Addiction is one of the fastest growing problems in the United States. It’s not reserved for a single section of society and it doesn’t just touch certain communities. It indiscriminately moves across demographic boundaries and wreaks its havoc on the lives of hundreds of thousands of people every year. And the world was wholly unprepared to meet the challenges that come with skyrocketing rates of addiction and overdose.
In the 1980s and 1990s, we saw a disturbing rise in cocaine and crack addiction that led to the creation of programs like D.A.R.E. and a crackdown on drug use and drug dealing. Politicians took hardline stances on drugs, vowing to lock away all offenders. The hope was that if drugs became harder to get and more legally frightening to partake in, people would stop using them.
But it didn’t work. Our drug problem is worse than ever. Treating people with substance use disorders as people with bad habits and moral failings is something we learned to be an error decades ago. Dr. William Silkworth studied alcoholism in the 1930s and he said,
“Alcoholism is considered by many physicians a chronic condition that gradually unfolds itself to a dismal end. They feel that it is a state of mind and advise these patients that it is up to them to discontinue their accustomed drug, which it is assumed they can do by merely making up their minds to do so. Proper attention is not given to the psychological problem as well as the physical condition of these people.”
We learned that addiction is a disease early in the 20th century and we’ve slowly started to develop treatments that can help. Now that the addiction epidemic has gotten worse, the need for increased availability of effective addiction treatment has grown with it. However, our treatment of addiction isn’t the only cause of the current addiction and overdose explosion.
Despite legal crackdowns, drugs have become more readily available on two fronts: from illegal black-market trafficking and straight from pharmaceutical companies. More medical organizations are prescribing addictive drugs like opioids and transnational criminal organizations have increased drug trafficking in the U.S. The result is more drug abuse, addiction, and overdose.
Still, we are starting to understand how addiction works in the mind and that it can have a whole host of underlying issues beneath the surface. To combat addiction and it’s spreading effects, we’ve developed substance abuse treatment standards that give people a fighting chance to achieve long-term recovery and live productive, meaningful lives free from active addiction.
There is still a lot to learn about the disease of addiction and there is a lot of debate over the best possible treatment modalities and methods. But treatment is available today. Even though so many have their lives impacted by addiction every day, many people have gone through treatment that leads to sobriety and freedom from drugs or drinking.
In this guide, you will learn more about the addiction epidemic and its causes, how addiction works, how addiction can be treated, and what you can do to find treatment for yourself or a loved one.
Addiction is a chronic and progressive disease of the brain that’s characterized by the habitual use of a psychoactive substance, despite wanting to quit and the negative impact of the substance on everyday life and on health.
Clinically, addiction is referred to as a substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Each of the classes of drug (like alcohol, opioids, benzodiazepines, etc.) have its own subtype disorders. Substance use disorders are recognized as a mental illness.
Addiction can also be broken up into categories of psychical (or chemical) and psychological. Chemical addiction is marked by a physical dependence on a specific substance. For instance, alcohol is a central nervous system depressant.
Frequent drinking can lead to a building up of tolerance, which is when your brain is growing used to the chemical’s depressant causing properties. To balance neurochemistry, your brain may stop producing its own CNS depressing effects and start counteracting the presence of alcohol with excitatory neurotransmitters. This phenomenon is what causes you to feel like you need higher or more frequent doses to achieve the same effects.
When you stop using a drug after you’ve developed a chemical dependency, the chemical balance in your brain will be dramatically thrown off. In the alcohol example, your nervous system will rebound from the now absent depressing effects but increasing CNS activity. This overactivity can result in withdrawal symptoms like tremors, anxiety, insomnia, and seizure.
Some drugs can cause addiction beyond the chemical effects, and other drugs that have no chemically addictive effects can cause psychologically addictive effects. For instance, a person who smokes marijuana regularly may feel that they need it after a stressful day, or to go to sleep. However, marijuana typically doesn’t cause chemical dependence. Instead, the user may have developed a psychological dependency.
Addiction doesn’t necessarily stop once you go through withdrawal and the chemicals are no longer in your system. Movies and television often portray it that way. For instance, in the movie “The Last Samurai,” Tom Cruise’s character appears to have an alcohol use disorder. He goes through one rough night screaming for sake and then wakes up in the morning never to drink again.
In reality, the changes in your brain after becoming addicted to a substance last a lot longer than a few days. Addiction is a chronic disease because the changes in your brain are long-lasting. Becoming addicted is a process that involves multiple parts of your brain but it primarily occurs in the limbic system, which is also known as the reward center. The reward center of your brain is designed to identify good things you do and encounter throughout your day and teach you to repeat those things.
For instance, imagine you are a nomad 10,000 years ago. You are walking in the woods and you find a berry bush. You try the fruit and it tastes great because it’s high in sugar. Sugar gives you a burst of energy and it’s fairly rare. The leisure you get from eating the berry releases feel-good chemicals like dopamine.
Your limbic system responds to the dopamine release and recognizes that eating that berry felt good and was good for you. It logs that information away to trigger berry cravings later, to motivate you to find rarer but very beneficial food sources.
The limbic system’s purpose is to get us to repeat good activities. However, the limbic system sometimes can’t tell the difference between good and bad things that both cause a dopamine response and it isn’t good in moderation. So, in 2018, when you see a cake in the conference room, your sugar-loving reward center tells you to eat the whole thing.
The problem is worsened when something causes a dramatic upsurge in the number of feel-good chemicals. As an example, cocaine blocks the reuptake (a process when neurotransmitters are reabsorbed when they are no longer needed) of dopamine.
