One of the potential consequences of substance abuse is addiction.
When a person misuses or abuses a drug, changes can occur in the brain and body that result in the person becoming dependent on the substance to the degree that it is impossible to function or feel good without using it regularly.
This can result in major problems for the individual and for loved ones, causing disruption in all areas of life.
Researchers and addiction experts are continually seeking answers about what addiction is, what causes it, who is most likely to become addicted to drugs, and how to help people who are struggling with addiction. While not all of the answers are known yet, the quest is ongoing, and there is a vast amount of information that has been found. These solid, research-based findings give a broad view of addiction and of ways in which people can work toward recovery from drug addiction.
What Is Addiction?
According to the American Society of Addiction Medicine, addiction is defined as a chronic illness that affects the reward, pleasure, memory, motivation, and connected areas of the brain, related to pursuit of substance use or other behaviors. Drug addiction, then, is this condition as related to use of chemical substances.
Drug addiction is characterized by an inability to stop using the substance of abuse, whether for pleasure or for relief. This compulsive need for the substance results in behavioral, physical, and psychological problems that can interfere with a person’s ability to function. These issues include:
- Physical impairment when trying to stop using the drug
- Development or increased severity of psychological disorders, such as depression or anxiety
- Relationship issues based on continued substance abuse
- Inability to keep up with responsibilities at work, school, or home
- Decrease in self-care, including malnutrition and poor hygiene
The main center for the addictive response in the brain is the complex reward system that produces pleasurable feelings through production of a neurochemical called dopamine. When a person uses drugs, the production of dopamine can be directly or indirectly affected, associating a pleasure response to use of the drug and a negative response to being without the drug. While this response is still not fully understood, it is generally considered to be the main mechanism behind addiction.
However, the process of addiction is more complex than this. Each type of drug disrupts the normal function of other chemical pathways, resulting in the particular type of “high” produced by that drug. As described by NIDA, other natural chemical pathways affected by substance abuse include:
- Serotonin: regulates mood and produces feelings of calm
- Norepinephrine: reduces anxiety levels
- Endogenous opioids: regulate pain levels and perception
- Endogenous cannabinoids: control cognition and memory
- Acetylcholine: increases arousal and mood
- Glutamate: increases activity in the brain
- Gamma aminobutyric acid (GABA): slows activity in the brain
Continued interference in these systems through drug use can result in tolerance of the drug, which means that more of the substance is needed to produce the same effect that it provided with initial use. This leads to a physical and psychological need to keep using the substance in order for the person to feel good.
As described in an article from Harvard Medical School, the brain’s pleasure response is not the only manifestation of addiction.
The events, feelings, and relationships associated with the addiction can also affect the person’s inability to stop using drugs. These elements of addiction are the triggers that can cause a person to relapse to abuse even after years of abstinence, when the brain’s systems should have returned to normal.
This psychological level of addiction can be extremely difficult to manage, and it is a major reason that addiction is chronic and should be treated throughout a person’s life. Much of this challenge can be attributed to stress and the memories connected to substance abuse. Some of the hormones released during the stress response can cause memories to surface that reignite cravings and result in relapse. Similarly, if a person encounters a situation, person, or feeling associated with previous substance use episodes, the memories can cause cravings to arise.
A research review in Neuron demonstrates that memory and stress are caught up in the neurochemical systems also associated with addiction, which implies that even when the systems themselves return to normal after a period of abstinence, the memories associated with them and feelings of stress can make the person feel that a need for the substance exists nevertheless. This connection of the stress and memory systems to the potential for relapse into substance use creates a need for ongoing sources of stress relief and cognitive-behavioral management to maintain recovery.
As described above, there are certain factors that make it more likely that a person will abuse or become addicted to drugs. According to an article in Osteopathic Family Physician, these risk factors are primarily environmental – that is, external factors or events that affect the person – or internal, including the person’s physical and psychological traits and genetic elements.
- Socioeconomic status
- Childhood or other trauma, abuse, or neglect
- High stress at home, work, or school
- Family or friends who are permissive or accepting about drug use
- Family history of mental illness or substance abuse
- Prior issues with substance abuse
- Existing or current mental illness, such as anxiety or depression
People struggling with these factors are more likely to initiate drug use, and they are also more likely to develop addiction to the drug of abuse.
There is a wide range of drugs that are commonly abused. These can be grouped under several larger categories based on how they affect the body. The groups include stimulants, depressants and hypnotics, and hallucinogens, as well as other drugs that may combine these elements. According to NIDA, some of the most commonly abused drugs fall into the following categories:
- Stimulants: These drugs cause increases in brain activity, resulting in higher energy levels, agitation, high heart rate and blood pressure, and euphoria. Examples include cocaine, methamphetamine, and cathinones (bath salts).
- Depressants: Central nervous system depressants cause relaxation, calmness, slowed breathing, decreased heart rate, and decreased cognitive function. Examples include opioids (prescription painkillers like OxyContin and Vicodin, or illicit heroin), benzodiazepines (anti-anxiety drugs like Valium and Xanax), and a
- Hallucinogens: These substances can cause a person to see, hear, and feel things that aren’t there, and can bring about a dissociative effect, making the person feel that everything is unreal. Examples include PCP (angel dust), ecstasy, and ketamine.
- Other: These substances can create feelings that combine various elements of the above, as well as other sensations. Examples include marijuana and cough medicines like dextromethorphan or promethazine-codeine.
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