Drug Abuse and Addiction

Tolerance, Withdrawal and Cravings

Tolerance - when a subject's reaction to a drug decreases so that larger doses are required to achieve the same effect. Drug tolerance can involve both psychological drug tolerance and physiological factors. Characteristics of drug tolerance: it is reversible, the rate depends on the particular drug, dosage and frequency of use, differential development occurs for different effects of the same drug. This can easily lead to overdoses, especially of illicit drugs.
Cravings - When drug dependent people build up their tolerance to drugs over time, cravings can develope as they become addicted. A person's body gets so used to having the drug, it craves more to fufill its need. Drug cravings, like other physical cravings, are taken as a symbol that the individual should give the body what it thinks it needs.
Withdrawal - the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of certain medications, recreational drugs, and/or alcohol. In order to experience the symptoms of withdrawal, one must have first developed a chemical dependence, or addiction. This happens after consuming one or more of these substances for a certain period of time, which is both dose dependent and varies based upon the drug consumed. In fact, the route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well. Generally, a person will start to feel worse and worse, hit a plateau, and then the symptoms begin to dissipate. However, it is important to note that withdrawal from certain drugs (benzodiazapines, alcohol) can be fatal and therefore the abrupt discontinuation of any type of drug is not recommended.

Drug Abuse vs. Drug Addiction

Drug abuse is the recreational use of drugs outside the established medical guidelines to achieve a certain effect. The drug of abuse can be illegal due to their high potential for addiction and abuse or they can be drugs obtained with a prescription, used for pleasure rather than for medical reasons. The person mistreating the substance has a choice to use the drug.
· Drug abuse leads to drug addiction. Someone can abuse drugs without being addicted but the opposite is not true. It is not possible to be addicted to drugs without abusing them.

Drug addiction is a chronic, often relapsing brain disease which causes compulsive drug seeking and use, despite harmful consequences to the individual. Drug addiction is a pathological brain disease because the abuse of drugs leads to changes in the structure and function of the brain. The disease of drug addiction involves the development of acute drug use to the progression of drug-seeking behavior as well as the vulnerability to relapse and the decreased, slowed ability to respond to naturally rewarding stimuli. Drug addiction implies a loss of choice over an individual’s actions. The urge for the drug is beyond the person’s control.

Drug Abuse - voluntary (want)
Drug Addiction - compulsive need

The point at which a person's brain is changed and drug abuse becomes drug addiction is different and unknown for each individual. Addiction may not occur after one episode, but death is certainly possible.

Long-Term Physical and Functional Changes in the Brain Associated with Drug Abuse and Addiction

The long-term changes in the brain caused by drug abuse and addiction vary according to the specific drug.

