What is DRUG ADDICTION?

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Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs. Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable. If left untreated, they can last a lifetime and may lead to death.

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Why do PEOPLE TAKE DRUGS?

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In general, people take drugs for a few reasons:

 

• To feel good. Drugs can produce intense feelings of pleasure. This initial euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the high is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opioids such as heroin is followed by feelings of relaxation and satisfaction.

• To feel better. Some people who suffer from social anxiety, stress, and depression start using drugs to try to feel less anxious. Stress can play a major role in starting and continuing drug use as well as relapse (return to drug use) in patients recovering from addiction.

• To do better. Some people feel pressure to improve their focus in school or at work or their abilities in sports. This can play a role in trying or continuing to use drugs, such as prescription stimulants or cocaine.

• Curiosity and social pressure. In this respect, teens and young adults are particularly at risk because peer pressure can be very strong. Teens are more likely than adults to act in risky or daring ways to impress their friends and show their independence from parents and social rules.

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If taking drugs makes people feel good or better, WHAT’S THE PROBLEM?

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When they first use a drug, people may perceive what seem to be positive effects. They also may believe they can control their use. But drugs can quickly take over a person’s life. Over time, if drug use continues, other pleasurable activities become less pleasurable, and the person has to take the drug just to feel “normal.” They have a hard time controlling their need to take drugs even though it causes many problems for themselves and their loved ones. Some people may start to feel the need to take more of a drug or take it more often, even in the early stages of their drug use. These are the telltale signs of an addiction. Even relatively moderate drug use poses dangers. Consider how a social drinker can become intoxicated, get behind the wheel of a car, and quickly turn a pleasurable activity into a tragedy that affects many lives. Occasional drug use, such as misusing an opioid to get high, can have similarly disastrous effects, including overdose, and dangerously impaired driving.

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Do people freely choose to KEEP USING DRUGS?

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The initial decision to take drugs is typically voluntary. But with continued use, a person’s ability to exert self-control can become seriously impaired; this impairment in self-control is the hallmark of addiction. Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control.12 These changes help explain the compulsive nature of addiction.

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Why do some people become addicted to drugs, WHILE OTHERS DO NOT?

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As with other diseases and disorders, the likelihood of developing an addiction differs from person to person, and no single factor determines whether a person will become addicted to drugs. In general, the more risk factors a person has, the greater the chance that taking drugs will lead to drug use and addiction. Protective factors, on the other hand, reduce a person’s risk. Risk and protective factors may be either environmental or biological.

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No single factor determines whether a person will become addicted to drugs.

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WHAT BIOLOGICAL FACTORS increase the risk of addiction?

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Biological factors that can affect a person’s risk of addiction include their genes, stage of development, and even gender or ethnicity. Scientists estimate that genes, including the effects environmental factors have on a person’s gene expression, called epigenetics, account for between 40 and 60 percent of a person’s risk of addiction. Also, teens and people with mental disorders are at greater risk of drug use and addiction than others.

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WHAT ENVIRONMENTAL FACTORS increase the risk of addiction?

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• Environmental factors are those related to the family, school, and neighborhood. Factors that can increase a person’s risk include the following:

• Home and family. The home environment, especially during childhood, is a very important factor.

• Parents or older family members who use drugs or misuse alcohol, or who break the law, can increase children’s risk of future drug problems.

• Peers and school. Friends and other peers can have an increasingly strong influence during the teen years. Teens who use drugs can sway even those without risk factors to try drugs for the first time.

• Struggling in school, work or having poor social skills can put a individual at further risk for using or becoming addicted to drugs.

 

What other factors increase the RISK OF ADDICTION?

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Early use. Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems.This may be due to the harmful effect that drugs can have on the developing brain. It also may result from a mix of early social and biological risk factors, including lack of a stable home or family, exposure to physical or sexual abuse, genes, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.

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How the drug is taken. Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense high can fade within a few minutes. Scientists believe this starkly felt contrast drives some people to repeated drug taking in an attempt to recapture the fleeting pleasurable state.

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What are the other health CONSEQUENCES OF DRUG ADDICTION?

