Changing Our Attitudes About Substance Misuse and Addiction
When people hear of others having a substance abuse problem, they may think that if they really wanted to, they could just simply quit. What many people don’t understand is that a substance use disorder (known as SUD, for short, and the medical name for a substance addiction), has a neurobiological basis. In fact, the clinical definition of addiction is “a chronic, relapsing brain disorder.”
When people begin to understand this, then the attitudes surrounding substance misuse and addiction can change, the stigma and shame still associated wrongly with addiction will be a thing of the past, and those affected may be able to access the proper treatment they need to recover more easily.
Facing Addiction in America
According to “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” published in November 2016, by the U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, 1 in 7 people in the U.S. is expected to develop a substance use disorder at some point in their lives. However, only 1 in 10 people with a substance use disorder receive any type of substance use treatment.
In the report’s preface, Vivek H. Murthy, M.D., M.B.A. Vice Admiral, the U.S. Surgeon General, wrote: “Before I assumed my position as U.S. Surgeon General, I stopped by the hospital where I had worked since my residency training to say goodbye to my colleagues. I wanted to thank them, especially the nurses, whose kindness and guidance had helped me on countless occasions. The nurses had one parting request for me…
If you can only do one thing as Surgeon General, they said, please do something about the addiction crisis in America.”
It is worth noting that the nurses’ request was made before the peak in fatal opioid overdoses seen during the very height of the national opioid epidemic – a crisis that is still with us, and that will take decades to fully resolve, if at all.
The report stresses the following important points – the sound, authoritative advice we need to constantly refer to if we wish to bring an end to the misguided conceptions still held by vast swathes of the nation’s population about the subject of addiction:
- Substance use disorders have a neurobiological basis. They should be treated as a medical issue like any other.
- We must change social attitudes, shifting how we think, talk, and act towards people with substance use problems.
We have a moral obligation and economic imperative to provide access to high-quality care for those suffering from substance use disorders.
The Truth: Why Do People Become Drug Addicts & Alcoholics?
Why can some people use drugs recreationally, like cannabis, or drink socially, even heavily on occasion, but they never become drug addicts or alcoholics? What makes them different? How are they more susceptible? Is it really just a question of willpower and self-control?
If you believe that – it’s simply a matter of “willpower and self-control” – then, unfortunately, you are sadly mistaken. Furthermore, no drug addict or alcoholic begins using their substance of choice because they want to become addicted. Please read on, as what follows is both informative and educational. As you’ll see, it has remarkably little to do with “willpower and self-control” in any real sense, and if at all. Importantly, however, it does fully answer the question of “Why?”
The Cycle of Addiction
Neurobiologists, after decades of study and research into substance abuse’s numerous effects on the human brain, believe that addiction can be best described as a repeating cycle with 3 distinct stages. Each stage is particularly associated with one of the brain regions; these are the:
- Basal ganglia
- Extended amygdala, and
- Prefrontal cortex
This addiction model provides a useful way to understand the symptoms of addiction, the best methods for prevention and treatment, and how people can successfully recover. Additionally, if you’ve never heard of the “basal ganglia,” rest assured that you do not have to be a brain surgeon to follow the explanation given here.
These 3 distinct stages of addiction are:
- Binge / Intoxication: when the individual consumes an intoxicating substance and experiences its rewarding or pleasurable effects
- Withdrawal / Negative Affect: when the individual experiences a negative emotional state in the absence of the substance, and
- Preoccupation / Anticipation: when the individual seeks substances again after a period of abstinence
As the individual continues their substance use, this cycle becomes more and more severe. Additionally, substance use produces dramatic and fundamental changes in the individual’s normal brain function. The most powerful of these changes is in the individual’s ability to control their substance use.
Put simply, the more times you participate in substance use, the less likely you will be to control that use in the future.
