Drug addiction is a chronic, debilitating disease that has become a serious issue in our society.  Prolonged substance abuse can result in both long-term chemical and structural changes in the brain. The reward pathway and the “feel good” neurotransmitter, dopamine, are heavily involved in this process. The pleasure felt from taking these addictive drugs is due to an increase in dopamine release. More intracellular dopamine results in more receptors which strengthens the synapse, or increases long-term potentiation. When this happens, more of the stimulus is required for the same pleasurable effect. Soon, you become dependent on the stimulus, as its absence can result in withdrawal symptoms.

Addiction is a vicious cycle and can seem completely hopeless for those trying to recover, but there are some effective ways to fight against it. These treatments include preventative measures, rehabilitation, and medication.
 
Technically, the most effective way to prevent addiction from occurring is to not try the substance in the first place. I know, way easier said than done, as some situations are completely out of control. Many become addicted to prescription drugs after needing them for some sort of medical treatment. Then, once their prescription runs out or expires, they realize they are dependent and often look to street drugs (ex. heroine) as replacement. However, there are scenarios of recreation, where the user is either not thinking about the risk or believes there is no chance they will become addicted after one time. Sadly, they are frequently mistaken.

Once an addicted individual seeks treatment, the first step is to go through a process of detoxification, often at a rehabilitation center to help with withdrawal symptoms. When the substance has left the body, there are a few different rehabilitation options available:

1. Inpatient Rehab refers to a more short-term program that allows patients access to healthcare professionals at all times, similar to a hospital stay. Often used in severe cases immediately after detoxification, this option gets rid of external distractions and responsibilities to allow the patient to focus solely on the recovery process. Often times, patients can be given medications to help with any lingering side effects, as well as starting some cognitive behavior therapy to understand their thoughts and feelings that may contribute to their behaviors.
2. Outpatient Rehab is more of a long-term program and gives the patient a little more freedom, as they just have to come in to the rehabilitation center at scheduled times for progress reports. There is also more emphasis on cognitive behavior therapy.
3. Social Programs consist of support groups to give patients a sense of community through sharing stories and experiences. Members can also work to keep each other accountable in living a better life and continuing sobriety.

Now, these treatment methods are not foolproof. Many relapse into their old habits after returning to their normal lives, as they still encounter the same old environmental cues and triggers. Treatments are also most effective when the addict truly wants to make a change in their life, as compared to being forced into treatment unwillingly.
 
While genetics don’t play a major role in addiction, they can make an individual more or less susceptible to developing addictive behaviors. For example, there are some genetic mutations that result in very unpleasant side effects to certain drugs or alcohol. As to be expected, these individuals are much less likely to abuse that substance and become addicted compared to someone who has no negative experience. It is interesting to think about the possibility of inducing these mutations in people as preventative measures, especially if there is a family history of addiction or alcoholism.

I cannot speak from experience, but I have watched close friends battle through the recovery process for drug addiction. It’s daunting, it’s ugly, and it definitely isn’t easy. It’s also extremely discouraging how high chances are for relapse, BUT, I’m here to tell you that it is possible and there is hope.
 

While we have amazing facilities in the US that aid in overcoming drug addiction, why are the chances of relapse are so high in drug addiction? The National Institute on Drug Abuse states that about 40-60% of people relapse. Relapse can be due to strong withdrawal symptoms and environmental triggers. Drug rehabilitation centers focus on cognitive behavior therapy to help change the thoughts associated with drug usage. These programs often last about three months or 90 days. While emersion in these programs often helps, there are still other factors at play.

In the case of drug addiction, we cannot forget biological processes as an opponent. With chronic drug use the cells change things that can be long lasting, and are a constant battle even after treatment.

Changes include increase receptors on the neurons which allow more binding of the drug and stronger effects of the drug. In the brain there is a region affected by drug use that contains spiny neurons which are true to their name, a neuron with spines coming off it. With chronic drug use, more spines develop on the neuron (long term potentiation) so it increases the receptors for drug interactions.

A common pathway associated with drug abuse is the dopamine or reward system. In the case of drug addiction, the brain system for reward is increased and punishment is decreased. Therefore, the good feelings associated with drug use are heightened and the feelings of punishment are lowered.

Some common words associated with drug use are sensitization and tolerance. In a biological sense sensitization means that with the increase of receptors, the brain is more sensitive or susceptible to drug use. With the same exposure a heightened or enhanced reaction happens. Tolerance means that although you may be sensitive to a small amount of drugs, it takes a longer time to satisfy the craving. This causes a user to need to increase the amount of drugs consumed to get the same effect.