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People with addiction often have one or more associated health issues, which could include lung or heart disease, stroke, cancer, or mental health conditions. Imaging scans, chest X-rays, and blood tests can show the damaging effects of longterm drug use throughout the body. For example, it is now well-known that tobacco smoke can cause many cancers, methamphetamine can cause severe dental problems, known as “meth mouth,” and that opioids can lead to overdose and death. In addition, some drugs, such as inhalants, may damage or destroy nerve cells, either in the brain or the peripheral nervous system (the nervous system outside the brain and spinal cord). Drug use can also increase the risk of contracting infections. Human immunodeficiency virus (HIV) and hepatitis C (a serious liver disease) infection can occur from sharing injection equipment and from impaired judgment leading to unsafe sexual activity. Infection of the heart and its valves (endocarditis) and skin infection (cellulitis) can occur after exposure to bacteria by injection drug use.

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Does drug use cause MENTAL DISORDERS OR VICE VERSA?

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Drug use and mental illness often co-exist. In some cases, mental disorders such as anxiety, depression, or schizophrenia may come before addiction; in other cases, drug use may trigger or worsen those mental health conditions, particularly in people with specific vulnerabilities. Some people with disorders like anxiety or depression may use drugs in an attempt to alleviate psychiatric symptoms, which may exacerbate their mental disorder in the long run, as well as increase the risk of developing addiction. Treatment for all conditions should happen concurrently.

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How can addiction HARM OTHER PEOPLE?

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Beyond the harmful consequences for the person with the addiction, drug use can cause serious health problems for others. Some of the more severe consequences of addiction are:

 

• Negative effects of drug use while pregnant or breastfeeding. A mother’s substance or medication use during pregnancy can cause her baby to go into withdrawal after it’s born, which is called neonatal abstinence syndrome (NAS). Symptoms will differ depending on the substance used, but may include tremors, problems with sleeping and feeding, and even seizures. Some drug-exposed children will have developmental problems with behavior, attention, and thinking. Ongoing research is exploring if these effects on the brain and behavior extend into the teen years, causing continued developmental problems. In addition, some substances can make their way into a mother’s breast milk. Scientists are still learning about long-term effects on a child who is exposed to drugs through breastfeeding.

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• Negative effects of secondhand smoke. Secondhand tobacco smoke exposes bystanders to at least 250 chemicals that are known to be harmful, particularly to children. Involuntary exposure to secondhand smoke increases the risks of heart disease and lung cancer in people who have never smoked. Additionally, the known health risks of secondhand exposure to tobacco smoke raise questions about whether secondhand exposure to marijuana smoke poses similar risks. At this point, little research on this question has been conducted. However, a study found that some nonsmoking participants exposed for an hour to high-THC marijuana in an unventilated room reported mild effects of the drug, and another study showed positive urine tests in the hours directly following exposure. If you inhale secondhand marijuana smoke, it’s unlikely you would fail a drug test, but it is possible.

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• Increased spread of infectious diseases. Injection of drugs accounts for 1 in 10 of cases of HIV. Injection drug use is also a major factor in the spread of hepatitis C, and can be the cause of endocarditis and cellulitis. Injection drug use is not the only way that drug use contributes to the spread of infectious diseases. Drugs that are misused can cause intoxication, which hinders judgment and increases the chance of risky sexual behaviors.

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• Increased risk of motor vehicle accidents. Use of illicit drugs or misuse of prescription drugs can make driving a car unsafe— just like driving after drinking alcohol. Drugged driving puts the driver, passengers, and others who share the road at risk. In 2016, almost 12 million people ages 16 or older reported driving under the influence of illicit drugs, including marijuana. After alcohol, marijuana is the drug most often linked to impaired driving. Research studies have shown negative effects of marijuana on drivers, including an increase in lane weaving, poor reaction time, and altered attention to the road.

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Can addiction be TREATED SUCCESSFULLY?

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Yes, addiction is a treatable disorder.

