Introduction about Addiction
Psychoactive substances and their abuse trace back to ancient times. For thousands of years humanity has sought relief from pain and an escape from the pressures of daily living. In its earliest forms they were invariably derived from natural sources, such as biblically recorded alcohol consumption and the isolation of opium from the poppy plant, as noted in the infancy of documented history. As technology marched forward, man-made chemical-based substances that mimic the effects of many of these natural derivatives proliferated. The potency of these synthetic drugs has led to an explosion of overdose injuries and fatalities.
As studies of human behavior progressed and the deleterious effects of abuse have become widespread and duly acknowledged, repeated attempts have been made to regulate substance use and criminalize its recreational practice. In the early 70’s Nixon declared the War on Drugs and famously proclaimed illicit drug abuse, “public enemy number one in the United States.” The search for a lasting resolution has been on ever since.
Philosophies in the methods best employed to curb rampant substance abuse have changed and evolved over the past 50 years. Where to aim the primary focus of attack has shifted from President to President and administration to administration. From strict federal oversight, increased legal ramifications and heavy incarceration rates to incentives, education and improving treatment access, both the carrot and the stick have made recurring appearances.
All these efforts notwithstanding, the opioid epidemic continues to explode. Over 130 lives are claimed daily in the USA per the CDC. From 1999 to 2016 rates of drug overdose deaths more than tripled across all age groups and genders, according to a NHCS data brief released by the CDC in 2019. The chief modern drug killer- synthetic opioids such as fentanyl, more than doubled its fatality rate in the space of one calendar year. The death toll keeps climbing and a real solution continues to evade us.
Aside from fatalities, victimhood of substance abuse takes many forms. Dysfunction, fissures in the family unit, and debilitating depression has come to define a generation. A rise in violence has been linked to drug abuse rates in areas across the country.
Addiction, often referred to as an “equal opportunity destroyer,” does not discriminate and has collected bounties from all tiers of society and every racial and ethnic group.
The CSA and Federal oversight of addictive substances
Signed into law in 1970 by President Nixon, the Controlled Substances Act (CSA) established USA policy under which activities regarding substances are regulated. It created five classifications (or schedules) in which illicit substances were categorized and was based on three major factors.
- How likely is the drug to be abused?
- Is there an accepted medical use for this substance in the US?
- What is the risk of addiction and to what extent?
Different levels of regulation and punishment for its abuse were placed for each schedule. The legislation kicked off the modern War on Drugs and has been the backbone of the American legal approach to illegal drugs ever since.
Debate has raged in the halls of politics as well as in the courts of public opinion on how to pick up the pieces of a failed drug war and reform policy to best help those suffering. The strain on the criminal justice system, overcrowded jails, and an escalation of drug related violence throughout the country has many lobbying for reforms to current federal policy.
Amidst cries for the decriminalization of addiction or substance use disorder and an easing of what some feel are punitive legal consequences, focus has been shifting to improving the rehabilitation process and infrastructure which includes education, prevention, and treatment measures. Research, access to care, and improving treatment quality can all significantly contribute to making inroads in an ongoing national crisis.
The following attempts to provide a broad window into addiction, its causes and effects, and the methods we can employ to fighting back.
What is Addiction?
“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases. “
Adopted by the ASAM board of Directors, September 15, 2019.
Addictive Substance Categories
Opioid drugs bind to opioid receptors in the brain, which are responsible for receiving pain messages from the nervous system. The drug will block or reduce those messages, thus relieving pain.
Naturally occurring opioids are derived from a plant called the opium poppy and include painkillers such as morphine and codeine. Often used to alleviate severe pain such as post-surgical or cancer patients they induce euphoric highs and a strong relaxed state. These substances carry a strong risk of addiction and must be very cautiously prescribed.
Heroin is a semi-synthetic opioid derived from morphine. It has no accepted medical use, is highly addictive and prone to overdose. It is a chief culprit in the opioid crisis and requires comprehensive treatment for long term recovery.
Synthetic opioids are lab-created analgesics (pain-relievers) that mimic the effects of their naturally occurring cousins but operate at much more potent levels. Fentanyl, reserved for extreme levels of pain such as in advanced cancer, has become one of the biggest killers of our generation. Cheaper to manufacture illegally than heroin and 50 to 100 times more potent, it is often added as a filler to heroin and can be ingested unknowingly. Overdose-related deaths have violently spiked as Fentanyl, both legally manufactured and diverted for illicit use or clandestinely made, has become more prevalent.
2. Addictive Stimulants
Dopamine is a chemical found naturally in the human body which sends signals from the body to the brain (neurotransmitter), and influences movement, concentration, sleep and many other aspects of brain function. A stimulant will raise dopamine levels and energize the brain.
Amphetamines is the active ingredient in Adderall and Ritalin and a commonly prescribed stimulant used to treat conditions such as ADD and ADHD. When administered properly, it will slowly raise dopamine levels and increase focus and productivity. Stimulants will be abused to produce feelings of exhilaration, extend wakefulness and maintain a sharp level of alertness.
