Addiction has been a problem for centuries, but recently in the United States, the prevalence of addiction and overdose has become worse than ever. Addiction, especially to opioids, has increased to epidemic proportions, killing thousands of people every year. Addiction is a complicated disease that’s affected by a variety of factors in a person’s life. It alters brain chemistry and the way a person perceives drugs and drug use. Addiction is characterized by compulsive use and quickly gets out of control, especially if you are going through it on your own. Even though it’s a chronic disease, it can be treated with evidence-based therapies and experienced clinicians and medical professionals.
Learn more about addiction, what causes it, and how it can be treated.
Psychoactive drugs and alcohol can lead to several problems that fall under the category of substance use disorders (SUD). Addiction is typically considered to be on the more severe end of the SUD spectrum which also includes substance abuse and chemical dependency. Many people may assume that all of these terms refer to the same thing. While they are closely related, there are some key differences.
Substance abuse refers to the use of an illegal drug or a prescription without authorization.
Abuse often refers to recreational use with the intent to get high, but it also can refer to self-medication and performance-enhancing drugs. A person can abuse a drug without ever becoming dependent on or addicted to it.
However, drug and alcohol abuse has its own risks, including auto accidents and the increased likelihood of being the victim of a crime. It can lead to dependence and addiction, too.
Chemical dependence refers to a change in your brain’s chemical communication pathways. Psychoactive drugs affect you by altering your central nervous system by introducing chemicals that bind to neurotransmitters. Depending on the drug, these chemicals either directly activate these neurotransmitters or increase efficiency or suppress other naturally occurring chemicals in the brain. Typically, this change is temporary, but if you continue to use, your brain may start to get used to the drug.
Your body will start to rely on the foreign substance to maintain brain chemistry. If you stop using, you will feel uncomfortable and may even experience dangerous withdrawal symptoms.
However, this does not necessarily mean you’ve developed a severe substance use disorder. In some cases, a person may notice a growing dependence, notify a doctor, and safely wean off the drug.
Still, many cases of chemical dependence quickly lead to addiction, which is defined as the compulsive use of a chemical substance despite clear consequences. For instance, if alcoholism has made your work suffer to the point that you get fired, but you continue to drink, it can indicate an addiction. You also may be addicted if you try but fail to quit, if you use drugs as a way to self-medicate, or if you drink or use increasing or more frequent doses.
According to the American Society of Addiction Medicine (ASAM), addiction is a chronic disease that affects the brain’s reward, motivation, and memory centers. The disease is closely tied to the limbic system of the brain, which is responsible for learning about rewarding activities and triggering motivation to repeat them. Under normal circumstances, your limbic system takes notice of activities like eating, sleeping, sex, and even positive emotional encounters, that trigger a release of “feel-good” chemicals like dopamine and norepinephrine.
The limbic system takes notice of that chemical release and identifies that activity as good for you and worth repeating. It passes that message on to other parts of your brain so that the next time you have an opportunity to take those positive actions, you will be encouraged to do so. In nature, this process is essential for survival. However, drugs and alcohol tend to hijack that process. Many of them cause a similar release of those chemicals, either directly or indirectly, except much more powerful. Your limbic system mistakes drug use for a positive, life-sustaining and enriching activity. This can cause powerful cravings and compulsions that can get out of control.
However, not every person who ever drinks or uses drugs becomes addicted or dependent. That’s because there are genetic, environmental, and social factors at play when it comes to addiction.
Genetic and biological factors are significant in determining whether or not a person may have trouble with substance use disorders throughout their life. Studies have shown a link between grandparents and parents and children with alcoholism and drug addiction. Some, including the National Institute on Drug Abuse (NIDA), suggests that a person’s genes can make up to half of their addiction risk. It also can predispose people to mental health issues that increase their likelihood of developing a co-occurring substance use disorder.
