Cindy West
The Gadsden Times

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."