The most infamous of the illegal stimulants is Cocaine. Although it is a schedule II drug, it is very rarely used for medicinal purposes. It can reach the brain in seconds, creates intense feelings of euphoria, and is highly addictive.
Methamphetamines (meth, crystal meth) is another commonly produced stimulant. It can cause extensive damage to dopamine and serotonin producing cells, induce paranoia and hallucination, and can result in homicidal and suicidal thoughts.
3. Addictive Depressants
Depressants are drugs that reduce neurotransmissions to the brain and are therefore known as “downers.” Called Benzodiazepines or Benzos for short, they act as the exact opposite of stimulants. Brain function slows and reduces arousal or stimulation levels.
Sleeping aids and anxiety-relief medications such as Xanax and Valium are among this class of drugs.
Somewhat surprisingly, alcohol is classified as a depressant. Although the alcohol abuser may initially turn to the bottle to loosen inhibitions and elevate moods, increased consumption will lead to impaired memory, decision making capabilities, and other similar symptoms of a slowed brain process. Alcohol, although not regulated nor illegal, is the most widely abused addictive substance in the United States per the National Council on Alcoholism and Drug Dependence (NCAAD). Denial, a major component of any user’s refusal to seek treatment, is perhaps most glaring in alcohol abuse.
Drugs that alter sensory perception are called hallucinogens. They distort spatial and time awareness. Either found in plants or synthetically produced, they are most commonly abused by high school and college students. Although fatalities from overdose are rare, they cause dangerous behavior, tragic accidents, and invite suicidal thoughts. Examples of hallucinogens are Ecstasy, LSD, and MDMA.
Symptoms and Effects of Addiction
Substance Abuse Disorder (SUD) is insidious. What begins as essential pain relief or innocuous recreation soon takes over the mind and crushes the spirit. As the brain’s receptors adjust to the deluge of pleasure and serotonin releases at accelerated levels, it begins to intensely crave those sensations at rapidly diminishing intervals. Moreover, it becomes desensitized to the effects of the drug and demands increasing dosages to satisfy those cravings.
The addict becomes obsessive. His focus is solely on procuring drugs and then using them, to the exclusion of all other activities. Nothing else matters. He cannot stop and there is no barrier that will hold him back.
A Philadelphia physician named Benjamin Rush, one of the founding fathers and a visionary in the field of alcohol abuse, famously quoted a local alcoholic as saying, “Were a keg of rum in one corner of the room, and were a cannon constantly discharging balls between me and it, I could not refrain from passing before that cannon in order to get at that rum.”
As the attrition builds, substance abusers cross all lines of normal behavior to reach their fix. Their social responsibilities fall by the wayside, along with work and family. They sometimes will resort to violence and lash out at loved ones when their needs are not met.
It will take a toll on him both physically and mentally. He may exhibit paranoia, severe mood swings, and declining personal grooming practices. Excessive weight gain or loss, insomnia, bloodshot eyes, along with tremors of his extremities are all signs of a bad habit maturing into full-blown substance dependence and addiction. Cardiac illness and respiratory failure are common in addicts as well.
Root Causes of Addiction
1. Addiction is a disease
As science has moved from viewing substance abuse as a moral failing and began understanding its progression as a disease, research efforts intensified on two fronts. Understanding on how the brain’s wiring changes with addictive substance intake and its subsequent manifestation in altered behavioral patterns is key to properly treating it.
2. External Factors
Additionally, studies have been conducted on discovering the role external factors contribute to falling prey to addiction. Factors such as genetics, stress levels, family dynamics and friend groups, and even climate and environment have all been found to play significant roles in an addiction’s development.
Inherent predispositions to addiction definitely exist. This does not mean that possessing these traits in your makeup will automatically translate into a substance dependence. It does, however, provide a window into the wiring of a user. It is crucial in charting out a proper course of treatment that comprehensively addresses the issues everyone struggling with addiction faces.
3. Co-occurring disorders
Research has shown that a significant majority of people struggling with addiction will be concurrently battling serious mental health issues. Illnesses such as bipolar disorder, personality and anxiety disorders, and varying levels of depression are examples of what can be facing a person with addiction. It exacerbates their substance dependence, potentially intensifies their withdrawal symptoms and creates a higher risk for relapse.
It is obvious that to properly assess patients and plan his recovery model, a full picture of what ails him must be provided. An incomprehensive diagnosis will inevitably lead to failure.
Addiction Denial and Intervention
One of the greatest impediments keeping a drug or alcohol abuser from seeking help is denial. He will reject any suggestion implying that he has a drug problem, insisting that his substance use is merely recreational and still subject to his control. Waiting for the addicted individual to realize on his own what he is struggling with can be futile and carry tragic consequences.
