As research into the impact of drugs on neurological functioning advances, it becomes increasingly clear that although the initial decision to use drugs is voluntary, addicts lose the power of choice.
As the National Institute on Drug Abuse explains, drug abuse results in physical changes to the brain that reduce impulse control and make it more difficult to quit using. The brain is not a static complex; it is highly dynamic and drug abuse alters it.
In short, addiction is a chronic brain disease susceptible to relapse, illustrated by the fact that 40 to 60 percent of recovering persons relapse. Neurotransmitters in the brain are responsible for communicating messages from different parts to the brain. For instance, a neurotransmitter can carry a message to the brain that there is pain in the back. Similarly, the brain can also carry messages of pleasure. Drugs disrupt this natural messaging and information processing system in at least two ways.
A drug can pretend to be a natural neurotransmitter and bond with a receptor site. A neurotransmitter is like a natural key that the body produces to fit into receptor sites in the brain. But a drug can essentially mimic a key, fit into a receptor site, and open a door to a new set of abnormal messages. A drug causes different activity on a receptor site than the natural neurotransmitter. Drugs can also overstimulate the brain, effectively inundating the reward circuits and causing a rush of pleasure.
But this description only provides one dimension. Add another layer – the brain has an internal recording device. The brain remembers the pleasure that drugs create. Then, when drugs are removed, the brain sends out messages of cravings to ask for the drugs back. In this way, the brain is blind to the negative impact of drugs. Once habituated to a drug, the brain becomes more focused on the drug than the overall survival of itself as an organism. The broad picture of drugs is that they actually interfere with the body’s survival instinct.
Drug Dependence vs. Addiction
The National Institute on Drug Abuse (NIDA) explains the main differences between dependence and addiction. As NIDA points out, the following are features of addiction:
- Compulsive use
- An inability to stop, despite wanting to do so
- Failing to meet work, family, school and social obligations
- Dedicating a disproportionate amount of time and resources to drug-related activities
- Developing a tolerance such that more of the drug is required over time
- Going through withdrawal when drug use ends or the amount of intake is reduced
Drug dependence is different. A person can be physically dependent on a drug and not be addicted to it. For instance, a veteran athlete may have an ongoing prescription for opioid pain relievers as part of a doctor-supervised pain management plan. Although this prescribed user will experience withdrawal if he were to stop taking the prescription opioids, if he is not psychologically dependent on the drug, he will be able to meet his normal personal obligations and lead an otherwise balanced life. While all addicted persons are drug-dependent, not all drug-dependent individuals are addicted.
It is important to note, drug dependence and drug addiction both require medical attention to be ended safely. In the case of drug dependence, the attending physician will appropriately wean the patient off the drug.
Psychological and behavioral counseling will not be necessary because the patient is not mentally attached to the drug.
In the case of drug addiction, after detox at a specialized facility, a structured rehab program is always advisable. During abstinence maintenance treatment, a recovering person will be provided with both individual and group counseling to address the psychological issues underlying the addiction and provide strategies to overcome addiction-related behaviors, such as giving into impulses, lying, associating with drug abusers, or stealing.
Drug Use in America
The National Survey on Drug Use and Health (NSDUH) provides accurate and detailed information on drug use patterns in America. The survey does not focus on drug dependence or addiction but provides many useful insights about drug use, which can, of course, lead to addiction in some cases. According to the 2013 NSDUH, Americans display the following types of drug use activity:
- Approximately 24.6 million Americans in the 12-or-older age group (9.4 percent of this group) used illicit drugs (including marijuana, cocaine and prescription opiates) in the month prior to the survey.
- About 19.8 million Americans in this same age group used marijuana, making it the most commonly used illicit drug in the country.
- Most illicit drug users were employed while 18.2 percent of unemployed adults (in the 18-or-older age group) were current illicit drug users.
- About 22.7 million individuals in the 12-or-older age group required treatment for an illicit drug or alcohol use problem (8.6 percent of this population). Of this group, only 2.5 million received treatment at a professional rehab center.
Statistics contribute to an understanding of drug abuse and addiction. The high number of drug abusers set against the relatively low number of treatment center admissions is an alarming part of the drug problem in America. Research repeatedly shows the need for structured rehab, but too many are not finding their way to recovery. In view of this deficit, ongoing education on drug addiction is necessary. Such education should include teaching some of the theories of the causes of addiction.
Psychology Today discusses the psychological underpinnings of addiction. First, different therapists may reach different conclusions or have different insights based on their theoretical and clinical training. For instance, a person trained in psychoanalytic theory may be biased toward finding a correlation between parent-child dynamics and addiction. It is unlikely, however, that there is ever one cause of addiction. This disease has many different elements that all hang together, and childhood relationships and experiences may only be one factor.
The psychopathological model of addiction views mental health disorders as the causes of addiction. This theory has support in related research findings on co-occurring disorders (when a person has at least one mental health diagnosis simultaneously with a substance use disorder). According to research conducted in 2011, approximately 50 percent of all persons seeking drug addiction treatment will have a diagnosis of a significant mental health disorder.
