The biggest thing I have realized from our classes weekly focus on the topic of addiction is that addiction is a complicated, multifaceted behavioral disorder. The article we read for this week explained that addiction is influenced by genetic, environmental, and developmental factors. While there seem to be several receptors and molecule interactions that influence the pathophysiology of addiction, it is clear that the normal reward pathway is disrupted.
In addiction, intracellular dopamine, a key player in the reward pathway, is increased in the brain. Dopamine is the neurotransmitter that induces pleasurable effects in the brain and solidifies memories associated with the pleasurable effects. With this increase in dopamine, addiction signaling can be impacted through changes in tolerance, sensitization, and dependence on the pleasurable substance.
Interestingly, addiction can actually physically change the brain. An example of this is an increase in the connections made by the medium spiny neurons (MSN) of the dorsal and ventral striatum of the brain. With overstimulation by different neurotransmitters supplied by the pleasurable drug, neural plasticity can be induced.
After learning more about the neurochemistry and epigenetics of addiction this week, one of my main questions is how do we combat addiction as a genetic and behavioral problem? It seems like society treats addiction like a choice, with very little sympathy for the fact that the chemicals ingested can actually change the pathways in the brain, resulting in modified behavior. While the initial use of a drug is generally the choice of the person, two people could make the same pleasure seeking choice but only one person, who happens to be more susceptible succumbs to addiction, while the other person that made the same choice, does not.
It is however important to recognize that addiction is a behavior that seems to be correlated with irrational choices for pleasure seeking. Addiction is also interesting because people who are addicted are clearly able to make the choice to quit using a substance without professional help, since many have done it before. At the same time, people who quit using an addictive substance can also be influenced resort to pleasure seeking behaviors by different triggers, even years after they have been sober.
Another interesting thought is that pleasure seeking is not limited to addictive drugs. While pleasure-seeking behavior can be appeased through substances with negative connotations like cocaine or alcohol, more socially acceptable addictions can be induced by caffeinated coffee or an addiction to sugar.
So how do we combat addictions in their varying forms?
- Specialized drug treatment facilities: provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders.
- Behavioral Treatment: delivered in outpatient, inpatient, or residential settings by a variety of providers.
- Limited pharmacological approaches:
- Expanded Educational Programs: education to young people about the effects of drugs and addiction can be used to reduce the forefront of the problem. Apparently educational programs have been shown to postpone or prevent smoking onset in 20 to 40 percent of adolescents.
