Addiction is a complicated illness of the brain. The terminology has changed over the years and addiction, as well as substance abuse, is often now referred to as a single condition: substance use disorder. Addiction is related to the parts of the brain that control memory, reward, and motivation. Consistent and frequent use of an addictive substance can change these parts of the brain and make it very difficult to stop using.
Addictive substances may be illegal drugs like cocaine and heroin, or prescription drugs like narcotic painkillers or the amphetamine substances used to treat ADHD. Alcohol and nicotine can also be addictive. Any misuse of these legal substances and any use at all of illegal substances are considered substance abuse, and have the potential to lead to addiction. Treatment requires professional support with detox, rehab, and recovery through therapy and often with medications.
What is Addiction?
The official terms for abusing substances used to include substance abuse and addiction or dependence. These terms are still used often, but the Diagnostic and Statistical Manual of Mental Disorders condensed these two conditions into one for its fifth edition: substance use disorder. Based on how many criteria a person meets out of a list of eleven, he or she may be diagnosed with mild, moderate, or severe substance use disorder. The criteria are:
- Using more of a substance or for a longer period of time than intended.
- Attempting to cut back, but failing to do so.
- Spending a lot of time trying to get and use a substance.
- Having strong cravings for a substance.
- Using a substance to the extent that it interferes with home, school, work, and other obligations.
- Using a substance in spite of it causing social or relationship problems.
- Giving up certain activities to have more time for using a substance.
- Continuing to use a substance in spite of harm or dangers it causes.
- Continuing to use a substance knowing it is causing health problems.
- Experiencing a tolerance, needing to use more and more of the substance to get the desired effect.
- Experiencing withdrawal symptoms when not using the substance.
These criteria can be used to define a substance use disorder for any kind of substance, including nicotine and alcohol, prescription drugs, and illicit drugs. Meeting two or three criteria is a mild disorder, four to five is moderate, and six or more is considered a severe substance use disorder, or what might also be called addiction.
How Addiction Works
For a long time it was assumed that someone addicted to a substance simply had weak willpower, but with modern research we now know that it is much more complicated than that. It all starts with the first use of a substance that is addictive. Using a drug or other substance triggers the brain to release a chemical called dopamine, which is essentially the “feel good” chemical. It is naturally released when we experience something pleasurable, like a hug from a loved one, but mind-altering substances release a huge flood of dopamine. This over-stimulation teaches the brain to reach for that substance again.
With continued use of the substance, the brain starts to adjust and responds less and less. This is called tolerance and is a powerful motivation that triggers a person to use more and more of a substance to achieve the original high. This change in the brain also makes it harder for a person to get pleasure from normal activities. Long-term use of an addictive substance causes even more changes in the brain and affects learning, memory, behaviors, decision-making, and the ability to make judgements.
The changes caused by the substance ultimately cause a person to experience withdrawal. These are real and serious physical and emotional symptoms that kick in when trying to stop using a substance. Withdrawal signals that a person had become physically dependent on a substance, a point at which stopping is extremely difficult.
How is Addiction Treated?
Addiction is a disease of the brain and a medical condition. It requires treatment and that means using a variety of strategies that works best for each individual. A substance use disorder, especially a severe one, should be considered a chronic condition. It is never cured, and a person must constantly monitor and get treatment as necessary. Typically there are three stages to addiction treatment:
- Detox. Detoxification is the period of time during which an addiction patient stops using substances and those substances leave the body. This may only take a few days, but it is very difficult and a common point of failure. For some patients it may be medically dangerous to detox without supervision because of the severity of withdrawal symptoms.
- Rehab. Rehabilitation is the long, hard part of the process of treating addiction. Some people may choose to go to a residential facility, while others may stay home and get treated on an outpatient basis. Treatment at rehab may include individual therapy of various types, group therapy, support groups, medical care, including medications, and alternative therapies and practices like art therapy or acupuncture.
- Recovery. When rehab is finished a patient is considered to be in recovery, but most will never claim to be recovered. Any patient can slip back into old habits at any time, so addiction needs to be treated as a chronic condition. Addicts in recovery typically still engage in regular therapy or attend support group meetings to avoid relapsing.
