Addictive Disease - Overview
Dr. Drew W. Edwards
Addiction fractures families, kills careers, steals joy, hinders hope and dashes dreams. Addiction is an equal opportunity disease—it does not respect race, gender, intelligence, income or zip code.
Addictive disease is characterized by increasing, dose dependent degrees of impairment that are directly associated with the use of intoxicating substances.
Addiction manifests as the inability to abstain from intoxicating substances, impairment in judgment and behavioral control, diminished ability to recognize significant problems with one’s behavior, choices and important relationships.
Like other chronic diseases, addiction often involves cycles of relapse and remission. There is no cure, but with expert professional help, lifelong recovery is possible.
A Brain Disease
Through extraordinary advances in neuroscience, brain imaging technology and behavioral medicine, we now know that addiction is a complex and multidimensional brain disease, affecting over 40 million adults and teens in the United States.
Yet in spite of widespread knowledge regarding the risks and consequences associated with drugs and alcohol, nearly 8,000 Americans will pick up and use an addictive substance for the first time TODAY—and most of these first time users are children and teens. Regrettably those who begin using drugs and alcohol early in life are at greater risk for addiction when compared to those who abstain or delay the onset until adulthood.
There is a growing body of evidence showing that the brain circuits involved in Substance Use Disorder are also are involved in other compulsive and addictive behaviors, such as gambling addiction, disordered eating (e.g., bulimia, obesity) and compulsive sexual activity. These are collectively know as “process additions” because they do not involve ingestion of a mood altering substance. Rather, these behaviors cause mood changes that are highly rewarding, compelling, destructive and difficult to control.
What Causes Addiction?
The exact cause of addictive disease is unknown. Although we often describe addiction as genetically based or as an inherited disorder. What we really mean is that susceptibility to addiction, not the disease itself, is passed along from parents to their children. In other words, about 40-60% of the risk for addiction is genetically based. However, the specific genes involved are still unknown.
But vulnerability is not destiny. Family functioning and social factors play a key role in the decision-making process regarding drug and alcohol use. Children raised in intact, secure family environments are less likely to abuse drugs and alcohol during childhood or adolescence, compared to children from less stable family environments. Children who suffer physical, sexual or emotional abuse, including bullying are at greater risk. Research also shows that high school students who participate in a religious activity at least once per week are significantly less likely to smoke or use drugs or alcohol.
Yet at its core, addiction is a biological process in response to the effect of a intoxicating substance or behavior. Persons with no known risk factors can and do become addicted.
The Collateral Damage: Living with an Addicted Person
The “collateral damage” associated with this addictive disease is nearly immeasurable. Broken families, depression, domestic violence, unemployment, child abuse and suicide is just the short list of human suffering associated with this disease. Watching a friend or family member destroy themselves with drugs or alcohol is devastating, both emotionally and physically. This is why family members of addicted individuals utilize nearly twice the amount of health care services (visits to doctors, emergency rooms, mental health providers…) than families without substance abuse problems.
The Neurobiology of Addiction
Over time, the repeated use of psychoactive drugs causes neuroadaptations involving the brain’s reward system.
The brain’s reward system consists of the Ventral Tegmental Area and the Nucleus Accumbens and ascends to the prefrontal areas of the brain. The reward system reinforces activities germane to human survival, such as such as eating, hydration and sex. This reinforcement is mediated by chemical messengers (neurotransmitters and neuropeptides) that induce intrinsic reward in response to these biologically important activities.
This system also enables the memory centers to store important details associated with the procurement food, water and sex—so they can be given priority, easily recognized and repeated.
Hijacking the Brain
All drugs of abuse target the brain's reward system by stimulating key neurotransmitters, primarily dopamine. Dopamine is the reason that drinking alcohol or using drugs is initially enjoyable for most people. However for some, alcohol or drug use produces feelings that are so intense, compelling and memorable that they cannot be ignored. As a result, the user becomes preoccupied with repeating the experience. Prolonged exposure to psychoactive substances results in neuroadaptive changes that redefine pleasure and degrade the neurocircuitry that normally inhibits impulsive and risky behaviors. As the disease progresses, the brain’s reward system is “hijacked” to the extent that experiencing pleasure, joy or even contentment in the absence of drugs or alcohol is unlikely.
As a result of these neuronal changes, an individual’s lifestyle becomes increasingly organized around attaining and using psychoactive substances. Lastly, the memories associated with drug use persist indefinitely. As a result, drug-associated environmental cues or stressful events can trigger intensive craving and relapse by activating the brain’s reward pathways.
Early Recovery & Relapse
Because disruption of the brain’s reward system often persists after initial abstinence. Early recovery is challenged by mood swings, boredom and anxiety—all of which could be immediately alleviated—just by getting high or drinking. This sheds light on why relapse — even in the face of severe consequence, such as divorce, job loss or incarceration — is common. Accordingly, treatment must addresses the neurobiological deficits, craving, and recognize that long-term medical, psychological and spiritual care is absolutely essential for sustained recovery. Anything less, is a waste of time.
If you, or a loved one is struggling with addictive disease and you want help, contact us.