Some drugs are more dangerous than others
- the number of dopamine receptors and the amount of dopamine released both decrease, causing a decrease in the stimulatory effect of the drug. This is how tolerance for cocaine develops. Prolonged cocaine use also makes users more sensitive to the anesthetic and convulsant effects of cocaine, which can cause death at a lower dose. Diagrams have shown that over a certain amount of time cocaine has a great impact on the brain's activity levels and the way the individual responds. After 100 days, the diagram indicates that there is decreased amount of brain activity.
Heroin- opiate receptors become less efficient in activating the cell messengers, which causes a decrease in the effect felt by users. Major withdrawal symptoms will develop in 24-48 hours. These symptoms include muscle/bone pain, insomnia, restlessness, cold flashes, vomiting, diarrhea, and involuntary leg movements. Heart disease and kidney disease can also result. Many times, heroin users can contract other chronic diseases from dirty needles like HIV/AIDS and hepatitis.
Amphetamine/Methamphetamine- There is some evidence that neurons in the cerebral cortex are killed. Long term Meth use causes damage to dopamine and serotonin producing cells. Long-term MDMA (ecstasy) effects include damage to serotonin producing neurons, and impairment of working memory. Changes in activity of the areas of the brain concerned with cognition, emotion, and motor function also occur.
THC- damage to the hippocampus occurs, which causes a decrease in short-term memory ability and changes the way the neurons function. THC can change a person's behavior and a person's abilities in movement, balance, coordination, memory, and judgment.
Alcohol- The mammillary bodies are very sensitive to the long-term effects of alcohol. Alcohol kills brain cells. They are damaged, resulting in a decrease in memory function. Neurons in the cerebral cortex are also killed, which causes a decrease in the quality of processing in different areas.
Hallucinogens and Dissociative Drugs- long-term use of LSD can cause chronic psychosis (personality changes and disorganized thinking), dramatic mood swings, and flashbacks (episode where effects of LSD are felt long after drug has worn off). LSD is the most common hallucinogenetic drug that people use.
Marijuana- the parts of the brain that control emotions, memory, and judgment are affected by marijuana. Smoking it cannot only weaken short-term memory, but can block information from making it into long-term memory. It can also been shown to weaken problem solving ability.
Inhalants-inhalants, such as glue, gasoline, hair spray, and paint thinner, are sniffed. The effect on the brain is almost immediate. And while some vapors leave the body quickly, others will remain for a long time. The fatty tissues protecting the nerve cells in the brain are destroyed by inhalant vapors. This slows down or even stops neural transmissions. Effects of inhalants include diminished ability to learn, remember, and solve problems.
LSD-While some people use LSD for the sense of enhanced and vivid sensory experience, it can cause paranoia, confusion, anxiety, and panic attacks. Like Ecstasy, the user often blurs reality and fantasy, and has a distorted view of time and distance.
Steroids-Anabolic steroids are used to improve athletic performance and gain muscle bulk. Unfortunately, steroids cause moodiness and can permanently impair learning and memory abilities.
Tobacco-Tobacco is a dangerous drug, putting nicotine into your body. Nicotine affects the brain quickly, like other inhalants, producing feelings of pleasure, like cocaine, and is highly addictive, like heroin.
Ritalin-This drug is often prescribed to treat attention deficit disorder. It is becoming an illicit street drug as well. Drug users looking for a high will crush Ritalin into a powder and snort it like cocaine, or inject it like heroin. It then has a much more powerful effect on the body. It causes severe headaches, anxiety, paranoia, and delusions
Nicotine- extended usage can lead to cancer due to the cell mutations the drug creates; lung cancer is the most prevalent of cancers due to these mutations. The lungs are damaged after long-term usage, and this leads to pulmonary diseases like emphysema and chronic obstructive pulmonary disease or COPD. Nicotine is highly addictive due to the chemical interaction that goes on in the brain. The carbon monoxide in nicotine builds up in the arteries, which can lead to a heart attack. The drug restricts blood flow to the brain, which increases the chance that users can suffer a stroke. It also damages the skin, turning it "sallow, yellow and dull"; users can age and wrinkle prematurely.

Social and Behavioral Context of Drug Abuse Influence Addiction

Drug abuse, at first, is a choice and is voluntary. Thus it involves the subject to willingly and consciously take the drug. In order to get this person to make such a rash decision, other factors must be in play. Of these are social and behavioral motives.
  • Social- the social context of drug abuse may either involve your peers, your school, or your community. Each of these can put pressure on the subject and expose them to the notion of using illicit drugs. For example, someone who would've never taken drugs in their life could end up in the wrong group of friends, and in order to be accepted, they would be "forced" to take a drug. As the person begins to abuse the drug more and more, they may become addicted. Also, a person's predisposition to addiction to a drug may depend on the environment they live in. A person who lives in an urban area where drug-dealing is prevalent may be more susceptible than someone who was brought up in a well-off community with relatively little illicit drug use. Another factor that can determine an individual's drug use is the structure of their family when growing up. If a child is born into a family that contains alot of drug use they will be more prone to using drugs when they grow up. Being around a family enviroment that contains drugs can greatly impact the way the child uses drugs.
  • Behavioral- There has been research done into the behavioral context of illicit drug abuse. It has been shown that introverted and antisocial behavior in childhood is linked to drug abuse in the person's later life. In addition, a person may be coping with something mentally or be in actual physical pain and use illicit drugs as either an escape from reality or an escape from other problems the person may be going through. There are also numerous risk factors that may predispose someone to drug abuse: genetics, family structure and influence, age when abuse begins, context of abuse, and coping mechanisms.

