life, and the brain will continue to associate that good feeling with that memory for the future.
While this is a very oversimplified explanation of how one slips into an addiction cycle, it shows how much of the brain chemistry is affected by drugs, and how dopamine and the reward center are slowly mutated with every use.
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Hallucinogens And Natural Highs
Moving on 15 centuries, the cults of Dionysus, Demeter and Persephone in ancient Greece used a special form of mead or beer to induce visions known as mysteries. Naturally, there is something very mystical in seeing hallucinations, and plants containing entheogens have been widely cultivated throughout the world these include the peyote cactus, fly agaric, and cannabis. Clearly, this is a form of drug abuse, although it was a socially acceptable one at the time.
While the Romans embraced these drugs for recreational use because of the ease of obtaining them through trade, there was a long period of time after the fall of the Roman empire known as the Dark Ages where relatively few intoxicants were imported to Europe. Over the Atlantic, the Aztecs, Incas and Mayans were experimenting with peyote, cannabis and mescaline to induce shamanic visions.
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The Start Of Addiction
Youre upset you feel lost everything seems to be going wrong. But if you could just try out this spectacular drug everyone talks about, you know everything will be better.
WRONG.
This is not how addiction starts. A typical first-time user does not need drugs to feel good and cope with their past, simply because they dont know what the drug feels like. How can they expect such results?
First time use happens without a detailed plan. Generally, a party is a big trigger for spontaneously abusing drugs. Picture this. You might have shown up to a party expecting alcohol as the main event, when in the corner of your eye you see someone pull out a baggie of white powder.
Cocaine. Youve never seen Cocaine before, but everyone here is trying it your best friend is trying it, so clearly you have to try it too, right?
Theyre laying out lines of the thin white substance on the counter. Someone picks up a rolled-up dollar bill, and the white lines start to disappear. Your friend picks another line, and then hands the bill to you.
Heart pounding, hands sweating, you begin to question everything about to happen. What will this feel like? Should I do it?
You begin to snort a line how does it feel?
Peculiar and empowering. Your body suddenly gets a burst of energy. Jitters come about. Hands are shaking, feet are tapping, youre dancing to the music like you never have before. Everyone is talking to you and laughing with you youre having the time of your life!
What do you do?
Most People With Addiction Simply Grow Out Of It: Why Is This Widely Denied
1 November 2014
3 years old
The idea that addiction is typically a chronic, progressive disease that requires treatment is false, the evidence shows. Yet the ageing out experience of the majority is ignored by treatment providers and journalists. So argues Maia Szalavitz in this article originally published by Substance.com
When I stopped shooting coke and heroin, I was 23. I had no life outside of my addiction. I was facing serious drug charges and I weighed 85 pounds, after months of injecting, often dozens of times a day.
But although I got treatment, I quit at around the age when, according to large epidemiological studies, most people who have diagnosable addiction problems do so without treatment. The early to mid-20s is also the period when the prefrontal cortex the part of the brain responsible for good judgement and self-restraint finally reaches maturity.
According to the American Society of Addiction Medicine, addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. However, thats not what the epidemiology of the disorder suggests. By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do, according to a study of over 42,000 Americans in a sample designed to represent the adult population.
Maia Szalavitz is a leading neuroscience and addiction journalist and a columnist at Substance.com.
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