Let’s get back to those 3 regions of the brain that play pivotal parts in the addiction process: the basal ganglia, the extended amygdala, and the prefrontal cortex. Scientific evidence shows that the dramatic changes that occur in these 3 regions are particularly important in the entire cycle; these are:
- Development, and
- Maintenance of substance use disorders
The clinical definition of substance addiction, as found in the latest edition of the “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition” (also known simply as DSM-5), is:
“A chronic, relapsing brain disorder, characterized by compulsive drug-seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness.”
Natural behaviors get rewarded when there is a normal level of activation. But, when you add drugs into the mix, over-stimulation occurs. When this happens, the brain is trained to keep repeating the same action, craving more to get the same feeling, which is why addiction develops.
There are also scientific studies to prove that addiction to drugs and alcohol is a chronic brain disease. Once everyone gets on the same page and accepts this, then the proper treatment can begin.
How Does the Brain Affect Addiction?
While some people may classify addiction as a character flaw, there is actual scientific evidence to disprove that thought. Although the choice to first try a drug may be voluntary, once a person repeats it, it becomes much more and can result in an addiction.
Drugs target the pleasure points in the brain. When someone uses a drug, the brain’s reward system receives large deposits of dopamine. The National Institute on Drug Abuse defines dopamine as “a neurotransmitter present in regions of the brain that regulate movement, emotions, cognition, motivation, and reinforcement of rewarding behaviors.”
The Fundamental Changes in Brain Function
The above definition states “long-lasting changes in the brain.” So what are the results of these changes? Once substance use has altered the brain’s functioning, the following things happen:
- Substance-associated cues will trigger an individual into seeking out the substance
- Brain systems involved in the experience of pleasure or reward become less sensitive, yet the substance will now activate brain stress systems
- The functioning of brain executive control systems (involved in the ability to make decisions and regulate actions, emotions, and impulses) is heavily reduced
Put another way, your own brain will make you search out your substance of choice, it’ll make the “high” less pleasurable, so you need more, you’ll feel stressed if you don’t take the substance, and, if all that wasn’t enough, you ability to fundamental control yourself is far more difficult.
These effects are often why those who abuse drugs make bad decisions that lead to other risky behaviors. Many times they often don’t remember what happened when they were high or even making the bad choices they did.
The 4 Altered Behaviors Central to the Addiction Cycle
The individual using substances may go through this 3-stage cycle over the course of several weeks or months, or the individual will progress through it several times in just one day. This is more normal in an active addiction phase. Regardless of how long it takes, the addiction cycle will ultimately intensify over time, leading to greater levels of both physical and psychological harm to the individual’s health.
The addicted individual will now be experiencing changes, possibly severe, to their normal behavior, primarily:
- Impulsivity: Unable to resist urges, and a strong tendency to act without foresight or normal regard for consequences and to prioritize immediate rewards over anything else
- Positive Reinforcement: The presentation of a stimulus, such as a drug, increases the likelihood of drug taking
- Negative Reinforcement: The removal of a stimulus, such as negative feelings or emotions, increases the probability of drug taking
- Compulsivity: People suffering from compulsions often recognize that their behaviors are harmful, but they nonetheless feel compelled to perform them; doing so reduces tension, stress, or anxiety
These effects are often why those who abuse drugs make bad decisions that often lead to other risky behaviors. Many times they often don’t remember what happened when they were high, or cannot even remember making the bad choices that they did.
Sadly (and the primary reason why so many recovering addicts and alcoholics are prone to relapse again and again), scientific evidence also shows that these changes in the brain – primarily affecting judgment, decision-making, behavior, and memory – will persist for a significant period of time after an individual’s substance use stops.
Lastly, it is not yet known how much these changes may be reversed or how long that process may take.
Adolescents & The Addiction Cycle
The above description of both the addiction cycle and the fundamental changes to brain function that occur during the process, apply to anyone over the age of 25 years of age – the age neuroscientists believe is when a brain becomes fully mature. So what happens if the individual is younger than that age – an adolescent, a teenager, or even a child, whose brain is still developing?