Medical Use of Addictive Drugs

Some addictive drugs can be beneficial medically when used correctly and in the right dosage.
  • -Two addictive drugs commonly used in hospitals are medical marijuana and medical morphine, morphine being the more prevalent and more widely accepted.
  • -Morphine can be prescribed by doctors as a painkiller. It is usually supplied through an IV drip that is administered right into the blood stream. It can also be applied through the click of a button from the patient, and the morphine is distributed throughout the body. There are certain limitations to it. The patient can not keep clicking the button. To avoid addiction, morphine drips have become self administered with a type of lever or button that releases morphine. Doctors beileve that this will cause less addiction as people will use it only when needed, not on an hourly basis. In experiments where patients are able to administer the morphine themselves only 4 out of 12000 patients become addicted.
  • -Medical marijuana has become a hot topic in recent years. Although marijuana is illegal across the country, some states have passed laws allowing marijuana to be prescribed as a type of painkiller. These states then believe that marijuana has shown proven medical benefits. Not all states believe these results however.

List of Diseases Medical Marijuana Treats
Drug Policy of Medical Marijuana
National Website for Medical Marijuana

The Transition Between Drug Addiction and Drug Abuse

It's different for everyone! However, it can be influenced by a variety of factors.

Environmental, Behavioral, Genetic and Social Factors

Environmental- A person's family's or community's environment can influence drug abuse and addiction. You are more likely to become addicted if you live in an environment where drugs are readily available and/or you are encouraged to use them. Examples are a neighborhood where drug dealing is common, a parent who is addicted to a substance and keeps it around the house, friends that use drugs etc. An environment where someone is under significant stress can also lead to drug use. This can be caused in a variety of ways, such as family conflicts, getting low grades in school, sexual abuse, physical abuse ect.

Behavioral - Certain behaviors, such as risk taking behaviors, can predispose a person towards addiction. The msot common example of risk-taking behavior is found in teenagers. Other behavoirs that can lead to addiction are emotional instability, anti-social tendancies, poor impluse control, insecurity and low self-control. Also, people with mental disorders, such as depression, bipolar disorder, schizophrenia and others, are more likely to use and abuse drugs.

Genetic- One can be predisposed geneticalkly to become addicted faster to certain drugs. One cna also be predisposed to resist addiction. For example, a drug may cause one person to feel better than another person, while the same drug could cause one person to feel sick. Also, if members of a person's family are addicted to drugs (a good example is alcoholics), there could be a gene that runs in your family that causes the addiction. However, having a genetic predisposition to addiction DOES NOT mean that you will definitely become addicted. The same rule applies for if you have a gene that prevents addiction (it doesn't necessarily mean you will not become addicted).

Social Factors- If one's reward pathway is not stimulated by one's present activites and environment, a person is more likely to turn to drugs and become addicted. If a person's job or relationships are not fufilling, they could become drug addicts as they seek that enjoyment and fufillment in their life.

But, with addiction... prevention is the key!

Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs that involve families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse, and for teachers, parents, and healthcare professionals to keep sending the message that drug use is harmful. Having all OR none of the risk factors DOES NOT means that one will or will not become addicted to drugs.

A Scenario: How Risk Factors, Choice and Peer Pressure May Influence Addiction

To answer this question, we must look at two different levels of drug abuse/addiction in order to determine how certain consequences affect their decision to use the drug. In the first scenario, Rod has been a heavy marijuana user for thirty years and is considered to be addicted to the drug. In the next scenario, Linda has been a light marijuana user for six months and can be considered a light abuser of the drug. In both cases, marijuana has the same short-term effects during the initial usage of the drug. THC, the main component of marijuana, activates the receptors on the post-synaptic neurons in the brain. As a result, both users will experience sedating effects during early use of the drug.
Most importantly, the long term usage of the drug creates the differences in how each of the abusers responds to the certain risk factors, choice, and peer pressure. Since Rod has been using the drug for an extended period of time and has developed tolerance and cravings toward the drug, he is more unlikely to respond to people telling him to give up the drug. The risk factors associated with the drug are unimportant to him since he is addicted to the drug. In addition, as a heavy drug user his choice to abuse additional drugs is increased. On the other hand, as a light abuser of marijuana, Linda is more likely to respond positively to people telling her to give up the drug. She has developed limited cravings for the drug and her tolerance is significantly lower than Rod’s. The risk factors associated with the drug are more important to her because she has not yet experienced the addiction associated with the drug and can still give the drug up. In addition, as a light abuser of the drug it is more unlikely that she will choose to experiment with other drugs.