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Why Do People Get Hooked on Pills?

  1. Prevalence of Pill Addiction
  2. Prescription for Addiction
  3. Example: Jessica
  4. What is Going On "Inside" When People Get Hooked?
  5. Negative Reinforcement: Theory of Addiction
  6. Other Things That Keep People Hooked
  7. Common Myths About Drug Addiction
  8. Co-Occurring Psychiatric Disorders
  9. Treatment Options for Those Addicted to Pills

The Drug Addict Next Door

Imagine, for a minute, the typical drug addict. What type of image comes to your mind? Perhaps you pictured a person out on the street, nestled between two dirty trash cans, shooting up heroin or even smoking a dirty and stained glass crack pipe. If you pictured this or a similar image, you may be quite wrong.

The typical drug addict actually looks a lot like your neighbor, the high school student you hired to watch your children, or even the older lady you enjoy chatting with when you run into each other at the grocery store.

The Drug Addict Next Door


Prevalence of Pill Addiction

According to results from the 2014 National Survey on Drug Use and Health, which was conducted by the National Institute on Drug Abuse (NIDA), an estimated 52 million individuals (20% of those who are 12 years of age or older) were reported to have used a prescription medication for a nonmedical purpose on at least one occasion during their lifetime. [1] That is greater than the rates for heroin (1.8% of individuals 12 years of age or older), crack cocaine (3.6% of individuals 12 years of age or older), and MDMA or ecstasy (6.6% of individuals 12 years of age or older) combined. This means that the typical drug addict looks more like someone who has developed an addiction to prescription drugs.


Prescription for Addiction

addiction
No one taking an opioid pain medication prescribed by their doctor has the intention of becoming addicted. Indeed, there are a number of reasons why an individual may choose to take a pill for the first time. For instance, an individual may start taking opioids on the recommendation of their physician or health care provider for managing symptoms of severe pain following a surgical procedure. This originally benevolent intention may lead to a dependency after continuous use.

It is important to note that not all prescription medications carry elevated risk for the development of an addiction. Moreover, most individuals are taking their prescription medications as directed by their doctor and do not go on to become addicted.

The development of a drug addiction is a complex process that unfolds over time and involves multiple interactions between a person's biological make-up (e.g., genetics) and the environment (including quality of current relationships, socioeconomic status, history of trauma or abuse, and overall level of stress). [5]


Example: Jessica

Twenty-three year old Jessica became addicted to prescription pain pills after being first prescribed hydrocodone for managing pain following wisdom tooth extraction when she was 19. At the time, she was living with her step-father who was prescribed Percocet (which contains the highly addictive opioid pain reliever drug known as oxycodone) as part of his long-term pharmacological treatment plan for managing chronic symptoms of fibromyalgia pain.

While, initially, it was likely a well-intentioned gesture, Jessica's step-father inadvertently reinforced Jessica's path toward addiction by freely providing her with access to his pills when she had none available. Over time, Jessica's tolerance to the drug's effects increased and she began to need much more of the drug than the original recommended dose in order to achieve relief from symptoms of pain, which were likely the result of withdrawal.

It was clear Jessica's use of prescription pain pills had become a problem when her attempts to wean doses down on her own were generally unsuccessful. While she was highly motivated to stop using pain pills, Jessica also felt that she was constantly worried that she might overdose, given that she needed such large doses of the drug in order to feel its effects. She described her relationship with the drug as the first thing she thinks about when she wakes up and the last thing she thinks about as she goes to sleep at night.

What is Going On "Inside" When People Get Hooked?

Commonly abused prescription pills are comprised of chemicals that interact with the brain's circuitry in one of two ways.

  • The first group of drugs are able to alter the processes of the brain by mimicking naturally-occurring chemical messengers (neurotransmitters or other endogenous endorphins). The chemicals within these drugs trick the receptors of the brain, thereby activating the associated neurons in preparation for the transfer of information and, ultimately, sending out abnormal messages.
  • The second group of drugs also interact with these same chemicals; however, do so by signaling to the brain to release them in large quantities unnecessarily, or by blocking the natural process of recycling any excess chemical left within the synapse.