Your environment can include your family life, your neighborhood, school, economic status, and quality of life. While genetics are inborn, environmental factors come from your surroundings. Peer pressure, family pressure, societal pressure, and drug and alcohol availability can all affect your risk of developing an addiction. Studies support the idea of risk factors and protective factors that can lead a person to or away from substance abuse. Risk factors can include a lack of parental supervision, normalized early drug or alcohol use, drug availability, and poverty. Protective factors can include parental monitoring, schools with strict drug policies, doing well in school, and a strong sense of community. Recent research has emphasized the role isolation and connection have played in the development of addiction, and some think community and interpersonal connections may be the key to overcoming the disease.
Both biological and environmental factors come together to affect a person’s development, which is the third factor in the development of addiction. Drugs can lead to addiction if they are taken at any age, but it seems more likely to cause a substance abuse disorder when drugs are taken early in development. Teens are in an incredibly risky age bracket for addiction because they are more likely to have or find access to drugs and alcohol while their brains are still developing.
Addiction is growing at record-breaking rates. Each year, overdose deaths exceed the previous year and dwarf other causes of death like gun violence and auto accidents. According to NIDA, the opioid epidemic kills more than 115 people every day. And the numbers are only increasing. While opioid addiction soars, other drugs like alcohol, cocaine, and meth continue to be a problem.
Part of the cause of this crisis is the overwhelming increase in the availability of heroin and other opioids. Pharmaceutical companies have dramatically increased the number of opioids they prescribed in the past few decades with no clear indication that the amount of pain American’s were reporting had increased.
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 191 million prescriptions were dispensed in the U.S. in 2017. The flood of prescription opioids often means people have more than they need, and the excess is kept in medicine cabinets or given to friends and family. Many people who become addicted to opioids start with prescriptions that are acquired without a prescription from friends.
But the influx of prescription opioids isn’t the only cause for the spread of opioid addiction. Illicit opioids like heroin have become increasingly common in the U.S. because of a surge in black market activity from Mexican cartels and China. Heroin is among the most easily accessible illicit drugs, second only to marijuana. Plus, the prevalence of synthetic opioids that are manufactured in clandestine labs is also increasing.
Fentanyl is one such synthetic opioid, and it’s one of the main culprits in the increase in opioid overdose rates. Fentanyl is about 50 times more powerful than heroin and 100 times more powerful than morphine. It’s cheaper and easier to make and transport than heroin, so it’s often used to increase heroin profits by mixing it into adulterated supplies. However, users often take heroin without knowing it is contaminated with fentanyl. This results in extremely powerful doses that lead to a deadly overdose.
Since the addiction epidemic has only increased in intensity in recent years, many clinicians and researchers have explored various methods to treat addiction. Both evidence-based practices and alternative therapies are used in addiction treatment programs; research supports the success of some therapies over others. Evidence-based treatment refers to the use of therapies that have been proven to be effective in scientific studies. These therapies can be replicated in a variety of treatment settings.
The effectiveness of a treatment program is an important consideration you should make when you are looking for addiction treatment. So much so that the National Institute on Drug Abuse (NIDA) has created a list of 13 principles of effective treatment. These principles are important to consider when you are choosing a treatment center for your needs. Effective treatment can mean the difference between relapse and long-lasting recovery. Here are some of the most important principles to consider:
ADDICTION IS A CHRONIC DISEASE
It’s important that a treatment center recognizes addiction for what it is: a chronic and complex disease. Addiction should be treated medically, psychologically, and socially with the understanding that evidence-based methods can treat this disease and lead to positive results. For a long time, addiction was seen as a bad habit or moral failing and treated with punishment, which turned out to be ineffective.
ADDICTION TREATMENT SHOULD BE PERSONALIZED
It might be simpler to create one comprehensive treatment plan for every client, but it’s far less effective. Addiction is a disease that can affect multiple aspects of your life, and it can have a variety of underlying causes. Personalizing treatment to an individual’s specific needs is important.
