Addiction is defined as a chronic, relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the person with addiction and to those around them. Addiction is a chronic disorder with physical, mental and social factors that influence how it develops and how it is maintained. Addiction has a genetic component but follows predictable patterns of behavior. It is a progressive disease, meaning that it can, and often does, get worse over time.
Addiction often involves a series of active use, remission and relapse. Sadly, after each relapse, use typically increases and will quickly return to the highest amounts used prior to remission. Addiction destroys lives, families and creates enormous societal costs. In 1999 alone, the cost of alcohol, tobacco and drug abuse was estimated at $510.8 billion dollars. These costs include treatment and prevention, medical care, police and fire department expenses, adjudication and sanctioning expenses, and expenses associated with crime, property damage, motor vehicle crashes, and fires involving alcohol.
Is addiction really a disease?
Addiction is a disease that can develop quickly or gradually over time. There are many factors that influence the development of an addiction. Approximately half the risk for addiction is genetic. Our genes affect the degree of reward that people experience when we use drugs and alcohol or when we engage in certain behaviors such as gambling or sex. Differences in biology also affects the way the body processes alcohol or other drugs.
Changes to your brain can occur with long-term use. These brain changes occur in both prefrontal cortex (thinking part of the brain) and the limbic system (emotional part of the brain) that involves the neural-circuitry of reward, motivation, memory, impulse control and judgment. These brain changes can lead to dramatic increases in cravings for a drug. Changes caused by addiction also lead to problems with successfully controlling impulses, despite the often-significant consequences related to the addictive behavior.
Dopamine is the primary neurotransmitter involved in the centers for pleasure, reward, motivation, and compulsion. Drug and alcohol use drastically increases dopamine then depletes dopamine stores, once the drug wears off. The depletion of dopamine after a person “comes down” from a drug, leads to a loss of pleasure during normal activities. The damage from long term drug use also leads to problems with coping or dealing with problems. Cognitive performance (our overall ability to think) also diminishes with chronic use. However, the brain can heal over time, with continued sobriety.
Chronic use also makes individuals more susceptible to mental illness, and those with diagnosed mental illness tend to have higher rates of substance abuse. Nearly 60% of individuals with substance use disorder also have a psychiatric disorder. Traumatic events often play a significant role in substance use disorders. Approximately 64% of people with a substance use disorder have at least one Adverse Childhood Experience.
Adverse Childhood Events, or ACE’s, are negative events that occur during childhood that often lead to addictions and other issues later in life. Examples of ACE’s are psychological abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, loss of a parent (for any reason), witnessing their mother treated violently, substance abuse, mental illness, and criminal behaviors in the home. People with ACE’s are among the highest risk for preventable illness, suicide, and overdose. In 2020 SAMSHA reported that 14-15% of adults over the age of 18 in Arkansas have experienced one or more Adverse Childhood Event, which is in line with the national average of 14.5%. Traumatic events are a major influencing factor on addictions.
New research in trauma and addictions has illuminated just how significant early childhood trauma can be on addictive behaviors. Studies show that each ACE is shown to increase opioid relapse rate by 17% and people with seven or more ACE’s have a higher rate of suicide attempts, which equates to approximately 1 in 5 people attempting suicide that report having seven or more Adverse Childhood Events.
High ACE scores also relate to addiction: Compared with people who have zero ACEs, people with ACE scores are two to four times more likely to use alcohol or other drugs and to start using drugs at an earlier age. Adults with an ACE score of five or higher are seven to 10 times more likely to use drugs, to report substance use disorders, and to inject illegal drugs. So what does all of this mean? Addiction is a much larger problem than some make it out to be. Addiction is not a flaw in character. It does not only affect weak-minded people. Addiction is a multifaceted, complex issue that affects individuals, families and society as a whole.
If addiction is a disease, how does it progress?
To most people who do not view addiction as a disease, it does not make sense that anyone would get addicted. What causes people to continue to use despite the negative effects? There are several reasons people use drugs and alcohol. Drugs and alcohol can provide an escape from the intense emotional processes that come from trauma. Substances can provide some relief for something that feels impossible to handle. As people use more often, a tolerance builds, which in turn leads to more intense substance use or moving on to more serious drugs. When people experiment with more intense ways to administer drugs, such as IV use or “shooting up,” they tend to use more often and have a more difficult time stopping.
Several factors can influence how quickly someone becomes addicted. Your mental state such as stress levels, history of trauma or depression can make you more susceptible to addiction. A person’s social group, or whether their friends and family use, can also significantly affect how quickly a person becomes addicted. This is also true for environmental factors such as how cheaply and easily drugs are to obtain.
There are risk factors that make abusing drugs more likely and harder to stop. Trauma, a family history of addiction, mental health disorder, peer pressure, a lack of family involvement or dysfunctional family patterns. The younger someone is when they first begin using drugs and how addictive a drug is in general tend to make addiction much more severe and therefore harder to change.
It is important to remember that the factors that influence drug use are never an excuse for someone to use. An important part of recovery is taking personal responsibility for one’s actions and accountability has long been a cornerstone of recovery. However, the more we educate ourselves about addiction issues, the more we can reduce the stigma that surrounds addiction. The stigma that “addicts” are all criminals and are never to be trusted only serves to shame those suffering and can reduce the chance of someone actually seeking out treatment.
How do I recover from addiction?
Treatment works! There are as many factors that affect recovery as there are that influence addiction. We cannot simply look at treatment in terms of black and white. Treatment is a continuum. When you start a diet, you don’t go from eating a box of cookies per day to fasting for 21 days. Likewise, many people with addictions do not stop all at once. The most effective way to stop using drugs is to attend an inpatient drug and alcohol rehabilitation center, and afterwards engage in Outpatient Counseling that gradually decreases over time, community support groups and remain engaged with some type of recovery group or organization. However, recovery may look different for some people. Medication Assisted Treatment (MAT) is an effective option for those who cannot stop using a drug (usually opiates) abruptly due to the severity of the withdrawal symptoms.
Just as there is stigma regarding drug use, there are also myths about MAT programs. However, research shows that there is a clear indication that MAT programs improve patients' physical and mental health and help prevent HIV, hepatitis C, other infectious diseases, and most importantly reduce death rates due to overdose. Many argue that abstinence-based treatments for opioid addiction simply do not work.
Recovery is a journey, not a destination. Changes in the brain that occur during addiction can heal, but still leave people susceptible to relapse if they do not remain focused on recovery. Relapse is not a death sentence for most people. Relapse is common in many chronic illnesses. In fact, substance use relapse rates are similar to the relapse rates of other chronic illnesses.
Relapse is a signal that something needs to change or that you need to return to your original treatment that was effective. To put this into perspective let's look at the rates of relapse on illnesses such as asthma and hypertension. One study found that relapse rates for substance use disorders were approximately 40-60%. That sounds pretty high, doesn’t it? However, the relapse rates for hypertension and asthma range between 50-70%. So, we can see that the relapse rates for other chronic illnesses can be even higher than for addictions.
These statistics serve to underscore how addiction is a disease, similar to diabetes, hypertension and asthma, and that recovery is achieved through being consistent with treatment. If you or a loved one struggles with addiction, please seek help. Thousands of people start the journey to recovery every day. There is hope on the horizon.
By Tim Hughes, LPE-I
