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A person with an addiction takes a substance or engages in a behavior where the rewarding effects give a compelling reason to continue the activity despite the negative repercussions. Addiction can involve the use of substances like alcohol, inhalants, opioids, cocaine, and nicotine, as well as activities like gambling.
There is evidence that addictive behaviors have the following key neurological characteristics: They are intimately involved in brain reward and reinforcement circuits, which involve the neurotransmitter dopamine. In addition, as with other highly motivated states, they cause synapses in the prefrontal cortex, the home of the brain’s higher functions, to be pruned, so that attention is hyperfocused on stimuli linked to the target substance or activity. It is critical to understand that such brain changes are reversible once the substance or behavior is stopped.
Substance use disorders and gambling habits are more likely to be accompanied by mental health diseases such as depression and anxiety, as well as other pre-existing issues. Substance use disorders and gambling disorders not only involve the same brain systems, but they also react to many of the same treatment techniques.
Substance abuse and gambling disorders are complicated illnesses that alter the brain’s reward, reinforcement, motivation, and memory systems. They are distinguished by impaired control over consumption, social impairment, which involves disruption of daily activities and relationships, and yearning. Continual use is usually detrimental to relationships as well as commitments at work or school.
Another defining aspect of addictions is that people continue to engage in the activity despite the physical or psychological suffering that it causes, even if the harm is aggravated by repeated use. Tolerance to a chemical typically increases as the body adapts to its presence.
Individuals who acquire an addiction may be unaware that their conduct is causing difficulties for themselves and others because addiction disrupts the brain’s executive processes, which are located in the prefrontal cortex. Pursuit of the pleasurable benefits of the substance or action may come to dominate an individual’s activities over time.
All addictions can cause emotions of pessimism and failure, as well as shame and guilt, but evidence shows that recovery is the norm rather than the exception. There are numerous paths to recovery. Individuals can improve their physical, psychological, and social functioning on their own—this is known as natural recovery. Others gain from the assistance of community or peer-to-peer networks. Others choose clinical-based recovery with the help of credentialed specialists.
The road to recovery is rarely easy: Relapse, or the recurrence of substance use, is common—but it is not the end of the road. Researchers reveal that the likelihood of relapse for those who attain remission of an addiction problem for five years is no larger than that of the general population. According to neuroscientists, synaptic density is steadily restored.
Whether the drug is crack cocaine or alcohol, or a habit such as gambling, the common denominator of all addictions is prolonged use in the face of negative consequences—whether to oneself, relationships, finances, school or work performance—and the inability to manage usage. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) prefers the term substance use disorder over addiction (but still refers to addictive disorders), and categorizes ten distinct such conditions based on the type of drug involved—for example, Alcohol Use Disorder; Stimulant Use Disorder, including cocaine use; Opioid Use Disorder, including heroin use; According to the DSM, all ten “cause such high activation of the reward system that routine activities may be neglected.”
Although each type of medication functions differently in the body, the behavioral effects, especially those related with gambling, all overlap. Another trait that is prevalent is the persistence of changes in brain circuitry after any detoxification period; studies suggest that it can take months or more after quitting usage for the brain to reorganize itself to react to normal rewards.
Many ideas exist about the causes of addiction, as well as the use and misuse of legal and illegal psychoactive substances. Biology, psychology, and social and cultural factors all play a role in the tremendously complicated causal chain that leads to addiction, and different theories place varied weight on the variables. They all point to the fact that there is no one path to addiction, and no single element renders addiction an unavoidable consequence. Addiction cannot occur without exposure to agents, although this is far from the deciding determinant. Addiction is not a property of the substance consumed or the action performed.
Instead, research suggests that it is more about what else is going on in a person’s life that makes the sensation a substance induces so appealing. Feelings about oneself, emotional state, quality of family relationships, social ties, community attributes, employment status, stress reactivity and coping skills, physical or emotional pain, personality traits, educational opportunities, compelling goals and progress toward them, opportunities for and acculturation are among the many factors that have been shown to influence the development of an addiction. While no one component dominates, each has some influence.
Addiction is a condition that has long perplexed physicians and philosophers, not to mention individuals who suffer from it and those who care for them. What to make of a set of behaviors that, in fact, generate changes in brain structure and function, provide temporary alleviation of distress only to create long-term problems with living and self-management, and are difficult to cease even when there is a strong desire to do so?
