The science of addiction medicine is far more sophisticated, now more than ever. Within the last several years, the medical community has established addiction as a disease rather than a choice. We have found evidence-based treatments that include behavioral and drug therapies. Part of the reason addiction science has progressed is because of robust yearly data collection by the National Institute on Drug Abuse (NIDA) in the United States. Since 1975, NIDA has collected data to help us understand drug usage trends.1
In 2020, it was estimated that over 18 million people 12 years and older had a diagnosis of Substance Use Disorder (SUD), the current term for “addiction.” SUD is broken into subcategories based on the drug of misuse and can include marijuana, cocaine, heroin, hallucinogens, methamphetamine, and prescription drugs.2
The large number of people suffering from SUD shows that this disease takes a major toll on the country. With such a high number of people diagnosed with SUD, it is important we find effective and long-lasting treatment to ensure people can thrive, and with the effectiveness that follows the science of addiction treatment, we are able to change lives.
What Is Addiction?
According to the American Society of Addiction Medicine (ASAM), addiction is “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”
Addiction is used interchangeably with the term Substance Use Disorder (SUD). SUD defines a person’s inability to resist impulsive behavior attached to drug abuse. Over time, addictive substances change the way a person thinks and acts, and they begin to compulsively seek out drugs, even if it causes them harm. Proper brain functioning is manipulated, for instance, when the brain is tricked into thinking that dopamine is only triggered when the substance binds with specific receptors in the brain to activate overwhelming sensations.
Addiction Science Confirms the Disease
Addiction is diagnosed by trained professionals, including therapists, physicians, and psychologists. They use an evidence-based methodology to diagnose and treat SUD. When someone meets with an addiction professional, that clinician will ask a series of questions to determine if the possible addict displays the behavior or is experiencing symptoms that follow SUD.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a SUD diagnosis requires that a person have at least two of the following in a given year:
- Using more of a substance than planned or using a substance for a longer interval than desired.
- Inability to cut down despite a desire to do so.
- Spending a substantial amount of the day obtaining, using, or recovering from substance use.
- Cravings or intense urges to use.
- Repeated usage causes or contributes to an inability to meet important social or professional obligations.
- Persistent usage despite the user’s knowledge that it is causing frequent problems at work, school, or home.
- Giving up or cutting back on important social, professional, or leisure activities because of use.
- Using in physically hazardous situations or usage causing physical or mental harm.
- Persistent use despite the user’s awareness that the substance is causing or at least worsening a physical or mental problem.
- Tolerance, or needing to use increasing amounts of a substance to obtain its desired effects.
- Withdrawal, which is a characteristic group of physical effects or symptoms that emerge as the amount of substance in the body decreases.
At first, using drugs or alcohol is a choice made by the person. However, over time, the drug changes parts of the brain associated with motivation and reward. As a result, these systems become hijacked, and a person will continue using the drug or excessively drinking alcohol, even if they know it is causing distress or health complications.
The Role of Dopamine
The science of drug addiction, in a sense, is a science of dopamine. Dopamine, neurotransmitters, and the central nervous system play a deep-rooted, significant role in substance abuse. Therefore, it is essential to understand how the brain functions. There are groups of molecules called neurotransmitters that carry information about how the body is working. Neurotransmitters also drive behavior and sensations.
The science of addiction helps us to understand that the main neurotransmitters are serotonin, norepinephrine, acetylcholine, and dopamine. Each has its own specific function in the brain. When regarding addiction, dopamine is the primary concern.
Prolonged exposure to drugs and alcohol increases dopamine levels in the brain, which affects reward and motivation centers. One of the issues that arise when a person misuses drugs and alcohol is that their dopamine levels will go much higher than they should.
Dopamine helps to motivate us to carry out day-to-day activities like eating and brushing our teeth. Therefore, When dopamine is abnormally high because of substance misuse, a person will eventually lose the motivation to care for themselves. This is seen as someone stopping their self-care like showering, exercising, or properly pampering themselves.
Over time, behavioral changes are layered on top of the changes caused by high dopamine in the brain. People with SUD change their behavior to continue seeking the “dopamine” reward from drugs and alcohol. When the substance is removed, these behaviors are likely to continue, perpetuating the addiction.
