Drug Addiction

What is Drug Addiction?

Addiction, as most people understand it, is being overly dependent on a specific substance, activity, or thing. However, medically speaking, addiction is defined as a chronic, recurring condition where a person seeks drugs compulsively, keeps using them even when it harms them, and experiences long-lasting changes in the brain. This definition is linked back to Roman law, where addiction referred to losing control by a court’s decree. It’s very similar to how people addicted to drugs lose control and can’t resist their cravings.

Two main types of addiction exist. One is substance addiction, which is a disorder related to the brain and nervous system where someone continuously wants to use a drug, even though it’s harmful. The other is non-substance addiction, also known as behavioral addiction, where a person doesn’t rely on a drug. However, they show behaviors akin to substance addiction, exhibited in issues like compulsive gambling, overeating, excessive internet use, gaming, sex addiction, and excessive use of mobile phones.

What Causes Drug Addiction?

Addiction to alcohol and drugs depends on factors such as brain function, genetics, and one’s environment. This complex process is thought to be influenced by the reward system in the brain. We mustn’t forget the roles of learning and memory in the hippocampus (a part of the brain), and emotional regulation in the amygdala, in developing and keeping an addiction.

Research suggests that Delta-FosB, a type of protein that controls gene activity, plays a significant role in addiction. This protein builds up in certain brain cells when drugs are taken repeatedly. Interestingly, it also builds up in the brain during other compulsive behaviors like excessive running.

Another significant aspect of addiction is how individuals deal with stress. This includes psychological responses, physical reactions, and biochemical processes. This is influenced by factors such as parental behavior, cognitive difficulties, and the individual’s stress levels.

Studies show that traumatic experiences, particularly in early childhood, can heighten the risk of addiction. Excessive or prolonged stress can lead to a state where the body’s equilibrium is disturbed, potentially leading to drug-seeking behavior and possible addiction.

In Latin America, research is focusing on the relationship between changes in certain stress-related genes and addiction. These genes may interact with stress hormones and other biological molecules, providing a possible way to identify those at higher risk of addiction. Ongoing studies are exploring new therapeutic targets for addiction, such as certain proteins in the brain, or the system that responds to cannabis compounds in the body.

In conclusion, addiction is often rooted in prolong stressful experiences, especially during early childhood. Risk factors for developing addiction include impulsivity, inadequate parental supervision, and behaving destructively. Studies also suggest that those who start one problematic behavior are likely to start another. Social factors, such as poverty, geographic location, family, and peer influence, can also affect the likelihood and course of developing addictions.

Risk Factors and Frequency for Drug Addiction

A 2005 study, based on the 2001 National Household Survey of Drug Abuse, showed that outof the 55,561 subjects, 33,576 people had used alcohol in the previous year. The study found a slightly higher rate of abuse-to-dependence in men versus women. According to a 2014 study, 7% of Americans fit the criteria for alcohol misuse or alcoholism. The World Health Organization estimated in 2010 that about 208 million people across the globe have alcohol use disorder. In 2016, alcohol dependence was the most common substance use disorder worldwide, but the most common drug use disorders were cannabis and opioids. Amphetamine and cocaine use was less frequent.

“Designer drugs” are illegal versions of existing psychoactive or painkiller molecules. These drugs are generally stronger than the substances they’re derived from. The international community is increasingly worried about designer drugs being made and sold to avoid drug laws. Designer drugs can change based on location, and they include:

• Synthetic stimulants like “bath salts”
• Synthetic tetrahydrocannabinol (THC), known as k2 or spice.
• A norepinephrine-dopamine reuptake inhibitor called flakka.
• Synthetic hallucinogens known as N-bomb and solaris.
• Synthetic opioids like “U4,” “pink,” or “pinky,” among others.
• A substance called 3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy.

The typical user of designer drugs is a young man between 15 and 25 years old who frequents clubs, raves, and house parties. A survey from the National Institute on Drug Abuse in 1993 reported that approximately 2% of American college students admitted to using MDMA in the previous 12 months. Some studies estimate that 6% to 17% of American college students had used synthetic cannabinoid drugs at least once. Around 1% of young Europeans between the ages of 14 and 18 used synthetic cannabinoid drugs at least once in their lifetime.

