The American Society of Addiction and Medicine (ASAM) defines addiction as "a primary, chronic disease of brain reward, motivation, memory and related circuitry." This means addicts persistently return to the substance they find rewarding or relieving, in a constant cycle. Fundamental characteristics of addiction include an inability to abstain consistently from the substance, coupled with behavioral impairments, lack of control or awareness in social and personal relationships, cravings and inappropriate emotional responses.
Similar to both medical and psychological diseases, addiction often involves periods of relapse and remission. While some are fearful of the implications of treatment, resisting treatment delays recovery and can result in serious consequences, including permanent bodily harm and, in some cases, death.
According to a 2014 report by the Substance Abuse and Mental Health Services Administration (SAMHSA), 22.5 million Americans over the age of 12 need to seek help for alcohol or illicit drug use.
Substance Use Disorders and the Brain:
Different substances cause different neuronal changes in a human brain. Some drugs, such as cannabis and heroin, have chemical structures similar to those that already exist in the brain. However, while such substances are able to activate neurons, they don't activate them in a natural way, which leads to abnormal signaling in the production of neurotransmitters. Other drugs, like stimulants, cause the brain to produce a large quantity of its own natural neurotransmitters, or block the reuptake of neurochemicals. The disruption of normal biological processes in this way can be very destructive, and lead to the amplified psychological, emotional, or physical responses seen in some addicts.
Substance use directly affects the brain's natural reward system, which is based primarily on the neurotransmitter dopamine. Dopamine simulates pleasure, emotion, and motivation, and regulates movement. The consistent return to a substance is due to the "rewarding" feeling that the substance produces. According to the National Institute on Drug Abuse, substances that are frequently abused, such as alcohol or heroin, can produce from 2 to 10 times the amount of dopamine produced by a naturally rewarding activity like eating or having sex.
Different drugs have different long-term consequences on the brain and other organs. Continuous substance use can cause permanent damage to the body and comes with grave consequences.
Differentiating Between Substance Use and a Substance Use Disorder:
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), most recently updated in May of 2013, has abandoned the terms "substance abuse" and "substance dependency." Instead, the DSM-5 contains criteria for a multitude of "substance use disorders". The DSM-5 defines a substance use disorder as the use of a substance that causes "clinically significant impairment or distress." A diagnosis of a mild, moderate or severe substance use disorder is made based on how many criteria individuals meet.
As outlined by the DSM-5, substance use only becomes a substance abuse disorder if and when it causes impairments in functionality and significant distress in the individual's life. When a drug is used frequently, the person may develop what is known as a tolerance, meaning an increase in the amount of the substance needed to reach the desired effect.
The DSM-5 outlines five primary categories of substances: depressants, stimulants, opioids, hallucinogens, and "other drugs of abuse." Each type of substance has different effects on the brain and thus provokes different responses in the body. The use of each substance also has a variety of ramifications for the addicted individual.
The term "depressant" refers to a broad range of substances, including anxiolytics (benzodiazepines), sedatives (barbiturates), hypnotics and alcohol. Anxiolytics, sedatives and hypnotics produce similar effects to that of alcohol.
Alcohol abuse is a major concern in the United States. Alcohol works by depressing the central nervous system, resulting in disorganized thinking, poor motor control and confusion. In 2014, the National Institute on Alcohol Abuse and Alcoholism reported that 24.7% of Americans ages 18 or older reported binge-drinking within the last month. Alcohol use is highest amongst Caucasian-Americans.
When a person stops consuming alcohol after using it habitually or in large quantities, they undergo alcohol withdrawal. This can be incredibly dangerous if detoxification is unmonitored. Symptoms of alcohol withdrawal within the first 6 to 12 hours include tremors, anxiety, sweating, nausea and vomiting, headache, and insomnia. After 12 hours, auditory and visual hallucinations can occur. The real danger occurs after 48 hours, when the risk of seizures and delirium tremens (DTs) increases. DTs is marked by fever, rapid heart rate and confusion, and those who experience DTs have an expected death rate between 1% and 5%. Even if you experience mild symptoms of alcohol withdrawal, you should seek treatment immediately, as the condition can quickly worsen.
