DOES THE CRISIS OF DRUG ADDICTION IN THE UNITED STATES ONLY OWE TO THE OFFER?
President Trump has continually pointed out that the only cause of drug consumption and its effects on American society is the entry of illicit substances through the southern border.
At no time has indicated that the drug addiction of 30 million Americans to these substances is the main engine that generates drug trafficking and associated deaths. Here is an explanation of what addiction means for American Addiction Centers:
The Disease Debate
The definition of addiction varies among individuals, organizations, and medical professionals, and society’s viewpoints about addiction are ever-evolving. The National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institutes of Health (NIH) all similarly describe addiction as a long-term and relapsing condition characterized by the individual compulsively seeking and using drugs despite adverse consequences.1
These organizations call addiction a disorder or a disease because:1
· Addiction changes how the brain responds in situations involving rewards, stress, and self-control.
· These changes are long-term and can persist well after the person has stopped using drugs.
Comparing substance addiction to heart disease may help illustrate why it is defined as a disease by so many:1
· Both addiction and heart disease disturb the regular functioning of an organ in the body – the heart for heart disease and the brain for addiction.
· They both can lead to a decreased quality of life and increased risk of premature death.
· Addiction and many types of heart disease are largely preventable by engaging in a healthy lifestyle and avoiding poor choices.
· They are both treatable to prevent further damage.
Furthermore, since addiction is marked by periods of recovery and symptom recurrence (relapse), it resembles other diseases like hypertension and type-2 diabetes.[3] These diseases are lifelong conditions that require continual effort to manage. Symptoms will likely return during periods where treatment compliance is low or absent, and symptoms will likely diminish when compliance with treatment begins again in earnest. 3
The idea that substance addiction is a disease is not, however, universal. Some would argue that addiction is not a disease because of:[4]
· Addiction is not transmissible or contagious.
· Addiction is not autoimmune, hereditary, or degenerative.
· Addiction is self-acquired, implying the person gives the condition to himself.
Proponents of this way of thinking put much more emphasis on the social and environmental factors of addiction—one proponent claims that addictions may be “cured” by locking addicts in a cell where there is no access to substances—instead of on the brain changes that occur as a result of substance abuse.4
Some schools of thought view treatment for addiction as little more than the individual making the decision to stop using.[5]
Specific aspects of these opinions are hard to refute. For example, it is true that most substance abuse begins with a decision (although in many cases substance use began with a prescription from a doctor for a real medical problem and evolved into abuse).
But while no one forced an addicted person to begin misusing a substance, it’s hard to imagine someone would willingly ruin their health, relationships, and other major areas of their lives. Surely, if overcoming addiction were as easy as simply choosing to stop, the problem of addiction would be much easier to address and relapse would not be as common.
It should be noted that “addiction is a choice” view is largely relegated to individuals and small groups. There are few, if any, nationally recognized substance abuse-focused organizations whose views have not evolved to understanding addiction as a disorder or disease. In fact, the NIH views the idea that addiction is a moral failing as an outdated, ill-informed relic of the past.[6]
The American Psychiatric Association (APA) no longer uses “addiction” as a term or diagnosis. Instead, the APA adopted the phrase “substance use disorder” as a way to describe problems related to “compulsive and habitual” substance use.[7]The change was made specifically to avoid confusion surrounding the term addiction and it’s “uncertain” definition, as well as the negative stigma attached to the word. 7
No matter how one defines addiction or what term is used, what is clear is that addiction is an enormous problem in the U.S. that affects millions. Another irrefutable fact is that many drugs—both illicit and prescription—are quite addictive.
Why Are Drugs Addictive?
People get addicted to drugs for many reasons, but one of the major factors behind why drugs are so addictive is the rewarding, euphoric high they bring about. Drugs have the potential to significantly impact the systems in the brain relating to pleasure and motivation and make it difficult for other natural pleasures to compare.1
Every person experiences natural rewards in their life like a delicious meal, a favorite song, the pleasant feeling following exercise, or happiness after sex, but drugs offer something more. The high that comes from abusing drugs is bigger, brighter, louder, and more gratifying than any natural reward, and it can make natural rewards seem small, dim, and quiet by comparison.
One of the brain chemicals often discussed in the addictive power of substances is dopamine.1 Scientists believe, when a rewarding event occurs, the brain releases dopamine to signal the experience and encourage repetition.1 In terms of natural rewards, this is healthy and keeps life going; consider the pleasure derived from sex: it encourages repetition, thus perpetuating the reproduction of the species.
Dopamine tells the brain that the experience of using a drug is important and should be repeated. The brain is programmed to remember the people, places, and things associated with the use, so it will be easier for the person to repeat the situation.