Deaths from overdose have increased due to adulterants in products sold as heroin or counterfeit painkillers, especially in North America and Canada. For example, in Miami, deaths caused by fentanyl increased 600% from 2014 to 2015. Deaths from these synthetic opioids have also been reported in other parts of the world, including Latin America, Asia, Europe, and Africa.

Abuse of prescription medications is also a serious problem. The misuse usually involves:

• Central nervous depressants such as benzodiazepines, non-benzodiazepines, and barbiturates.
• Prescription opioids like hydrocodone, oxycodone, fentanyl, and codeine.
• Prescription stimulants like dextroamphetamine, a combination product of dextroamphetamine or amphetamine, and methylphenidate.

In 2016, deaths from prescription opioid overdose were five times higher than in 1999. The National Center for Health Statistics reported in 2012, that pain relievers (opioids) caused more “drug poisoning deaths” than heroin and cocaine.

According to the Ontario Student Drug Use and Health Survey in 2013, approximately 9.7% of students in grades 7 to 12 reported using dextromethorphan recreationally, compared with 6.9% in 2011. Most of the calls to poison control were related to dextromethorphan, which primarily involved adolescent males.

Acetylsalicylic acid (ASA) or acetaminophen use of more than 4 g per day for an extended time is considered misuse.

Extracts of several plants have also been found to have addictive substances. One such example is the extract from the Mitragyna speciosa (kratom) tree. Reports suggest that calls to poison centers related to kratom use increased from 2010 to 2015. Misuse of Kratom appears to be on the rise in the Western world at a concerning rate, with reported deaths.

Signs and Symptoms of Drug Addiction

People with addiction may have different symptoms and experiences based on the addiction type, the consumed substance, the time since ingestion, and how it was consumed. For instance, symptoms of most alcohol intoxication forms usually include slurred speech, unsteady movements, and poor judgment. However, if the dose was high or quickly ingested, it might even lead to depression of the central nervous system, a coma, and failures of various organs. This is applicable to alcohol types like ethanol, methanol, isopropanol, and ethylene glycol.

For people who have taken cocaine or other stimulants, you might see them in a state of worry or fear, possibly experiencing psychosis, and having an unusually fast heart rate or breathing due to their sympathetic nervous system response. In these cases, the initial treatment starts with reducing stress, stabilizing vitals, and preparing emergency response teams for worsening situations.

Also, symptoms can differ depending on the addiction stage and the substance causing the addiction. Let’s break down the five stages of addiction:

• First Use: These patients are just starting to experience the effects of the substance. This could be due to a new prescription for pain medication or trying a substance due to peer pressure.
• Continued Use: At this stage, people start to go back to a medication they don’t “need” anymore but want, as they notice the effects of the ‘high’ don’t wear off quickly.
• Tolerance: These patients realize they need larger doses of the drug to achieve the ‘high’ they were used to.
• Dependence: Here, patients start to physically display withdrawal symptoms when not using the substance and feel “normal” only when they use it.
• Addiction: At this final stage, patients may either continue using the substance despite the severe problems it causes or are in denial about their addiction.

These descriptions help understand how a patient with addiction might present themselves. A person in the ‘First Use’ stage is usually not in acute distress (unless they’re experiencing active trauma or chronic pain) or show physical withdrawal signs. However, someone with ‘Tolerance’ will usually need to increase their medication dose or ask for an unexpected refill. Lastly, a person at the ‘Addiction’ stage might present themselves in acute withdrawal, with symptoms depending on the substance they are addicted to.

Testing for Drug Addiction

When dealing with addiction, various lab tests, imaging, and specific exams may be performed. These can vary depending on what is causing the addiction. For example, if the addiction is linked to a mind-altering substance, there can be noticeable changes in comprehensive metabolic panel (CMP) and complete blood count (CBC) values, as well as in mental health screenings.

