Drug Abuse and Addiction

There are many reasons for substance abuse to develop. Once it begins, more and more aspects of life become involved in drug craving. Virtually any feeling, thought or memory may become associated with drug craving and drug use. When a severe psychological and physical addiction to opiate/opioid drugs develops, fear of withdrawal becomes the main factor maintaining drug seeking and drug use. At this point, methadone or buprenorphine maintenance treatment becomes an attractive option for the patient.

Opioid agonist treatment "cures" psychological addiction, i.e. the patient quickly feels "normal" and reverts to some abuse thinking with intermittent craving. This is similar to the state before the addiction developed. The patient may completely stop drug abuse behaviors. He/she can "take or leave" abusable drugs and usually no longer commits unethical acts to get drugs. However, unethical practices and psychological problems that preceded the drug addiction may return and may not change. For example, posttraumatic stress disorder (PTSD) symptoms may return when drug abuse stops. Prostitution is usually the result of sexual abuse occurring earlier in an individual's life, and may not stop as a result of opioid agonist treatment.

There are basically three ways of feeling good or three primary factors motivating behaviors: nature (instincts), culture (traditions, rituals, games, arts), and drugs. Abusable-addicting drugs bypass thoughts and actions, leading directly to rewarding, good feelings, as if the person would have done something of natural and/or cultural value. While cultural activities feel like "second nature", drugs function as "third nature", competing with culture and natural inclinations. Drug addiction leads to a severe disturbance of the emotional-behavioral system.

Drugs are self-reinforcing. They lead to a feeling of reward and craving for further use. It is "normal" for people to develop drug abuse and addiction when exposed to drugs. Virtually all animals used in experiments become quickly addicted to "hard drugs" and it is easy to teach animals to 'love' alcohol. People who do not get addicted to drugs, when exposed, benefit from protective factors, e.g. oversensitivity and fear of drug side effects, fear based on knowledge about drugs (insight), sense of wanting to be completely in control, religious and ethical beliefs, strong positive motivations that exclude the use of drugs, etc.; for people with strong positive life goals, insight into the problems of drug abuse/addiction may deter experimenting with drugs. Young people may be particularly prone to addiction if insecure, anxious, depressed, if suicidal, if there is an abuse/neglect history, and if there are other psychiatric conditions. Males are more likely to become addicted without major psychological stresses since young males are more likely to explore and take meaningless risks. Even if addiction appears to be caused by specific psychological problems, treating those problems will not treat the addiction-once addiction develops, it has its own life.

All drug abuse and addiction patterns interfere with a healthy and ethical life style. Drugs compete with healthy, natural inclinations, e.g. to take care of and nurture a child, to eat healthy food, to pursue artistic talents, or to be social and supportive with friends. Drugs are not only self-reinforcing, they also reinforce feelings and actions preceding the drug use, e.g. alcohol, when used in an anxious state, reinforces anxiety; heroin, taken after an unethical act, makes the unethical act seem acceptable, normal and natural. When addiction develops, family and loved ones suffer first; although life may become meaningless, the abuse behaviors are exciting and the addict feels mostly good. The European fairy tales about contracts with the devil, in which a poor man inadvertently sells his daughter or first-born to Satan, are metaphors for alcoholism.

Psychological addictions are similar to drug addictions, except that the good feeling is based on an inappropriately followed instinct or cultural behavior. Examples include eating because of boredom or for relaxation rather than because of hunger; gambling with the hope of "winning big", i.e. instantly becoming a wealthy, important person; seeking the physical excitement of sex in a non-loving relationship and/or with unjustifiable risk. Addictions may include significant, insignificant, or no physiological dependence, and drugs may lead to physiological dependence without being taken in an abusive or addictive way.

Addiction is a learned disordered pattern of feelings, thoughts, and behaviors. It involves many parts of the mind (or brain, nervous system). It can never be truly forgotten or unlearned, but when controlled or suppressed for an extended time, it is no longer "just below the surface", and the person leads a normal life. For people with a history of addiction, the danger of relapse is increased permanently. It appears that such learned behavior patterns stay side by side with other thought-behavior patterns but seem quite dominant even after not pursuing lapsing thoughts for over a year. With very strong positive motivation, people often stop addiction behaviors with little or no help, but they often relapse, when the motivation has weakened, or when there is major stress. Development and treatment of addiction may be compared to panic disorder. In panic disorder, a person who recently experienced major stress, may, in a potentially dangerous situation, slip into vicious cycles of catastrophic thinking with consequent adrenergic arousal symptoms. Once this reaction is learned, lesser and lesser triggers may start the disordered pattern. Studies showed, that if panic disorder is suppressed with benzodiazepine or antidepressant therapy, it is very likely to recur if the medication is tapered after nine months, but rarely reoccurs, if the medication is tapered after 18 months. Similarly, if a woman does not smoke for nine months because of pregnancy, she is very likely to relapse. Generally, the prognosis is best if positive motivation, psychological therapy and/or pharmacotherapy help to control or prevent the pathological responses for a long time.