DRUGS CHANGE ADDICTS' BRAINS

For all that has been written and spoken about addiction as a medical
disease, most people, including most physicians, understand little about
what draws people to drugs and keeps them hooked, often despite severe
consequences and repeated attempts to quit.

A better understanding of the pull and tug of addiction can help those who
are hooked and those who want the monkey off their backs for good.

The savings in life-years, quality of life and lost income can be huge, not
to mention the costs of drug-instigated crime and medical care. As of 2003,
$133 billion a year was being spent just on treating the short-term and
longterm medical complications of addiction, according to the National
Institute on Drug Abuse.

Among the many health consequences of addictions are sudden cardiac arrest,
irreversible kidney and liver damage, AIDS, fetal harm and many cancers,
including cancers of the lung, bladder, breast, pancreas, larynx, liver and
oral cavity.

That it is possible to become free of addictions and remain so is unquestioned.

Seeking Definitions

The nature of addiction is the same no matter whether the drug is cocaine,
heroin, alcohol, marijuana, amphetamines or nicotine. Yes, whether they
know it or not, chronic cigarette smokers and users of chewing tobacco are
addicts.

Every addictive substance, according to a 2003 report in The New England
Journal of Medicine, induces pleasant states or relieves distress.

Furthermore, the authors of the report, Dr. Jordi Cami and Dr. Magi Farre
of Barcelona, Spain, wrote, "Continued use induces adaptive changes in the
central nervous system that lead to tolerance, physical dependence,
sensitization, craving and relapse."

In other words, addiction is a brain disease, not a moral failing or
behavior problem. People do not deliberately set out to become addicts.
Rather, for any number of reasons -- like wanting to be part of the crowd
or seeking relief from intense emotional or physical pain -- people may
start using a substance and soon find themselves unable to stop.

Of course, not everyone who smokes a cigarette, be it tobacco or marijuana,
takes a drink, snorts cocaine or self-injects morphine is destined to
become an addict.

Most drinkers, for example, know when to stop before they become
intoxicated or tolerant to large amounts of alcohol.

Many people do not like the sensation of losing control and having their
feelings and actions determined by a drug. Others refrain from taking the
chance that trying a potentially addictive substance will lead to
dependence, and so never take a drink, a puff or a snort, or swallow pills
or inject a substance that is not medically indicated. Still others may be
protected by their genes. Most Asians, for example, carry a gene that makes
them physically ill and flushed before they can consume an addicting amount
of alcohol.

But genes can work two ways. The risk of addiction can be inherited. The
genetics of alcoholism have been well studied, and heredity accounts for
about 40 percent of the risk, though it is unclear whether what is
inherited is an underlying emotional disorder that drives people to seek
relief or a particular physiological reaction to addictive substances that
gets them easily hooked.

Dr. Nora D. Volkow, director of the drug abuse institute, told a conference
on drug dependency that she had never met a patient who wanted to be an addict.

"Sure," she said, "they start out wanting to take a drug. But the problem
is we don't know who will become addicted."

According to the Institute of Medicine of the National Academy of Science,
32 percent of people who try tobacco become dependent, as do 23 percent of
those who try heroin, 17 percent who try cocaine, 15 percent who try
alcohol and 9 percent who try marijuana.

Cami and Farre observed that personality traits like risk-taking and
novelty-seeking tendencies, as well as mental disorders, are "major
conditioning factors in drug addiction."

An increased risk of drug abuse has been associated with psychiatric
disorders like schizophrenia, bipolar disorder, depression and attention
deficit hyperactivity disorder, they wrote.

Changing The Brain

Writing in The Journal of the American Medical Association, Brian Vastag
said, "The brain changes during addiction."

Vastag explained that all drugs of abuse activated a pleasure pathway in
the brain, the "dopamine reward circuit," which is connected to areas that
control memory, emotion and motivation. Any activity that activates those
pathways reinforces the pleasurable behavior.

"Eventually," he wrote, "the dopamine circuit becomes blunted; with
tolerance, a drug simply pushes the circuit back to normal, boosting the
user out of depression but no longer propelling him or her toward euphoria."

By repeatedly supplying the body with the substance, a new state of
"normal" is created, causing the person to continue using the substance to
feel normal.

The changes in the brain, though not permanent, can be long lasting. Volkow
found that the dopamine system of cocaine users remained impaired for up to
three months after their last snort.

And despite years of abstinence, former addicts may experience intense
cravings when they are exposed to certain cues like drug use by a movie
character.

The Barcelona experts, in discussing the addiction mechanisms, noted,
"Long-term administration of addictive drugs produces alterations in the
brain that increase vulnerability to relapse and facilitate craving even
months or years after successful detoxification."

Those changes involve cognitive areas and drug-rewarding circuits.

Preventing Relapse

For someone who used drugs to relieve an emotional problem or psychiatric
disorder that was not otherwise treated, the temptation to revert to the
assuaging drug can be irresistible. Without follow-up treatment for both
the addictive disorder and the underlying mental illness, the chances of a
lasting recovery from addiction may be slim.

Further, there is clearly not one route to recovery. Some addicts manage to
kick their habits without any outside help; others require monthlong
inpatient programs and continued reinforcement, either professional or lay.
Still others may need a year of outpatient treatment plus aftercare. Many
former addicts find that support groups like Alcoholics Anonymous and
Narcotics Anonymous help them maintain their drug-free status.

Because prolonged exposure to abused drugs results in long-lasting changes
in the brain, "addiction should be considered a chronic medical illness,"
the Barcelona scientists said.

As with other chronic illnesses, including hypertension and diabetes,
addiction and its treatment require "long-term strategies based on
medication, psychological support and continued monitoring," they
concluded. In addition, other experts have suggested, treatment of
addiction should be fully insured with no limit on the number of visits
covered.