How Addiction Happens

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Attractive man breaking cigarette representing quit smokingNo one begins using drugs or alcohol thinking that they will turn into an addict. Substance use can seem appealing after seeing friends or family use, seemingly without consequences – maybe a few drinks after dinner, a joint at a concert, or a tablet of Adderall to push through a term paper.

The Journal of Studies on Alcohol and Drugs found the reasons adolescents reported for using alcohol and marijuana included:

Other reasons for using drugs include improving performance, such as using stimulants to get through a long work day or stay awake at night, or using depressant drugs to self-medicate a mental illness like anxiety.

Even if you have watched a friend or family member have problems with their substance use, such as struggling with alcoholism, it can be easy to tell yourself that such problems will never happen to you.

For many people, this can be the case. The Substance Abuse and Mental Health Services Administration (SAMHSA) found that there were 137 million current drinkers in 2013, but only 23 million binge drank, drinking until their blood alcohol concentration (BAC) reached 0.08 percent or above. The Centers for Disease Control and Prevention (CDC) define this use pattern as excessive drinking. Furthermore, of these excessive drinkers, the CDC also found that 90 percent were not alcoholics.

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The numbers are similarly low for marijuana addiction. The National Institute on Drug Abuse (NIDA) reports that marijuana dependence only develops in about nine percent of people who try the drug.

Factors that can influence whether someone using drugs or alcohol gets addicted can include:

  • Frequency of use. The more often you use drugs, the more widespread the changes that addiction causes in the brain.
  • Type of drug. Some drugs, like tobacco, are highly addictive – NIDA reports that of people who try to quit smoking, over 85 percent relapse, usually within the week. Depending on what type of drug it is and how the drug’s pharmacology works, different drugs can have very different addictive profiles. For example, while 9 percent of marijuana users become addicted, NIDA found that 23 percent of heroin users will become addicted.
  • Reason for use. Someone who is using drugs or alcohol for social or recreational reasons may be less likely to develop a serious drug problem than someone who has an inner drive to use substances, such as to cope with stress or to self-medicate a mental illness.
  • Genetics. A wide range of genes has been linked to addiction to alcohol and various drugs.
  • Family history. People who have a family member who has been addicted to drugs or alcohol are at elevated risk for developing a problem themselves.
  • Early use. The earlier someone begins using drugs or alcohol, the higher their risk for developing a problem later in life.

Signs that someone may be abusing drugs include:

  • Using drugs in situations when it is not appropriate, such as at work or when caring for children
  • Using drugs in situations where it can be physically dangerous, such as drinking while driving
  • Failing to fulfill responsibilities or obligations because of drug use or time spent recovering from drug use, such as missing work because of a hangover
  • Acting inappropriately because of excessive intoxication, such as arguing, lashing out physically, or failing to respect the boundaries of others
  • Needing to use drugs in order to feel okay
  • Using prescription drugs:
    • Without a prescription
    • That do not belong to you
    • In higher doses than directed
    • More frequently than directed
    • In ways other than directed, such as crushing a tablet then snorting or injecting the powder

As drug use escalates, it begins to cause changes in the brain. The drugs interfere with neurotransmitters – the chemicals that nerve cells use to communicate with each other. Various drugs use different methods to disrupt cell communication, but the effect is the same: the downstream cells become overstimulated. NIDA found that some drugs can stimulate these cells two to 10 times as powerfully as the body’s own neurotransmitters do normally. In an attempt to defend themselves, the downstream nerve cells may reduce their number of receptors or otherwise lose sensitivity. To add injury to insult, many drugs are also actively neurotoxic, directly damaging the nerves.

As your nerve cells lose sensitivity due to prolonged exposure to drugs, you will need to use higher and higher amounts of the drugs in order to get the same effects – a condition known as developing a tolerance. If you continue to use drugs past this point, your brain may become so desensitized that your body’s own neurotransmitters will no longer be sufficient to keep your brain running properly in a condition called dependence. Once dependent on the drug, you have to keep taking it regularly, or else you will experience withdrawal symptoms. These can vary based on the drug, ranging from unpleasant to life-threatening.

Drugs can work on a variety of neurotransmitters. In addition to acting on neurotransmitters like serotonin, glutamate, GABA, endorphin, or endocannabinoid, NIDA reports that most drugs also affect dopamine, the brain’s primary reward neurotransmitter. The dopamine system guides attention, motivation, and habit; it also helps the rest of the brain in evaluating risk, reward, and how best to make decisions. Once these changes set in, the person has become addicted.