This causes the chemical to float around in the synapse, attaching to more and more dopamine receptors. To you, it feels like an intense rush of feeling energized and powerful. To your limbic system, it recognizes cocaine as a source of an intense dopamine response. It logs cocaine away as a method to make you feel good.
Now that the limbic system has learned what cocaine can do, it may cause random cravings or it might respond to negative emotions or situations by triggering cocaine cravings. Once the reward center has learned something, it’s very difficult to unlearn. Plus, it passes the message to other parts of your brain responsible for learning and subconscious impulses.
Addiction has a variety of causes and it’s difficult, if not impossible to point to one cause as a definitive determining factor in the development of a substance use disorder. Typically, a combination of factors contribute to a person’s struggle with addiction, and someone with similar factors may never have trouble with substance abuse. Still, there are a few risk factors that can increase your likelihood of developing an issue with addiction or alcoholism. Here are some of the prevailing contributors to addiction:
Genes are the blueprints that build a human being and they are based on the genes of both of their parents. Everything from eye color to your taste in food can be passed down through your genetic code. Unfortunately, certain diseases can be passed down from your parents and grandparents as well.
Your genes can also make you more susceptible to diseases as well. Your likelihood of developing certain diseases like diabetes, heart disease, and stroke can all be tied to genetic influences. Science has discovered that there is a link between a family history of addiction and your risk factor for it.
Genetic factors in addiction refer to the apparent link between a family history of drug addiction or alcoholism and a person’s likelihood of developing a substance use disorder of their own. Studies show that people who are addicted to a psychoactive substance were more likely to have parents or grandparents that also had an addiction.
Studies also show that the children of people with addiction processed alcohol and drugs differently. This points to genetic predispositions to addiction. Still, this doesn’t mean addiction is inevitable if you have parents that are addicted or had an addiction. Many children of addicts go on never to have any problems with alcohol or drugs. But, it does mean that you may be at increased risk.
Environmental factors are a significant catalyst for addiction and may dramatically increase a person’s risk of developing a substance use disorder. Environmental factors can include the normalization of drugs and alcohol during childhood or in a person’s home life.
Other environmental influencers could be a person’s friend group, social status, economic status, and where a person lives. For instance, certain areas in large cities called open-air drug markets are areas of increased drug availability where illicit drugs are sold openly.
A teen that walks to school every day through an open-air drug market is more likely to experience, abuse, and become addicted to an illicit drug. A person’s exposure to peer pressure, stress, abuse, and a lack of parental guidance has shown to lead to increased addiction risk.
Both genetics and environmental factors come together to affect a person’s development. These developmental factors can leave lasting effects on the way a person deals with stress, interacts with addictive drugs, and addictive behavior.
In a person’s formative years leading up to adulthood, experiences with drugs and alcohol can leave significant and lasting impressions. Taking and abusing drugs can lead to addiction at any age. However, experimentation with drugs and alcohol at an early age can increase their risk of developing an addiction later in life.
Teens, especially are at risk. During your teenage years, your brain is developing judgment, self-control, and decision-making skills, which makes them vulnerable to risky behaviors like drug use. They are also going through an important process of brain development called myelination. This process is when your brain’s white matter (myelin) is rapidly growing.
Certain substances like alcohol and, to a lesser extent, marijuana have shown to slow or stunt this process. Stunting myelination can lead to issues with mental processing and decision making, increase your risk of using drugs and developing a substance use disorder.
Addiction typically doesn’t happen overnight. Some substances like methamphetamine can cause fairly quick chemical dependence, but most drugs require high doses or regular use to become addictive. At first, the signs and symptoms of addiction can be subtle but they’ll become more apparent as you continue to develop a tolerance. If you have used a medication or recreation drug and you’re worried that you may be becoming dependent, there are a number of signs to look out for. Symptoms can vary depending on the drug your using, but addiction has a few general signs, including:
If you are concerned that a friend or family member might be addicted, there are several common signs that may point to a possible substance use disorder that loved ones may be able to observe. Outward signs of addiction include:
As the addiction epidemic grows, researchers, doctors, and clinicians have worked to make strides in the way we treat the disease. There is still a lot to learn, but we have discovered effective treatment methods that have shown to have the most likelihood of success. However, there are a few principles that need to be taken into account in any given treatment plan. The National Institute on Drug Addiction has outlined 13 principles of effective treatment. Here are a few of the most important factors:
To help treatment centers meet the needs of a client based and follow NIDA’s principles of effective treatment, the American Society of Addiction Medicine has outlined the general progression treatment should take called the continuum of care.
When you plan to enter an addiction treatment program, clinicians will help determine where your needs would place you on this continuum. As you progress, your doctors and therapists will lower the intensiveness of your treatment and increase your independence, while continuing to offer you the support you need.
Here are the different levels of care you can encounter in addiction treatment:
Addiction is a complicated problem that needs a complex solution that is responsive to a person’s individual needs. There is no such thing as one simple solution that will work for everyone, which is part of the reason addiction rates have gotten out of control. However, there is treatment available that can be tailored to you as an individual, in the form of addiction treatment. A treatment plan can be built around the challenges you are facing, the concerns you have, and the experiences that have contributed to your substance abuse problem.
American Psychological Association. (n.d.). from http://www.apa.org/monitor/jan08/earlydrinking.aspx
American Society of Addiction Medicine. (n.d.). from https://www.asam.org/resources/the-asam-criteria/about
Children of Alcoholics? Are They Different? – Alcohol Alert No. 09-1990. (n.d.). from https://pubs.niaaa.nih.gov/publications/aa09.htm
National Institute on Drug Abuse. (n.d.). Drugs and the Brain from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain
National Institute on Drug Abuse. (n.d.). Drugs and the Brain. from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain