Drug and alcohol addiction is one of the most prevalent public health problems in the United States. Addiction has been an issue since human beings started using addictive substances like alcohol and opiates. While substance use issues have been a consistent problem in the U.S. for centuries, our understanding of it has changed significantly.
While there’s still more to learn, we know that addiction is a treatable disease, and it can be successfully managed for long-term sobriety. Still, the past few years have seen one of the biggest drug addiction epidemics in U.S. history.
In 2018, 67,367 people died of a drug overdose, according to the U.S. Centers for Disease Control and Prevention. That year marked the first time we saw a decrease in national overdose rates since 2010. The misuse of prescription drugs and the influx of illicit substances into the U.S. has caused an increase in the rates of addiction and overdose over the last decade.
But what is addiction, and how can you treat it in a way that improves individual and public health?
Drug addiction is a chronic disease that affects the brain. It is characterized by the compulsive use of drugs or alcohol despite harmful consequences. These consequences can affect your health, relationships, or financial stability. A person who continues to use drugs when they are damaging their life is likely to have a substance use disorder. Substance use disorders can alter your behavior, thoughts, cognitive ability, and even physical functions.
Substance use disorders can increase your risk of mental and physical health problems. It’s also linked to homelessness, legal issues, and being the victim of a violent crime. Drugs that impair certain functions can also increase your risk of an accident.
According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM), the publication that informs doctors and clinicians about currently recognized disorders, addiction is considered a disease. But addiction doesn’t make you sick directly, right? It just affects your behavior. How could addiction be a disease like diabetes or heart disease? A disease is any disorder that changes the structure or function of the body in a way that produces signs and symptoms that aren’t a result of physical injury.
So does a substance use disorder do that?
Addiction has been found to affect the brain in specific ways that lead to long-term changes. Psychoactive drugs affect brain chemistry to achieve their effects. Drugs like opioids and marijuana are similar to existing brain chemicals, while other drugs like alcohol or stimulants suppress or excite other brain chemicals.
Your brain can get used to chemical interference from drugs and come to rely on them. Your brain will learn to adapt, expect, and crave your drug of choice in a way that can cause changes in your thoughts, behaviors, and motivations. Because addiction is caused by a change of the brain’s structure and function that causes negative effects, addiction is a disease.
But how can it be a disease if it’s caused by personal choices?
In most cases, addiction does start with the choice to misuse drugs, though sometimes it can be caused by regular prescription drug use. However, addiction is one of several diseases that are caused by choices. Type 2 diabetes, heart disease, hypertension, and lung disease from smoking are serious medical issues that are significantly impacted by lifestyle choices. Still, like addiction, these diseases can and should be addressed as treatable medical issues.
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Addiction is a consequence of your brain adapting to the presence of a drug and then coming to rely on it. There are various stressors in your life, and you naturally gravitate toward methods that help you deal with them. Different healthy activities cause a release of “feel-good chemicals” in your brain, such as dopamine, endorphins, and serotonin. These chemicals are important to homeostasis, which is your body’s process of achieving mental and physical stability.
Drugs can interact with these chemicals in powerful ways. In fact, it can be challenging for natural methods of stimulating these chemicals to compete with potent drugs. Long-term drug use or high doses of a drug can train your brain to learn to seek out that substance to achieve balanced brain chemistry. When you don’t get it anymore, it can be mentally and physically uncomfortable and even dangerous in some cases.
Addiction mainly affects the brain’s reward center, which is related to your limbic system. Your reward center is responsible for mediating reward and reinforcement. It’s thought to be designed to help motivate you to repeat important tasks, like finding food and making meaningful connections, and other things that are necessary to sustain your life. Pleasurable things like eating, making personal connections with others, and sex trigger your reward center to release more dopamine.
The resulting pleasurable effect reinforces that behavior and teaches you to repeat that activity. When you encounter stress or discomfort, your brain may point to one of those pleasurable activities as a coping mechanism. This is partially why we eat pints of ice cream after a breakup and feel better when someone gives us a hug.
But drugs are extremely effective in producing pleasurable effects in the brain, and your reward center learns that drugs can make you feel better, at least in the short-term. That’s why people in recovery often experience cravings during stressful moments, even after not using a drug for years.
There is no current cure for addiction. For most people who have a substance use disorder, recovery is a lifelong process. But if you are struggling to overcome a substance use disorder, it’s important to realize that many people that seek treatment enjoy lifelong freedom from addiction.
Currently, data shows that 40 to 60 percent of people with substance use disorders that achieve sobriety relapse at some point. These rates are on par with some other chronic diseases, such as asthma and hypertension.
Still, that doesn’t mean half of the people that seek treatment will fail; it just means that half will experience a relapse and may need to revisit their relapse prevention strategies. The National Institute on Drug Abuse points out that a relapse doesn’t mean that treatment has failed.
Instead, it indicates that people recovering from substance use disorders should stick to their current relapse prevention plan or adjust it to meet their current needs. They also are encouraged to seek support from professionals and their community and find a treatment plan that works for them.
Some people cycle through treatment once and achieve lasting sobriety. Others enter several rounds of treatment and relapse several times, but even they can achieve life-long recovery.
Addiction treatment is a complex process that addresses multiple needs related to addiction. According to the National Institute on Drug Abuse, effective treatment should treat more than just a person’s drug use problems. It should also address medical issues, mental health, social problems, and financial instability. Addiction treatment should be customized to each person’s needs, as there is no one-size-fits-all approach to it.
When you enter an addiction treatment program, you’ll meet with medical and clinical professionals to go through an assessment process. This is intended to place you in a level of care that is appropriate for your needs. There are four main levels of care, including medical detox, inpatient treatment, intensive outpatient, and outpatient services. As you progress through treatment, you are likely to move from more intensive to less intensive treatment.
Through treatment, you may receive a combination of therapies, including the use of medication and psychotherapies. Behavioral therapies are widely used, especially cognitive behavioral therapy (CBT), which is used in relapse prevention. You will also attend group and individual therapy sessions each week. One-on-one therapy sessions are instrumental in assessing and reassessing your treatment plan to make sure it is working for you as well as possible.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
National Institute on Drug Abuse. (2020, July). Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
National Institute on Drug Abuse. (2018, January). Principles of Effective Treatment. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
National Institute on Drug Abuse. (2020, March). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
Rodolfo, Kelvin. (2000, January). What is Homeostasis? Retrieved from https://www.scientificamerican.com/article/what-is-homeostasis/