Pleasure-Pain Hypothesis

In my blog entry, What Are The Causes of Addiction?, I wrote about an article that discussed four different theories. I decided to write about the first cause and my interpretation of that since I found the information to be so pertinent.

The first cause this article identifies is "the traditional view that drugs are taken first because they are pleasant, but with repeated drug use homeostatic neuroadaptations lead to tolerance and dependence, such that unpleasant withdrawal symptoms ensue upon the cessation of use". This statement seems aligned with what I discussed in my most recent blog about addicts initially choosing to use, but eventually their brains are damaged in such a way that it is no longer a choice. The withdrawal symptoms that occur following prolonged use can be both physical and mental torture, causing the addict to want or need to use again. Once a person becomes an addict, they are no longer using to feel good, they are using to stop feeling bad. There is an old adage that comes to mind to describe this phenomenon: "the person takes the drug and then the drug takes the person."

While this theory makes sense, there is a major flaw with it. If addicts are using primarily to escape withdrawal symptoms, then why would an addict relapse after they were already through the withdrawals. Relapse amongst addicts is common, even for those who have many years of sobriety. 

The article does not offer an explanation for this shortcoming in the theory, but I think there are likely multiple causes. While this cause affects a person who is in active addiction, there are clearly other factors that would cause a person with substantial time sober to relapse. In addition, there might be other factors related to why an individual would take addictive substances to begin with.  

Addiction and Free Choice Revisted

I revisited my blog entry, Addiction and Free Choice, and decided to break it down based on what I have learned since then.

The article states that addiction is a disease and that those who die from their addictions are sick people, rather than morally deficient. The author states that "an addicted person’s failures in the realm of choice are the product of a brain that has become greatly compromised". This statement makes a lot of sense to me after reading about brain scans and other studies that show differences in the brains of addicts and non-addicts. It is also an interesting paradox of sorts, because while the addict is choosing to use, their brains are not really capable of making any other choice. Although free-will may be present initially when the addict begins using, the article claims that is still not a reason to judge them later on. When compared to diabetes or cancer, both of which can be caused by a persons' decision to partake in unhealthy behaviors, it is apparent to me that we are dealing with a similar phenomenon. Just because an addict makes poor decisions by using potentially addictive substances, does not discount the fact that they develop a disease. When viewing addiction from this disease model, it is clear that despite whatever led to the addiction, some type of treatment or intervention is necessary for recovery. This is not just a moral, emotional, or spiritual issue- it is also biological. 

Sick or Sinning?

I found the following source during our in-class scavenger hunt. This article is extremely balanced and offers arguments on both sides of the biological vs. moral debate. I copied and pasted the parts of the article that apply to this issue, however left out big chunks of the article that discussed insurance and government policy issues. While that was all very interesting to read, I believe my paper is going in a different direction. 

Clemmitt, M. (2007, February 9). Combating addiction. CQ Researcher, 17, 121-144. Retrieved from http://0-library.cqpress.com.skyline.ucdenver.edu/cqresearcher/

Addiction is a compulsion — not only to use an addictive substance like tobacco or cocaine but also to gamble or even shop — despite serious negative consequences. Addicts generally feel a loss of control over their behavior, and many give in to their compulsions after quitting.

The brain rewards certain behaviors — such as eating sweet food or having sex — with an evolution-ensuring payoff: pleasure. Many scientists believe drugs like cocaine hijack that reward system, skewing the brain to prefer a drug to other experiences. But skeptics say it's not surprising that some people habitually seek a predictable, intense drug reward. Others point out that psychological problems or a stressful environment may predispose some people to develop addictions.

Nevertheless, “most people who try any drug, even heroin, use it only experimentally or continue use moderately and without ill effect,” according to analysts from the Drug Policy Research Center at the Rand Corporation think tank.  Only about 9 percent of marijuana users become clinically dependent on the drug, as do 15 percent of alcohol users, 17 percent of cocaine users and 23 percent of heroin users. But 32 percent of those who use tobacco — considered the most addictive substance — become addicted. 

Not all substance abusers remain addicted, however. In a long-term study of heroin addicts, for example, after 33 years just under half of the surviving participants said they'd been off heroin for five years or longer. At the same time, 11 percent of the original participants had died from a drug overdose; 10 percent from homicides, suicides and accidents — many probably related to drugs — and 7 percent from a chronic liver disease that afflicts injection-drug users. 

No one knows why only a small percentage of people become addicts or how best to help addicts kick their habits for good. “We basically know how to get people off drugs for a month,” says Alexandre B. Laudet, director of the Center for the Study of Addictions and Recovery at the New York City-based National Development and Research Institutes. “But we know there are people in recovery for 35 years.”

