What is drug addiction?


Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain - they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.



Why do people take drugs?


In general, people begin taking drugs for a variety of reasons:

- To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the "high" is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction.

- To feel better. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction.

- To do better. The increasing pressure that some individuals feel to chemically enhance or improve their athletic or cognitive performance can similarly play a role in initial experimentation and continued drug abuse.

- Curiosity and "because others are doing it." In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure; they are more likely, for example, to engage in "thrilling" and "daring" behaviors.



If taking drugs makes people feel good or better, what's the problem?


At first, people may perceive what seem to be positive effects with drug use. They also may believe that they can control their use; however, drugs can quickly take over their lives. Consider how a social drinker can become intoxicated, put himself behind a wheel and quickly turn a pleasurable activity into a tragedy for him and others. Over time, if drug use continues, pleasurable activities become less pleasurable, and drug abuse becomes necessary for abusers to simply feel "normal." Drug abusers reach a point where they seek and take drugs, despite the tremendous problems caused for themselves and their loved ones. Some individuals may start to feel the need to take higher or more frequent doses, even in the early stages of their drug use.



Is continued drug abuse a voluntary behavior?


The initial decision to take drugs is mostly voluntary. However, when drug abuse takes over, a person's ability to exert self control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.



Why do some people become addicted to drugs, while others do not?


As with any other disease, vulnerability to addiction differs from person to person. In general, the more risk factors an individual has, the greater the chance that taking drugs will lead to abuse and addiction. "Protective" factors reduce a person's risk of developing addiction.



What factors determine if a person will become addicted?


No single factor determines whether a person will become addicted to drugs. The overall risk for addiction is impacted by the biological makeup of the individual - it can even be influenced by gender or ethnicity, his or her developmental stage, and the surrounding social environment (e.g., conditions at home, at school, and in the neighborhood).



Which biological factors increase risk of addiction?


Scientists estimate that genetic factors account for between 40 and 60 percent of a person's vulnerability to addiction, including the effects of environment on gene expression and function. Adolescents and individuals with mental disorders are at greater risk of drug abuse and addiction than the general population.



What environmental factors increase the risk of addiction?


Home and Family. The influence of the home environment is usually most important in childhood. Parents or older family members who abuse alcohol or drugs, or who engage in criminal behavior, can increase children's risks of developing their own drug problems.

Peer and School. Friends and acquaintances have the greatest influence during adolescence. Drug-abusing peers can sway even those without risk factors to try drugs for the first time. Academic failure or poor social skills can put a child further at risk for drug abuse.



What other factors increase the risk of addiction?


- Early Use. Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs the more likely they are to progress to more serious abuse. This may reflect the harmful effect that drugs can have on the developing brain; it also may result from a constellation of early biological and social vulnerability factors, including genetic susceptibility, mental illness, unstable family relationships, and exposure to physical or sexual abuse. Still, the fact remains that early use is a strong indicator of problems ahead, among them, substance abuse and addiction.

- Method of Administration. Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense "high" can fade within a few minutes, taking the abuser down to lower, more normal levels. It is a starkly felt contrast, and scientists believe that this low feeling drives individuals to repeated drug abuse in an attempt to recapture the high pleasurable state.

Source: National Institutes of Health

Withdrawals Can Be Mild, Moderate or Severe
Alcohol withdrawal refers to a group of symptoms that may occur from suddenly stopping the use of alcohol after chronic or prolonged ingestion.

Not everyone who stops drinking experiences withdrawal symptoms, but most people who have been drinking for a long period of time, or drinking frequently, or drink heavily when they do drink, will experience some form of withdrawal symptoms if they stop drinking suddenly.

There is no way to predict how any individual will respond to quitting. If you plan to stop drinking and you have been drinking for years, or if you drink heavily when you do drink, or even if you drink moderately but frequently, you should consult a medical professional before going "cold turkey."