Stimulants refer to drugs such as cocaine, amphetamines (such as legally prescribed ADHD medications or illicit ecstasy and crystal meth), nicotine and caffeine. Stimulants typically increase alertness and energy in users, but also come with a variety of physical symptoms, including heart rate and blood pressure changes, perspiration or chills, dilated pupils, nausea, muscular weakness, and restlessness. Ingesting too much of a stimulant can lead to hallucinations, agitation, panic and/or paranoid delusions. Overdosing on stimulants like cocaine can lead to problems with the blood vessels and various heart and nerve-related issues such as stroke, seizure, heart attack and an irregular heart rhythm.
Cocaine gives users a short-lived sensation of increased vigor and lowered fatigue. Withdrawal from cocaine and other stimulant drugs produces a depressive effect and a mood characterized by apathy. The desire to use resurfaces both to recreate the feelings of elation as well as the level of focus, alertness and cognitive functioning achieved on the substance.
Opioids, often referred to as painkillers, are either natural or synthetic substances with narcotic effects. Some examples of opioids are vicodin, oxycontin, morphine, codeine and heroin. Low doses of opiates slow breathing, cause drowsiness and induce euphoria. Higher doses can be deadly, and withdrawal symptoms can occur within the first 6 to 12 hours after stopping.
Opioid addicts have weakened immune systems from using the substance too much. Because opioids are often administered intravenously, systemic infections are much more common in opioid users. They also have a higher incidence of blood-borne illnesses, such as HIV. The fatality rate from opioid use is higher than all other illicit drugs combined.
Methadone, a long-acting opioid agonist, is often used to prevent withdrawal symptoms and stave off cravings that accompany opioid addiction. There are other treatments that should be combined with methadone maintenance; counseling is suggested to make methadone treatment more effective.
Another detoxification medication is buprenophine. Like methadone, buprenophine delivers some similar effects to that of the drug of abuse. This being said, these medications should not be used in place of opioids, but rather should be used as treatment to wean users off the substance.
Hallucinogens are known for changing the way a user perceives the world and him/herself. Some hallucinogens produce paranoia, hallucinations, an altered sensory perception or delusions. Hallucinogens include but are not limited to ketamine, DMT, mescaline and LSD.
Ketamine, DMT, mescaline and LSD, along with a host of other hallucinogenic drugs, can produce psychotic delusions as well as hallucinations. Withdrawal symptoms from these drugs are not common, however, the substances have impact on the brain and neural chemistry both during use and after.
Different hallucinogens affect the brain differently. A hallucinogen that targets the neurotransmitter serotonin will disrupt mood, sleep, hunger and satiety, sensory perception, temperature regulation, muscle control and sexual behavior. A hallucinogen that targets glutamate will affect pain perception and experience, learning and memory, emotion and response to the environment.
Other Substances Explained:
Although there are a number of other substances that can be abused, inhalants and anabolic-androgenic steroids are the most common ones (outside of depressants, stimulants, opioids and hallucinogens).
Inhalants are substances found in volatile solvents that can be breathed directly into the lungs. Examples of inhalants are paint thinners, gasoline, hair spray and spray paint. These types of drugs are absorbed rapidly into the body and cause a feeling similar to alcohol intoxication, but for a shorter period of time.
Anabolic steroids are used either medicinally or to increase body mass. They are synthesized from the naturally-occurring hormone testosterone. Anabolic-androgenic steroids do not produce a "high," and even short-term use can have long-term consequences on mood, including paranoid jealousy, extreme irritability, an impairment in judgment and/or delusions.
The Path to Recovery
Every addiction is different and no treatment will be the same for anyone on the path to recovery. There are many available treatments for individuals who wish to seek help, including inpatient rehabilitation, outpatient rehabilitation and partial rehabilitation. Medication can be administered in monitored settings to aid in the detoxification. Withdrawal should be medically managed and treatment must be available for substance users. Treatment must also be maintained for a period of time during recovery to ensure success.
There are also a host of support groups to help users understand that they're not alone in their struggles. Support groups can be chosen not only based on substance, but also by religious affiliation (or lack thereof), gender, and family inclusion or exclusion. A successful treatment solution will meet all the individual's needs.
Behavioral therapies are the most common treatment for drug addiction. Cognitive Behavioral Therapy (CBT) was originally used to prevent alcohol users from relapsing, and later adapted for cocaine users. CBT teaches self-control and the power of breaking a habit. It can be highly effective in recovering from addiction.
The consequences of drug abuse can be severe if help is not sought in time. Alterations in brain functioning in all areas– cognitive, behavioral and biological – can be permanent and irreversible. It is important for users to seek help and find the treatment that caters best to their needs in order to have a happy and healthy future.