Finding out how to help kick addictions permanently is vital, not just for addicts but also for society, says David C. Lewis, a professor of medicine at Brown University. “When people get into treatment, crime costs and accident costs both dive,” he says. “A family's health-care costs also go right down within the first year or two, along with absenteeism” from work. A Brandeis University study found that addiction costs the American economy $400 billion a year. 

New neuroimaging techniques are enabling scientists to learn more about how addictive substances affect the brain, possibly eventually leading to new drugs or other treatments foraddiction. Recent studies have found, for instance, that:

• Stroke patients with damage to a particular brain area were able to quit smoking without experiencing cravings or relapse;
• Socially dominant monkeys are less likely to overuse cocaine than more passive monkeys;
• Drug addicts show impaired function in several brain regions that are important for distinguishing the relative value of different rewards and behaviors.

Researchers also have learned that social and personal environments can influence people in unexpected ways to either seek or avoid treatment, Laudet says. In a study of women addicts, for example, researchers initially thought husbands and boyfriends might reinforce women's efforts to kick drugs and encourage them to stay in treatment. Not so, one study participant said of her partner: “Actually, he likes me better when I'm high.” 

Americans have long debated whether addiction should be viewed as a disease or a moral choice. “We're really torn as a society on whether we want to help addicted people or punish them,” says Scott Kellogg, a psychotherapist and clinical assistant professor of psychology at New York University.

Advocates of the “disease” point of view note that current science shows high levels of drug use change brain function. They also cite the value of removing addiction's moral stigma so substance abusers will come forward and seek help. Opponents of the disease label argue thataddiction science remains fuzzy and that calling addiction an incurable disease robs abusers of hope that they can change.

Addiction is more serious than substance abuse and indeed qualifies as a disease, according to John T. Schwarzlose, president of the Betty Ford Center. “There is a well-defined criterion that distinguishes between the abuse of alcohol and alcoholism,” he said. “Once someone is addicted . . . there is a change, an alteration, of the neurochemistry of the brain. And you cannot go back once you've become addicted.” 

Actress Mariette Hartley, a long-time spokesperson for alcoholism recovery who wrote a book about her own struggle with alcoholism and depression, calls alcoholism “a self-diagnosed disease” in which sufferers realize they are powerless over their own desire to drink. For an addict, “it's very, very hard to try to drink like a normal drinker. I find it impossible,” she said. “A lot of people who've tried . . . desperately to control their drinking, can't physically control their drinking.” 

Most who see addiction as a disease view it as a “primary” disease — not a symptom of another medical or psychological condition — and believe it afflicts those who are “biologically susceptible,” according to William L. White, a senior research consultant for Illinois-based Chestnut Health Systems, a mental-health and substance-abuse treatment organization. “One either has or does not have the biological risk for addiction.” 

Laudet, of the Center for the Study of Addictions and Recovery, contends that addiction is not just a disease but a chronic disease — similar to diabetes and high blood pressure — characterized by a tendency to relapse if the sufferers go off their treatment.

“There is a behavioral component” to developing addictions, as with other chronic diseases, says Laudet. Addicts who relapse are like someone who has had a heart attack and goes back to eating unhealthy foods, she says. “But we don't blame people” with chronic disease for their relapses the way we do addicts who fall off the wagon, she notes. “As long as society — at least in the back of its mind — thinks addiction is a moral failing, it's very difficult to sell enhanced treatment.”

In fact, brain scientists are finding, among other things, that drugs change the brain and that different brain structures may give people different predispositions to begin or relapse into drug abuse.

Michael A. Nader, a professor at North Carolina's Wake Forest University School of Medicine, studies the relationship between brain function and behavior. Among his findings: Cocaine use changes the brains of laboratory monkeys, and socially dominant monkeys have fewer of certain neuroreceptors in their brains and are less prone to use large amounts of cocaine. This research and a series of other studies are showing that drug addiction “is at main a disease,” Nader says. “It's clear as day” that addiction is not the result of “some moral weakness.” 

The new science is “guilt-relieving,” says Brown University's Lewis, and may give people hope to continue or re-enter substance-abuse treatment instead of giving up because they think they are doomed to failure. The new findings allow people to see that a drug relapse, for example, “isn't 100 percent within their control, that people relapse despite their best efforts,” Lewis says.

He is quick to point out, however, that by calling addiction a disease scientists are helping people to better understand the condition — not trying to justify substance abuse or abuse-related bad behavior.

Furthermore, treating addiction as a “disease” may imply that it can be treated with drugs — such as methadone for heroin addicts — and “this creates controversy,” Lewis says. “Using a drug to treat a drug-related problem seems like a moral issue to some people.” In its “wishful, utopian view of itself, the United States is an abstinence-based society,” he says. “There can be almost religious overtones to abstinence only.”