Addiction was once regarded as a moral failing, but it is now regarded solely as a medical issue. The urge to treat addiction as a sickness is well-intentioned (motivated by a desire to reduce stigma), but it fails to account for the condition’s various dimensions and facts. Worse, it deprives victims of the belief that they can overcome their difficulties with courage, inventiveness, and hard effort. Rather, there is substantial evidence that addiction is a complex cultural, social, and psychological phenomenon that is as much a biological phenomenon as it is a biological one.
While addiction is extremely costly to individuals, families, and society as a whole, it reflects the brain’s remarkable plasticity—its ability to shape and reshape itself, adapt itself in response to experience and environment—as well as the deep human need for joy and rewards in life, as well as opportunities to obtain them. The fact is that the brain alterations that characterize addiction are set in motion by substance-seeking actions that coalesce into near-automatic habit. Changes in behavior and environment, according to the findings, can reverse them.
Shifting patterns of illegal drug usage and prescription medication abuse suggest that addiction reflects societal and cultural factors as much as it does the abilities of any substance or individual vulnerability. Drug problems are particularly related to a person’s age and stage of life, as well as the availability of opportunity and future prospects. According to a 2017 report by the National Academies of Sciences, Engineering, and Medicine, “the opioid epidemic’s toll is felt across the life span and in every sociodemographic group, but it disproportionately affects vulnerable populations, such as those living in economically depressed areas of the country.”
According to surveys, illicit drug use is largely a concern among young males aged 18 to 25 in industrialized countries. Prescription medication abuse is more prevalent among middle-aged and older women. Furthermore, problematic drug use varies dramatically not only by gender and age, but also by ethnicity, education, geographic area, and religiosity.
Addiction is a disease characterized by difficult-to-control behavior that persists despite negative consequences. The behavior stimulates the brain’s reward regions, and the extremely gratifying benefits provide an increasingly powerful motivation to continue the activity, frequently displacing everyday habits to the point of damaging relationships, livelihood, health, and other pillars of normal existence.
A variety of psychoactive chemicals have the potential to be addictive, and while they differ pharmacologically, what they all have in common is direct stimulation of the brain’s reward system. Changes in the brain’s reward circuits they cause lay the scene for severe cravings while weakening pathways involved in behavior control.
Addiction was once assumed to be a feature of the substances themselves—morphine, heroin, alcohol, and other psychoactive agents. It was eventually realized that features of both the individual (including the larger environment in which a person lives) and the substance contribute to the risk of addiction. However, research has provided sufficient evidence in recent decades to include not only chemicals but also behaviors, the most prominent of which is compulsive gambling, under the umbrella of addiction. Evidence suggests that gambling practices, like medications of abuse, can directly engage brain reward circuits and create behavioral effects comparable to those seen in substance use disorders.
The American Psychiatric Association formally amended the definition of addiction to include compulsive gambling with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, adding a new category called behavioral addictions. The diagnostic criteria are similar to those for substance use disorders. There is much discussion regarding integrating other hazardous practices, such as video gaming, internet use, and porn consumption, to name a few. The data on behavioral problems other than gambling is less clear, according to DSM-5. What is certain is that technology is altering modern life in ways that raise the possibility of addiction-like disruption from a variety of activities.
Addiction is frequently stated to occur when drugs “hijack” the brain. It’s tough to pin down what it means, but it correctly implies that there is an involuntary takeover of the brain that degrades decision-making and diminishes freedom of choice, making quitting difficult even when there is a strong desire to do so. What happens in addiction is that the brain prunes neuronal circuits of attention and motivation to preferentially detect, focus on, want, and seek the substance through entirely natural mechanisms involved in all learning. What begins as a choice becomes, in some ways, a prison.
Addiction can be viewed as a shortcut to reward, one that, over time, can have a significant cost to physical and mental health since substances of abuse work directly on the reward region of the brain to provide their high—this entails a rapid and strong release of the neurotransmitter dopamine. Nonetheless, the exaggerated experience of reward creates a compelling justification for repetition. The response also reduces activity in the brain’s decision-making center, the prefrontal cortex, via nerve connections to other sections of the brain.
Overcoming addiction typically includes not just abstaining from a substance, but also identifying or rediscovering important activities and goals, the pursuit of which provides the brain with more naturally occurring rewards (and more gradually). And, because they necessitate effort, they contribute to the development of many aspects of personality and individuality.
