Into the Mind of Addiction

1. Introduction

Addiction is an incredibly taboo subject in society. Any form of substance abuse is often viewed as a moral failing—society believes that addicts are purposely evil and hedonistic. Yet, what has often been viewed as a moral illness is, in reality, a mental illness with far-reaching and devastating impacts.

2. What is addiction?

Addiction, or reliance on compulsive substances such as drugs or alcohol, is complex and affects the brain in multiple ways. The brain is an intricate organ consisting of networks of neurons, which send and receive messages to and from different structures within the brain and nerves in the rest of the body. It is made up of various components: the brain stem regulates many basic functions, such as sleeping, breathing, and heart rate, while the limbic system consists of the brain’s reward circuitry and manages emotions and memory. The cerebral cortex is the wrinkly, outermost layer of the brain, responsible problem-solving, planning, and decision-making abilities as well as helping people to process information provided by their senses. All this complex circuitry is impacted and altered by addictive substances.

Different drugs impact the human body in many different, yet also similar, ways. When someone at a party uses a drug like cocaine, they feel euphoric. This is because cocaine is a stimulant drug, intended to increase activity in the central nervous system, heart rate, body temperature, and blood pressure. Such drugs produce an especially intense high as they rapidly flood the brain with dopamine. Dopamine is a neurotransmitter, a chemical that transmits messages between neurons and is involved in emotion, motivation, and feelings of pleasure. When activated normally, this system rewards positive behaviors such as listening to a favorite song or eating good food. Drugs, however, release 2-10 times the amount of dopamine natural rewards do and produce euphoric effects. These effects can occur almost immediately and last much longer than the release of natural rewards do. The response of the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors, and people stop finding enjoyment in every day pleasurable activities. The effect of such powerful reward works to reinforce drug use as people keep chasing the high.

In addition to stimulant drugs, there are also prescription opioids, heroin being the most common. These drugs bind to opioid receptors in the brain and trigger the release of dopamine. This “rush” causes pain relief and euphoria. Over time, however, the brain adapts and builds a tolerance to prescription opioids. As pain thresholds decrease, many users find themselves consuming an increasing amount of the same drug to produce the former relief. Opioid drugs are considered highly addictive; according to the American Society of Addiction Medicine, nearly 23% of heroin users suffer from addiction to opioids.

Finally, we have marijuana, the most commonly used drug in the United States, especially among young adults. The main active chemical in marijuana is delta-9-tetrahydrocannabinol (THC). This chemical interacts and binds to cannabinoid receptors (found on neurons in regions of the brain that impact learning, memory, appetite, coordination, and pleasure and in lungs, liver, and kidneys) to produce mellowing effects. Marijuana also interferes with dopamine levels in the brain (as is the case with most drugs), resulting in the euphoric “high” that users often experience.

As mentioned above, drug and alcohol abuse is most common amongst teens and young adults. However, addiction and its adverse effects can continue for many years into one’s future and impact all aspects of one’s life.

3. Relationship between addiction and mental illness

Addiction changes the brain in fundamental ways and dramatically disrupts one’s hierarchy of needs, suggested by their tendency to act against their self-interests in order to procure the drug. Such compulsion overtakes the brain’s ability to control impulses, as is the case with mental illnesses too. For these reasons, substance abuse is characterized as a mental illness, which focuses on the psychological effects of addiction and not the drug dependency itself. Thus, the act of consuming drugs is not an addiction, but it’s mental impacts are. Additionally, people diagnosed with substance use disorders (addiction to drugs or alcohol) can also be diagnosed with other mental illnesses.

In 2018, 19.3 million Americans over the age of 18 had a past year substance use disorder, of whom 9.2 million were also diagnosed with a Mental Illness, which is about 3% of the U.S. population. Research has continued to indicate individuals who develop drug dependencies are often also diagnosed with mental disorders-- and vice versa. For instance, up to 67 percent of alcoholic individuals are also diagnosed with a depressive disorder, as is also the case with 75 percent of opioid-dependent individuals. On the other hand, between 20 and 45 percent of those in recovery for addiction had also been diagnosed with post-traumatic stress disorder (PTSD), which led to their reliance on illicit substances.

Such overlap exists because substance use disorders and mental illnesses can both be caused by many of the same factors—genetic predisposition, abnormality in similar regions of the brain, and outside influences such as exposure to stress or trauma. Additionally, there is some evidence that suggests that drug abuse might increase the chance of people experiencing symptoms of mental illness (there is a higher chance of psychosis in marijuana users). Substance abuse might also be a means of coping with a mental illness such as depression or anxiety. In other words, there is no one cause for the comorbidity of addiction and mental illness, which can either occur independently or cause one another.