Some critics of the disease model say that neurological research shows such wide variations in the way different substances affect brain structure and function that the science can't possibly lead to the conclusion that addiction is an actual disease.

In fact, “recent research on the effects of drugs points us toward the conclusion that . . . addictionhas little to do with what drugs contain, although it has a lot to do with what we think drugs can do to us,” according to New Jersey psychologist Stanton Peele, the author of several books on substance abuse.  This means that addiction is not a disease in which drugs alter brain structure in a way that forces addicts to seek more drugs, as some argue, Peele says.

Peele argues that brain research actually provides evidence that addiction is not a disease, because brain studies find different drugs acting differently in many different regions of the brain. Many neuroscientists “try to unify all drugs of abuse around their impact on dopamine,” which they “regard as the mediator of pleasure in the brain,” he says. But since other behaviors, like eating, having sex, winning a competition or being praised, also affect the brain's dopamine system, just as drugs do, “drug use cannot be distinguished from a hundred other activities.” 

Instead, Peele says the variety of responses to drug and alcohol use — some people growing addicted, some not, some breaking away from addiction on their own or with treatment — shows that “addiction is caused by environmental factors” that lead people to feel insecure or unhappy. Increasingly in modern society, people don't have a personal sense of “joy and competence,” according to Peele. Developing a regular, ritualized habit of using pleasure-producing substances like drugs and alcohol, often in a social situation, or engaging in activities like gambling, shopping, or overeating, provides “a soothing sensation that everything is all right,” Peele said. As such, it is experienced as a difficult-to-end addiction by people plagued with “uncertainty, self-doubt and anxiety.” 

Twelve-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous rely on two vital tools for recovery: mutual support and the acknowledgment that addicts are “powerless” to combat their addiction alone. But critics argue that most people who beat addictions do so without such groups and that the idea of being “powerless” over drugs or alcohol may make some people more rather than less likely to go on using.

Twelve-step programs insist that abusers keep up their participation in a program and help other recovering addicts, says former addict McDaid, the Washington lobbyist. “In treatment, they tell you, 'When you're not using, your addiction is doing pushups,' ” she says, so staying involved in a recovery group is a crucial source of ongoing support — even for addicts who are not currently using.

And helping other addicts keeps recovering abusers conscious of their own vulnerability toaddiction's dangers, says McDaid. “If I'm not working with new people, I'm much less likely to stay tuned in” to that fact, she says.

Most of the low-income addicts she knows who are kicking their habit say their success is due to mutual support and reliance on some higher power, says Laudet, of the Center for the Study of Addictions and Recovery, and “most go to 12-step” programs. Ex-addicts continually talk about the need for support from family and friends, and many are involved in churches. “People draw enormously on religion,” she adds.

Twelve-step groups also subscribe to the addiction-is-a-disease theory, says Brown University's Lewis. “They've always gravitated toward the medical explanation, in part because it's guilt-relieving.”

Addicts go to 12-step programs because they identify with the model of addiction presented by such programs, says psychotherapist Kellogg, at New York University. According to AA, addicts cannot control their response to the addictive substance, he says. “Some addicts respond to this idea very deeply, and others are troubled by it.”

Current science may be leaving some AA doctrine behind, Kellogg says. For example, 12-step groups have long stressed the “mysterious” nature of alcohol and its hold on addicts. “But scientists are finding now that relapses are very predictable.”

Some 12-step critics say that by emphasizing quitting “one day at a time,” 12-step groups let addicts off too easily. “American society at large is now the carrier of AA doctrines,” says Trimpey, always assuming there is a hidden reason for misconduct. This theory has contributed to a creeping national philosophy of powerlessness that makes addicts less likely to end their addictive behavior, he says.

By suggesting that an addict commit only to staying substance-free one day at a time, 12-step programs “inexplicably reserve the privilege of relapse,” says Trimpey, making it more likely that they will do so. That approach robs people of their belief that “they have free will, that humans have a choice in the matter.”

Saying “no” one day at a time gives the abuser an excuse for any future failures, so it doesn't have the good effect of saying “never,” Trimpey continues.

Mutual-help groups aren't needed to beat the most physically addicting substance, nicotine, which suggests that they aren't the answer for other addictions either, according to psychologist Peele.

Surveys indicate that nicotine is the most hard-to-quit addictive substance — harder than crack or alcohol, he wrote. “Yet . . . a large percentage (half or more) of people ever addicted to smoking have quit,” says Peele, most without any group work or treatment.