Withdrawal Symptoms:
Mild to moderate psychological symptoms:
Feeling of jumpiness or nervousness
Feeling of shakiness
Anxiety
Irritability or easily excited
Emotional volatility, rapid emotional changes
Depression
Fatigue
Difficulty with thinking clearly
Bad dreams

Mild to moderate physical symptoms:
Headache - general, pulsating
Sweating, especially the palms of the hands or the face
Nausea
Vomiting
Loss of appetite
Insomnia, sleeping difficulty
Paleness
Rapid heart rate (palpitations)
Eyes, pupils different size (enlarged, dilated pupils)
Skin, clammy
Abnormal movements
Tremor of the hands
Involuntary, abnormal movements of the eyelids

Severe symptoms:
A state of confusion and hallucinations (visual) -- known as delirium tremens
Agitation
Fever
Convulsions
"Black outs" -- when the person forgets what happened during the drinking episode

Liver Patients Offered a Lifeline
Jo Revill, Health Editor
Observer (London)
Sunday, January 2, 2005

The increasing number of middle-aged patients with chronic liver disease caused by heavy drinking is forcing doctors to look at new ways of saving their lives.

A pioneering trial to help seriously ill people will begin this month, using the patient's own cells to regenerate the organ. By injecting patients with their own stem cells, the basic 'building blocks' for all kinds of cells, doctors hope that the liver can regrow itself to a point where the organ starts to work again.

The trial is experimental, but follows other work which shows that stem cells have helped patients with heart failure. The dire shortage of donor organs for transplant has encouraged the specialists to think of new ways of helping patients who otherwise have a very bleak future.

One in 20 people in Britain is now dependent on alcohol and a similar number are at serious risk of liver disease. Physicians and government experts have warned that alcohol-related harm - severe liver disease and injuries caused by drink-related violence - are on the rise as the nation's drinking habits become heavier.

Deaths from liver disease in patients under 50 have risen sevenfold in the past 30 years and surgeons have warned they are seeing a growing number of patients with cirrhosis of the liver, a condition where the healthy liver tissue is gradually replaced by scarred, useless tissue. The disease is insidious, because apparently healthy people may have it without knowing and the first signs do not occur until a late stage of the disease.

When alcohol is drunk, it is quickly absorbed and passes in the bloodstream to the liver, where it can cause excessive fat to be deposited within the liver cells. Between 20 and 30 per cent of those who drink heavily beyond the initial stages of liver damage will develop alcoholic hepatitis, a condition which can be fatal. A smaller number, about 10 per cent, go on to develop cirrhosis. Although alcohol is the leading cause of cirrhosis, it can also be brought on by forms of hepatitis or by some toxic chemicals.

Scientists at Imperial College London believe stem cell therapy holds out enormous hope for those who need new organs. Professor Nagy Habib, head of liver surgery at London's Hammersmith Hospital, who is running the trial, said: 'The liver is a wonderful organ in the way it can regenerate itself, but if there is a lot of damage it stops functioning properly. If we can get 15 to 20 per cent of the organ regenerated, then that is enough to really improve the patient's condition. These cells seem to have the fantastic ability to become whatever is needed in order to repair the damage.'

By injecting the patient's own stem cells, taken from their blood, directly into the bloodstream, the researchers hope they may be able to improve the function of the liver by getting the stem cells to repopulate the liver.

The procedure, known as leukapheris, involves taking blood from a patient and then separating it into its component parts. The stem cells are taken from the white blood cells, while the red blood cells are returned to the body through the arm. Habib and his team then inject the stem cells into the hepatic artery, the vessel which goes into the liver.

Habib believes they have to look at all the potential cures. There are about 700 liver transplants in the UK each year, but 7,500 die annually from liver disease. Alcohol is the major reason for a transplant, followed by the virus hepatitis C. 'The demand for a transplant has really risen,' said Habib. 'We don't have the equivalent of a kidney dialysis machine for these patients, so unfortunately most of them will die while waiting for an organ.'

It is not yet known how many stem cells may be needed for the trial to succeed. The worse the patient's liver function, the more cells may be necessary. 'If you can provide 1 per cent of liver cell mass, and then allow that 1 per cent to grow over a three-month period, it's possible that the liver will have enough healthy cells to behave properly, and start to produce what it needs,' said Habib.

Like many specialists, he worries that people do not understand the damage that can be done by heavy, prolonged drinking. 'If people could see what life was like in the final stages of liver failure, they might think seriously about giving up at a much earlier point,' he said. 'The liver is a very forgiving organ, but there's a limit to how much alcohol it can process before the damage sets in.'

Pediatricians may be able to provide an additional service to the children they treat, by screening their parents for alcohol use. According to a study conducted by the Center for Adolescent Substance Abuse Research (CeASAR) at Children's Hospital Boston, parents are open to alcohol screening during their child's pediatric visit and to discussing drinking habits with a pediatrician. When a potential drinking problem arises, the pediatrician could provide educational materials about alcoholism, and refer the parents for evaluation or treatment. The findings are published in the November issue of Pediatrics.