With repetition, these bursts of dopamine tell the brain to value drugs more than natural rewards, and the brain adjusts so that the reward circuit becomes less sensitive to natural rewards. This can make a person feel depressed or emotionally “flat” at times they aren’t using drugs.1 If natural rewards are a plate of broccoli, drugs are a huge bowl of ice cream, and broccoli is even less appetizing after ice cream.
Over time, the desire for drugs becomes a learned reflex—a person can be triggered to use by the people, places, and things that are linked to their drug use, just as someone might get hungry driving by their favorite restaurant, only the desire is likely to be much more overwhelming. Cravings can feel uncontrollable even years after a person gets sober.1
At the same time, the drug is producing these changes in the brain that are associated with the development of addiction, the individual may also come to tolerate higher doses and even depend on the drug to feel well. 3 Tolerance and dependence develop because of adjustments the brain makes to manage the alterations that come from the repeated presence of a drug. Tolerance and dependence are two signs of a substance use disorder but may also develop to some extent in the absence of addiction. 3 So what are they?
· Tolerance is a state where the body’s reaction to the presence of a given amount of drug becomes diminished over time. To compensate, the person will consume a higher dose or consume it more often (or both).1 A growing tolerance to a substance’s effect and the ensuing increase in substance use may hasten the development of an addiction and increase the risk of overdose.
· Physical dependence is the state of needing alcohol or other drugs just to feel normal. 3 Without these substances in the system, the withdrawal will arise, and depending on the substance, symptoms could range from irritating to life-threatening.7
Addiction and physical dependence are often talked about as though they are interchangeable; however, they are separate phenomena that can exist without the other. 3 Someone using their opioid pain medications as prescribed can develop some physiological dependence but may not exhibit the compulsive behaviors of addiction. Conversely, some drugs may be used in a compulsive manner that indicates an addiction without physically relying on it to feel well.
What Are the Causes?
Apart from the case of beginning drug use via a prescription from a doctor, there are 4 main reasons people may try substances, according to NIDA:1
· To feel good. Drugs may lure people with the appeal of:
o A euphoric high.
o Feelings of power.
o Increased confidence.
o Energy.
o Relaxation.
· To feel better. Someone with anxiety, high stress, or depression might turn to drugs to try and manage distressing symptoms.
· To do better. Some drugs have the reputation of improving athletic or academic performance, so people may see them as a way of getting ahead or even just keeping up.
· To fit in or experiment. People, adolescents especially, may use out of sheer curiosity or to try and impress their peers.
People who have an intensely good experience their first time using begin to learn that drugs can make them feel great and the foundations of addiction are set. Not everyone responds the same way to drugs and alcohol, however.
For years, experts have debated if it was nature (biology/ genes) or nurture (upbringing/ environment) that determined whether someone will become addicted. Now, the prevailing view is that there is no one thing we can look at to predict someone’s risk of developing a SUD—rather, the interaction of the person’s unique biology and environment BOTH influence how the drug will impact a person’s susceptibility to becoming addicted.1
Biological factors impacting addiction account for between 40% and 60% of someone’s risk for addiction.1Possible biological factors include:1
· Genes and epigenetics (the way environment impacts gene expression).
· Gender.
· Ethnicity.
· Stage of development.
The person’s developmental stage is particularly important since teens who use drugs are much more likely to become addicted and remain addicted to adulthood.1
Environmental factors include all situations and experiences a person lives through. The most significant environmental influences include: 1
· Home environment.
· Family dynamics.
· Friends.
· School.
Each person will have a number of biological and environmental risk and protective factors.1 A risk factor is something that puts the individual in more danger of becoming addicted, while a protective factor is something that minimizes that danger.
Possible biological and environmental risk factors include:1
· Family history of addiction.
· Family history of mental illness.
· Chaotic home life.
· Negative attitudes of parents and friends.
· Unsupportive community.
· Poor school achievement.
· Easy access to drugs and alcohol.
Possible biological and environmental protective factors are:1
· No family history of addiction or mental illness.
· Good physical health.
· Supportive, involved family.
· Healthy relationships at home and in the community.
· Access to positive resources in the neighborhood like community groups, safe playgrounds, recreation centers, etc.
· Academic success.
· Strong impulse control.
Finally, the risk of addiction may be strongly impacted by the route of administration of the abused substance. Certain routes will produce stronger highs. For example, injecting opioids will produce a rapid intense euphoria that snorting or swallowing opioids can’t match.1
Intense highs that come on rapidly also tend to dissipate quickly,1 and the quicker comedown may further encourage drug abuse.