The Cycle of Addiction

DepressionIf you, or a loved one, have become addicted to drugs or alcohol, you’re not alone. SAMHSA found that in 2013, nearly 22 million people experienced substance dependence or engaged in substance abuse.

Dependence alone doesn’t mean you are addicted – for example, you might be dependent upon a medication prescribed by your doctor that you take to treat a chronic condition. However, when dependence fuels a destructive pattern of harmful behavior, it has crossed the line into addiction. Signs of drug or alcohol addiction can include the patterns of abuse mentioned above, as well as:

  • Feeling strong cravings to use drugs or alcohol
  • Needing to use higher and higher doses in order to get the same effects
  • Using drugs in higher amounts than originally intended
  • Spending considerable amounts of time trying to obtain drugs, using drugs, and recovering from the effects of having used drugs
  • Losing interest in usual hobbies or activities in order to spend more time using drugs
  • Engaging in risky or deceitful behaviors in order to get more drugs, such as stealing from a friend or relative, or lying to a doctor
  • Continuing to use drugs despite them causing problems in your life, such as poor performance at work, fights with friends or family, neglect of children, or legal troubles
  • Continuing to use drugs despite them causing or worsening physical or mental medical conditions, like heart disease or anxiety

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If left unchecked, this pattern of behavior can result in drugs taking a disproportionately central role in your life, with other activities and non-drug-using friends drifting farther away. Some people have family or friends who may stage an intervention to get their loved one into treatment, but for others, a wakeup call is often necessary to motivate change. Such wakeup calls might include:

  • Getting into a car accident from driving while intoxicated
  • Losing your driver’s license from getting too many DUIs
  • Getting injured while intoxicated, such as falling or getting burned
  • Getting arrested for fighting while intoxicated
  • Losing your job or failing out of school due to drug-related poor performance
  • Losing custody of children because of drug use
  • Experiencing an overdose or other medical emergency caused by drug use

After experiencing such tangible consequences, many people find the motivation to get clean. Research in Addiction found that 75 percent of people who had been dependent upon alcohol in the past were no longer fully dependent in the past year, and nearly 36 percent were low-risk drinkers or fully abstinent from alcohol consumption. Only 25.5 percent of them received treatment for their problem, however.

This recovery, however, often doesn’t last. Some people may start to use again, thinking that this time they will be able to keep their use under control. For others, certain circumstances might precipitate a relapse, like:

  • Sources of newfound stress, such as a divorce or loss of a job
  • Holidays that are associated with increased drinking or substance use, like April 19th and 20th, the Fourth of July, Halloween, Christmas, and New Year’s
  • Social rituals that involve drinking, such as holiday toasts or religious ceremonies
  • Places or situations that emphasize drinking, such as clubs, bars, or parties
  • Meeting old friends who encourage substance use
  • Accidentally consuming drugs or alcohol that you didn’t know were in food or beverages
  • Flare-ups of medical conditions that you once used drugs to self-medicate, such as chronic pain or depression
  • Being prescribed a drug for medical reasons that is chemically similar to the drug you used to abuse

For many people, relapse happens not just once, but many times as a cycle of relapse and recovery. SAMHSA found that 60 percent of admissions for substance abuse treatment were of people who had received treatment at least once in the past, and 13 of admissions were of people who had been treated for substance abuse five or more times.

Of such substance abuse treatment admissions, SAMHSA also found that:

  • 36 percent found treatment on their own or with the help of an individual, like a family member or friend
  • 34 percent were referred to treatment through the criminal justice system, such as for DUI
  • 17 percent were referred by a substance abuse care provider or other health care provider
  • 12 percent were referred to treatment by a member of the community
  • Two percent were referred by their school or employer

Substance use disorder has similar rates of relapse – about 40 to 60 percent – to other medical conditions like high blood pressure, diabetes, and asthma, reports NIDA.

Remission and Recovery Through Treatment

doctorBy seeking treatment, you can learn new strategies for avoiding relapse as well as gain access to medications that make quitting and staying clean easier. The form that treatment takes can vary depending on your situation and your needs.

Inpatient treatment offers around-the-clock medical monitoring and pharmacotherapy for people going through withdrawal, and provides hours of daily therapy and a structured, drug-free environment. Outpatient treatment is usually less intensive and far less expensive, and provides treatment options for people who are looking to integrate their treatment with work/school, family, and home life.

If you’re looking for treatment for yourself or a loved one, we have the resources you need. Take the first step and call our admissions coordinators to learn more at the number listed below.

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