Historically, the debate has been characterized by ambivalence. For example, in an 1825 sermon, the Rev. Lyman Beecher, a Presbyterian clergyman and temperance leader, simultaneously dubbed uncontrolled drinking “a disease as well as a crime.” Were “any other disease as contagious . . . and as mortal, to pervade the land, it would create consternation,” Beecher said. Despite calling addiction a disease, however, he condemned intemperate drinkers as being “addicted to the sin,” and enmeshed in “an evil habit.”

In 1829, Boston-born physician William Sweetser wrote of alcoholism as both a medical and a moral problem. Chronic drunkenness has bad physical effects, creating a “morbid alteration” in most bodily structures and functions, and some alcoholics have inherited vulnerability to the problem, he wrote.

But he worried about the implications of the “disease” label. It's clear that chronic drunkenness “becomes a disease,” he wrote, but a “disease produced and maintained by voluntary acts.” Thus, he wrote, “should the opinion ever prevail that intemperance is a disease like fever, mania, etc., and no moral turpitude be afflicted to it, drunkenness . . . will spread itself even to a more alarming extent than at present.”

Similar ambivalence attended public views of other drugs. For example, women and higher-income Americans widely used opium-based drugs like morphine in the late 19th and early 20th century, and most had been introduced to the drugs by their physicians. In fact, most “opium eaters” were women, partly because doctors widely prescribed opiates for menstrual pain and menopausal symptoms. An 1885 survey in Iowa, for example, revealed that 63.8 percent of opiate users were female. Many opium users became addicted. A 19th-century adage attested to opium's power: “It is not the man who eats opium. It is opium that eats the man.”

But others fought the notion that addicts were powerless over drugs. “That the responsibility of taking the opium or whiskey . . . is to be excused and called a disease, I am not willing for one moment to admit,” wrote Chicago physician C. W. Earle, in the 1880s. “I propose to fight this pernicious doctrine as long as it is necessary.”

Today, brain imaging and other neuroscience research have revealed much about how some drugs operate, and decades of experience offer clues about what treatment techniques work. But the question of what addiction is and how best to deal with it remains cloudy.

“Addiction is a mystery, and it continues to be a mystery,” says New York University psychotherapist Kellogg, even though addiction knowledge has advanced substantially. “We're like the blind men and the elephant,” taking on an issue too complex for simple conclusions.

For instance, drug use may be different for different people, and “some drugs may have more biological issues involved,” he continues. “Because of genetics, perhaps, some substances may be more reinforcing for some people.”

Many different models exist, all with different consequences for how addicts and addiction are viewed, he says. For example, he says, there is a significant difference between the traditional “disease” model promoted by 12-step programs and the “medical” model pursued by neuroscientists.

Calling addiction a “disease” has been interpreted as saying, “once you're an alcoholic, you can never change, and it's impossible to control your alcoholism,” says Kellogg. “Many people experience that as true. They talk about their disease as a metaphor for the part of themselves that wants to keep drinking. It could be the brain, or a spiritual part of the self.”

Brain scientists may or may not buy that idea, but they have their own “medical” — or “pharmacological” model — whose key goal is to develop addiction treatments, especially anti-addiction drugs, Kellogg says. So far, studies show that chronic substance abusers are especially vulnerable, because there are changes in the brain that could increase the strength of drug cravings.

“Ten years ago, people believed everything was genetic,” says Brown University's Lewis. With time has come a different understanding. While everyone is born with certain inherited brain structures, “ 'genetic' is not a fixed entity,” he says. Increasingly, scientists believe vulnerability toaddiction is due to an interaction between genetic and environmental factors. Rather than being a disease that's biologically determined, “a 50-50 equation looks closer to the mark,” Lewis says.

Substance-abuse researchers hope neuroscience and behavioral research will yield new medications to treat substance abuse and a better understanding of what treatments help which people. But most agree that addiction's complexities will not be easy to crack.

Independent researcher Peele believes addictions arise mostly from social conditions that leave people feeling powerless and directionless and that addiction may be more prevalent in the coming decades. During speeches to parents around the country, he often asks if they think there will be more addicted kids in the future. “About 90 percent raise their hands,” he says.

Americans increasingly have been “medicalizing” more and more conditions, such as childhood hyperactivity, Peele explains. “In college, kids swap pharmaceuticals.” That all adds up to more future addiction, he predicts.

Others say it is more likely there will be a future boom in addiction treatments rather than a jump in addiction rates. Over the next decade more and better anti-craving medications will be on the market, says Brown University's Lewis. “The big pharmaceutical companies have figured it out, especially with alcohol. There are a lot of people out there who want these treatments.”

Meanwhile, the addiction-as-disease theory may extend to more behaviors, says Lewis. “I suspect that when the science is in, most similar things — like gambling — will show some of the same neuroceptor changes as drug addiction.”