"Pediatricians, with their commitment to child health, frequent interactions with parents, and close relationships with both children and families, have a unique opportunity to screen parents for alcohol use and refer them for further assessment and treatment," says Celeste Wilson, MD, researcher and pediatrician in the CeASAR program at Children's and lead author of the study.

In the multi-center study, 879 parents from three pediatric primary care clinic sites---rural, urban and suburban---were surveyed using anonymous questionnaires. The questionnaire included two brief alcohol screening tests and questions designed to assess parents' preferences for who should perform the alcohol screening, acceptance of the screening, and preferred interventions if the screening was positive.

Nearly 90% of all parents responding to this anonymous survey reported being open to being asked about their alcohol use at their child's pediatric appointment. Surprisingly, over 75% of parents with a positive alcohol screen also indicated acceptance of being screened for alcohol problems during the pediatric office visit. The top three preferred screening methods for parents, including those found to have alcohol problems, were direct conversation with the pediatrician, computer-based questionnaire, and paper-pencil questionnaire. The researchers believe that the endorsement of the pediatrician over screening conducted by other medical staff (e.g., nurse, medical assistant) results from an intangible, yet distinct, quality of the parent-pediatrician relationship.

While the parents' openness to alcohol screening at pediatric appointments was encouraging, the researchers are quick to point out some of the findings are cause for concern. Of the 879 parent participants, one out of every nine (11.5%) were found to have a positive alcohol screen; an alarmingly high number when considering recruitment for study participation was on a volunteer-only basis.

"It is possible that those parents who declined participation in the study were the ones with the most severe alcohol problems," says Wilson who is also an Instructor in Pediatrics at Harvard Medical School. "However, if this is true, our results represent an underestimate of the actual problem."

According to research, children of alcoholics are at increased risk for behavioral, cognitive and mental health problems. They are more likely to witness domestic violence, and have a greater chance of becoming victims of all forms of child maltreatment including neglect, physical abuse, and sexual abuse. Furthermore, children of alcoholics are 3 to 4 times more likely to have their own alcohol problems later in life.

"Given the negative consequences of growing up with an alcoholic parent, it is critical, for the future health and well being of the child, to identify and provide a pathway to assessment and treatment for the parent with an unhealthy pattern of alcohol consumption," adds Wilson.

Dr. Wilson and her colleagues suggest that to optimally treat patients, pediatricians must acknowledge the potential adverse effects of parental alcohol use on the child and embrace the concept that alcohol use should be addressed with parents during the clinic visit. When considering possible implementation strategies, they believe that an alcohol screening tool could be incorporated into a preexisting health survey and completed by the parent prior to their child's clinic appointment.

The study was supported by a grant from the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program. Dr. Wilson was supported by a faculty fellowship grant from The Center of Excellence in Minority Health and Health Disparities at Harvard Medical School.

Drug addiction dramatically shifts a person's attention, priorities, and behaviors towards a focus almost entirely on seeking out and taking drugs. Now, an animal study funded by the National Institute on Drug Abuse, part of the National Institutes of Health, has identified some of the specific long-term adaptations in the brain's reward system that may contribute to this shift. These long-lasting brain changes may underlie the maladaptive learning that contributes to addiction and to the propensity for relapse, even after years of abstinence from the drug. The study was published in Neuron on July 30, 2008.

Investigators from the University of California, San Francisco (UCSF) using an animal model of addiction, were able to distinguish brain changes in rats trained to self-administer cocaine, versus those animals that were trained to self-administer natural rewards such as food, or sucrose for several weeks. The investigators also were able to look at how much the "expectation" of receiving the drug influenced those brain changes by comparing rats trained to self-administer the drug versus animals who received the same amount of cocaine, but received it passively, i.e. they could not control their own drug taking by self-administration.

It has been hypothesized that persistent drug seeking alters the brain's natural reward and motivational system. The current study focuses on how drug seeking alters the communication between brain cells in this critical circuitry. In the normal processes of learning and memory formation there is a well documented strengthening of communication between brain cells, this process is known as "long-term potentiation" (LTP). The new study reports that LTP was similar in the rats that had learned to self administer cocaine, food or sucrose, but with a critical distinction. The increase in LTP due to cocaine persisted for up to three months of abstinence, but the increase in response to natural rewards dissipated after only three weeks. Importantly, the nature of the cocaine experience had a strong effect on the outcome, since rats exposed to cocaine when they did not expect it (passive infusions) displayed no LTP, neither transient nor long lasting. Finally, the study showed that LTP in rats that self-administered cocaine persisted after they were trained to stop drug self-administration behaviors. This indicates that, once established, it is very difficult to reverse the "memory trace" associated with drug reward.