TREATMENT SHOULD ADDRESS MULTIPLE NEEDS
Addiction treatment needs to address more than just a person’s substance use disorder. Different complications come with addiction, including legal problems, diseases, the inability to hold a job, and homelessness. For treatment to be effective, these other problems need to be addressed. Effective addiction treatment will address the person’s medical, psychological, social, financial, and legal needs.
TREATMENT SHOULD LAST LONG ENOUGH
Addiction takes time to treat effectively, and it usually lasts longer than just a weeklong detox program. Addressing all of the underlying needs and developing a relapse prevention strategy can take several months. According to NIDA, research suggests that a minimum of 90 days is the optimal length of time to attend addiction treatment.
BEHAVIORAL THERAPIES ARE RECOMMENDED
Behavioral therapies are a type of addiction treatment that deals with the way thoughts affect behavior. Behavioral therapies have shown to be among the most effective treatment options. Cognitive-behavioral therapy, in particular, has become instrumental in helping formulate relapse prevention programs in treatment centers all over the country.
Addiction treatment is a holistic process that addresses multiple issues, starting with your most urgent medical needs. Since addiction is a complex disease affecting the brain’s reward center, the process of addiction treatment is complicated, involving multiple levels of care.
Your treatment plan will primarily be based on your specific needs, but it generally follows a continuum of care where you would start with highly intensive care and move through less intensive services as your progress.
Here is the continuum of care as outlined by the American Society of Addiction Medicine (ASAM):
Also called medically managed intensive inpatient services, detoxification, or detox for short is the highest level of addiction treatment. It’s primarily designed to help people with pressing medical needs including potentially dangerous withdrawal symptoms. If you have recently stopped using a drug or if you are intoxicated when entering a treatment program, you will probably be placed in detox. During this process, medical professionals will help you through your body’s recovery from chemical dependence on a drug. They also can monitor and manage other medical needs like diseases, injuries, and ongoing health concerns.
If you have ongoing medical or psychological needs that require intensive addiction treatment, you may be placed in an inpatient program after detox. Inpatient services can range from medical monitoring to clinically managed residential services. At these levels, you may not need highly intensive medical care, but you will be monitored for medical safety. For instance, some acute withdrawal symptoms can last longer than a week and should be monitored until they pass.
INTENSIVE OUTPATIENT SERVICES
Intensive outpatient services involve more than nine hours of clinical services every week. You may attend therapy sessions with a schedule close to a workweek. This level is reserved for people undergoing intensive addiction therapies with no urgent medical or psychological needs. It’s common for clients to do the majority of their therapies and relapse prevention work at this level of care.
Outpatient services involve fewer than nine hours of services every week. This low-intensity level of care is common as a step between intensive outpatient services and the completion of treatment. Outpatient services are an excellent way for clients to ease back into everyday life while still having clinicians’ support when needed.
This is a common practice in addiction treatment, and it is, unofficially, the last step in the continuum of care. A treatment center’s aftercare program will connect you to continued support through community resources and programs like Narcotics Anonymous. It’s important for you to continue your commitment to recovery when you complete formal treatment, and aftercare programs will help you do that.
Relapse prevention is an important step in the addiction recovery process. According to NIDA, studies show that addiction relapse occurs about as much as relapse of other chronic diseases such as hypertension and asthma. Addiction relapse rates can be as high as 60 percent. Because relapse is such a significant threat, treatment often spends significant time devoted to developing relapse prevention strategies.
Relapse prevention therapy often follows the cognitive-behavioral model. During this type of therapy, you will learn how your thoughts can cause relapsing behavior, and you will learn how to increase self-efficacy or your mastery over your own behavior. To do this, your therapist will help you identify triggers and high-risk situations that can lead to relapse. You will learn to avoid these scenarios and how to cope with them in a positive way if they are unavoidable.
Through this process, you will develop appropriate strategies to help you respond to stress and triggers as they occur in the real world. This may also include recognizing imminent relapse and reaching out to a sponsor, clinician, or therapist for help. A solid relapse prevention strategy can help you safeguard your recovery in the long-term.
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