The National Institute on Drug Abuse defines addiction as a chronic, relapsing brain disease characterized by compulsive drug-seeking and use, despite serious distress and other complications in their lives. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 21.2 million Americans ages 12 and older needed treatment for an illegal drug or alcohol use problem in 2014. But in order to understand the science behind drug treatment, it’s important to consider the nature of addiction, including the causes and side effects. It’s also important to understand the dynamics of physical dependence on a particular substance.
Research into the probable causes of drug addiction is vast and ongoing. Traditionally, the primary cause of drug addiction has been compulsive drug use, which can then lead to physical dependence (when the body adapts to a drug and requires more of it to achieve a certain effect). Some people are more likely to become addicted, such as those who live in poverty, engage in criminal behavior, are mentally ill, are products of addicted parents or caretakers, and abuse highly addictive substances. However, are these people actually more likely than the general population to become addicted, or are they just more likely to engage in drug use to begin with?
In order to determine that a poor woman is more likely to become addicted to a substance than a middle-class woman, all other factors would have to be constant. Comparing a person in poverty who engages in occasional amounts of drug use with a middle-class person who rarely (if ever) uses any illicit drug isn’t a fair comparison. While PsychCentral reports an estimated 10 percent of the U.S. population is addicted, only 13 percent of individuals ever get treatment. With further research into what causes addiction, there is hope for increased treatment rates in the future.
The latest data indicates physical dependency actually lies at the foundation of drug addiction. When someone engages in recurrent use of a substance with addictive potential, the brain begins to grow more and more reliant upon the substance’s effects to feel pleasure. Of course, not every drug elicits joy, which shouldn’t be considered synonymous with happiness. Some drugs are indeed stimulating, and chemically excite the brain to create euphoric feeling. However, others are depressants that can actually dampen the individual’s mood. Despite the name, depressants don’t automatically induce a depressed mood. Often, people who benefit from using these drugs enjoy the relaxed mood they bring about, and frequently, they may suffer from insomnia, anxiety and other issues that a depressant can help to eliminate.
So is addiction physical? Yes. Marijuana is a great example, since it’s known to be milder than most other substances. Nonetheless, an Addiction Science & Clinical Practice publication states that around 9 percent of people who try marijuana end up dependent on it, noting that the rate is 15 percent for those who use cocaine and 24 percent for people who use heroin. Over time, those who use addictive substances develop a tolerance. Thus, the dosage must be increased continually to keep achieving the same desired response. Gradually, the effects that individuals feel from drug abuse wane, and they end up using repetitively just to feel a sense of normalcy, not to feel high. It isn’t hard for a regular social habit to turn into a full-blown addiction; it happens often.
Digging even deeper into a physical connection to addiction, there have been reports of genetic ties. Aside from heredity, both childhood and adult environments have an effect on the potential for developing an addiction. In fact, the National Institute on Drug Abuse notes that addiction carries a 40-60 percent genetic predisposition. The Do It Now Foundation reports that children of alcoholics are three to four times more likely to become alcoholics than the general population.
No one starts using drugs or drinking alcohol with the expectation of addiction, and environmental factors can have a large effect on the predisposition to this disease. The Scientific American conducted a study that served as a good example of this, one that found 60-80 percent of substance-dependent teenagers and 20-somethings were addiction-free in their 30s. This implies that environmental influence may contribute to the development and the resolution of addiction. Childhood trauma also seems to increase the risk of addiction. According to an article featured on The Fix, a child with at least four traumatic experiences is 46 times more likely to use IV drugs one day, as compared to one with no adverse childhood experiences.
An older, but resurfacing theory of the cause of addiction has come to be recognized with more legitimacy in the addiction treatment community. This theory postulates an idea that happiness, or the lack thereof, has more to do with addiction than physical dependence does. Reaching back a few decades to an experiment with lab rats, the study proved that heroin-laced water was preferred over plain water, supporting physical dependency.
However, an initial oversight allowed for these conclusions to be drawn based on a lone rat. When rats were given a more comfortable life with quality food, as well as fellow rats and toys to entertain them, the majority of them opted for the plain water over the drug solution. Thus, a happy, content, and fulfilling life may have more to do with preventing addiction than previously realized, and therefore lacking those features may contribute to the development of addiction.
The chemical foundation of a physical and psychological addiction lies mostly with dopamine and norepinephrine. This theory applies to biology, physical dependence and a need for a fulfilling and happy life, because regardless of what leads to addiction, chemical reactions keep you there.
Both drugs and alcohol seriously affect your mind and body. Upon ingestion, most substances take anywhere from minutes to an hour to start taking effect, but this can vary considerably from one person to the next, depending on body metabolism and the amount ingested. In addition, different types of substances have different effects.
Psychedelic drugs like LSD and PCP disrupt nervous system communication and cause the brain to experience sensory distortion. This is the explanation for visual, tactile and auditory hallucinations. Even what you taste might be entirely different than what you’re used to. Sounds and colors are crisper and more amplified than ever before when under the influence of these drugs.