Withdrawal is a set of unpleasant symptoms caused by the abrupt cessation or reduction of long-term drug usage, ranging from anxiety, tremors (“the shakes”), and nausea to hallucinations and full-fledged seizures. It is the clinical symptom of abrupt withdrawal of an addictive substance. The severity and duration of symptoms vary depending on the substance, how long it was taken, how strong it is, the duration of action, and how rapidly the drug is eliminated from the body (its half-life), but they are all caused by disruption in the brain’s normal nerve activity pathways.
The longer a substance is taken and the more strong it is, the more probable withdrawal symptoms may occur. The acute withdrawal symptoms can last a week to ten days, while the more psychological withdrawal symptoms, such as worry or depression, might continue weeks or months.
Withdrawal, like addiction, displays the brain’s ability to adapt to experience. Addiction does not happen overnight; frequent use of psychoactive drugs reprograms numerous circuits in the brain, particularly its dopamine-rich reward center, such that they become increasingly dependent on the substance (dependence). When that chemical abruptly stops, the nerve pathways are cut off. The brain rewires itself in the weeks and months following the cessation of substance use to effectively reverse the adaptations it developed to the substance and return to normal, but this process takes time. Fear of the unpleasantness of withdrawal often keeps people taking a substance even when they desire to stop in the short term.
Every day, people begin the process of recovering from addiction. Some opt (or are remanded by law enforcement) to do it with the assistance of a therapeutic agency, some prefer peer support, and many do it on their own. There is no single path into or out of addiction, just as there is no single way out. Residential, inpatient programs with stays of a month or more are the most well-known type of care—“rehab” facilities are frequently in the headlines when a celebrity admits an addiction problem—but they are neither the most prevalent nor the most effective.
Successful therapy, in whatever form addiction takes, reverses the abnormalities in brain circuitry that make substance use difficult to regulate. However, many aspects other than biology must be addressed for treatment to be successful, including a person’s mental state, relationship quality, stress reactivity, coping skills, educational and job prospects, to mention a few. Environments are important, as is the creation of alternate sources of reward and purpose. Jobs, housing, and friends all help with remission.
Because discontinuing substance use usually results in a period of intense and often all-consuming distress that passes in a matter of days or weeks, treatment is usually separated into two discrete stages. The acute phase of care tackles the physiologic implications of discontinuing a biologically active substance. The purpose is to remove the substance from the body and manage the physical discomfort, drug cravings, and psychological suffering that result from abruptly discontinuing a substance on which the body has become dependent and acclimated.
However, detoxing the body and treating withdrawal symptoms are only the beginning; they also help to stabilize the body. The removal of the substance does not result in an understanding of the fundamental causes of the addiction. It also does not heal the harm done, give critical psychological and behavioral skills, or provide a goal in life, which is required for creating emotions of reward that the substance previously supplied. It also does not address the issue that made the usage of a psychoactive substance so appealing in the first place. Treatment focused at restoring a person and a life must follow “detox.” This process might take months or years, and many different forms of assistance and supportive services are available along the route.
Because there is so much at risk in addiction treatment, a vast industry has sprung up to address the demands of often-desperate substance users and their families; it is critical to choose care choices that follow scientific standards and are supported by data.
Addiction recovery is not only attainable, but it is the norm rather than the exception. According to the most recent United States National Survey on Drug Use and Health, more than 75% of people addicted to alcohol or drugs recover—their health improves and substance use no longer dominates their lives. That is not to claim that healing will be simple. It’s typically a long and bumpy road, and relapse is practically unavoidable—but that doesn’t mean recovery is done. There are coping methods and skills to circumvent urges to be taught, and exercising them not only tames the need to resume substance use but also gives people pride and a positive new identity, which speeds up recovery.
There is no single route to recovery. Only 1.0 percent of persons undergo inpatient or outpatient substance misuse treatment at a specialized institution. Some people go to a hospital for medical treatment. Others go to an outpatient mental health center for assistance. Many people want to recuperate without the use of clinical services. The utilization of peer support groups in the community is the single most prevalent path.
It can be difficult to love someone who has an addiction because it is hard to watch them lose control and do harm, painful to witness the “disappearance” of the person you care about, and painful to endure the many deceptions that generally accompany addiction. Still, it is possible to help someone recover from addiction, though it usually requires time, many tries, many disappointments, and a thorough understanding of how addiction works, particularly how it robs substance users of the ability to limit their use even when they want to.
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