DRUG ADDICTION MAY BE BRAIN DISORDER, NOT MORAL FAILING

Is drug addiction a moral failure or a psychological and physiological
condition?

Phrased another way, do people become addicted and stay addicted to drugs
because they are morally weak or have no willpower, or is there a clear
medical condition behind addiction?

Registered nurse Sharon Douglas had every motivation to quit drinking. She
had two children, and she was putting her career at risk. Those were
incentive enough to make her quit for up to six months, but then she would
stop drinking again. "I thought I was amoral," Douglas said. "I was brought
up in the Catholic religion. I thought, 'What's wrong with me?' I really
thought I was mentally ill. I thought I was beyond help or hope."

David Friedman believes that people can become mentally and physically
dependent on drugs. Friedman is professor at Wake Forest School of
Medicine's Department of Physiology and Pharmacology in Winston-Salem, N.C.

"It is believed widely by society that drug addiction is a moral failure,"
he said. "If you look at it that way, somebody who is an addict probably
should end up in jail. I mean, all they need to do is get their act
together, right?

"However, the evidence has been increasing -- and increasing incredibly
rapidly over the last decade or so -- that addiction is not an ethical or
moral or minor behavioral problem, one of bad choices," Friedman said.
"Instead, it's a brain disorder."

Studies in the 1930s proved that chimpanzees preferred morphine injections
to food, which showed a psychological dependence.

Although ancient cultures used the raw ingredients of the drugs we know
today - such as the coca leaf, from which cocaine is made - they didn't get
the physiological reaction that we understand as "getting high."

"Technological advances have allowed us to extract drugs in purer forms,"
Rochelle Schwartz-Bloom said. Schwartz-Bloom is a professor at Duke
University Medical Center's Department of Pharmacology and Cancer Biology
in Durham, N.C.

"Furthermore, the marijuana grown in the 1960s was different from what is
grown today because growers over the years have taken the best of the
plants to get a higher concentration of THC, the active ingredient in
marijuana," Schwartz-Bloom said. "It makes all the difference in the world
as how users are continuing to use. We're fine tuning it to get more bang
for the buck."

Friedman describes drug use as a voluntary behavior that might be socially
condoned and does not necessarily have adverse consequences. People use
drugs because the drugs produce pleasure, they relieve anxiety and they are
something new to try, he said. Drug abuse is also a voluntary behavior, but
abuse is defined as drug use that deviates from approved social patterns;
for instance, people accept someone who drinks socially but tend to not
accept someone who gets very drunk at every social event. Abusing alcohol,
nicotine or illegal drugs might not have any bad effects on the abuser.
"But all drug addicts pass through a period of drug abuse before they
become addicts, so it is still risky behavior," Friedman said.

The immediate effects of abused drugs include intoxication, which is a
feeling of euphoria and well-being; sedation or stimulation; the reduction
of anxiety; sometimes hallucinations; and toxicity. Toxicity results if the
dose is too high - this usually occurs when the person is tolerant. The
neuroadaptations, or the ways the brain is changed, include tolerance and
physical dependence.

The body has certain set points, such as temperature and blood pressure. If
something changes those points, the body adjusts. For instance, if the body
gets too cold, it shivers to raise its temperature, and if it gets too hot,
it sweats to cool itself down. When a person stands, his blood pressure
falls, and his heart rate increases to compensate. Those changes are called
homeostatis. "Tolerance is a homeostatic response," Friedman said.

Addicts are tolerant - they need more of the drug over time to achieve the
same effect. This increases the chances that they will become both
physically and psychologically dependent on the drug.

"Tolerance is common across most abused drugs," Friedman said. "Bigger
doses (needed to produce the same feeling) are one of the risk factors
before becoming addicted."

Physical dependence on a drug occurs when the body functions normally only
in the presence of drugs or alcohol. "You can't see it except when the drug
is not present; then the body goes through withdrawal," Friedman said.
"Cells change their metabolic machinery to deal with the effects of drugs.

"You can be physically dependent on drugs (so that you would suffer
withdrawals if you abstained) and still not be an addict," Friedman said.

A person becomes physically dependent on a drug when the drug has changed
the way his brain works. The person's brain learns to work differently
while the person is using drugs and cannot immediately return to the way it
was before drug use.

Psychological dependence occurs when drug taking becomes central to a
person's life, when the user considers the drug to be necessary for
continued well-being, Friedman said.

A drug can cause little physical dependence but great psychological
dependence. Alcohol creates both great physical and psychological
dependence, while amphetamines produce little or no physical dependence but
create a great deal of psychological dependence.

Drug addiction is characterized by loss of control of the drug-taking
behavior. There is an overwhelming compulsion to take drugs, and the person
will ignore adverse social and medical consequences to continue using,
Friedman said.

Drug addiction is a chronic, relapsing disorder, meaning that it lasts a
long time and people who are trying to quit are prone to start using again.

The chemical changes in the brain that are caused by drugs affect the
prefrontal cortex, the area of the brain that controls higher reasoning,
and the limbic system, the older part of the brain that controls more
primitive functions. "Drugs alter the function of the brain structure that
is crucial for survival," Friedman said.

Drug addicts still have free will, but it is impaired. Free will is
necessary for recovery to occur.

People who are treated for serious, chronic pain normally don't become
addicted, even though they are using the same drug another person uses for
recreation, leading to addiction. "The chronic pain patient however, can
become dependent, which is different from addiction," Schwartz-Bloom said.

Pain patients experience the same immediate effects of the drug and undergo
some of the same changes in their brains, but their reasons for using the
drug are different, so what they learn from the changes is different.

"Some people take a drug to relieve pain so they can live a normal life,"
Friedman said. "Drug addicts do it to get high and avoid a normal life."

There is not only a chemical process involved in becoming addicted, but
also a learning process. Those chimpanzees became physically addicted to
morphine, but their brains also learned that when they took morphine, they
received pleasure. The most basic, scientific behavioral studies show that
lab rats will learn to press a lever to receive food. Humans are the same
way: if they receive pleasure from an action, such as taking drugs, their
brains learn to repeat the action to keep getting the pleasurable result.
Friedman offers this argument as to why addicts can't just quit using: "If
the brain is an organ of the mind and controls behavior, then drugs change
thoughts, feelings and behavior by changing the way the brain works. If
those changes are enduring, then addiction is a brain disorder."