Tolerance develops rapidly with the use of hallucinogens, and even though overdose rates are lower in comparison to other drugs, increased doses of hallucinogens are quite dangerous. Drugs like LSD increase both heart rate and blood pressure while causing insomnia, dizzy spells, excess perspiration, lethargy, tremors, loss of appetite and other issues.
Stimulants, like cocaine and amphetamines, boost energy levels and alertness. Illicit substances often gather more fame and attention than legal forms of medication that are just abused illegally. However, despite its reputation, cocaine was only accountable for about 85,498 of 1,800,704 treatment admissions in 2012, according to SAMHSA. Cocaine blocks the reabsorption of dopamine, and thus, it heightens pleasure levels since more dopamine is available than there usually is. Methamphetamines inhibit the synthesis of both dopamine and norepinephrine, resulting in feelings of euphoria and increased alertness.
One of the most commonly abused stimulants is of the prescription variety. Adderall is typically prescribed for individuals with attention deficit hyperactivity disorder (ADD), and many feign the symptoms of this illness in pursuit of the drug. Reuters reports 18 million prescriptions were written for Adderall in 2010, a 13.4 percent escalation from the previous year. Even a stimulant as mild and common as caffeine inflicts the same effects as stronger varieties, including but not limited to an accelerated heart rate, racing thoughts and anxiety. Stimulants do wear off, and the user will experience a crash following use of them. This often leads individuals who abuse drugs to use them more frequently and in larger quantities, which can lead to overdose in some cases.
Depressants like alcohol and prescription painkillers are among the most popular drugs of abuse. The Centers for Disease Control and Prevention (CDC) reports for every 100 people living in the U.S. in 2012, 82.5 prescriptions were written for opioid painkillers. Opiates — including heroin and prescription opioid pain relievers like OxyContin and Lortab — are popular with individuals who are addicted to drugs, due to their numbing and euphoric effects. Around 2.1 million Americans were addicted to prescription opioids, and another 467,000 were addicted to heroin in 2012, per the NIDA.
Among the 28 reporting states in the nation, the National Association of Boards of Pharmacy notes 9,869 people died of prescription opioid painkiller overdoses in 2012, a great deal more than the 3,635 who lost their lives to heroin that year, debunking the theory most hold that heroin is a far bigger problem. A sleepy demeanor, constipation and queasiness — with or without vomiting — are some common side effects of opioid painkiller use.
Around 17 million people have an alcohol use disorder as of 2012, the National Institute on Alcohol Abuse and Alcoholism notes. For some people, alcohol abuse starts in their teens and early 20s and develops into addiction over the years. For others, it goes unnoticed, acting as a social lubricant at happy hour, which they frequent often. Alcohol affects different people in different ways, but regardless of how hyper or excited one might get while partying with friends, all alcoholic beverages are depressants. Even if initial euphoria is experienced, a crash will follow, much like it does with stimulants. Likewise, depressants cause a wide array of side effects, from decreased reaction time and confusion to hypotension, a melancholy mood, and serious fatigue.
Marijuana acts much like a depressant. It’s to blame for over 4 million addictions in the United States, the Alcohol and Drug Abuse Institute reports. NIDA attests to marijuana altering the functionality of the hippocampus over time and thereby changing the way the brain processes information and limiting memory capabilities. Antipsychotics, barbiturates and benzodiazepines (benzos) are also depressants. Benzos are typically abused by individuals who have taken them for too long and grown dependent. The Royal College of Psychiatrists states that about 4 out of 10 people who take benzodiazepines daily for six weeks or longer will end up dependent on them.
The majority of central nervous system depressants elicit their calming effects by increasing a key neurotransmitter, gamma-aminobutyric acid; others may inhibit the increase of detrimental neurotransmitters like cortisol. Marijuana slows your ability to respond to a stimuli, creates a feeling of panic and anxiousness, and may inhibit coordination. Despite current trends in legalization and decriminalization, which lead people to view cannabis as a safer drug, the side effects that stem from marijuana use have the potential to be just as dangerous as alcohol when it comes to everyday activities, like driving.
The first step in any effective treatment plan is a thorough intake interview. During this process, you’ll likely meet the physician who will oversee your care, a therapist, and possibly nursing staff members as well. Generally, mental health and medical screenings are completed at this time.
Screening for underlying conditions is a pivotal part of addiction treatment that is still too often overlooked. The addicted patient who suffers from an undiagnosed mental health disorder like schizophrenia hardly benefits from treatment for substance abuse if drug or alcohol abuse habits are merely self-medicating behaviors. After treatment, undiagnosed disorders remain and inflict unruly symptoms that lead individuals who abuse substances right back to a life of using.
Once the screening process is over, and you’re admitted as a client, detox begins. The period of time you spend in detox varies for each client and is dependent on the substance. Some addictions, such as those to benzodiazepines, can be handled by merely tapering the dosage every day or two in a weaning process that can often safely be done on an outpatient basis. Withdrawal symptoms are manageable with the right professional help and supervision.