Types of Addiction Treatment
SUD is complex and involves changes to dopamine pathways in the brain that affect motivation and reward, and it also involves behavioral changes that perpetuate the addiction and can trigger relapses. A relapse is a return to drug or alcohol misuse.
There are a few main stages of treatment for SUD, including:
- Detoxification and withdrawal: During this period, the drug or alcohol misuse is stopping or has just stopped. Withdrawal symptoms occur during this period as the drug is leaving the body.
- Acute treatment: Initial treatment typically lasts the first 90-180 days of treatment and involves behavioral counseling and medications for relapse prevention.
- Maintenance and relapse prevention: Once past the initial 180 days, the risk of relapse decreases but is always present. A strong support system should be established for long-term relapse prevention. This may involve support groups, individual counseling, or group counseling.
An effective addiction treatment program will involve a multi-factor approach that addresses substance misuse as well as the behaviors, motivations, and thinking patterns related to substance misuse.
There are several factors that are required for a successful treatment program, including:
- Staying in treatment for long enough, which is usually 90 days at a minimum.
- Different treatment strategies may need to be tried to find the right one for each person.
- The stoppage of drug and alcohol use so the underlying behaviors and motivations can be addressed.
- Treatment that addresses all the needs of the person, including their mental, physical, and social needs.
- Appropriate medication can be an effective component of treatment.
- Access to treatment should be quick, easy, and non-judgemental.
What Is Behavioral Therapy?
Behavioral therapy cannot begin until the detoxification and withdrawal stage is complete. This is because drugs and alcohol affect thinking in ways that will prevent effective therapy programs.
The primary goal of behavioral therapy is to address the behaviors that perpetuate addiction. Mental health disorders that contribute to SUD should also be addressed during this type of therapy. People with unaddressed mental health disorders have a much higher risk of developing SUD.
Cognitive-behavioral therapy (CBT) is one of the most common and effective forms of behavioral therapy. It involves the development of skills to cope with life stressors that are not substance use. The CBT therapist will help a person to understand what stresses them, how to recognize warning signs, and healthy methods to cope with this stress. CBT also trains a person to recognize situations that have a high risk for relapse. Other types of SUD therapy include dialectical-behavioral therapy (DBT), motivational interviewing, and motivational incentives.
What Is Pharmacological Therapy?
Medication, or pharmacological therapy, can be used for all stages of SUD treatment. For many drugs, the withdrawal symptoms are extremely uncomfortable and are a period of high risk for relapse. Certain medications alleviate withdrawal symptoms to make the process more comfortable and lower the risk for relapse.
There are also drug treatments for relapse prevention, with drugs approved to treat addiction to opioids, alcohol, and tobacco. Drugs for relapse prevention may be part of a long-term maintenance strategy. They help to re-establish normal brain function and reduce cravings to misuse substances.
Treatment Versus Cure at Better Addiction Care
SUD is a chronic condition like high blood pressure (hypertension) and diabetes. Chronic diseases are never truly “cured,” but they will not negatively impact a person’s life if managed correctly. Addiction science and treatment should assist with stopping drug misuse, maintaining a drug-free life, and allowing a person to be productive and function in all areas of their life.
- National Institute on Drug Abuse. Treatment and Recovery. National Institute on Drug Abuse. Published July 10, 2020. Accessed May 17, 2022. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
- Merikangas KR, McClair VL. Epidemiology of substance use disorders. Human Genetics. 2012;131(6):779-789. doi:10.1007/s00439-012-1168-0
- SAMHSA. 2020 National Survey of Drug Use and Health (NSDUH) Releases | CBHSQ Data. www.samhsa.gov. Published 2020. Accessed May 17, 2022. https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases
- Wise RA, Robble MA. Dopamine and Addiction. Annual Review of Psychology. 2020;71(1):79-106. doi:10.1146/annurev-psych-010418-103337
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
- National Institute on Drug Abuse. Treatment Approaches for Drug Addiction DrugFacts. National Institute on Drug Abuse. Published January 17, 2019. Accessed May 17, 2022. https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction
- American Society of Addiction Medicine (ASAM). Definition of Addiction. Default. Published 2019. Accessed May 17, 2022. https://www.asam.org/quality-care/definition-of-addiction
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