Pubdate: Tue, 09 Jul 2002
Source: Gadsden Times, The (AL)
Copyright: 2002 The Gadsden Times
Contact:  http://www.gadsdentimes.com/
Details: http://www.mapinc.org/media/1203
Author: Cindy West

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."
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