What causes addiction, and why is it so hard to treat? - Judy Grisel — Transcript

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1. 0:06As of 2021, more than 36 million people worldwide
2. 0:11were estimated to be experiencing substance abuse disorder.
3. 0:15This condition spans a spectrum of patterned drug use
4. 0:19that causes issues in a person’s life.
5. 0:22At the more severe end of the spectrum is substance addiction.
6. 0:25To understand why some people are more susceptible to addiction
7. 0:29and why it can be so difficult to treat,
8. 0:31let’s take a look at how addictive drugs affect the body.
9. 0:36When someone repeatedly uses an addictive substance,
10. 0:39their brain may adjust to account for its regular presence.
11. 0:44This is called tolerance; it diminishes the drug’s effect
12. 0:47and means more is required to produce the same experience.
13. 0:52Alcohol, for instance, increases the transmission of chemical messengers
14. 0:56like endorphin and GABA,
15. 0:58which promote sensations of pleasure and calmness.
16. 1:02When someone uses alcohol frequently, their brain will adapt to its presence.
17. 1:06So when they don’t use it, their brain receives fewer signals
18. 1:10from those pleasure- and calm-inducing neurotransmitters,
19. 1:14which impacts their energy and mood.
20. 1:17In addition to the unique effects each addictive substance has,
21. 1:20all of them alter the release of dopamine
22. 1:23in a brain region called the nucleus accumbens.
23. 1:27This area is part of the brain’s reward pathway,
24. 1:30which is sensitive to experiences that give us pleasure
25. 1:33and drives us to repeatedly seek them out.
26. 1:36The reward pathway is essential to our well-being—
27. 1:39but addictive substances also exploit it.
28. 1:42When someone is repeatedly using a substance
29. 1:45and their body has adapted to its presence,
30. 1:47they may develop dependence
31. 1:49where the drug is necessary for them to function comfortably.
32. 1:53Meanwhile, repeated use can decrease the influence of the brain’s cortex,
33. 1:57which is responsible for driving deliberate decision-making
34. 2:01and limiting impulsive behaviors.
35. 2:03And it can increase the influence of the brain’s subcortex,
36. 2:07which is crucial in habit-learning and impulsivity.
37. 2:11Together, these changes can make someone feel a lack of control
38. 2:15over how they’re using a substance.
39. 2:18This can mean suffering in other facets of their life
40. 2:21and taking risks to continue using it.
41. 2:24If the substance leaves their system, their body's equilibrium is disrupted,
42. 2:29so they may experience cravings that motivate thoughts and behaviors
43. 2:33of seeking and using the drug.
44. 2:35And if they continue without the substance,
45. 2:37they may experience withdrawal.
46. 2:40Opioids, for example, relieve pain and induce sedation.
47. 2:44Withdrawal from them causes heightened pain, anxiety, and insomnia.
48. 2:49The faster a drug reaches the brain and stimulates the reward pathway,
49. 2:53the more addictive it is.
50. 2:55For example, heroin and morphine have similar effects,
51. 2:59but heroin’s chemical structure enhances its ability
52. 3:02to penetrate the blood-brain barrier and bind to specific receptors.
53. 3:07This makes it faster acting and more addictive than morphine.
54. 3:12Meanwhile, compared to nicotine patches and gum,
55. 3:15regular and electronic cigarettes are more addictive
56. 3:18because smoking and vaping deliver nicotine to the brain fastest.
57. 3:24Depending on their chemical structure and mode of delivery,
58. 3:27drugs vary in how addictive they are—
59. 3:29but people also vary in how susceptible they are to substance use disorder.
60. 3:35Scientists think this is due to a mix of life experiences
61. 3:39and genetically inherited traits,
62. 3:41though neither predetermines addiction.
63. 3:44Trauma and mental health conditions appear to make people more susceptible.
64. 3:48And, overall, using addictive substances before 18
65. 3:52is considered a strong risk factor.
66. 3:55This is in part because the reward pathways of younger brains
67. 3:59are especially sensitive.
68. 4:01Many of the genetic factors at play remain unknown,
69. 4:04but some genes do seem to track with certain substance use disorders.
70. 4:09For example, specific genes increase the risk for nicotine addiction
71. 4:13by making certain receptors more sensitive to nicotine
72. 4:17and withdrawal from it more difficult.
73. 4:19At the same time,
74. 4:20some genes actually make people more resistant to substance use disorders,
75. 4:25such as genes that slow the breakdown of alcohol,
76. 4:28leading to unpleasant side effects that make people less interested in drinking.
77. 4:33In fact, one drug that treats alcohol use disorder
78. 4:36operates with this very mechanism.
79. 4:39Detoxing from a substance the body has become dependent on
80. 4:42can be extremely difficult.
81. 4:44And in some cases, abruptly quitting can also be physically risky,
82. 4:49so it isn’t always advised.
83. 4:51Beyond detoxing, quitting is often a long-term process.
84. 4:55It’s aided by treatment plans that prioritize
85. 4:58addressing underlying conditions;
86. 5:00developing new associations with experiences
87. 5:03previously linked with drug use;
88. 5:04and creating safe, supportive environments.
89. 5:08Ultimately, both addiction and recovery are the results of a brain
90. 5:12with an incredible ability to adapt from experience.