The Addicted Brain: What's in This Book, and Why Should I Read It?
"I'm only 14 years old and I'm in a drug counselor's office. I've been stealing, missing school, and failing most of my subjects. It seemed to start when I got involved with drugs. We got dope from older brothers and sisters, from parents' medicine cabinets, and on the streets. We never thought of it as 'doing drugs.' We were just having fun and hanging out, and we thought we could stop anytime. But we fooled ourselves. It caught up to us big time. Now I need to find out about what happened and what I can do to turn my life around. I need to know everything!"
Getting hooked on drugs is a sequence of attraction, seduction, compulsion, and pain. Drugs are dangerous and widespread, and dealing with them requires knowledge and help. This book is about alcohol, nicotine, and illegal drugs—how they work, what they do to the brain, and what can be done to stop using them. The book is especially about what happens inside the brain and why the brain just happens to be set up for drugs. Yes, the brain is set up for drugs; the brain is a co-conspirator, albeit an unwitting one!
When is someone a drug abuser or an addict?1 If someone uses drugs casually and infrequently without significant problems and can take them or leave them, that person might best be called a user, which is still a dangerous situation. If taking drugs causes significant distress and problems in the person's life, then abuser might be the best descriptor. If drugs are in control of a person's life, or if they can't stop, or if they do drugs in spite of personal distress and negative consequences, then they might be drug dependent or addicted. Even people who are not users, abusers, or addicts are very likely to gain from reading this book.
The text box that follows provides definitions of specific levels of drug use. Addiction is the most serious form of the disorder2 and it can develop when drugs are taken repeatedly over a long period of time. Taking larger quantities of drugs more frequently is likely to result in addiction more quickly. However, there is no mathematical equation describing this process. It is not exact. Moreover, the process varies depending on the individual and his or her circumstances.
The use of drugs is not simply a passing fad or the latest, cool thing. Drugs of one type or another have been with us for a long time, literally thousands of years. Opium has been used in China for centuries, and cocaine use in early Indian cultures goes back centuries. There is even a reference in the Bible about getting drunk on wine. There are things about both the nature of drugs and the human brain that make drug use enduring over the ages, and this reveals a special vulnerability in humans. For example, in 2006-2007 in the United States, there were more than 22 million people, 12 years of age and older, who were classified with drug abuse or drug dependence on illicit drugs4 or alcohol.
What is it about addiction that grips certain individuals so firmly that they lose at least some control over their drug taking and sometimes over their lives? This book attempts to answer this question by examining research discoveries from the previous couple of decades. Extraordinary progress has been made in drug abuse research.
What Is a Drug?
When talking about drugs that can be abused, there are about seven different groups of substances. These are nicotine; sedatives such as alcohol, barbiturates, benzodiazepines, and inhalants such as fumes from glue; opiates such as heroin and morphine; psychostimulants such as cocaine, amphetamine, and methamphetamine; marijuana; hallucinogens; and caffeine. Prescription drugs that are abused comprise many of the previous classes and are shown in the following list:
- Club drugs, which includes:
- GHB (Also known as Goop)
- Ketamine (Also known as K)
- MDMA (Also known as E)
- Rohypnol (Also known as Roofies)
- Cocaine, which is also known as nose candy, C, and blow
- Crack (another form of cocaine, and also known as Freebase, Rooster, and Tornado)
- Hallucinogens, which includes:
- Mescaline (cactus)
- Psilocybin (Mexican mushrooms)
- Heroin (Also known as Big H, China White, and Smack)
- Inhalants, which include:
- Air blast
- Moon gas
- Methamphetamine (Also known as Crank, Ice, and Stove top)
- Prescription drugs, which include:
- Methaqualone (Also known as Ludes)
- Oxycontin (Also known as Hillbilly heroin)
- Ritalin (Also known as Vitamin R)
- Steroids (Also known as Juice, Pumpers, and Weight trainers)
This list is composed of illicit drugs and doesn't include alcohol or nicotine. A much more detailed list of abused drugs can be found on the ONDCP (Office of National Control Drug Policy) website at http://www.whitehousedrugpolicy.gov/drugfact/crack/index.html.
Why are these groups of chemicals addicting? It is striking how they can have such different effects and uses; for example, opiates relieve pain, and sedatives produce sleep, yet both have the danger of addiction. What is it about these chemicals, and not others, that give them such power? A reasonable answer is that it is an accident that all these particular compounds are addicting. There are, perhaps, millions of chemical compounds on this earth, and it is, perhaps, just unfortunate that some of these chemicals can hook into the brain in such a way that they become addicting. Of course, some of these drugs are used more than others (see Figure 1-1).
Figure 1-1 The number of individuals, ages 12 or older, who have used the indicated drug within the past 12 months (in millions). Psychotherapeutics refers to prescription drugs that were abused; these drugs include Oxycontin, Vicodin, amphetamines, Ritalin, and sedatives. These numbers of users, which range from 200,000 to over 15 million, are small compared to the number of individuals using the legal drugs, like alcohol and nicotine. More than 50 million people smoke, and an even larger number take alcohol regularly. The relatively larger use of alcohol and nicotine are probably due to the legality of these drugs and their greater availability. Legal drugs are used probably ten times more than illicit ones.(Source: SAMSHA, 2008, National Survey on Drug Use and Health, September 2009).
It is useful and can eliminate confusion to make a distinction between the words drugs and medications. The word drug is used in this book to refer to a substance with the potential to cause harm, abuse, and addiction. Of course, there are other drugs that are therapeutic, cure diseases, and are employed by doctors to treat specific maladies. These latter substances are referred to herein as medications. Drugs of abuse can also have legitimate uses in medicine and be medications. Cocaine is a powerful vasoconstrictor in that it closes off blood vessels and can be used to reduce bleeding in surgery. Amphetamine is a stimulant and can be used to treat Attention Deficit Hyperactivity Disorder (ADHD). Opiates are indispensable in the treatment of pain, but they can cause addiction nonetheless. Depending on how and why they are used, many of the substances can be both drugs and medications. Prescription drugs are another example of this; they are medications that can be abused and therefore are also drugs.