A related branch of the psychopathological model holds that some people have addictive personalities. This view holds that certain personality characteristics predispose a person to drug abuse. Such characteristics include being delusional or in denial about one’s problems, being unable to manage one’s emotions, and having problems with impulse control. At present, there isn’t sufficient evidence to support a full-blown theory, but it may provide some insight into the high rate of co-occurring disorders (drug abuse and mental health disorders occurring simultaneously).
Johann Hari, author of Chasing the Scream: The First and Last Days of the War on Drugs, writing for the Huffington Post, describes his theory of addiction. Hari, after having loved ones pass away from drugs, developed a profound interest in the causes of addiction. Hari traveled over 30,000 miles, conducting a quasi-anthropological experiment, to ask people in different parts of the world about their addiction experience. After hearing numerous stories, Hari began to question whether the main reason for addiction is being chemically hooked on drugs or something else.Hari learned of an experiment involving rats. The experiment involved caging a rat alone, in isolation, with access to two water feeders, with and without drugs. The isolated rats most often became addicted. In a second cage, rats were grouped together and given every comfort they could want, and also offered a drugged and non-drugged water feeder. The rats in the second cage rarely became addicted. Further, when a drug-addicted rat was transferred from its isolated cage to the community cage, the rat usually maintained abstinence.For Hari, drug abuse is driven more by environment than chemicals. In this conception, positive human interaction must become a main component of addiction treatment programs because the more connected a person feels to others, the greater the odds that he will not relapse. As Hari explains, this theory encompasses all types of addiction, including gambling; in the absence of meaningful connections in life and a positive environment, a person may seek to bond with anything that feels good, be it a pack of cards or heroin.
Hari’s book and the rat study provide an important insight – human connection is an integral part of treatment. Many rehab centers are dedicated to fostering community during treatment, and even hold alumni reunion meetings to keep the camaraderie going after clients leave the program.
Why Addiction Recovery Is Challenging
Yes, recovery is a challenge – it’s a lot of work, but it’s also absolutely necessary work and the best work anyone addicted to drugs can do. Being drug-free is necessary to live a fulfilling life and to give oneself every opportunity to live as long as possible. But what is it about recovery that makes it so much more challenging than just quitting drugs?
There is a host of reasons why recovery is a challenging experience:
- The brain has habituated to drugs and now craves them
- The association between environmental cues, such as a street corner, with drug activity
- A person not wanting to face the reality of her life, which may be full of conflict with others, self-turmoil, poverty and other disadvantages
- The existence of an underlying condition that is not being adequately treated and spurring on the conditions conducive to drug abuse
- The existence of enablers or other people who unwittingly or intentionally impede the recovery process
- Not having adequate strategies in place to choose a healthy alternative to taking drugs when a drug craving arises
From a clinical perspective, Dr. Floyd P. Garrett advises that a main reason why recovery is difficult is that addicted people often do not have an adequate understanding of what is happening to them. For instance, the “personal choice” theory of addiction – that an addict can control and end his addiction – is limiting. An addicted person who believes he can stop whenever he wants, because using drugs is a matter of his personal choice alone, is being delusional. At the same time, family members and friends who believe their loved one can stop using drugs but is just choosing not to do so (and hurt everyone in the process) are essentially blaming the drug abuser, and unwittingly causing guilt, which is an impediment to recovery. In summary, seeing addiction as a personal choice levels a challenge against overcoming addiction. Educating drug abusers and their loved ones on the fact that addiction is a disease can help to shift thinking in this area to a more realistic place.
The psychological defense of denial also makes recovery challenging. As Dr. Garrett explains, denial keeps a person from learning from her mistakes and moving on – hopefully into recovery. For instance, after a drug binge, a person may feel ill to the point where she vows never to use drugs again. For some, this may be true, but for others, it is an empty statement made in a state that is absent of cravings. The true test of recovery is how she will react when she is faced with cravings and other drug cues.
Denial can involve not just denial of the drug use alone, but also of reality itself. Some drug abusers may even become psychotic and lose touch with reality to an extent where they cannot sufficiently understand the role of drugs in their psychosis.
Dr. Garrett astutely points out how a drug user’s assumptions about drug abuse and involuntary thoughts (such as delusions and denial) can hinder efforts to get into recovery, let alone achieve abstinence. Dr. Garrett’s points illuminate that drug abuse is multi-factored and cannot be reduced to one theory. For this reason, addiction must continue to be treated with a multidisciplinary approach by a team of specialists.
Here at The Canyon, our team of addiction treatment experts are prepared to help you or your loved one to navigate every step of the rehab process, from detox to aftercare. We tailor our treatment plans to the individual needs of each client.
Our rehab services always include drug education, as we believe that the more you know about addiction, the better prepared you are to overcome it. Call us to learn more.