4. Symptoms

Addictions’ psychological and physical symptoms include:

Obsession: an individual is consumed with thoughts of how and when they will consume the substance.
Denial: not wanting to admit that their dependence on drugs or alcohol is a problem.
Risky behavior: an individual with an addiction has an abnormal sense of priorities and might be willing to take risks to obtain the substance, such as trading sex, stealing, starting fights, etc.
Withdrawal: when the amount of a substance drops below a certain level and an individual experiences physical symptoms: intense cravings, diarrhea, seizures, sweats, and uncharacteristic behavior.

Substance abuse can also cause serious long term damage to one’s physical and mental health:

Respiratory system: The lungs can suffer serious damage when one smokes or inhales drugs. This can cause diseases such as emphysema, lung cancer, and chronic bronchitis.
Cardiovascular system: Stimulant drugs have an incredibly negative effect on the heart. The long-term abuse of such drugs can lead to tears in arteries that supply the heart with oxygen or even in the walls of the heart itself, along with the increased risk of heart disease and heart failure. Injection drug users are also at risk of collapsed veins and infections in blood vessels or the heart.
Kidney damage: Repeated use of certain substances can cause dehydration, muscle breakdown, and increased body temperature, all of which contribute to kidney damage and might even lead to kidney failure (which is life-threatening).
Liver damage: Liver failure is often linked to alcoholism, but can also occur as a result of opioid use. Damage to the liver can lead to inflammation, scarring, tissue necrosis (the death of cells in a certain organ), and cancer.
Mood disorders: Substance abuse is very closely linked with mood disorders (depression, bipolar disorder, etc). This relationship might exist because a substance abuse disorder or mood disorder might increase the chance of an individual contracting the other and vice versa. Additionally, such mood disorders are a common symptom of drug withdrawal.

5. Treatment

Most people get introduced to addictive substances as adolescents. Unfortunately, substance abuse has become increasingly popular at that age and many believe that it is normal and even accepted. Once people get addicted to certain substances, it can be very difficult to quit and the stigma around it makes it even more difficult. People with addiction are often blamed by the public and even some healthcare providers for their addiction. Many believe that one can simply overcome their addiction by simply quitting. Even though medicine has long shown that addiction is a complex mental disorder, the public still believes that it is a moral failing. Individuals reliant on substances take this message to heart and often feel ashamed to reach out and seek treatment. This stigma creates a harmful system where individuals feel trapped and isolated in their suffering.

In reality, addiction is not something that can be overcome easily. But it can be treated with long term care that supports an individual’s journey to a healthier lifestyle.

The Journal of Neuroscience

Some treatments for drug addictions are:

Medication: Can be used to establish normal brain function, decrease cravings, and manage withdrawal symptoms. Currently, medications are available to treat opioid, tobacco, and alcohol addiction, and progress is being made on treatment for stimulant and marijuana addiction. While medication can be an important tool when recovering from addiction, an underlying bias against medication remains in many patients and even some substance abuse treatment centers.
Behavioral Counseling: This helps alter a patient's attitude towards drug use and work to promote healthy lifestyles. Counseling often occurs with other forms of treatment as well. Different forms of behavioral therapy include but are not limited to:

Cognitive-behavioral therapy: helps recovering addicts cope with and identify the thoughts and feelings that lead to substance abuse. This therapy helps patients dismiss their insecurities, provide them with skills to better their moods, and decrease their reliance on substance abuse to regulate emotions.

Contingency management: behavioral therapy that offers incentives and rewards to help recovering addicts abstain from drugs or alcohol.

Recovery Housing: Short-term housing that provides a safe and substance abuse--free environment for recovering addicts. This is often a valuable transition for individuals into an independent life while still having access to support.
Diagnosing and providing support for co-occurring mental illnesses: As mentioned earlier, mental illnesses such as depression or anxiety can sometimes be the cause of a patient’s addiction. Providing therapy and medication for these mental disorders is often a crucial step in helping a patient recover from addiction.

Note: This is not a comprehensive list, instead it merely discusses certain forms of treatment that studies have shown to be effective. If you are struggling with addiction, or know someone who is, contact the resources listed below and/or do additional research on treatment options available near you.

6. Resources & Volunteer Opportunities: