Young children twirl around in circles until they are dizzy and then fall to the ground, laughing and feeling giddy. Moments later they jump up and do it again. A teenage boy becomes nervous and anxious as he builds up the courage to ask a girl out on his first date. After school, he races home to excitedly tell his friends about his experience. On the same day, one person wins the lottery while another loses her job. Every day, people have experiences that alter their mood and feelings. Some experiences cause subtle changes in mood, whereas other experiences cause tremendous mood changes.
Drugs use can have similar effects because they produce changes in mood by stimulating or depressing natural brain chemicals called neurotransmitters. Neurotransmitters are naturally occurring chemicals in the brain that are necessary for the transmission of nerve messages in the nervous system. Some neurotransmitters cause nerve messages to travel quickly, whereas others help to slow messages down. Neurotransmitters are responsible for the normal activity of the brain, including emotions, thinking, perception, and behavior. Consider a person being robbed at gunpoint.
Because of the danger involved, it is likely that both the thief and the victim will experience an increased heart rate, shortness of breath, a trembling sensation, muscle tension, and a surge in energy. The victim might describe her feelings as anxiety and fear. In contrast, the thief may describe his feelings as excitement and power. Their interpretation of the experience is different, hut both may experience the same symptoms and signs caused by a rapid release of certain neurotransmitters. The body tries to remain in a state of homeostasis or balance.
With a healthy diet and life-style, the body may be able to keep these neurotransmitters in balance. However, severe elevations or depletions of certain neurotransmitters cause anxiety, depression, psychosis, mania, and other psychiatric problems. A drug is capable of having an effect on a person’s emotions, thinking, perception, and behavior precisely because of its ability to exert an effect on these neurotransmitters. Thus drugs are able to mimic psychiatric problems such as anxiety, depression, psychosis, and mania.
Certain drugs are also able to inhibit psychiatric problems. For example, alcohol decreases anxiety, and stimulants temporarily reduce depression. Drugs also can cause euphoria. Drugs such as crack cocaine or ice amphetamine cause a particularly stimulating euphoria. Drugs such as heroin cause a euphoria that includes an absence of pain and problems. Other drugs such as LSD do not cause euphoria as much as they provoke changes in perception, thinking, and consciousness that many people find pleasurable.
The types of drugs that are most commonly abused are psychoactive drugs. Psychoactive drugs are chemicals, substances, and medicine that have a generally rapid effect on people’s mood, emotions, behavior, and thinking. For example, changes in mood include stimulation, sedation, and euphoria. Behavioral changes can include an acceleration or retardation of movement or activity (Habib, Bhuiyan, Hossain and Lovejoy 30). Changes in thinking can include a speeding or slowing of thinking, as well as delusions, hallucinations, and illusions.
Some medications such as antidepressants are able to modify people’s mood after several days or weeks, but are not considered psychoactive because they do not cause rapid or euphoric changes in mood. Thus, medications such as antidepressants can be described as mood regulators. Similarly, antipsychotic medications cause normalization of the thinking process but do not cause rapid mood alteration or euphoria (Macmaster 2005). Why do people use drugs? There is no single answer to this question. Many people use drugs to experience the euphoria.
Some people experiment with drugs once or a few times and never go any further. Other people use drugs to help deal with social interactions, to decrease anxiety or pain, or to fight insomnia. Athletes may use stimulants or steroids for performance enhancement. Factory workers may use stimulants to stay alert or depressants to drown out the drudgery. Whatever the reason, the user experiences a temporary change in brain chemistry and subsequent changes in mood, emotion, thinking, and behavior.
Drug abuse is defined as the use of psychoactive drugs in such a way that it seriously interferes with a person’s life, including physical, psychological, occupational, legal, educational, spiritual, or social functioning (Macmaster 2005). The key concept regarding drug abuse is evidence of impairment. This impairment can include a family fight, working while hung over, or spending rent money on cocaine. Drug abuse also includes behaviors that are risky or hazardous, such as driving or taking care of children, while intoxicated.