Current treatments typically help with symptoms of drug addiction, withdrawal and aid in preventing relapse. However, we do not have drug that can target and stop these adverse pathways from happening. There are a few novel drug targets being researched. Until we are able to identify a viable, effective strategy, the battle continues.

Looking forward is important to continue researching and understanding the pathways involved in reward and drug-seeking behavior. Once we are able to couple therapy with an effective drug treatment can we begin to fight drug addiction on all fronts.

The term “drugs of abuse” gets thrown around when trying to specify drugs that are detrimental in nature. This is opposed to the “drugs of use” that would include over-the-counter and prescription medication. It is far too often that these abusive drugs lead one into a path of addiction, and it is far too often that this path of addiction leads to death. So I must ask, why are “drugs of abuse” drugs of addiction?
Our remarkable human bodies have evolved in such fascinating ways. We, as a species, have honed in on the most practical ways to learn about the world, and remember what we learn, so that we might apply it in, ultimately, reproducing and raising our offspring. A result of this evolution is our ability to remember what gave us a “good” experience.
When I say “good”, I mean in the sense that the experience will increase one’s likelihood of creating and rearing successful offspring. This “good” experience can manifest itself in multiple ways: the awareness that comes along with a cup of morning coffee, the relaxation of a massage, the satisfaction in eating a pastry, or the intrinsic pleasure of sexual activity. It is such that all of these activities increase the odds of making successful children (some more directly than others).

Thanks to evolution, our brains devised incredible ways to “lock on to” these events, remembering exactly how they felt, and the specific steps taken to allow them to occur. Because of this, we get remarkably good at reproducing these feelings of pleasure, and most of the time, it is a very good thing.
The brain must transmit its signals somehow, and since the basic building blocks of life are chemicals, it chooses to transmit the signals as chemicals. Neurotransmitters, as they are called, are the chemicals released within the synapses of the brain, and they give us the ability to be humans. During the aforementioned “periods of pleasure”, many of these neurotransmitters are released, but the most important (and plentiful) of these is dopamine.

Dopamine is used colloquially as the “feel-good” hormone, and indeed it produces pleasurable effects. It is important in other aspects, however. As was mentioned, our brains are very good at remembering exactly how pleasurable events were created. It is dopamine that locks down these memories.
This is where drugs of abuse play such an important role. Nearly every abusive drug increases dopaminergic receptor agonism (“extra dopamine release”). This is either done in a direct (mescaline and amphetamine) or indirect (most other drugs of abuse) manner. Regardless of the process, the brain is receiving signals of pleasure from an unnatural source. Note, I use the term “unnatural” to mean that the brain is not triggering its own dopamine release, but rather substances from outside the body are.
Since these drugs can be administered in any dosage, it is quite common for internal dopamine levels to increase past the point of any natural setting. This incredibly high concentration of dopamine creates the “high” felt by abusers, as well as the second effect of dopamine: the formation of intense memories associated with obtaining the feeling of pleasure.
It is well-hypothesized that these “memory-forming” effects of dopamine play just as important of a role in addiction as the pleasurable effects do. While the pleasurable effects are likely more important in the development of withdrawal symptoms, the intense memories give addicts the urge that cannot be erased from their minds. When we look at the two together, we can see why the road to addiction is far too short.

Since extra dopamine is flooding the synapses, the brain thinks something is wrong, and down-regulates its dopamine receptors. This is, again, a result of evolution as it is meant to “reset” the brain to a normal state. But once the drug wears off, and dopamine levels return to normal, the brain cannot activate as many receptors as it normally would have. The result of this is initially depression, but follows with all sorts of horrendous symptoms which the reader may look up for themselves. This process is characterized as withdrawal.
The sad case of the matter is that eventually addicts do not seek the drug to experience a high, but rather to avoid a low.
The memory-effects of dopamine also come into play here, for just as the drug wears off, an abuser will remember the “good ol’ times” vividly. It will cease to matter whether the process of getting the drug is detrimental (expensive or dangerous); the addict will seek out a repeat experience nonetheless. And of course, each time the process “works”, the abuser will have strengthened the memory further. It is through this process that the “cravings” of addiction are created.
And so, terrible withdrawal symptoms, coupled with cravings, arises from repeated abuse of drugs. The well-known saying that drugs “hijack the body’s reward mechanism” are completely true. There is little escape from the self-administration of “dopamine” because of its grip on creating habits, and when administered in high concentrations, our bodies cannot prepare. What was meant to reinforce habits capable of creating life, in the end creates habits capable of destroying it.