8.1: Drug Use and Drug Addiction

Drug addiction is a complex illness, many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or the willpower to quit without recognizing that drugs change the brain in ways that make quitting hard, even for those who want to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. A person may initially choose to take the drug, however over time they are incapable of choosing not to take the drug.

Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

Drug Use and Overdose

The National Survey on Drug Use and Health (NSDUH)^[1] is published each year to share statistics on drug use in the U.S. Key findings from the 2020 annual report show that drug use is fairly common.

Among people aged 12 or older in year 2020:

• 58.7 percent (or 162.5 million people) used tobacco, alcohol, or an illicit drug in the past month (current user).
• 21.4 percent (or 59.3 million people) used illicit drugs in the past year.
• Marijuana was the most commonly used illicit drug, with 17.9 percent (or 49.6 million people) using it in the past year.
• 3.7 percent (or 10.3 million people) misused central nervous system (CNS) stimulants in the past year.
• 3.4 percent (or 9.5 million people) misused opioids (heroin or prescription pain relievers) in the past year.
• 3.3 percent (or 9.3 million people) misused prescription pain relievers in the past year.
• 2.6 percent (or 7.1 million people) used hallucinogens in the past year.
• 14.5 percent (or 40.3 million people) had a Substance Use Disorder in the past year

Unfortunately both first time users and those who have an addiction are both at risk of possible drug overdose. Between 1999-2000 more than 932,000 people have died from a drug overdose. Most recently, the majority of overdoses are caused by synthetic opioids. For example in 2020, about 92,000 drug overdose deaths occurred in the United States and 75% of the overdoses involved opioid use. Data from just 24 states from January–June 2019 showed that Illicitly manufactured fentanyl, heroin, cocaine, or methamphetamine (alone or in combination) were involved in nearly 85% of drug overdose deaths.

Drug Addiction

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a “relapsing” disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It’s common for a person to relapse, but relapse doesn’t mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.

What happens to the brain when a person takes drugs?

Most drugs affect the brain’s “reward circuit” by flooding it with the chemical messenger dopamine. This reward system controls the body’s ability to feel pleasure and motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. This overstimulation of the reward circuit causes the intensely pleasurable “high” that can lead people to take a drug again and again.

As a person continues to use drugs, the brain adjusts to the excess dopamine by making less of it and/or reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug, an effect known as tolerance, which involves taking more of the drug to try to achieve the same dopamine high. It can also cause them to get less pleasure from other things they once enjoyed, like food or social activities.

Long-term use can cause changes in other brain chemical systems and circuits that can negatively impact a persons learning, judgment, decision-making, stress, memory, and behavior. Long-term use can also lead to drug dependence, where your body is used to functioning with the drug in your system. If you are dependent on a drug and the drug is removed, it can cause withdrawals symptoms. Withdrawal symptoms vary depending on the type of drug dependence and may include tremors (shaking), cravings, agitation, nausea, sweating, or changes in mood.

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don’t?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

• Biology
  • The genes that people are born with account for about half of a person’s risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.
• Environment
  • A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.
• Developmental stages
  • Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

What are some consequences of Drug Abuse?

Drug abuse is a serious public health problem that affects many communities and families in some way. Each year drug abuse causes millions of serious illnesses or injuries among Americans. Drug abuse also plays a role in many major social problems, such as drugged driving, violence, stress, and child abuse. Drug abuse can lead to homelessness, crime, and missed work or problems with keeping a job. It harms unborn babies and destroys families.

Some people who are addicted don’t believe that they are sick and out of control, so they don’t look for treatment. They don’t see the problems they are causing themselves and those around them. Other people who are addicted are aware of the problem, but may be so upset and confused that they do not know how to ask for or get help.

Drugs don’t just hurt the person taking them. Everyone connected to the person can get hurt. When you or a loved one abuse drugs, everyday life can feel out of control.

Drug abuse affects the family in many ways, including:

• When a person has a drug problem, they have a disease that can hurt the family.
• Drug abuse puts a lot of stress on parents, brothers and sisters, children, grandparents—anyone who is part of the home.
• Family members might fight a lot because of the problems the drug abuse is causing.
• The drug user might do and say things that upset neighbors and friends, and make the family ashamed.

When family members take drugs, you may experience situations such as:

• You generally can’t count on them to do what they say they will do.
• They may forget or get distracted because their focus is on getting and taking drugs.
• They might lie or steal money to buy drugs.
• They might get fired from their jobs.
• They might not come home at night.
• They may do bad things they would never do if they weren’t abusing drugs.

Drug abuse can cause many problems including: Fighting and violence in and outside the home; money problems; trouble at school; trouble at work, losing a job; trouble in relationships; child abuse, neglect; driving accidents; and arrests and jail.