In these cases, people are making poor decisions that can easily lead to disaster: they are taking drug-induced risks. Drug use includes a wide range of behaviors. At the low end of the continuum, a person becomes intoxicated, experiences a hangover, dislikes it, and never uses any drug again. At the other end, an individual experiences a pattern of drug-induced impairment over many years. Thus, some people experience drug abuse patterns, whereas others have only rare drug abuse experiences. Fortunately, most people who abuse drugs “grow out of it,” often in response to adverse consequences caused by the drugs.
What Is Addiction? People who are addicted often say: “I’m not addicted; I only drink on weekends. ” Others say: “I can’t be an addict; I only smoke marijuana, and you can’t get addicted to marijuana. ” Still others claim: “I’m not an addict; I don’t use nearly as much as she does! ” (Macmaster 10). Many people mistakenly believe that addiction relates primarily to how frequently the drug is being used, what type of drug is being used, the amount of drug being consumed, or how long a drug has been used. Although these are important factors, they do not define addiction.
Rather, addiction can be described as a progressive, chronic, primary disease that is characterized by compulsion, loss of control, continued drug use despite adverse consequences, and distortions in normal thinking, such as denial. Addiction is a progressive disorder. If addiction is untreated, it generally gets worse, not better. Spouses who wait for their husbands to “get better” will eventually notice that the severity of the addiction will worsen over time, not go away. In medicine, the word chronic is the opposite of acute, the latter word meaning having a rapid onset and a short course.
Although addiction may have a rapid onset for some people, it is generally of long duration. Thus, addiction is described as chronic. Addiction is a primary disorder. Addiction is described as primary, meaning it is not merely the symptom of some other medical or psychiatric problem such as anxiety. Other problems (such as anxiety) may be the reason for someone’s initial drug use. But once the process of addiction begins, the addiction is viewed as a primary disorder that requires treatment as a separate and independent problem. Addiction involves craving and compulsion.
Compulsion is the overwhelming preoccupation, desire, or drive to use a psychoactive drug. This compulsion may take the form of obsessive thinking about the next drug use experience or planning to obtain additional drugs (Clayton and Lacey 1982). Drug compulsion may take the form of simple drug hunger or of drug-seeking or drug-hoarding behavior. Addiction invariably involves the loss of control over drug consumption or loss of control over drug-induced behavior, or both. Because the loss of control worsens over time, people in early stages of addiction may have some control over their drug use, but the control generally fades with time.
There are exceptions, such as maintenance alcoholism. In addition to uncontrolled drug use, loss of control may emerge as the loss of control over drug influenced behavior such as impulsive actions, verbal or physical violence, and impulsive sexual behavior. Continued use despite adverse consequences. A hallmark feature of addiction is the tendency for continued drug use despite adverse consequences. Drug-induced problems, such as arrest for driving while intoxicated, would prompt many people to stop or alter their drug use.
In contrast, addicted people literally can’t “just say no,” and continue to use drugs despite job loss, family trauma, or health problems. The most common distortion in thinking caused by addiction is denial. Denial can take many forms: denial that a drug problem exists, denial that the problem is severe, and denial that help is required. People with addiction generally deny that the adverse consequences they experience are caused by their drug use. Rather, they often believe that they use drugs because of these problems. Denial is not the same as lying.
When applied to addiction, denial is an unconscious defense mechanism that protects people from the harsh reality of their addiction. People who deny what others can plainly see may honestly believe what they say. Addicted people can lie, but the denial process itself is not purposeful lying (Weisner and Schmidt 1993). Addiction can affect every aspect of people’s lives: their physical, cognitive, psychological, emotional, social, and spiritual health. Because addiction is progressive, these areas of functioning also progressively worsen. Impairment in each of these areas has a particular pattern of symptoms and time course.
Drug-induced deterioration of physical health is often a gradual process, measured over years. Thus, physical health is often the last aspect of health to deteriorate, but the first to return to normal. In fact, physical recovery after detoxification often makes people feel that they are “cured,” prompting them to leave treatment against medical advice. Cognition refers to reasoning, judgment, intuition, memory, and perception. Examples of impaired cognition include intoxication, short-term memory problems, periods of amnesia, deterioration of concentration, and various neurological problems.
Impairment of cognitive health can be short-term and long-term. Addicted people often perceive their environment inaccurately. They may distort what they hear, misperceive what they see, and misinterpret events around them. Mild symptoms include irritability and frustration. Severe symptoms include suspiciousness, paranoia, and delusions. The emotional health of addicted people is often characterized by extremes; negative emotions are frequent. They are often filled with anger, hate, and resentments. Addicted people may lack love, joy, warmth, and intimacy.