Put succinctly, the changes are more fundamental, more invasive to future brain function, and have the potential to be exceedingly harmful. Sadly, there is also the strong potential for varying degrees of permanent brain damage.
Therefore, adolescence should be considered as a critical “at-risk period” for substance use and addiction. All addictive substances, including the legal ones, eg. alcohol and, depending on where you live, marijuana, have especially harmful effects on the adolescent brain, as it is still undergoing significant development. However, a primary feature of adolescence is risk-taking and experimentation, which, for some young people, includes trying substances, such as alcohol, marijuana, or other drugs.
One of the regions of the brain that is intrinsic to the development of addiction (as described earlier) is the prefrontal cortex. In adolescents, the prefrontal cortex is not mature until the mid-20s, and research shows that heavy drinking and drug use during adolescence affects development of this critical area of the brain. Furthermore, adolescents who start using substances often experience more chronic and intensive use, and, therefore, they are at greater risk of developing a substance use disorder compared with those who begin use at an older age.
In other words, the earlier the exposure, the greater the risk.
Finally, there are other factors that are more prevalent in adolescents, apart from risk-taking and experimentation; these are:
- An “extreme” or gregarious personality
- Lower levels of endorphins
- Potential hypersensitivity to the neurological rewards of drugs, and
- Parents’ strict responses to a child’s outgoing behaviour
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Never Enough: How the Brain Adapts to Substance Use
In her book, “Never Enough: The Neuroscience and Experience of Addiction,” Judith Grisel, Ph.D., renowned behavioral neuroscientist and a Bucknell University Professor of Psychology & Neuroscience, writes about a vital feature of the balance between brain function and substance abuse. Importantly, the brain does not remain passive by any means while being disrupted with addictive substances.
She believes that however we try to affect the brain with drugs, the brain, in direct response, will adapt to counter this. Grisel terms this action, and subsequent reaction, as the “A & B” process. Furthermore, Grisel describes the 3 psychopharmacological rules that apply to substance use:
- All drugs act by changing the rate of what is already going on
- All drugs have side effects
- The brain adapts to all drugs that affect it by counteracting the drug’s effects
The “A & B” process applies to this third rule. More specifically, when a person uses an addictive substance, this is the “A” part of the process – the action, where the person experiences pleasure directly from using. In response to this, the “B” process follows – the reaction, where the brain reacts by producing the exact opposite effect. This is the brain’s attempt to return itself to its normal state.
“What was once a normal state punctuated by periods of high inexorably transforms to a state of desperation that is only temporarily subdued.” – Judith Grisel, Ph.D., renowned behavioral neuroscientist
It’s the reason why hangovers from heavy drinking and coming down from an extended period of drug use are very unpleasant experiences. It is the reason why a person will inevitably need more and more of the drug to feel the benefit of the “A” process, because of the brain’s responses – the “B” process – to previous occasions of drug use.
The result of these constant “A & B” adaptations over time? Our brains are creating a tolerance to the substance. Not only that, but when the brain recognizes the substance from its memory banks, the “B” process begins almost instantaneously. This is the very reason that alcoholics and drug addicts require their substance of choice to just feel normal. Quite simply, without it, they would only feel the effects of the negative “B” process.
Risk Factors: Substance Use, Misuse & Addiction
Earlier in this article, we posed the question: Why do people become drug addicts and alcoholics? The question was mostly answered by our description of both the cycle of addiction and the fundamental changes in brain function that enable the development of substance addiction.
However, there remains one element of the full answer still to be explained – the risk factors that increase the chances of an addiction developing. These risk factors are dependent upon variable life experiences and family genetics, which is why one person is more likely to develop an addiction compared to another person.
In addition, there are many other mitigating factors that can influence the eventual outcome – the development of a substance use disorder or not, including various environmental and social factors, and the possible presence of a co-occurring mental health disorder.
Let’s look at both of these primary factors: life experiences (particularly during childhood) and family genetics.
