FROM USE TO ADDICTION: THE STAGES OF A DRUG USE

This Is The First Story In A 13-Week Series That Will Focus On Drug
Addiction In South Central Alabama.

Two weekends ago, 200 people were arrested at Oak Mountain Amphitheater in
Birmingham while attending a Widespread Panic concert.

Charges ranged from underage drinking to possession of illegal drugs,
including marijuana, LSD, Ecstasy, Cocaine and Oxycontin. In addition, two
young ladies lost their lives - one died from a drug overdose and the other
committed suicide after consuming cocaine and ecstasy. But what causes
these incidents?

Why is it that drug use and addiction has seemed to be on the rise in
recent years? Recently, several professors of the Addiction Studies Program
at Wake Forest University School of Medicine held a spring workshop to help
answer these questions for journalists. "After the September 11 terrorist
attacks, three-fourths of states reported an increased demand in drug use
treatment," said Jack Strandhoy, a professor in the Department of
Physiology and Pharmacology at Wake Forest. "Everything changed in all
areas of America, not just in New York. But, to have a good discussion of
treatment, one must understand cause." Genetics sometimes may play a part
in drug addiction, but most individuals are not born addicts.

As individuals begin experimenting with drugs, they are not automatically
addicts. "What we have is casual use and abuse that at some point
transitions into disease," said Kent Vrana, associate professor at Wake
Forest. But finding the point at which the stage changes is not easily
discovered, and for many families and even doctors, not easily understood.
"Biology, psychology and genetics will play a role beginning at use but
sometimes these factors will help lead to abuse and addiction," said Vrana.
Dr. David Friedman, director of the addiction studies program, explained
that there are three stages that individuals may go through before becoming
an addict.

He said the first stage, drug use, is voluntary behavior that may not
necessarily have adverse consequences, and may even be socially condoned.
"There is a real basis to why people use drugs, such as a reward for hard
work. Many drugs produce pleasure and euphoria and are used as novelties.

Many drugs also relieve anxiety." Friedman said the second phase is drug
abuse. "Drug abuse is a voluntary behavior but at this stage, it deviates
from approved social patterns.

From here, it leads to drug addiction because drugs change behavior by
changing the brain." "Use, abuse and addiction sometimes get very
confusing," he explained. "It may go from a joint on the weekend to cocaine
all through the week." Friedman said that addiction begins with a loss of
control of drug-taking behavior, and that it is the loss of free will that
leads users to go from abuse to addiction. "Drugs change behavior by
changing the brain.

Free will is not absent because addicts can use free will in other domains
of their lives." He explained that the behavior of addicts and pain
patients often are similar, but that the major difference is that if the
pain is taken away, pain patients will stop using the drug because they can
function.

However, addicts reach a point where they can not function without the
drug. "Physical dependence is a change in the body that causes the body to
act normal only if the drug is there," Friedman said. "There are no outward
signs of blood tests that show one is an addict.

The single sign of dependence is to take the drug away and go from there."
He said the problem with dependence and withdrawal is that the addiction
remains even if the drug is taken away. "Physical dependence is a change in
the body that causes the body to act normally only if the drug is there.

The symptoms of withdrawal are usually the complete opposite of what the
drug does, and withdrawal sometimes can be very dangerous.

People used to die from alcohol withdrawal because of the risk of
seizures." But, many times, it is the psychological difference that can be
the toughest to battle, said Friedman. "The common symptom of all drugs is
craving, which is a psychological symptom.

Addicts have a feeling that they just can't live without the drug. "The
problem many times is that the drug becomes part of the lifestyle of the
user. For example, in the life of a cigarette smoker, nicotine is deeply
embedded in the life of the use. The behavior becomes a learned pattern and
has learned responses to an environment such as smoking in the car or while
on the phone.

There actually are behaviors that lead to craving," he said. Friedman also
explained that cocaine, at one time, was not considered addictive because
there is little physical dependence on it. However, the drug can be
addictive because it becomes a psychological addiction. But not everyone
who uses drugs will become an addict, and chances are, many of those
arrested at last weekend's event were not even abusers.

But what law enforcement, government agencies and families must do is
battle drugs from the beginning so that use may not turn into addiction.