Addiction is pretty straightforward for most people – someone uses drugs or drinks too much, becomes addicted, wants to stop. If that were the case, there’d be no need for much treatment; just detox and abstain from use, right?
That’s not the case. Addiction is far more than some physical dependence on a chemical. In fact, the substance itself is more of a symptom than the disease itself. Recognizing this distinction is paramount for proper treatment and recovery.
The Physical Changes in the Brain
The first step in regular use is chemical change. The brain develops new neurotransmitters and pathways that weren’t there before. When someone experiences a high level of reward in response to something, it’s likely that the neurobiological pathways already existed. However, when someone uses drugs or alcohol, they change.
For example, the mesolimbic reward pathway – a series of brain regions connecting to a dopaminergic nucleus – become pathologized in response to sustained and repeated use and no longer responds appropriately to naturally occurring rewards like food, socialization, and accomplishment.
Substance-induced highs are often accompanied by excessive dopamine release – much more than natural rewards can provide. Over time, the brain adjusts by releasing less dopamine as well as creating fewer receptor sites to which dopamine can bind.
While these changes are physical manifestations that continue to keep individuals addicted even when they stop using immediately post-recovery, this does not explain why people begin using in the first place or why they revert when detoxed. Once you’ve gotten the chemicals out of your system and stabilized brain chemistry, what’s left?
People escape to substances and learn to rely on them because nothing else can provide that high stimulation response they need. But it also fails to acknowledge what’s going on beforehand – why addicts so desperately want to escape in the first place.
Psychological Causes of Addiction
When people talk about negative development in childhood, it’s not usually about substance abuse; however, childhood trauma plays a direct role in our ability to cope with stress and emotion regulation.
If someone grows up in an abusive household – beaten, neglected, sexually abused – or even witnessed domestic violence or was in a chaotic household, the chances of developing an addiction in their future rise significantly. Over 60% of adults report experiencing at least one childhood trauma.
Therefore, when someone grows up without learning coping mechanisms – if they learn they’re even allowed to have feelings at all – substance use fills that void. Add that many mental health issues go comorbid with addiction – at least 27% of people diagnosed with an anxiety disorder also have substance abuse problems – and critical symptoms go unaddressed over time.
For example, someone with severe anxiety naturally cannot cope well; if they find that alcohol or another depressant takes the edge off their constant psychological turmoil, they’re likely going to keep using that to manage.
Thus, at a New Jersey addiction treatment center, professionals recognize mental health issues play a vital role in recovery as much as the addiction does. Substance use and mental health problems become comorbid conditions that still require diagnoses and treatment but instead of accommodating one action over another, therapists primarily treat both together.
For example, simply stopping using alcohol without addressing depression has established a recipe for relapse; when life becomes unbearable again without any alternatives, people are going to turn back to their vices.
Environmental Factors of Addiction
The environment also dictates how and why addiction develops and sustains itself. Are you always stressed? Poverty makes housing instability compounded by food insecurity enough to cause anyone stress each and every day; therefore, the occasional release through substances seems to make sense.
Furthermore, what do your friends do? If everyone you know uses drugs or other substances or drinks excessively, it’s normalized; in other words, excessive use crosses a threshold into concern once it becomes socially unacceptable instead of just heavy partying.
That’s not to say these friends should always remain friends post-recovery – sometimes the best thing someone can do is cut ties – but breaking away from a social network almost certainly means you’re losing out on community.
Access also becomes a problem – if drugs are easily accessible – i.e if doctors give out prescriptions for opioids to those who request them without much scrutiny, addiction is more likely.
Culture also dictates how people perceive substance use and mental health conditions; if compounded with shame or guilt rather than as an illness needing treatment, people are less likely to recover because they’re less likely to get help, or seek it out too late.
Genetic Predisposition
Genetics play a huge role; research shows that approximately 40-60% of substance use disorders involve genetic components. If parents or siblings have addictions, children are predisposed as well. Precipitative genetics include weak resistors to impulse control or errors in chemical regulation.
In other words, if certain people are predisposed to receive greater effects from use or respond poorly without developing effective coping mechanisms through normal growth and development – even if they get clean years later – they’re much more likely.
Two people can take the same substance in the exact same fashion; for one it works and for one it’s terrible – but initially there’s no way to know.
Although epigenetics also matter (genetics account for 50% but they also prove susceptible depending on environment), the propensity enables researchers to understand why some can use casually while others cannot.
Trauma
Trauma deserves its entire section because post-traumatic stress disorder (PTSD) boasts strong overlaps with substance abuse; if a doctor treats one but not the other – and both symptoms overlap daily – recovery involves relapse stressors.
PTSD changes how people respond and appreciate safe spaces; when someone has unresolved trauma – with counseling costs far exceeding access – it becomes impossible to understand vulnerabilities where PTSD diagnosed individuals become constantly hypervigilant.
Substance use offers a relief response that’s psycho-somatic; over time, veterans may develop substance abuse issues without exploring their trauma from military service; abused individuals may seek sexual avenues as an adult with kids who don’t realize those triggers emerge halfway through an alcohol-induced bout of depression on the couch.
Therefore, it’s not the substance that’s a problem but rather symptomology without solutions found from adequate mental health provision and sometimes geographical relocation away from triggers where adequate ACA recommendations fail.
Why “Just Say No” Fails
It’s a lack of willpower – which makes sense when recognizing all these factors. Just say no? Is it that simple? No! When one’s brain has changed due to chemicals beyond their control compounded by psychosocial trauma and failure during childhood to learn coping mechanisms – including community connections despite relapse-triggering conditions – it’s a recipe made for disaster.
Treatment requires change for those who never learned change over time; this means coping skills learned through treatment after addressing underlying issues with access between time spent receiving medication assisted treatment for stabilization vs stabilization equals time lost leveling out other symptoms.
When professional empathy addresses relapse through medication-assisted treatment (stabilizing brain chemistry necessitating other contributing factors) and approaches comprehensively redefining trauma assessment, emotional regulation skill set development while teaching coping skills over time promoted by support reduces isolation, making friends is key.
Furthermore, different people recover at different rates; some people need three weeks others need three months. Some substances are too drastic to overcome without learning how life should be instead of just learning substance free living.
Outpatient programs only work when people have the best supports; sometimes residential support works best when rehabilitation elements allow separation from outside triggers.
Everyone’s timelines differ depending on their lived experience. Whether this is someone having childhood trauma in their past contributing to their issues, or other health conditions which have exacerbated their use of substances.
Recovery is possible – but it’s only possible due to recognizing how it’s not about the substance but rather connected conditions that create it as such.
