Addiction is a growing issue, but it’s also a treatable illness. Pre-covid, the Global Burden of Disease reported that the United States has the highest death rates of opioid, amphetamine, and cocaine overdoses in the world. Unfortunately, this trajectory will likely rise due to the immense stressors caused by the covid-19 global pandemic. (2017)
Listening to a TED Talk by Johann Hari, Everything you think you know about addiction is wrong, Hari peels away at how society currently manages addicts and addiction. It seems clear that the century old way of how addicts are treated and how society reacts to addiction is not working and change is necessary. Precursor knowledge of the neurobiological mechanisms, biomedical models, and interventions are necessary in order to grasp the full impact of addiction, in order to understand how addiction is diagnosed, prevented, and treated. (Hari, 2015)
The neurobiological mechanisms of addiction include how drugs are administered and how chemical substances act on the brain. When drugs are injected or inhaled, they tend to have stronger and more immediate effects because they enter the bloodstream faster. As drugs reach their target receptors, there are several ways they can alter neural transmission. Agonists, produce neural actions that mimic or enhance the action of a naturally occurring neurotransmitters. Antagonists, produce neural actions that block the action of the neurotransmitters. In Health Psychology, Straub details this process using the example of the neurotransmitter dopamine in relation to cocaine. The stimulant cocaine, “binds to proteins that normally transport dopamine, thus blocking its reuptake. Because dopamine is not reabsorbed by the sending neuron, it remains in the synapse and continues to excite the neuron. As more dopamine remains to stimulate neurons, the result may be prolonged feelings of pleasure and excitement.” (Straub, 2017). Stimulants are known for their powerful reward effects, and these rewards tell the brain, this is good, let’s do it again. Remember, repeat. However, in order to keep producing a state of happiness and euphoria, the body and mind readjust to repeated use, which can produce different states of dependence and withdrawal. Substance use disorder occurs when one continues to take drugs, despite experiencing many problems, such as: physiological pain and risk to themselves and others, disrupting daily tasks and work, frayed relationships, and financial insecurity. This holds true for all psychoactive drugs; hallucinogens, stimulants, and depressants, all of which alter mood, behavior, and thought processes in different ways. (Straub, 2017)
Many social scientists and medical professionals have tried to unravel the mystery of addiction through the use of different biomedical models. Some models of addiction view physical drug dependency as a chronic brain disease inherited through biological vulnerability. However, specific genes that promote physical dependence are inconsistent or unfounded, as evidenced by concordance rate in twin studies. There is also a gaping inability of ruling out other possible confounding variables. (Straub, 2017)
The Withdrawal-Relief model hypothesizes that the neurochemistry of certain drugs restores abnormally low levels of dopamine, serotonin, and other important neurotransmitters. This rationale dictates that addicts need more of their drug to relieve physical distress. While this model seems rational, it’s unable to explain why addicts begin taking drugs in such frequency to develop a physical dependence in the first place. Also, long after withdrawal symptoms subside, the model fails to explain why many users suffer a relapse. (Straub, 2017)
The Gateway Drugs Theory, which has dominated drug prevention for decades, refers to the use of tobacco, alcohol, and marijuana as substances that bolster the probability of experimentation with other drugs. In addition, this theory views tobacco and alcohol use as strong predictors or stepping stones for marijuana, and eventually harder drug use. However, a study from the University of Pittsburgh followed over 200 boys for 12 years, starting at age 10-12 and reported findings that were incongruent with the gateway drug theory. The participants were categorized into three groups based on their eventual legal and illegal drug use: (1) those who only used alcohol and tobacco, (2) those who used alcohol and tobacco then proceeded to use marijuana (the gateway drug use) and (3) those who used marijuana before using alcohol or tobacco. A surprising 25% of participants reported using marijuana first, instead of tobacco and alcohol and “those individuals were no more likely to develop a substance use disorder than those who followed the traditional succession of alcohol and tobacco before illegal drugs.” (Straub, 2017) This data supports a different model, the Common Liability to Addiction, which proposes that the likelihood a person will begin using illegal drugs does not predict subsequent illicit drug use, but instead notes that particular tendencies of substance use may depend more on the social and environmental circumstances of the drug user.
