From Drug Use to Drug Addiction: No Longer Having a Choice

From Drug Use to Drug Addiction: No Longer Having a Choice

Seventy-five years ago two men came together and agreed that they had no power over their addictions. The power to quit would have to come not from their will power but from somewhere else. It took 75 years for science to catch up to what the founders of Alcoholics Anonymous figured out intuitively — addicts have no choice but to continue to use and reuse whatever drug or substance they are addicted to because they cannot stop. Addiction is by definition a habit that is beyond rational choice.

The two men who founded AA also determined that once addicted, always addicted, although they did not know why.

Although two ordinary men figured out how addiction works in 1935, the American Medical Association did not officially recognize substance addiction as a disease beyond control until 1970, opening the door for insurance and government programs to pay for drug addiction treatments like any other medical condition. Today drug addiction is considered an organic brain disease something like asthma, diabetes and hypertension in that it is caused and determined by a complex interaction of a person’s genetic tendencies, behaviors, and environment. Like those other three diseases, drug addiction has approved methods of treatment that include medication and behavioral changes. Also like asthma, diabetes and hypertension, drug addiction is a chronic, incurable disease. How much you recover and how healthy you remain depends on how well you comply with medical recommendations. Drug addicts have about the same level of compliance as people with other diseases.

Some people can try drugs many times without being addicted, others become addicted almost immediately. Studies of separated identical twins indicate that the reasons may be partly genetic because if one twin is addicted, the other has a much higher than average chance of being addicted too. Scientists also know the genes of a laboratory animal alter if the animal is injected with cocaine, and that these genetic changes affect their offspring in ways that make them in turn more susceptible to drug addiction. A study of female drug addicts found that their children and grandchildren were more likely to become drug addicts, even if the woman quit before getting pregnant. If a child has a disease that causes brain inflammation, the child has an increased risk of becoming a drug addict. Such research indicates that people can be born or acquire a tendency toward drug addiction in the same way that genetics can put people at higher risk for other chronic diseases.

Scientists have also discovered that once a person is addicted to drugs, they experience certain irreversible changes in their brain circuitry and the way they feel pleasure. This means that if they go back to drugs after treatment, they will become addicted again, which the founders of AA understood when they said, “Once addicted, always addicted.” The reason is that drug addiction causes permanent changes in the brain’s structure and functions, particularly in five of the brain’s neurotransmitters. Neurotransmitters are chemicals that permit the brain to transmit signals from one cell to another. So far, research indicates that drug addiction permanently affects two of these chemicals, serotonin and dopamine, which are involved in the process of feeling pleasure. Addicts feel depressed and then experience an overwhelming need to seek out their drug of choice because their past substance abuse has created a chemical imbalance in their brains. Although a drug addict’s first use of drug was a voluntary choice to experiment, once he becomes an addict, he loses the ability to choose.

The treatment for drug addiction involves medications and behavioral changes. Diabetics have to monitor their blood sugar, eat healthy foods, and maintain a healthy weight. Former drug addicts have to monitor their feeling states because certain ones, such as anger or depression, can “trigger” drug cravings. Likewise, they have to learn how to deal with their former drug-using friends as well as places and opportunities that are cues for using drugs. Since it is so hard for a recovering addict to overcome these triggers, she usually has to remain in a drug-free facility for several months and then get continued support from psychologists and self-help groups like Narcotics Anonymous. Socio-economic status, psychiatric disorders, dropping out of treatment, and the amount of support from family and friends affect the ability to recover from drugs. How the person complies with her treatment program determines if she remains healthy and drug-free.

REFERENCES
Alcoholics Anonymous Services. Alcoholics Anonymous: Big Book, 4th Edition. New York: Alcoholics Anonymous World Services, Inc., 2003.
“The Brain: Understanding Neurobiology through the Study of Addiction,” National Institute of Health, pamphlets and web instruction, see http://drugabuse.gov/Curriculum/HSCurriculum.html
Childress AR; McElgin W; Mozley PD; Fitzgerald J; Reivich M; O’Brien CP. “Limbic activation during cue-induced cocaine craving,” American Journal of Psychiatry, 1999, 156:1, pg. 11-18.
Everitt, Barry and Trevor W Robbins. “Neural systems of reinforcement for drug addiction: from actions to habits to compulsion.” Nature Neuroscience 8, 1481 – 1489 (2005)
Leshner, A.I. “Science Is Revolutionizing Our View of Addiction—and What to Do About It,” Focus, Spring 2003; 1: 194 – 195.
Leshner, A.I. “Addiction is a brain disease, and it matters,” Science 3 October 1997: Vol. 278 no. 5335 pp. 45-47.
McLellan, Thomas; David C. Lewis; Charles P. O’Brien; Herbert D. Kleber. “Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation.” JAMA, Oct 2000; 284: 1689 – 1695.

Siegfried, Tom. “Mom’s Past Drug Abuse may alter brain chemistry of offspring,” US News and World Report, November 15, 2011, posted at http://www.usnews.com/science/articles/2010/11/15/moms-past-drug-abuse-may-alter-brain-chemistry-of-offspring.html

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