“Gambling, sex and shopping will probably get in,” says New York University's Kellogg.

When it comes to treatment, today “we're stuck with the reality that everything works with somebody, and nothing works for everybody,” he says. While many who recover do so entirely on their own, many different kinds of help — from 12-step programs to medication — also seem to work for some people.

“We're seeing greater flexibility” in how treatment professionals and researchers view theaddiction and recovery landscape, he says. For instance, while it was once unthinkable, he predicts that the U.S. substance-abuse paradigm may slowly shift toward “an increased emphasis on moderation” in substance use, rather than immediate total abstinence. “It's kind of moving that way now,” he says.

Researchers will continue their quest to “tailor treatments” to the right people, says Laudet, at the Center for the Study of Addictions and Recovery. In the complex landscape of addiction, that's a top goal, but it will be difficult to reach, she says.

Ending social stigma so addicts are more willing to get treatment may be even more important, but that depends on the public — not on medical researchers, says Laudet. “If all of these people in respected roles in society could come forward and show a positive face of recovery, it would probably do more to change things than all the research we can do in our lifetimes.”

Early Maladaptive Schemas Influence on Addiction

http://0-www.ncbi.nlm.nih.gov.skyline.ucdenver.edu/pmc/articles/PMC3905522/
At the above website I found a very interesting study discussing the relationship between addiction and early maladaptive schemas. This study indicates that the cognitive make-up of individuals influences how their biology and environment will affect them.
I especially think the graph is useful in seeing visual representation of the differences between addicts and non-addicts.

Shaghaghy, PhD, Farhad, Majid Saffarinia, PhD, Mohadeseh Iranpoor, and Ali Soltanynejad. "The Relationship of Early Maladaptive Schemas, Attributional Styles and Learned Helplessness among Addicted and Non-Addicted Men."Millennium Web Catalog. Kerman University of Medical Sciences, 18 Mar. 2011. Web. 28 Mar. 2014.

Addiction is considered as one of the major problems in family and community in the world. According to the World Heart Organization (WHO) and the United Nations Office on Drug and Crime (UNODC) drug abuse is on the upswing.1

Social science and psychology researchers believe that studying the causes of people’s tendency to drug abuse is one of the requirements to reduce addiction. They assume that addiction is a multifactorial phenomenon divided into three categories including sociocultural, biological, and psychological factors.

Among these, psychological factors are very important. Psychologists believe that the effects of biological and sociocultural factors are affected by psychological trends.

According to cognitive view, organizing the experiences determines how to behave. Organizing the experiences is based on cognitive processes and any disruption in these processes can create behavioral, emotional and communicational problems.3

Cognitive theorists developed a new approach to treat a variety of mental health problems, including personality disorders and addictive behaviors, by focusing specifically on the development of dysfunctional schema that emerge during childhood.4

Early maladaptive schemas (EMSs) are chronically self-defecting emotional and cognitive patterns that develop early in life. They are the causes of many psychological disorders. Maladaptive schemas and inefficient ways the patient learns to adapt with others often lead to chronic symptoms of anxiety, depression and substance abuse.5

Based on the revised model of learned helplessness theory, another factor that increases a person's vulnerability is attributional style which means how individuals explain different events. It means that when individuals encounter an unpleasant and uncontrollable event, they are interested in recognizing the cause. Abramson states three indexes for this issue namely internal/external, stable/unstable, and specific/global. Therefore, if a person attributes a bad event to a stable, internal, and global cause, it can result in learned helplessness (LH)

Comparing means of attributional styles of addicts and non-addicts showed significant differences between optimistic and pessimistic attributional styles, i.e. addicts were more pessimistic and developed LH more. Although these findings are consistent with studies conducted by Haj Hosseini, and also Garcia et al.,20,21 Fletcher did not find a significant difference between addicts and non-addicts in terms of attributional styles.6 and his findings indicate that LH is related to relapse to addiction after treatment. He stated that pessimistic addicts were more likely to return to substance abuse.6 We also found a direct relationship between LH and successful addiction treatment. Therefore, addicts who suffered more from LH were less successful in treatment and more likely to relapse to substance abuse.