"This research provides a better characterization of the variables, at the cellular, circuit, and behavioral level that contribute to the persistent nature of addictive disorders," said Dr. Elias A. Zerhouni, NIH director.
"The researchers were able to illuminate why drug related memories are so stable," said NIDA Director Dr. Nora Volkow. "Their persistence is highly refractory to new learning, which makes our jobs that much tougher, and reminds us that treatment must recognize and address the high propensity for relapse almost anywhere down the road."

"These results indicate that the LTP induced by self administered cocaine is more persistent than that produced by natural rewards, such as food; and that the LTP is not just a result of exposure to cocaine, but also is linked to the drug's effects and the animal's learning to obtain the drug," said Dr. Billy Chen, postdoctoral fellow at UCSF's Ernest Gallo Clinic and Research Center and lead author of the study. "These are important distinctions that will help us better understand how addiction develops, and why drugs can overshadow other natural rewards and become the mainstay of an addicted person's life."

In 2006, six million Americans age 12 and older had abused cocaine in any form. There are currently no medications for cocaine addiction, therefore standard treatments typically rely on behavioral interventions. However, relapse after treatment for cocaine addiction is common.

The most difficult challenge in finding substance abuse treatment for a loved one is how to know which programs have a proven track record. That is just one of the topics being discussed today at the conference "Blending Addiction Science and Treatment: The Impact of Evidence-Based Practices on Individuals, Families and Communities." Held at the Duke Energy Center in Cincinnati, the conference is hosted by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. It is part of NIDA's Blending Initiative, in which teams of experts create clinical tools based on the latest treatment research.

"It historically has taken almost 20 years for published research findings to be implemented into clinical practice," said NIH Director Dr. Elias A. Zerhouni "The Blending Initiative Products are designed so that research-based drug abuse treatment approaches can be easily disseminated into the community, and consequently, more quickly benefit people who are often in desperate need."

The Cincinnati meeting is the largest-ever Blending Conference, bringing together over 1000 leading addiction practitioners, health care providers, criminal justice professionals, researchers, and policymakers. Together they will explore how the latest findings from drug abuse research can fill the current gap between science and clinical treatment practices. Treatment providers will be introduced to new clinical tools that will in turn benefit thousands of substance abusers in the United States who are in need of help. The tools will also help families make more informed decisions about treatment programs.

Participants will learn about new treatment products that include:

MIA:STEP, a motivational interviewing assessment supervisory tool, tailored for clinical supervisors to train front-line treatment providers. It also includes a new package of tools designed to enhance patient engagement and retention.

"The Science of Treatment: Research Dissemination of Blending Team Products" CD Set. The printed CD inserts provide a brief overview of the NIDA research that led to the formulation of the Blending Team products, including training materials such as CDs, PowerPoint presentations, videos and other resources needed to facilitate the adoption of science-based interventions in community settings.

"Guide to Selecting, Evaluating, and Utilizing Evidenced-Based Practices." To be released in Fall 2008, this product is designed to help consumers and practitioners determine whether a treatment practice is "evidence-based," as well as whether an intervention is beneficial for specific populations and settings. It will include guidelines, frequently asked questions and an easy-to-use checklist. This year's conference will include sessions to highlight evidence-based psychosocial interventions and practices for engaging resistant substance users.

"The exchange of information in the Blending Conference has multiple benefits," says NIDA Director Dr. Nora D. Volkow." Not only can we rapidly share the latest research with community treatment providers, but we also gain the benefit of their wisdom and experience in the clinical practice arena."

The conference will also highlight the latest information on the role of stress in co-occurring psychiatric and substance use disorders; the link between traumatic brain injury and substance abuse; the impact of addiction on the family; the science of addiction and the brain; and treatment for special populations, including adolescents, women, African-Americans and patients with HIV.

Blending Products are created by Blending Teams, composed of NIDA researchers, community-based substance abuse treatment practitioners, and trainers from the Substance Abuse and Mental Health Services Administration's Addiction Technology Transfer Center Network. Blending team products and more information on the NIDA Blending Initiative can be accessed at http://www.drugabuse.gov/blending