In both instances, the result is a chemical flood within the system. For example, the brain might experience an overflow of dopamine, which plays a role in the regions of the brain responsible for emotion, controlling movement, motivation, and modulation of pleasure and pain. As the brain is flooded with dopamine, the body's natural reward system is artificially activated, leading to a greater likelihood of repeating that behavior. [2]

Negative Reinforcement: Theory of Addiction

Given that these drugs produce sensations of intense pleasure along with temporary relief from any feelings of discomfort, they act as negative reinforcement for using the substance. In other words, negative reinforcement refers to the removal of unpleasant stimuli and, thereby, promoting the use of substances in the future in order to achieve relief from discomfort.

Other Things That Keep People Hooked

Reducing the number of risk factors that may contribute to ongoing substance abuse is critical to successful treatment. [8] For instance, individuals may have to separate themselves from their old social groups and form new friendship with individuals who don't abuse substances. Removal from any triggers for drug use is also important. Individuals who are recovering from drug addiction should also be sure that they closely monitor and manage their degree of stress, as this may increase the potential for relapse.


Common Myths About Drug Addiction

addiction2
Myth #1: Individuals who are addicted to drugs can stop at anytime. It is only a matter of willpower. Shortly after repeat exposure to a drug, several changes occur within the brain that can cause strong cravings when the drug is withheld and a compulsory urge to use again. [9] These alterations of the chemicals within the brain mean that, in most instances, individuals are much more successful if they receive some form of assistance in recovering from their addiction.

Myth #2: Substance addiction is a disease. Therefore, the individuals is doomed to substance abuse for life, because nothing can be done about it. While addiction to substances certainly affects the structures and function of the brain, this does not mean that the individual is powerless to change their condition. The brain made alterations in response to the presence of the substance, and these changes can be reverse through treatment.

Myth #3: Do not try to force an addict to go to treatment. They must want to get help first. It is not necessary for individuals to enter the treatment program on a volunteer basis in order for them to be successful.


Co-Occurring Psychiatric Disorders

A large portion of individuals who are addicted to pills also meet criteria for one or more concurrent psychiatric conditions. [10] More specifically, individuals who are addicted to pills are nearly twice as likely to also suffer from a mood or anxiety disorder. [11]


Treatment Options for Those Addicted to Pills

Addiction to pills is complex and involves the development of both psychological and physical dependence. As such, the most effective treatments for the disorder are those that address its complex nature. Medications may be prescribed for a recovering addict as a way to buffer the severity of withdrawal symptoms, while the individual's body undergoes detoxification from the drug.

Programs that provide behavioral modification therapy work with the recovering addict in a structured manner, in order for them to learn and practice skills necessary to function without the drug. Examples of therapeutic interventions for prescription pain pills include:


References:

  1. National Institute on Drug Abuse. 2014 National Survey on Drug Use and Health: Trends in prevalence of various drugs by age group, 2014. Online article available for access at: http://www.drugabuse.gov/national-survey-drug-use-health
  2. National Institute on Drug Abuse. DrugFacts: Understanding Drug Abuse and Addiction, 2012. Online article available for access at: http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction
  3. McCabe SE, Cranford JA, West BT. Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: Results from two national surveys. Addictive Behav 2008;33:1297-1305.
  4. Crabbe JC. Genetic contributions to addiction. Annu Rev Psychol 2002;53:435-462.
  5. Xian, H., Scherrer, J. F., Grant, J. D., Eisen, S. A., True, W. R., Jacob, T., & Bucholz, K. K. (2008). Genetic and environmental contributions to nicotine, alcohol and cannabis dependence in male twins. Addiction, 103(8), 1391-1398.
  6. Upadhyay J, Maleki N, Potter J, Elman I, Rudrauf D, Knudsen J et al. Alterations in brain structure and functional connectivity in prescription opioid-dependent patients. 2010;133(7):2098-2114.
  7. Younger JW, Chu LF, D'Arcy NT, Trott KE, Jastrzab LE, Mackey SC. Prescription opioid analgesics rapidly change the human brain. Pain 2011;152(8):1803-1810.
  8. Holmes D. Prescription drug addiction: The treatment challenge. World Report 2012;379(9810):17-18.
  9. Compton WM, Volkow ND. Abuse of prescription drugs and the risk of addiction. Drug Alcoh Dep 2006;83(1):S4-S7.
  10. US Department of Justice Drug Enforcement Agency: Drugs of Abuse. Online article available for access at: http://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf#page=38
  11. Brady KT, Verduin ML. Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Sub Use Misuse 2005;40:2021-2041.
  12. Dabu-Bondoc S, Shah AA, Effraim PR. Prescription drug abuse. Substance Abuse 2015:127-141.
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