On the physiology of addiction

Addiction: A Brain Ailment, Not a Moral Lapse

A better understanding of the pull and tug of addiction can help those who are hooked and those who want the monkey off their backs for good.

The savings in life-years, quality of life and lost income can be huge, not to mention the costs of drug-instigated crime and medical care.

According to the National Institute on Drug Abuse, $133 billion a year is spent just on treating the short-term and long-term medical complications of addiction. Among the many health consequences of addictions are sudden cardiac arrest, irreversible kidney and liver damage, AIDS, fetal harm and many cancers, including cancers of the lung, bladder, breast, pancreas, larynx, liver and oral cavity.

That it is possible to become free of addictions and remain so is unquestioned.

This article does a very nice job of summarizing our knowledge and lack of knowledge related to addictions. Interestingly, almost all addictions have the same final pathway.

The nature of addiction is the same no matter whether the drug is cocaine, heroin, alcohol, marijuana, amphetamines or nicotine. Yes, whether they know it or not, chronic cigarette smokers and users of chewing tobacco are addicts.

Every addictive substance, according to a report this month in The New England Journal of Medicine, induces pleasant states or relieves distress.

Furthermore, the authors of the report, Dr. Jordi Cami and Dr. Magi Farré of Barcelona wrote, “Continued use induces adaptive changes in the central nervous system that lead to tolerance, physical dependence, sensitization, craving and relapse.”

In other words, addiction is a brain disease, not a moral failing or behavior problem. People do not deliberately set out to become addicts. Rather, for any number of reasons ? like wanting to be part of the crowd or seeking relief from intense emotional or physical pain ? people may start using a substance and soon find themselves unable to stop.

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According to the Institute of Medicine of the National Academy of Science, 32 percent of people who try tobacco become dependent, as do 23 percent of those who try heroin, 17 percent who try cocaine, 15 percent who try alcohol and 9 percent who try marijuana.

Interesting statistics! Hopefully, continued research will allow us to better help addicts through their physiologic withdrawal.

Mr. Vastag explained that all drugs of abuse activated a pleasure pathway in the brain, the “dopamine reward circuit,” which is connected to areas that control memory, emotion and motivation. Any activity that activates those pathways reinforces the pleasurable behavior.

“Eventually,” he wrote, “the dopamine circuit becomes blunted; with tolerance, a drug simply pushes the circuit back to normal, boosting the user out of depression but no longer propelling him or her toward euphoria.”

By repeatedly supplying the body with the substance, a new state of “normal” is created, causing the person to continue using the substance to feel normal.

The changes in the brain, though not permanent, can be long lasting. Dr. Volkow found that the dopamine system of cocaine users remained impaired for up to three months after their last snort.

Read this interesting article and you will better understand the challenge these patients face.