A primer on addictionWhat is addiction? Addiction is a brain disease, characterized typically by tolerance, dependence, craving and compulsive drug seeking behavior. Tolerance and dependence may be thought of as primarily physical symptoms. Tolerance is defined as the need to take increasingly larger doses of a substance in order to achieve the desired physiological or psychological effect (usually euphoria or sedation). Eventually, the brain becomes accustomed to having the drug and its effects. Dependence is the phenomenon found when one tries to discontinue using the drug, at which point arises a number of withdrawal symptoms making it very difficult to stay off of the drug. For example, common physical withdrawal symptoms of the benzodiazepine class of drugs (Valium, Xanax, and others) include agitation, weakness, fever, sweating, elevations in pulse and blood pressure, severe mood states, hallucinations, and sometimes seizures. Other substances, such as nicotine, alcohol, stimulants and some psychedelic drugs also have withdrawal syndromes. Many a user will forsake his or her abstinence rather than face a painful and feared protracted withdrawal. Craving is about desiring, wanting and needing to use. All along, the user is obtaining his or her substances from drug dealers at known, now frequented, locations. He is using his drugs with familiar paraphernalia (pipes, papers, needles, etc.) and at familiar times of the day, sometimes with the same user buddies, all of which creates a strong drug-use supporting context for living. Unbeknownst to the user, the drugs are not only passing through his body and brain, giving the typically desired effects of sedation or euphoria – these drugs are slowing re-wiring the brain’s pleasure circuits, adding more and more associations between drug induced feelings and future urges to use. Nearly all attempts to stop using will run the addict into the two roadblocks of withdrawal and craving. Even if successful at getting “off” of the offending drugs, the addict will still have to cope with months of sometimes constant craving. Cue-induced craving is the brain’s reminder system. Anything or anyone that looks even remotely like the addict’s former using world now elicits powerful sensory memories of using, quickly overriding the moral and medical reasons for abstinence, and negating any promises made to loved ones that they will remain drug free. Along with craving, which has more to do with persistent thoughts about use and ways to obtain one’s fix, uncontrollable compulsive drug seeking and use behavior signals a loss in one’s voluntary capacity to choose whether or not to use. Although one’s first use of an addictive substance is nearly always voluntary, once the brain’s pleasure circuits are wired-in for the drug, controlled use becomes more difficult and compulsive use takes over the new addict’s life. Such a person has truly become an addict. While individual responsibility is an essential component of treatment and abstinence, the emerging realization that addiction is a brain disorder with a strong behavioral component has given medical and substance abuse professionals a renewed sense of hope that together we can discover more effective treatments, including medications to combat the addicting properties of these substances, psychotherapeutic tools to strengthen the addict’s capacity to recognize and resist cue-based triggers to use, and family and social support services that are essential for the addict to rebuild his or her life with a new, drug free frame of reference. Readers may wish to visit the National Institute on Drug Abuse website, at http://www.nida.nih.gov for more information on addiction-related topics.
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