In contrast, a dependency on alcohol — while more common — is far more severe when it comes to detox, and most often should be handled on an inpatient basis. More intense addictions to more dangerous substances warrant the need for long-term detox programs, such as those designed for individuals who are addicted to opiates. Some patients remain on methadone and buprenorphine in lieu of heroin or opioid painkillers for an indefinite period of time.
Methadone has been around for decades and comes with a fairly steady 60-90 percent success rate — per the California Society of Addiction Medicine – that gives many who enter treatment the reassurance they need to forge ahead. Buprenorphine is an opioid antagonist with a success rate that was reported by The Fix to be around 88 percent. Both of these medications work in similar manners to fill opioid receptors so the body still thinks it’s getting regular doses of the abused substance while the individual using it slowly weans off the replacement drug by decreasing regulated doses.
Some facilities promote the use of rapid detox measures for those who are addicted to opioids, but this practice is unsafe and has already claimed the lives of individuals, per the CDC. The process involves sedating a client and administering opioid antagonist medications before waking the detoxed patient, sparing them the effects of withdrawal. Currently, while it’s not advised in many states, rapid detox is legal and promoted by some facilities as an easier way to break free of opiate addiction.
Additionally, medicated treatment methods continue to prove their worthiness in the addiction treatment field. During detox, a wide range of pharmaceuticals can be prescribed to aid in transitioning to a drug-free state. The side effects of withdrawal are notably unpleasant. Medications, such as benzodiazepines and antidepressants, can prevent the person detoxing from alcohol from experiencing delirium tremens and suicidal ideation.
Medication is often necessary to mitigate the symptoms of mental health disorders, which may very well be the cause of the discomfort that leads someone to abuse drugs or alcohol. According to Helpguide, around 29 percent of mentally ill individuals are also addicted. Most cases of mental illness respond best to both medicated and therapeutic forms of treatment. Cognitive behavioral therapy has been shown to be highly effective in the treatment of many disorders, including bipolar disorder.
There is no shortage of cognitive therapy methods that are effective in the treatment of addiction. The most popular method is talk therapy, which comes in the form of individual and group counseling, as well as support groups. All of these genres can be found at most mainstream, quality treatment institutions. Many holistic-based treatment facilities rely on therapy methods, in conjunction with holistic treatments, such as meditation, acupuncture and yoga, to heal addiction without pharmaceutical medications.
Cognitive behavioral therapy is a form of psychotherapy that is used to change negative thought patterns that produce inappropriate actions or emotional responses. One Archives of General Psychiatry publication notes that 60 percent of addicted individuals who participated in CBT treatment for their addiction were drug- and alcohol-free one year later. Dialectical behavior therapy is another commonly used form of treatment. It focuses on changing self-harming thoughts and behaviors, and it includes skills groups, family interventions and more.
Twelve-step programs are among the most traditional and widely recognized methods for treating addiction. The structure stems from the Alcoholics Anonymous (AA) program and relies on a commitment to oneself and a higher power. Individual and group counseling sessions are widely recommended to all substance abuse treatment clients.
Just as there are genetic links to addiction, there are genetic links to mental illness. The Department of Psychiatry and Behavioral Sciences at Emory University notes that children of parents with major depressive disorder are four times more likely to develop a mood disorder than children with parents who are not ill. Furthermore, Patient reports that close family members of schizophrenics have a 1 in 10 chance of developing the disorder, and children of schizophrenics are at an even greater risk, with a 50 percent chance. According to the Pennsylvania Family Support Alliance, more than half of all sampled children who were hospitalized for psychiatric disorders turned out to be children of one or more addicted parents.
Some mental health disorders commonly seen in addicted individuals include:
Whether you attend a clinic, enroll at a residential care facility, or seek treatment through your doctor, integrated treatment methods are vital to ensure your attempts at sustained sobriety are successful. If you plan to seek long-term treatment, such as methadone maintenance, through your doctor, you must also seek the help of a skilled therapist who can work in tandem with your chosen medical professional. Undiagnosed or poorly treated mental health conditions often lead back to the road of substance abuse and addiction.
If your addiction is biological in nature, a thorough treatment plan inclusive of therapy and support groups following detox is your best bet. If it’s a learned behavior, you may have the best chance at sobriety through therapeutic remedies like CBT. If your addiction stems from a lack of happiness, skilled therapists and understanding peers can help you find what’s missing from your life. If your addiction was born out of self-medication to cope with the symptoms of a mental illness, treatment is even more necessary for your success, and fortunately, most mental health disorders are effectively treated with prescribed medication and counseling.
As you can see, what causes addiction is a tricky question to answer. It may be one of the reasons described above or a complex melting pot of them all. Many socioeconomic and personal factors contribute to addiction. Regardless of what brought you here, you can get through it. The good news is that help is available. Call us today for more information on recovery.