Early Life Experiences
Negative childhood and adolescent experiences, such as physical, emotional, and sexual abuse, childhood neglect, household instability (such as parental substance use, the conflict between family members, primarily between the parents, the presence of mental illness within the family, the incarceration of family members, and, finally, poverty, can all influence the future development of substance use disorder.
Additionally, scientific research suggests that the stress caused by these risk factors may, in fact, act on the identical stress circuits in the brain that addictive substances act on, which may explain why they substantially increase the risk of addiction.
Genetic & Molecular Factors
It is estimated that genetic factors account for 40-70% of individual differences in the risk of addiction. Research has identified only a few specific gene variants that either predisposes to or protect against addiction. Like other chronic health conditions, substance use disorders are influenced by the complex relationship between a person’s genetic makeup and their environment.
Treating Substance Misuse and Addiction
As mentioned earlier, it is estimated that 1 in 7 people will have a substance use disorder at some point in their lives. Therefore, it stands to reason that treating substance misuse and addiction must start with prevention. Obviously, for those already addicted, this step is too late in the cycle.
However, for those who are at high risk of using drugs, prevention is key. It’s important to encourage family bonds and support people’s emotional health. Some people who begin to use drugs do so because they feel depressed and disconnected from family and friends. Working to strengthen bonds can give people the support system they need instead of turning to drugs and alcohol.
Community and school-based prevention and education programs are also important to keep young people away from drugs. Showing adolescents the serious effects of drug abuse, and that there are alternatives, can help to reduce the initial temptation to try drugs and the amount of drug use.
For those who are already addicted, finding reputable and reliable treatment is key. Many addicts think they can do it on their own, when, in fact, that is not the case. Once those who are addicted to drugs understand that their addiction is a chronic brain disease, they can begin to understand that the treatment is necessary. Any family and friends must also understand this so that they can help to support the recovery process.
Treatment for Substance Misuse & Addiction at Springboard Recovery
Making the decision to get help is the first and, often, the hardest part of seeking treatment for a drug or alcohol addiction. However, once you make a call to Springboard Recovery, our expert team will begin by assessing your addiction. This will include reviewing your history of drug abuse so that a customized treatment plan can be made.
Once the treatment plan is established, any detox program will occur first. This is often best done under the supervision of doctors and nurses who can help with any physical side effects that can accompany detox. The duration of detox differs from patient to patient since each person’s type and level of drug use is not the same.
When detox is complete, the team at Springboard Recovery will introduce you to therapy sessions, so that you can begin to discuss your addiction. This includes getting down to the root of what caused the addiction. There has to be a reason why you chose to start using drugs. Once again, understanding that addiction is not a character flaw is crucial to treating substance misuse. Through individual and group therapy sessions, those struggling with addiction can begin to understand what influences and experiences led them to their addiction. Once they understand what they are, they can begin to work to resolve them or avoid them.
While some patients thrive in a one-on-one setting, others do better in the presence of others who are fighting the same battle. They can share their stories more easily, and get support from others who are going through the same thing. Through therapy programs, addicts learn how to live better lives without the use of drugs and alcohol. They often find new interests and new groups of friends as they begin to live their sober lives.
Recovering addicts also learn the necessary life skills and coping mechanisms to help keep them sober. Some even go on to become treatment advisers to help others who are experiencing the same thing they once did.
Changing Our Attitudes = Ending the Stigma of Addiction
By knowing more about addiction and how it impacts a person’s mind, body and spirit, we can begin to change attitudes surrounding addiction and recovery and support those affected by it. Sometimes, this comes in the form of open and honest communication, or by sharing your own addiction recovery story.
Additionally, if you haven’t been personally impacted by addiction, it can mean listening with an open mind when you find out about someone who is struggling with addiction. These are the ways that we can help to end the stigma of addiction.
If you’re ready to take the first step in treating your substance misuse and addiction, contact Springboard Recovery today. Let our team help you by first assessing your addiction so that we can find the best way to help you. Take the first step, and let Springboard Recovery show you how to finally begin your journey to sobriety.