Some common substances and corresponding tests include:

1. Alcohol:
– A CBC test might show increased mean corpuscular volume (MCV) and anemia, caused by a lack of folate, with regular use.
– CMP can indicate changes in blood urea nitrogen/creatinine ratio (BUN/Cr), low blood sugar levels, and irregular electrolytes due to dehydration. An increase in the anion gap and decrease in CO2 and bicarbonate indicate an acidic state during acute intoxication.
– For Methanol, regular eye exams are advised due to potential eye problems.
– Ethylene glycol use can cause kidney failure and may result in blood in the urine, requiring regular monitoring of BUN/Cr levels and kidney function.

2. Cocaine: Stimulates the body, resulting in high heart rate and rapid breathing. Patients may also experience a sudden severe mental disorder. It may require multiple troponin tests, cardiac stress tests, and possibly even a cardiac catheterization.

3. Opioids: These drugs have the opposite effect to stimulants like cocaine and can cause slow heart rate, low blood pressure, constricted pupils, low body temperature, and sleepiness. The main concern with opioids is respiratory depression caused by heavy sedation.

Addiction severity is often evaluated using a tool called the Addiction Severity Index (ASI), which looks at seven factors, including medical and psychological status, employment and support, substance use, legal status, and family/social status.

While not commonly used, imaging techniques may also be used to evaluate addiction. Studies gound that a decrease in certain dopamine receptors correlated with less activity in specific brain regions in people recovering from cocaine addiction.

For substances that don’t show up on basic urine or blood tests, techniques like liquid chromatography, mass spectrometry, and ion mobility spectrometry (IMS) can be extremely helpful.

Treatment Options for Drug Addiction

Intoxication and addiction often occur simultaneously. Intoxication can either be the addiction itself or the trigger for behavioral disruptions and suicidal tendencies. Managing these conditions involves closely monitoring the patient’s vital health signs. The management strategies depend on the stage at which the patient presents the addiction or substance. Many treatments are available to address the two most common substance addictions: tobacco and alcohol. These treatments range from pharmacological approaches (medication) to group meetings and psychological and social support.

In the case of alcohol addiction, medications like disulfiram, naltrexone, and acamprosate are often used. Disulfiram helps a patient maintain abstinence once they’ve quit drinking, as it causes hangover-like symptoms quickly if they consume alcohol. Naltrexone helps to eliminate the feeling of reward or pleasure associated with drinking, and acamprosate helps to minimize withdrawal symptoms when a person initially stops drinking. In cases of relapse resulting in alcohol intoxication, long-acting benzodiazepines like chlordiazepoxide or diazepam can be used to manage the situation.

When it comes to tobacco addiction, bupropion and varenicline are the primary treatment options. Other medications, like the blood pressure drug clonidine and the antidepressant nortriptyline, can also be effective if used before quitting smoking. Bupropion can help reduce cravings for tobacco, while varenicline both lessens nicotine cravings and reduces withdrawal symptoms. Nicotine patches, gums, sprays, and lozenges are other potentially useful approaches.

However, it’s crucial to remember that these medications work best when combined with non-pharmacological methods. This combination optimizes their effectiveness and helps prevent substance use from escalating into substance misuse or addiction. For example, when treating nicotine dependence, combining these medications with a healthcare professional’s guidance and empathy has been shown to significantly increase long-term abstinence rates.

Notably, more people have managed to overcome their addictions without formal programs like 12-step initiatives or cognitive-behavioral therapy than those who have participated in these programs. These findings suggest the importance of providing personalized treatment strategies, ideally involving the patient’s input for most effective results.

What else can Drug Addiction be?

When dealing with addictions, it’s important to uncover the underlying causes. Some potential causes could be:

• Bipolar disorder – This condition is found in more than half of people with substance abuse problems. Major mood swings can be a sign of this disorder.
• Post-traumatic stress disorder (PTSD) – This is commonly found in people who abuse alcohol. Even though PTSD and addiction are two different conditions with different symptoms, treating PTSD can help to address or even eliminate the associated addiction.