They may not have experienced hope in a long time, which is something that should be nurtured during the treatment and recovery process. Addicted people’s social health often deteriorates rapidly. As drug cravings become stronger, the quest for social interactions weakens. Old friends may be ignored and replaced by drug using acquaintances. As the addiction progresses, problems at work, with the family, and with friends will progressively worsen. Legal and financial problems may emerge or escalate. For people with addiction, life is centered around obtaining, using, and recovering from the effects of drugs.
They may feel disconnected from others, no longer a part of their world. They may feel that their lives are without meaning and that there is no higher or spiritual purpose to their lives. They may feel that there is no power greater than themselves to which they can turn for help. If a husband and wife are both tall, anxious professional chefs, there is an increased likelihood that their children will become tall and anxious and will know how to cook. The influence on the children is both hereditary and environmental. Similarly, there are factors that increase the likelihood or probability of drug use, abuse, and addiction.
Addiction risk factors are not guarantees of future addiction; they are rather predictors and indicators of potential addiction. Psychiatric problems may play several roles in the development of addiction. Such problems are often the reason for initial drug use, as well as a reason to maintain drug use. For example, people may drink alcohol to reduce panic and anxiety symptoms. Although there is no evidence of an “addict personality” that leads to addiction, there is a cluster of personality traits that result from addiction, such as low stress tolerance, negative self image, inadequacy, isolation, and depression.
Early antisocial, delinquent behavior such as conduct disorder is associated with early drug abuse and addiction. Poor academic performance and a lack of educational commitment are also associated with an increased likelihood of abuse. Abuse often follows a period of negative attitudes toward self and others, social involvement with other troubled peers, and evidence of socially unacceptable behavior to achieve self-worth and gratification. Parents and other family members can increase the likelihood of children’s drug use and abuse through modeling and example.
There is an increased chance for abuse and addiction when children can see that other family members abuse alcohol and other drugs and personally accept this behavior. Inconsistent parental discipline, lack of family warmth, and having parents who lack parental skills are all associated with early involvement with alcohol and other drugs. A recent study noted that parental alcoholism influenced adolescent substance use through stress and negative affect, through decreased parental monitoring, and through increased temperamental emotionality (which was associated with heightened negative affect) (Macmaster 2005).
Similarly, children are influenced by their peers’ use of alcohol and other drugs, as well as by their peers’ attitudes regarding use. Adolescents who have friends with access to alcohol and other drugs have increased exposure and, thus, an increased probability of becoming users themselves. Adults are often influenced by their peers as to which specific drug they choose. It has long been known that there is a genetic component that influences the likelihood of becoming addicted to alcohol after drinking it.
For instance, sons and daughters of alcoholic individuals are three to four times more likely to develop alcoholism than people without a family history of alcoholism. Similarly, addiction to other drugs is also associated with a family history of alcoholism (Greenfield and Weisner 6). A family history of addiction is one of the most influential factors, suggesting a high risk for developing addiction. Initially, psychoactive drugs are often used to self-medicate frustration, tension, anxiety, depression, and social pressures.
Also, adolescents experiment with drug use out of curiosity, for peer bonding, as an act of defiance, and out of boredom. Initial drug use may occur in the home under the supervision of a parent or sibling. Initial drug use and abuse are governed by areas of the brain concerned with logic and rationality. During this phase, the behavior controls the drugs. As the adolescent “crosses the line” into addictive use, the drugs control the behavior. At this point, the drugs affect the more primitive areas of the brain, which in turn control the addictive behavior.
Adolescents experience three progressive stages of addiction: early-stage, intermediate-stage, and advanced addiction. As the addiction progresses, developmental maturation is progressively impeded, the number of adverse consequences increase, and the negative consequences become progressively more severe. Young people who drink, smoke or use illicit drugs are generally unremarkable, simply because use of these substances is common. There is, however, evidence from the USA, Britain and elsewhere that individuals whose drug use is heavy or problematic frequently have educational problems.
