Understanding Drug Addiction

Drug addiction is a mental health disorder that affects millions of people all over the world. According to the 2014 National Survey on Drug Use and Health, about 21.5 million people in the US have a substance use disorder that requires treatment, and various government and municipal agencies are struggling with an epidemic of drug use, abuse, and addiction problems.

Drug addiction is part of a larger spectrum of substance use disorders. From misuse, to abuse, to addiction, these disorders affect large numbers of people, either through intentional, recreational use of drugs, or through problems in use of addictive medicines designed to treat pain and mental health disorders.

By understanding what drug addiction is, how it develops, and how it can be avoided or treated, it may be possible to stem the increasing issue of drug addiction and abuse in the US.

Overview on Drug Addiction

Addiction is considered to be a mental health disorder focused around substance use and other behaviors associated with brain reward and motivation responses, as defined by the American Society of Addiction Medicine. On a simple level, having a drug addiction means that a person is physically or mentally dependent on a drug to feel able to function normally.

However, defining addiction simply as dependence is an oversimplification. Some people are dependent on drugs to treat and manage medical conditions, but these people are not considered to be addicted to their medications. The difference has a lot to do with the reasons for using the substance and the behaviors involved in the substance use.

The Difference between Physical Dependence and Addiction

As an example, a person who has chronic pain may be prescribed prescription painkillers to manage that pain.

Over time, the body develops a tolerance for the medication, so the prescribing doctor may increase the dosage if the initial dosage no longer effectively manages the pain. If the person continues using the medication, the body grows accustomed to its presence, and withdrawal symptoms may occur if the person stops taking it.

This is physical dependence; the body is used to operating in the presence of the drug and goes into withdrawal if the drug leaves the system.

A person who is physically dependent on a drug is not necessarily addicted to it. If the person uses the medication as prescribed, addiction is usually not present.

When a person begins using the medication outside the parameters of the prescription (increasing dosage levels, taking the drug more frequently, or combining it with alcohol or other substances) or begins using it recreationally, addiction may be present.

When a person is addicted to a drug, they have usually lost control over their drug use, and they can’t stop using drugs even if they want to. Even if they think they can “cut back,” attempts to do so generally fail. There are a number of other symptoms specific to addiction defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as described by the National Institute on Drug Abuse, such as:

When a person is addicted to a drug, they have usually lost control over their drug use, and they can’t stop using drugs even if they want to. Even if they think they can “cut back,” attempts to do so generally fail. There are a number of other symptoms specific to addiction defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as described by the National Institute on Drug Abuse, such as:

  • Taking more of the substance than desired or intended; feeling lack of control over use

  • Having relationship issues based around drug abuse

  • Experiencing cravings for the drug and spending a lot of time seeking or using it

  • Giving up favorite activities or flaking on responsibilities due to drug abuse

  • Being unable to stop use even when faced with negative consequences

Addiction is defined as much by the behaviors surrounding drug use as it is by the body’s physical need for the drug, as described by the National Institute on Drug Abuse. This is part of what makes addiction a difficult condition to treat. Also, some substances don’t trigger physical dependence; however, when a person is addicted to a substance and goes without it, psychological withdrawal symptoms often occur.

How People Get Addicted

The basic pathway through which people get addicted to drugs has to do with the body’s pleasure, reward, motivation, and memory systems.

As described by a Harvard Medical School publication, when a person uses a psychoactive drug, the body responds by releasing dopamine, a brain chemical that makes the person feel pleasure. This feeling of reward is what creates the sense of elation or euphoria associated with drug use.

The drug may also create new connections between brain cells that hold positive associations or memories connected with drug use. This is what can make cravings arise even years after a person has stopped using the drug. These physical changes in the brain and its chemical pathways are what result in the person becoming addicted to the drug.

This can occur either with long-term use or misuse of certain medicines like opioid painkillers or benzodiazepines, or with recreational use of substances like cocaine, methamphetamine (meth), or club drugs.

There may be other neurochemical pathways affected as well, depending on the type of drug. Still, even across broad drug categories, it appears that this dopamine pathway is the main contributor to the development of addiction.

Difference between Abuse and Addiction

The Diagnostic and Statistical Manual of Mental Disorders currently does not distinguish between drug abuse and addiction. It lays out types of substance abuse on a spectrum from mild to severe, depending on the number of criteria met. However, there are some distinctions that can be made between addiction and other types of substance abuse.

Most simply, a person does not need to be addicted to a drug to abuse it. For example, an individual who binges on club drugs once every month or so is abusing the drugs, but may not have an addiction. The person may not have developed a “tolerance” for the drugs because use is not frequent enough to make chronic changes in the dopamine or other neurochemical systems.

Tolerance is when use of a drug is frequent and regular enough that the body becomes accustomed to the drug and stops producing natural levels of the neurotransmitters affected by the drug. So, for example, the body begins to produce less dopamine.

The individual then feels like more of the drug is needed to get the same effect it had previously. Tolerance is a hallmark of addiction; in fact, a review from the Journal of the American Medical Association indicates that tolerance is also part of what distinguishes between dependence and addiction.

The Genetic Connection

Most people are aware that there can be a genetic basis for addiction. One of the major risk factors for developing a substance use disorder is a family history of substance abuse or mental health disorders, indicating that genetics are indeed a factor.

However, just because a person has a family history of drug abuse doesn’t mean that the person will necessarily end up becoming addicted to drugs.

As described by the Genetic Science Learning Center at the University of Utah, there is no single gene related to substance abuse or addiction. Multiple other factors contribute to the development of addiction, including:

  • The individual’s childhood circumstances, including abuse, neglect, or trauma

  • Levels of stress in the individual’s life

  • Exposure to or acceptance of drug abuse among the individual’s friends or family

  • Peer pressure

  • Lack of a social support system, loneliness, anxiety, and other psychosocial factors

These can all contribute to whether or not the person begins to use drugs at all. Subsequently, if a person has specific genetic combinations that affect the brain’s response to drugs, the individual is more likely to develop substance abuse behaviors that result in addiction.

Treatment Options

Substance abuse treatment programs are equipped to help people recover from drug addiction. Through a reputable, research-based program, an individual struggling with drug addiction can get professional treatment that can lead to recovery and continued abstinence. The elements of such treatment generally include:

  • Detox with medical support to ease withdrawal symptoms and cravings

  • Therapy to help the person understand the specific motivating factors behind the addiction and learn to manage triggers and cravings

  • Support group work, like 12-Step programs and other peer support groups, to provide social support, understanding, and advice from others who have struggled with addiction and recovery

  • Family or couples therapy to improve relationships that were damaged by active addiction and to improve communication in order to support recovery

  • Aftercare to help the person transition back to daily life with confidence in their ability to maintain recovery

With these treatment elements customized to meet the individual’s specific needs, it is possible to manage addiction on a long-term basis and move forward in sobriety, resulting in a more productive and happier life without drugs.

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Brooke Abner,
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