Although some people believe that a recovering addict should never use any drugs unless absolutely necessary, modern medical research is proving that certain medications can help. For example, methadone can be used to reduce cravings and withdrawal in opioid addicts and naltrexone can block the pleasant effects of opioids and alcohol to make using them ineffective.
There are many drugs that are illegal and most of these are addictive to some degree. Some are highly addictive, like heroin or crack. Other illegal drugs are not as addictive, like marijuana. All have the potential to cause someone to develop a substance use disorder. The most commonly abused illicit drugs are marijuana and synthetic marijuana. Less often used, but still fairly common are heroin, cocaine, and hallucinogens like LSD. More and more popular are synthetic drugs like synthetic marijuana or bath salts. These drugs are made in laboratories and may not be illegal when they are first made, but eventually are made illegal as they become more popular. Illegal drugs are especially dangerous because they are generally very addictive, cause serious side effects and long-term harm, and are not necessarily pure and may contain unknown substances.
Much more commonly abused are legal, prescription drugs. Any misuse of these is considered substance abuse. Using a drug that was prescribed to someone else, taking larger doses than recommended, or continuing to use a drug after a doctor has said it is no longer needed all constitutes abuse. One of the most commonly abused and most dangerous classes of prescription drugs are narcotic opioid painkillers. These include: fentanyl, hydrocodone, oxycodone, morphine, hydromorphone, methadone, meperidine, and codeine. Some of the brand names of these drugs are Zohydro, Lorcet, Vicodin, Dilaudid, Demerol, OxyContin, and Percocet.
Abusing these drugs is extremely dangerous. Using more than directed can worsen side effects like drowsiness, nausea, constipation, mood swings, a rash, and slow and irregular breathing. Narcotics are also easy to overdose on, which can quickly become fatal if not treated immediately as an emergency medical situation. And, of course, these drugs are highly addictive. There is a high risk that abuse of these drugs will lead to addiction.
Adderall and Other ADHD Medications
Medications like Adderall and Ritalin that are used to treat attention deficit hyperactivity disorder are not as addictive as narcotics, but they are susceptible to abuse and can be dangerous. These medications are amphetamines, also known as speed when used illicitly. They are classified as Schedule II drugs by the Drug Enforcement Administration, which means there is a high potential for abuse and that they can be very addictive.
Common reasons for abusing ADHD medications include trying to lose weight. As a stimulant, these drugs can rev up metabolism and energy. They also produce wakefulness and have become a popular type of drug for students to abuse in order to stay awake to study or party. Any abuse of prescription amphetamines is dangerous and can cause nausea, vomiting, diarrhea, weight loss, shaking, delusions, aggression, paranoia, shortness of breath, a fast heartbeat, seizures and even death.
Prescription medications used to treat anxiety, like Valium or Xanax are Schedule IV controlled substances. This means there is some potential for abuse, but the risks are much lower for addiction than with drugs like opioids or amphetamines. The main reason someone might abuse these drugs is less for a high than for the feeling of calm and relaxation. A person using these drugs to combat anxiety may develop a psychological dependence, feeling like they need the drug to feel calm.
Antidepressants and Withdrawal Syndrome
Prescription drugs used to treat depression are not scheduled or controlled substances and they are officially considered to be non-habit forming. And yet, these drugs are known to cause withdrawal. Anyone prescribed them is warned to never stop using the medication without a doctor’s direction. Sudden stoppage can cause serious symptoms. Antidepressants include Paxil, Celexa, Prozac, Lexapro, Effexor, and others. Symptoms of withdrawal include anxiety, diarrhea, nausea, insomnia, vomiting, numbness and tingling, nightmares, irritability, mood swings, and excessive sweating.
Addiction and substance abuse—substance use disorders—are serious and real medical conditions. For those who have been through it, or who has watched a loved one go through it, addiction is painful, debilitating, and damaging. Addictive substances range from legal products like alcohol and tobacco to prescription drugs that are dangerously addictive to illicit substances. To enjoy recovery from addiction requires professional guidance, support from loved ones, and time.