Alan Frischer, MD, MPH
Have you noticed how much COVID-19 and isolation humor revolves around alcohol use? We are all aware that the pandemic has led to a huge rise in alcohol sales; some estimates show more than a 60% increase. This may, in part, be a sign of a dramatic increase in mental health and particularly addiction issues. Of course, long before this worldwide pandemic, we became aware of the opioid crisis, and long before that, drug and alcohol addiction has existed as a serious and tragic problem.
Addiction is a mental disorder, which compels the victim to repeatedly use substances or engage in behaviors even when there are harmful consequences. Addiction destroys relationships and careers, and threatens one’s health and safety. Nearly every family is touched in some way by addiction.
Alcohol is the most widely abused substance in this country. It is likely that 6% of Americans have an alcohol disorder, yet only 7% of those addicted ever receive treatment. Worldwide, alcohol may be a factor in one in every 20 deaths.
Opioids are a class of drugs that block pain and cause euphoria, and pose a high risk for addiction and overdose. They are controlled substances, but are often sold illegally. In particular, heroin mixed with fentanyl has contributed significantly to the opioid epidemic in the United States. Both legally prescribed and illegal opioids have lead to a surge in deaths over the past two decades.
For most of us, having a drink or taking a pill is an experience we can walk away from without needing more. It’s not easy to truly understand why or how others become addicted. Addiction is a complex disease; quitting may take more than good intentions, moral principles, or a strong will. While the initial decision to take a drug is voluntary, repeated drug use can lead to changes in the brain that challenge self-control and interfere with the ability to resist the drug. These brain changes can persist, which is why addicts are at increased risk for returning to drug use even after years of sobriety. Therefore, treatment must not only be ongoing, but permanent.
As the addict continues to use a drug, the brain adapts by reducing the ability of cells to respond to it. Over time, this reduces the high – which is known as tolerance. The user might try taking more of the drug to achieve the same high. These brain adaptations lead to the person becoming less and less able to derive pleasure from the other things they once enjoyed, like food, exercise, sex, or social activities.
Long term drug use can also cause changes in other brain chemical systems and circuits, affecting learning, judgment, decision making, handing stress, memory and behavior.
Why do some people become addicted and not others? A number of factors change the odds. Biological factors, including the genes that we are born with, gender, ethnicity, and the presence of other mental disorders, have a significant influence. Environmental factors include family influences, friends, socioeconomic factors, economic status and quality of life, peer pressure, physical and sexual abuse, early exposure to drugs, stress and parental guidance. These genetic and environmental factors interact with developmental stages. Areas of the brain that control decision-making, judgment, and self-control are not fully developed in the teenage years, so an early start to drug use makes an addiction more likely.
Can drug addiction be cured or prevented? When we treat chronic diseases like diabetes, asthma or heart disease, we don’t necessarily find a cure. Instead, the goal is to control the disease. Similarly, addiction is treatable and can be successfully controlled. The most successful treatment plan is tailored to the individual’s drug use pattern and any existing medical, psychological, or social problems, and may be a combination of addiction treatment medicines with behavioral therapy.
The number of addicts in the United States is staggering. Prevention is aimed at family, schools, religious organizations, and communities. If you or someone you know has a substance abuse problem, there is help available, and I urge you to seek medical attention.