Pearson correlation between EMS and pessimistic attributional style in addicts revealed positive relationships between pessimism and defect/shame, dependence/incompetence, and emotional inhibition schemas. Therefore, more pessimistic addicts had more sever schemas. In addition, Pearson correlation between LH and EMS in addicts indicated direct relationships between LH and entitlement, emotional inhibition, dependence/incompetence, failure, defect/shame, social isolation, abandonment, and emotional deprivation. These findings are consistent with Aimee’s research which found dependence/incompetence schema related to LH.4 Similarly, Hoffart and Sexton, and Tarquinio also suggested that since emotional deprivation, mistrust/abuse, social isolation vulnerability to harm and compliance were related to pessimism, schema therapy would lead to increased optimistic attribution.22,23 Likewise, Tilden and Dattilio, and Hoffart et al. found a positive relationship between pessimistic attributional style and EMS in depressed individuals and many couples with marital problems.24,25

At the end, according to what was mentioned in this study, addicts have more cognitive problems in comparison with non-addicts. Therefore, it is necessary to pay more attention to cognitive factors in addiction treatment to increase the success rate of the treatment.

Conclusion

Our study showed that addicts suffer from high levels of early maladaptive schemas. They had a more pessimistic attributional style. Moreover, addicts who developed higher levels of learned helplessness were less successful in addiction treatment and more likely to use drugs again after treatment. These issues show that addiction institutions and therapists have to pay attention to cognitive factors for addiction prevention.

Causes and Risk Factors Associated With Addiction

This article, which I found on the same site as the article in my previous blog, provides support for the biological disease model of addiction. It discusses how brain chemistry is literally changed due to repeated drug use.

Nordqvist, Christian. "What Are The Causes of Addiction?" Medical News Today. MediLexicon International, Mar. 2009. Web. 27 Mar. 2014. <http://www.medicalnewstoday.com/info/addiction/what-causes-addiction.php>.

Doctors say there is a link between the repeated use of an addictive substance and how the human brain experiences pleasure - its use has a nice reward, leading to further and more frequent use. The addictive substance, be it nicotine, alcohol or some drug actually causes physical changes in some nerve cells in the brain. Another name for a nerve cell is a neuron. Neurons release neurotransmitters into the synapses (empty spaces) between nerve cells, which are received by receptors in other neurons.

What is a neurotransmitter - it is a chemical that a nerve cell releases, which thereby transmits an (electric) impulse from one nerve cell to another nerve cell, organ, muscle, or other tissue. Put simply, a neurotransmitter is a messenger of neurologic data from one cell to another cell.

Tolerance increases

After a while, the user of the potentially addictive substance does not get the same pleasure and has to increase the dose - his/her body’s tolerance to it increases.

Eventually, the user no longer experiences pleasure from the substance and takes it simply to prevent withdrawal symptoms - taking the substance just makes them feel normal.

Experts say that when tolerance increases, the risk of addiction is much greater.

_________________________________________________________________________________

The following article, also from the same webpage, lists several risk factors to addiction:

Nordqvist, Christian. "What Are The Risk Factors for Addiction?" Medical News Today. MediLexicon International, Mar. 2009. Web. 27 Mar. 2014. <http://www.medicalnewstoday.com/info/addiction/risks-of-addiction.php>.

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Although anybody, regardless of age, sex or social status can potentially become addicted to some substances, there are certain factors which may increase the risk:

• Genetics (family history) - anybody who has a close relative with an addiction problem has a higher risk of eventually having one themselves. It may be argued that environmental and circumstantial factors that close family members share are the prominent causes.
• Alcoholics are six times more likely than non-alcoholics to have blood relatives who are alcohol dependent. Researchers from the Universidad de Granada, Spain, in a study revealed that "the lack of endorphin is hereditary, and thus that there is a genetic predisposition to become addicted to alcohol".
• Geneticists believe that the reason some people try cigarettes and do not become smokers, while others do so very quickly is probably linked to the type of genes we inherit from our parents. Some people can smoke once in a while, throughout their lives, and never seem to become addicted, while others are unable to stop smoking without experiencing the unpleasant withdrawal symptoms. It is most likely that the way the receptors on the surface of our brain nerve cells respond to nicotine is influenced by our genes.
• Gender - a significantly higher percentage of people addicted to a substance are male. According to the Mayo Clinic, USA, males are twice as likely as females to have problems with drugs.
• Having a mental illness/condition - people with depression, ADHD (attention-deficit hyperactivity disorder) and several other mental conditions/illnesses have a higher risk of eventually becoming addicted to drugs, alcohol or nicotine.
• Peer pressure - trying to conform with other members of a group and gain acceptance can encourage people to take up the use of potentially addictive substances, and eventually become addicted to them. Peer pressure is an especially strong factor for young people.
• Family behavior - young people who do not have a strong attachment to their parents and siblings have a higher risk of becoming addicted to something one day, compared to people with deep family attachments.
• Loneliness - being alone and feeling lonely can lead to the consumption of substances as a way of copying; resulting in a higher risk of addiction.
• The nature of the substance - some substances, such as crack, heroin or cocaine can bring about addiction more rapidly than others. For example, if a group of people were to take crack every day for six months, and another identical group of people were to drink alcohol every day for the same period, the number of crack addicts at the end of the six months would be a lot higher than the number of alcoholics. For some people trying a substance even once can be enough to spark an addiction. Crack, also known as crack cocaine or rock, is a freebase form of cocaine that can be smoked.
• Age when substance was first consumed - studies of alcoholism have shown that people who start consuming a drug earlier in life have a higher risk of eventually becoming addicted, than those who started later. Many experts say this also applies to nicotine and drugs.
• Stress - if a person’s stress levels are high there is a greater chance a substance, such as alcohol may be used in an attempt to blank out the upheaval. Some stress hormones are linked to alcoholism.
• How the body metabolizes (processes) the substance - in cases of alcohol, for example, individuals who need a higher dose to achieve an effect have a higher risk of eventually becoming addicted.