These include truancy and early departure from full-time education (Milliam 12). There is abundant evidence that heavy drinking and illicit drug use are associated with crimes, including violent crimes (Morrison 1990). In spite of much extensive research no clear causal relationship has yet been demonstrated. An association may imply many things. The frequently noted link between alcohol, other drug use and crime certainly involves the disinhibiting effects of drugs. In addition, this association also involves other factors such as the characteristics of criminals, heavy drinkers and drug users and situational or environmental factors.
No psychoactive drug is able to generate criminal behaviours when consumed by individuals who are not otherwise likely to engage in such acts. Psychoactive, mood-altering drugs are consumed specifically because they alter the central nervous system and thus alter mood, thinking, and behavior. Stimulants cause mental and behavioral stimulation, sedative-hypnotics cause sedation and sleep, and psychedelics alter sensory perception. High-dose, long-term drug use causes the intensity of drug induced symptoms to increase. Indeed, the symptoms may become severe enough to become psychiatric symptoms.
Thus, intense use of stimulants can cause anxiety, agitation, and paranoia; intense use of sedative-hypnotics can cause depression; and intense use of psychedelics can cause symptoms similar to those of psychotic disorders (Miller, Dackis and Gold 1987). The symptoms caused by psychoactive drugs may appear identical to symptoms and signs of various psychiatric disorders. However, psychiatric disorders that are not drug related have a different course and often a different treatment. In particular, drug-induced psychiatric symptoms are generally short-lived and temporary, whereas psychiatric disorders are often chronic and long lasting.
For example, anxiety, depression, and thought disorders are often chronic problems that require prolonged and intensive treatment. In contrast, symptoms of anxiety, depression, and disordered thinking caused by stimulants, depressants, and psychedelic drugs, respectively, generally fade as the drug effects fade. Treatment for such problems may range from supportive counseling to medical management, depending on the severity of the symptoms, the dosage of the drug ingested, and the psychiatric stability of the individual. Drug withdrawal can cause psychiatric symptoms in much the same way that drug use can.
In general, drug withdrawal symptoms are the opposite of the effects of those drugs. For instance, withdrawal from stimulants is a period of depression, lethargy, and agitation. In contrast, withdrawal from depressants is a period of anxiety, tension, and agitation (Bachman and Wadsworth 12). Just as anxiety and depression can be symptoms of withdrawal, they can also be symptoms of psychiatric disorders such as panic disorder and major depression. For this reason, withdrawal from stimulants and depressants can mimic psychiatric disorders.
Thus, health care professionals should be immediately informed of the relationship between the current symptoms and recent drug use if the individual is brought to a medical setting during a withdrawal syndrome. Psychiatric symptoms such as depression and anxiety are uncomfortable and cause personal distress. Some people who experience psychiatric disorders try to diminish their symptoms with psychoactive drugs. Although addiction is not the result of people self-medicating their psychiatric symptoms, self-medication may sometimes be the reason for initial drug use.
For instance, some people may use alcohol to diminish the symptoms of anxiety and agitation. Someone else may be prescribed a sedative-hypnotic such as a benzodiazepine for the same purpose. The drug consumption of some of these people may progress to addiction. Addiction is not the only possible cause of erratic, impulsive, and dysfunctional behavior. In fact, various psychiatric, behavioral, and emotional problems can cause the same type of defense mechanisms (e. g. , denial, projection, and minimization) and maladaptive behavior (e. g. , anger, isolation, and lying).
For this reason, psychiatric disorders may cause behavior that is similar to the behavior of addicted people. For example, people with untreated bipolar disorder may experience disturbing episodes of mania and depression that are similar to some aspects of stimulant and depressant use. More importantly, the crises and psychosocial problems with family, friends, and employers caused by psychiatric disorders are similar to those caused by addiction. Addiction and drug use are nothing new. Drug use and addiction affect every group at every level in our society.
In the United States, one out of four people has a parent, child, or sibling who is addicted. Lost productivity, illness, premature death, and health care expenditures are all part of this picture, as are costs associated with motor vehicle accidents and with crime and incarceration. The emotional and social damage is immeasurable. Abuse of alcohol and drugs disrupts personal development, relationships, and families, corrupting the very fabric of society. Addiction to nicotine is a problem of massive proportions, and the difficulty of shaking that habit is familiar to millions.
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