An intervention done correctly can save lives. It is wise to be in touch with a professional drug abuse counselor when setting up the parameters of your intervention. They will guide concerned friends and family on what needs to be said, and perhaps more importantly, what rhetoric should be avoided at all costs. Often, they will be present to moderate the session. Finding the correct balance of empathy while demanding accountability is walking a tightrope. Professionals will help you thread that needle and make an impact.
The role of family and friends in the recovery process cannot be understated. Intervention is one way that family can help a sufferer of SUD, but it doesn’t end there. Facing drug addiction is a cold and isolating experience. The mere knowledge that there are people on his side who genuinely believe in him greatly enhance his or her chances of real long-term success. A sense of belonging is powerful, especially to those who have stopped believing that they do indeed belong.
As they enter the cycle of treatment and even if they go away to residential facilities, they will continue to need and and continue to lean on family and friends. Constant encouragement, empathy, and unwavering support are an integral part of recovery.
Addiction Treatment Process
The first step of treatment and crucial for embarking on a successful journey to long-term recovery is abstinence and sobriety. This is usually accomplished by entering a detox program. Generally running on a five to seven-day timetable, detoxification clears the body of toxins ingested from illicit substances while managing withdrawal symptoms. Medications and other methods are used to alleviate these symptoms and all patients are carefully monitored.
For some users and certain types of drugs, withdrawal can be life threatening and the process must be closely supervised by medical professionals.
2. Residential, Inpatient, and Outpatient Programs
Once sobriety is achieved, recovering addicts will be directed to a residential treatment program. While residing there they will participate in a variety of evidence-based group therapy sessions, as well as individual one on one counseling. Intense effort will be made to establish an environment of honesty and self-betterment. Programs will vary from 30 to 90 days depending on which facility, the severity of the addiction, and each person’s individual progress.
Methodologies such as Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT) are utilized. Additionally, the 12-step philosophy is widely incorporated in treatment plans in most recovery centers. For some sufferers of SUD, Medication-assisted treatment (MAT) will be extended. These medications are designed to help curb craving and to stave off relapse. It must be noted, as signified by its clinical term, this is an assistance to an individual in recovery and not the solution to achieving long term health. The importance of relearning behaviors and identifying triggers is the foundation of successful treatment, and without it, in the long run any medication will prove to be useless.
As the former user moves along on his journey, the level of care will decrease. Partial Hospitalization Programs (PHP), followed by Intensive Outpatient Programs (IOP), and eventually Outpatient Programs (OP) are all benchmarks in the progression of overcoming addiction. A good treatment facility will carefully and consistently assess each individual drug abuser and decide where they best belong at any stage in their recovery.
3. Peer support
Today, training as a Certified Peer Recovery Specialist (CPRS) training is available for people who want to give back. Trigger avoidance and reversing dangerous behavior patterns lie at the core of recovery. People who have successfully navigated these pitfalls in their own personal battles are a wellspring of empathy and motivation for those starting to find their way back. Although peer support cannot take the place of professional therapists and counselors, as an accompaniment to treatment their insight is a significant resource.
The Reality of Relapse from Addiction
As established, prolonged drug abuse physically damages the brain and rewires its process for reward, motivation, and memory. Although maintaining abstinence repairs the neurological trauma to some extent, SUD is a chronic disease and a complete return to its pre-abuse state does not exist. Furthermore, behavior patterns that cause and are caused by extended substance abuse are not easily dissolved. External triggers and temptations lurk everywhere, and regression in vulnerable moments is not unexpected. Being and staying in recovery requires full engagement and constant maintenance in physical, mental, emotional and spiritual wellness.
Hence the drug abuser is prone to relapse. It is a common occurrence and often misunderstood. Relapse is not a statement of defeat in the odyssey of a recovering person with addiction. It is a setback in an ongoing return to stability and in no way the end of the road of hope. This needs to be understood by their treatment teams, their family and friends, and most significantly by sufferers of relapse themselves.
When perceived properly, a relapse experience can even become a weapon in the arsenal of a person in recovery. The value of a deeper understanding of the unique slate of triggers and vulnerabilities that each former abuser carries cannot be understated. It can bring renewed commitment and focus on engagement in the processes that led them to their initial success.
Time and Commitment- in conclusion
The substance abuse treatment industry is rife with fraud and corruption. The path to a quick buck has littered the field with bad-faith operators and casts a shadow of skepticism on the good people on the frontlines saving lives.
Promises of a quick fix in a vacation atmosphere with luxurious digs offered by “destination rehabs” miss the point of real SUD treatment completely. Inevitably the addict will be cycled through facility after facility, trapped in a maelstrom and drowning in pain.
Real recovery does not happen overnight. It’s a long road that rewards hard work and real communication. The drug abuser has suffered prolonged trauma, both emotionally and physically. They need to surround themselves with good people and a good environment, to build a community that they belong to and are fully engaged in.
They need to recognize and reestablish their rightful place as productive and giving members of society.
This takes time. Time to heal, time to make and solidify their commitment to getting well, and time to recapture the most precious thing they have lost.
To believe in themselves again.