A Broad View of Addiction

I found this website today and it has several interesting articles. This particular article discusses addiction on a more broad scale. It briefly mentions non-chemical addictions, but I am more interested in the physical substances which is the focus of this article.

Nordqvist, Christian. "What Is Addiction?" Medical News Today. MediLexicon International, Mar. 2009. Web. 26 Mar. 2014. <http://www.medicalnewstoday.com/info/addiction/>.

People with an addiction do not have control over what they are doing, taking or using. Their addiction may reach a point at which it is harmful. Addictions do not only include physical things we consume, such as drugs or alcohol, but may include virtually anything, such abstract things as gambling to seemingly harmless products, such as chocolate - in other words, addiction may refer to a substance dependence (e.g. drug addiction) or behavioral addiction (e.g. gambling addiction). 

This article focuses mainly on addiction to physical substances. 

In the past addiction used to refer just to psychoactive substances that cross the blood-brain barrier, temporarily altering the chemical balance of the brain; this would include alcohol, tobacco and some drugs. A considerable number of psychologists, other health care professionals and lay people now insist that psychological dependency, as may be the case with gambling, sex, internet, work, exercise, etc. should also be counted as addictions, because they can also lead to feelings of guilt, shame, hopelessness, despair, failure, rejection, anxiety and/or humiliation. 

When a person is addicted to something they cannot control how they use it, and become dependent on it to cope with daily life. 

A habit may eventually develop into an addiction

Many of us can use substances or become engaged in activities without any significant problems. Some people, however, may experience damaging psychological and/or physical effects when their habit becomes an addiction. 

What is the difference between a habit and an addiction?

• Addiction - there is a psychological/physical component; the person is unable to control the aspects of the addiction without help because of the mental or physical conditions involved.
• Habit - it is done by choice. The person with the habit can choose to stop, and will subsequently stop successfully if they want to. The psychological/physical component is not an issue as it is with an addiction.

Put simply - with a habit you are in control of your choices, with an addiction you are not in control of your choices. 

Addiction to substances or activities can sometimes lead to serious problems at home, work, school and socially. 

The causes of addiction vary considerably, and are not often fully understood. They are generally caused by a combination of physical, mental, circumstantial and emotional factors. 

Addiction, often referred to as dependency often leads to tolerance - the addicted person needs larger and more regular amounts of whatever they are addicted to in order to receive the same effect. Often, the initial reward is no longer felt, and the addiction continues because withdrawal is so unpleasant. 

According to Medilexicon's Medical Dictionary: 

Addiction is Habitual psychological or physiologic dependence on a substance or practice that is beyond voluntary control. Withdrawal has many meanings, one of which is A psychological and/or physical syndrome caused by the abrupt cessation of the use of a drug in an habituated person.

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association: 

Substance dependence is When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders..

The Addict

The following source has a definition for the term addict that I found to be quite fitting:

"Addict." Gale Encyclopedia of American Law. Ed. Donna Batten. 3rd ed. Vol. 1. Detroit: Gale, 2010. 94. Opposing Viewpoints in Context. Web. 26 Mar. 2014.
"Any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or who is so drawn to the use of such narcotic drugs as to have lost the power of self-control with reference to his or her drug use."

The following source outlines how addiction occurs biologically:
"Introduction to Addiction: Opposing Viewpoints." Addiction. Ed. Louise I. Gerdes. San Diego: Greenhaven Press, 2004. Opposing Viewpoints. Opposing Viewpoints in Context. Web. 26 Mar. 2014.
"Craving, increased tolerance, and withdrawal were considered clinical evidence of this dependence. Craving involves an intense desire for the drug, tolerance means that the user needs more and more to achieve the high, and withdrawal is the physical and mental suffering that occurs when drug use is discontinued."
"Drug research revealed that drugs mimic or block the brains neurotransmitters in the reward center and take over the brain's dispensing of the reward—the good feeling people get when they eat or have sex. Psychology professor Alice M. Young explains: 'Drugs such as alcohol, nicotine, heroin and cocaine may short-circuit the natural reward pathways that have evolved to ensure that we engage in activities critical to our survival.' Thus, in order to get the "reward," the good feeling people often attribute to being high, people must continue to use the drug."