If someone seems intoxicated, doctors in the emergency department might use a handy memory tool to help diagnose what is happening:

• A – alcohol
• E – problems with the brain (like high blood pressure or liver disease), electrolytes, endocrine problems, or environmental factors
• I – insulin
• O – opioids, or a lack of oxygen
• U – uremia (high levels of waste products in the blood)
• T – trauma, toxins
• I – infection, an increase in the pressure inside the skull
• P – psychosis, poisoning, a genetic condition called porphyria
• S – stroke, shock, seizure

What to expect with Drug Addiction

Research shows compelling evidence of the long-term impacts of drug dependence. Individuals diagnosed with this condition typically live 22.5 years less compared to those without the diagnosis. This shortened lifespan is due to the harmful effects of substances on various body systems, such as the heart, lungs, and nervous system.

A five-year research into alcohol and drug rehabilitation treatment revealed that older adults, particularly older women, tend to have more favorable outcomes compared to young adults. These outcomes are influenced by factors like social networks, gender, and age. For instance, older women had a 52% sobriety rate for 30 days compared to a 40% rate among younger adults.

With the current understanding of addiction, healthcare providers should transition the approach towards patients from treating acute episodes to a chronic disease model. It’s important to enhance the screening and intervention process, as well as overall management of this condition. This transition is urgent since roughly 2.8% of the US population, or 6.9 million people, are at risk of premature death linked to illegal drug use.

However, any significant changes must be supported by more research that highlights the correlation between decreased mortality and reduction in addiction prevalence and incidence rates. At present, a clear connection exists between the changes in mortality risk and when patients begin their treatment journey.

Possible Complications When Diagnosed with Drug Addiction

Chronic alcohol consumption can cause a range of health complications. Wernicke encephalopathy and Korsakoff syndrome, which typically result in confusion, problems with eye movement, and lack of coordination, are common complications. However, it’s important to note that not all symptoms are present all the time. Medical scans often reveal shrinkage in certain areas of the brain in those affected by these conditions.

Another complication related to long-term alcohol use is hepatic steatosis, a condition where fat accumulates in the liver. This happens because of changes in how the body processes fats due to the damage alcohol causes. Along with that, chronic heavy drinking significantly raises the risk of chronic pancreatitis, a condition that causes inflammation and fibrotic changes in the pancreas over time.

Chronic alcohol consumption can also contribute to heart problems, specifically cardiomyopathy. This heart condition occurs due to oxidative stress, calcium handling disruptions, and faulty mitochondria. Addiction to substances such as cocaine can further compound health issues, causing heart-related problems, psychosis, and potentially deadly irregular heartbeat patterns. Finally, the cycle of addiction can also lead to multiple episodes of withdrawal and relapses.

• Common complications of chronic alcohol use:
• Confusion, problems with eye movement, and lack of coordination
• Brain shrinkage noted on medical scans
• Hepatic steatosis, a condition where fat accumulates in the liver
• Chronic pancreatitis, which causes inflammation and fibrotic changes in the pancreas over time
• Cardiomyopathy, a heart condition caused by oxidative stress, calcium handling disruptions, and faulty mitochondria
• Issues related to cocaine addiction, such as heart-related problems, psychosis, and potential deadly irregular heartbeat patterns
• Multiple episodes of withdrawal and relapses

Recovery from Drug Addiction

Rehabilitation treatment is the key way to help someone managing an addiction, from the point of their initial recovery to maintaining their ongoing sobriety. Since the 1960s, a variety of services have been made available to the public, like methadone clinics, free outpatient treatment options, and residential community treatment centers.

Arguably the most common and successful programs are 12-step groups like Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous. These groups offer peer support, which has been proven effective in managing addiction, as well as concurrent mental health issues. Participants in these programs often find their self-confidence improved, they develop a personal belief in their ability to change, and they learn healthy ways to handle stress that help them stay sober. In summary, addiction management includes safety measures to prevent relapse like medication options and peer-support groups.

Preventing Drug Addiction

Preventing addiction largely relies on early detection of signs and educating children from a young age. Programs like DARE, which are typically introduced in schools, play an important role in discouraging drug use and trial. Although it’s more beneficial to provide this education before any health issues arise from substance abuse, it’s also important to educate individuals at any point in their addiction journey. Individuals fighting addiction are more likely to successfully quit and adopt healthier lifestyles if they receive continuous and positive encouragement from healthcare providers and medical professionals.