Research on the science of addiction and the treatment of substance use disorders has led to the development of research-based methods that help people to stop using drugs and resume productive lives, also known as being in recovery

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Can addiction be CURED?

 

Like other chronic diseases such as heart disease or asthma, treatment for drug addiction usually isn’t a cure. But addiction can be managed successfully. Treatment enables people to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives.

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Does relapse to drug use mean TREATMENT HAS FAILED?

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No. The chronic nature of addiction means that for some people relapse, or a return to drug use after an attempt to stop, can be part of the process, but newer treatments are designed to help with relapse prevention. Relapse rates for drug use are similar to rates for other chronic medical illnesses. If people stop following their medical treatment plan, they are likely to relapse. Treatment of chronic diseases involves changing deeply rooted behaviors, and relapse doesn’t mean treatment has failed. When a person recovering from an addiction relapses, it indicates that the person needs to speak with their doctor to resume treatment, modify it, or try another treatment.

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What are the principles of EFFECTIVE TREATMENT?

 

Research shows that when treating addictions to opioids (prescription pain relievers or drugs like heroin or fentanyl), medication should be the first line of treatment, usually combined with some form of behavioral therapy or counseling. Medications are also available to help treat addiction to alcohol and nicotine.

Additionally, medications are used to help people detoxify from drugs, although detoxification is not the same as treatment and is not sufficient to help a person recover. Detoxification alone without subsequent treatment generally leads to resumption of drug use.

For people with addictions to drugs like stimulants or cannabis, no medications are currently available to assist in treatment, so treatment consists of behavioral therapies. Treatment should be tailored to address each patient’s drug use patterns and drug-related medical, mental, and social problems.

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What medications and devices help TREAT DRUG ADDICTION?

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Different types of medications and devices may be useful at different stages of treatment to help a patient stop using drugs, stay in treatment, and avoid relapse.

• Treating withdrawal. When patients first stop using drugs, they can experience various physical and emotional symptoms, including restlessness or sleeplessness, as well as depression, anxiety, and other mental health conditions. Certain treatment medications and devices reduce these symptoms, which makes it easier to stop the drug use.

• Staying in treatment. Some treatment medications and mobile applications are used to help the brain adapt gradually to the absence of the drug. These treatments act slowly to help prevent drug cravings and have a calming effect on body systems. They can help patients focus on counseling and other psychotherapies related to their drug treatment.

• Preventing relapse. Science has taught us that stress cues linked to the drug use (such as people, places, things, and moods), and contact with drugs are the most common triggers for relapse. Scientists have been developing therapies to interfere with these triggers to help patients stay in recovery.

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How do behavioral therapies TREAT DRUG ADDICTION?

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Behavioral therapies help people in drug addiction treatment modify their attitudes and behaviors related to drug use. As a result, patients are able to handle stressful situations and various triggers that might cause another relapse. Behavioral therapies can also enhance the effectiveness of medications and help people remain in treatment longer.

• Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the situations in which they’re most likely to use drugs.

• Contingency management uses positive reinforcement such as providing rewards or privileges for remaining drug free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.

• Motivational enhancement therapy uses strategies to make the most of people’s readiness to change their behavior and enter treatment.

• Family therapy helps people (especially young people) with drug use problems, as well as their families, address influences on drug use patterns and improve overall family functioning.

• Twelve-step facilitation (TSF) is an individual therapy typically delivered in 12 weekly session to prepare people to become engaged in 12-step mutual support programs. 12- step programs, like Alcoholic Anonymous, are not medical treatments, but provide social and complementary support to those treatments. TSF follows the 12-step themes of acceptance, surrender, and active involvement in recovery.

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How do quality treatment programs help patients RECOVER FROM ADDICTION?

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Stopping drug use is just one part of a long and complex recovery process. When people enter treatment, addiction has often caused serious consequences in their lives, possibly disrupting their health and how they function in their family lives, at work, and in the community. Because addiction can affect so many aspects of a person’s life, treatment should address the needs of the whole person to be successful. Counselors may select from a menu of services that meet the specific medical, mental, social, occupational, family, and legal needs of their patients to help in their recovery.