Interviewing Addiction

In class we came up with questions we would ask our topic. The following will all be interesting subjects for me to look in to. The interview questions cover "who", "what", "where", "when", and "why".

Who is afflicted?
Who recovers?

What defines addiction?
Is it just chemical dependence?

When did addiction begin?
When does use become addiction?
Is there a point of no return from addiction?

Why does it occur?

Question For Kyle

If you refer to my previous blog entry "Questions to Explore Further", do you see any areas I might be overlooking? The questions I listed are issues I would like to delve in to deeper, but I don't want to miss anything. Thanks a bunch!

Biological vs. Behavioral

This source provides interesting information about the biological and behavioral models of addiction.

"Introduction to Addiction: Opposing Viewpoints." Addiction. Ed. Jennifer A. Hurley. San Diego: Greenhaven Press, 2000. Opposing Viewpoints. Opposing Viewpoints in Context. Web. 20 Mar. 2014.

"Throughout history, the prevailing attitude toward addiction has been one of disapproval, even repugnance. Addiction was seen as a personal failing, one that resulted from moral weakness and a lack of discipline. At best, addiction was a bad habit, at worst, a sin. Although addiction has not entirely lost its stigma, an increasing body of scientific research has improved people's understanding of and sympathy for the problem. One major development in addiction research is the theory that addiction is primarily a biological phenomenon."

"Drug use—along with other potentially addictive activities such as gambling or sex—causes the brain to release dopamine, a chemical involved in experiencing pleasure. This surge in dopamine can be so powerful that it compels users to keep taking the drug. With prolonged use, however, drugs can alter the brain so that experiencing pleasure without the drug is nearly impossible. At this point, drug use does not raise dopamine levels or produce a "high"; instead, the user keeps taking the drug to stave off painful withdrawal symptoms such as fever, cramps, violent nausea, and depression."

"Based on their research of how drugs affect the brain, scientists have theorized that people who are deficient in dopamine may be more likely than others to become addicts. George Koob, a professor of neuropharmacology at the Scripps Research Institute in La Jolla, California, contends that the neurotransmitter systems affected by drug abuse may already be abnormal in people who are susceptible to addiction."

"But while most people agree that biology plays some role in addiction, experts on addiction are generally separated into two camps: those who believe that addiction is a biological disease with behavioral aspects, and those who believe that addiction is primarily a behavioral problem that is sometimes influenced by biology."

"The latter group maintains that labeling addiction as a medical condition creates a false assumption that addicts have no control over their own behavior. In the view of this group, people become addicts because of their behavior, not their brain chemistry. Neal Williams, a critic of the notion that biology is responsible for addiction, says that 'the disease concept is so popular [because] it gives people an easy way out. They believe that they inherited their addiction, therefore they're not responsible for their own behavior'."

"Other critics question whether scientific research has proven that addiction is biological. Stanton Peele, a vociferous opponent of the belief that addiction is a disease, contends that the disease model of addiction is flawed for a number of reasons. First, he claims, most people who take drugs do not become addicted, but may take drugs for a period of time, then stop when they choose to do so. For example, most smokers who successfully kick their addiction to nicotine—a drug purportedly more addictive than heroin—rely solely on willpower to do so. Second, Peele challenges the theory that dopamine is responsible for addiction. He states, "The wide range of activities that stimulate the pleasure centers of the brain—including sex, eating, working, chocolate—should alert us that these brain theories tell us nothing about differences in behavior, let alone addiction.... Chocolate stimulates the pleasure centers, but only a few people compulsively eat chocolate or sweets. Apparently, stimulation of the pleasure center is only one small component in the entire addiction syndrome."

"The two contrasting perspectives on addiction—biological versus behavioral—influence debate over the appropriate way to treat drug addicts and alcoholics. Those who believe addiction is a disease generally favor a treatment plan that includes both counseling and medications. Moreover, they maintain that abstinence is the best way to break an addiction to drugs or alcohol. In contrast, opponents of the disease model insist that many addicts recover without any type of psychological or medical intervention—and that some are able to moderate their intake of drugs or alcohol. In the following chapters—What Factors Contribute to Addiction? Is Addiction a Serious Problem? How Should Addiction Be Treated? How Should the Government Deal with Addiction?—Addiction: Opposing Viewpoints provides a variety of perspectives on the nature of addiction, and offers opposing views on the treatments and policies proposed to control this troubling problem."