I believe every challenge can become an opportunity for learning and for gaining a new perspective.
I was recently challenged by an acquaintance of mine (my dog trainer in Telluride) about an addiction-related petition I signed. She was clearly mired in the negative stigma associated with addiction and insisted it was not a disease, but a weakness mostly stemming from bad parenting. Even in the face of being told my son died from this disease, she did not back off her conviction. She boldly asked me if I raised my son as a divorced parent, trying to find a reason to place blame on me.
While I certainly was not a perfect parent and made many mistakes with Cody, I didn’t cause my son’s addiction.
I am surrounded by those who understand addiction, who have lived with it, and have educated themselves about it. Most of my past writing assumed those who read it had a basic understanding of the disease, but perhaps that is not true. Perhaps there are many readers who don’t believe it is a disease at all, but a bad choice based on weak moral character. If I am to sincerely promote addiction awareness through my blog and nonprofit work, I believe I need to start with Addiction 101. Education is the only way to end the stigma.
Here is my attempt, in the most basic terms possible, to define addiction.
Addiction is not about willpower, it’s about brain chemistry.
It is scientifically defined as a chronic, relapsing brain disease that is characterized by compulsive drug use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive behaviors.
In 2013, the American Psychiatric Association updated the Diagnostic and Statistic Manual (DSM-which is the definitive resource for diagnostic criteria for all mental disorders), replacing the categories of substance abuse and substance dependence with a single category: substance use disorder.
Most people in the field have dropped the word “addiction” and now use the more accurate term “substance use disorder”. I am going to continue with the word addiction in this blog in order to keep it as familiar as possible.
Is addiction a mental disorder? Yes, because it changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and substituting new priorities connected with obtaining and using the drug. The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses. In other words, it is a mental obsession.
The science is indisputable. Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.
Dysfunction in the brain circuitry leads to characteristic biological, psychological, social, and spiritual manifestations. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
The initial decision to take drugs is mostly voluntary. However, when drug abuse takes over, a person’s ability to exert self-control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.
Drug use compromises the long-term health of the brain and leads to addiction. Unfortunately, a drug’s short-term pleasure comes with long-term consequences. As drug use increases, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals.
This means that eventually dopamine simply doesn’t work as well on the reward circuit of a drug abuser’s brain, and the ability to experience any pleasure is reduced. A person then takes drugs just to try and bring their dopamine function back up to normal — and larger amounts of the drug are needed to create the dopamine high, an effect known as tolerance. The compulsion to use drugs is fueled by the need to just feel “normal”.
No one is born with addiction. No child wants to be an addict when he grows up. No adolescent starts using drugs with the intention of making a career of addiction. It doesn’t work that way.
Unlike any other major disease, there is a relatively narrow window when addiction develops: it nearly always originates during adolescence. The pre-frontal lobe, the area of the brain where decision- making, judgment and self-control reside, is the last area of the brain to develop, usually in the early 20s. This makes adolescents particularly vulnerable to alcohol and other drugs. Drugs stop the development of the pre-frontal lobe and target the brain’s reward system literally changing brain chemistry. All of this combines to make it nearly impossible for many adolescents to stop use once they start.
Ninety percent of those who are currently addicted began using alcohol and other drugs before the age of 18.
My son’s first use was at age 13, and it progressed from there. I asked him why he started to drink and use drugs in the first place and he said it made him feel more comfortable fitting in with other kids. It reduced his anxiety and made him feel at ease in social situations. In other words, it increased his self-confidence around his peers and helped him cope with his life.
Approximately 10% of people who use drugs develop an addiction. It takes the life of more than 120,000 people annually, making it the third largest cause of death in the United States, after heart disease and cancer. Drug overdoses are now the first largest cause of accidental deaths in the United States, and have reached epidemic levels in all areas of our country.
All told, at least 100 million Americans suffer directly or indirectly from this disease – nearly one in three people in this country.
It is my hope this information might give a better understanding about the disease of addiction to all of those who are open to learning the facts and thus ending the stigma surrounding the disease.
In my next blog, I will discuss the causes of addiction; why some people get addicted and others don’t, including the genetic predisposition to addiction.
Mary Cucarola – July 12, 2016
“The Science of Drug Abuse and Addiction: The Basics.” National Institute of Drug Abuse. https://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics
“Science of Addiction.” Shatterproof.org. http://www.shatterproof.org/pages/science-of-addiction
Barnes, Henrietta. Hijacked Brains: The Experience and Science of Chronic Addiction (Dartmouth: University Press of New England, 2015) 61.