The lead author Dr. Tartar and professor of pharmaceutical sciences, elaborated that “the emphasis on the drugs themselves, rather than other, more important factors that shape a person’s behavior, has been detrimental to drug policy and prevention programs.” (Science Daily, 2006)
Many theories seem to diminish the social and environmental elements that shape behavior. Looking at the theory of Wanting-and-Liking, the first stage is comprised of rewarding good feelings from drug use; the second stage, drug use becomes an automated behavior. It’s understandable that substance abuse can eventually become habit forming, but how is that one’s internal mechanisms of responding to negative consequences of substance abuse, such as vomiting, being threatened of losing their family and friends, or the potential of going to jail, fail to halt some people from course correcting when reckless behavior goes too far? This argument is the same for behavioral addictions such as overeating, gambling, gaming, shopping, or sexual addictions. Unfortunately, in many situations, the consequences severely outweigh the pleasures, yet the addiction remains. (Straub, 2017)
Alcohol particularly throws a wrench into these systems of thought, especially around genetics. According to Epps and Holt ( 2011), “there is no single gene for alcoholism, but genes and alleles that make alcoholism more likely have been found on every chromosome except the Y.” There is some evidence that for males, alcoholism in a first degree relative is the single best predictor or alcoholism, but for as much emphasis has historically been put on genetic vulnerability, it seems that personality traits and temperament may be a more accurate indicator that links to alcohol dependence. The traits most in common with alcohol abuse are: a quick temper, impulsiveness, intolerance of frustration, vulnerability to depression, and a general attraction to excitement. (MacGregor et al, 2009)
Depression seems to be a consistent factor among many types of addiction. Several studies on teens and smoking found that students who had persistent symptoms of depression at the start of a longitudinal study were, “more likely than other students to increase smoking, even when other factors were taken into consideration.” (Straub, 2017)
According to a study on psychological correlates of substance related addictive disorders in males, “Depression is among critical clinical issues with addictive disorder.” Further, results elaborated that “social anxiety and psychological distress was seen connected with augmented use of alcohol, anti-anxiety and other drugs, frequently to fulfill everyday hassles of life including personal/occupational issues and sometimes were used in a deliberate effort to reduce distress.” (Majeed et al, 2017)
Knowing that social and behavioral factors, as well as traits, personality, and genes, all influence a level of compulsiveness in substance abuse, what interventions are working? It seems that multi-faceted problems need multi-faceted interventions. Cessation of smoking among younger generations has been rather successful. The CDC reported that “the percent of high school students who smoked decreased from 36% to 22% during 1997 and 2003.” (Straub, 2017) The multi-factor approach of increasing taxes on cigarettes, creating campaigns that view smoking as addictive and having more negative social consequences, and programs that instruct students on how to resist social pressure have been most successful. In general, many programs are aimed at delaying addiction and substance use for as long as possible. As Straub notes, “for every year that drinking alcohol is delated, the risk of becoming alcohol-dependent decreases by 14%.” (2017)
Stage approaches, such as the use of the Transtheoretical model and 12-step programs, generates higher rates of participation, whether through Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, or Project MATCH. What these stage approaches have in common are more individualized treatment plans, the availability of participating at home and not only in clinics, and the gradual approach of a series of reasonable steps to help addicts advance one stage at a time. Another advantage of these models usually includes participation from a sponsor or peer who is or has already gone through an individuals stage. The Therapeutic Alliance and Psychosocial Interventions for Successful Treatment of Addiction states that,
“the combination of the different approaches (ie, practitioners in formal treatment and peers in self-help groups) can provide a synergy beneficial to patient motivation for maintaining the lifestyle change necessary to remain drug-free.” (Kelly, 2015)
Person-centered approaches to interventions and treatment are becoming more available. There’s a growing number of treatments that are being used to help substance and behavioral addicts from mindfulness, eye movement desensitization and reprocessing, aversion therapy, CBT, and even psilocybin treatments. Whatever combination of techniques that are used, Lichentenstein and Glasgow argue that there are three interacting factors that influence effectiveness of treatment: motivation to quit, level of physical dependence, and barriers to or supports in remaining drug free. (Straub, 2017)
Support is a huge factor but can be a difficult road for addicts and their families, friends, and people within their social networks, especially for parents of addicts. Many parents will feel as though they have failed their children or didn’t do enough to prevent their addiction. It can be emotionally devastating as a parent to see drastic behavioral changes in your child and feel an immense amout of responsibility to figure out the best methods of helping them, while simultaneously experiencing alienation, isolation, and depression due to the shame that’s connected to drug addiction.
The shame cast on addicts and the inability to reintegrate into society only reinforces a narrative that addicts deserve to be punished. Hari argues with studies by Psychiatrist Benjamin Alexander, that addiction isn’t just about chemical hooks, but it’s rather an adaptation to one’s environment. Happy and healthy people tend to have happy and healthy bonds, relationships, and environments. In contrast, if someone cannot bear to be present in their life because they’re dealing with depression, anxiety, isolation, and exist in an unhealthy environment, then as social beings, that person will bond with something to cope with their emotions, be it alcohol, drugs, over-eating, the internet, work, or gambling. (Hari, 2015)
Complex, long-term issues call for multi-factor solutions. A cultural, political, and medical shift towards empathy, rehabilitation, and reallocation of resources is needed in order to bring relief to those struggling with addiction, as well as their caregivers. Changes in this direction will not only alleviate those struggling, but can also alleviate burdered systems and infrastructures. Multi-faceted rehabilitation in media, government, education, and culture can create societal shifts so that addicts are not seen as degenerates, but as people that can benefit from cognitive restructuring, physiological treatment, and rehabilitation assistance to rejoin their communities with greater resilience and the ability to thrive.
References
Hari, J. (2015). Everything you think you know about addiction is wrong. TED. https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong.
Kelly, T. M. (2015). The Therapeutic Alliance and Psychosocial Interventions for Successful Treatment of Addiction. Psychiatric Times, 32(4), 33.
Majeed, S., Khan, A. Q., & Yasmeen. (2017). Psychological Correlates of Substance Related Addictive Disorders in Males. Journal of Pakistan Psychiatric Society, 14(4), 28–31.
Ritchie, H., & Roser, M. (2018, March 16). Opioids, cocaine, cannabis and illicit drugs. Our World in Data. https://ourworldindata.org/illicit-drug-use#specific-drug-use-disorders.
Straub, R. O. (2019). Health psychology: a biopsychosocial approach. Macmillan International Higher Education.
University of Pittsburgh Medical Center. (2006, December 4). No ‘Smoking’ Gun: Research Indicates Teen Marijuana Use Does Not Predict Drug, Alcohol Abuse. ScienceDaily. Retrieved April 5, 2021 from www.sciencedaily.com/releases/ 2006/12/061204123422.html