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Why does addiction occur in the young and beyond?

BY JOAN JACOBSON, Park City Register (Utah), April, 2007
 

A sobering lecture was presented by Dr. Glen Hanson, who has doctorates in both dentistry, University of California at Los Angeles, and pharmacology at the University of Utah. He practiced dentistry for 10 years prior to his pharmacology degree. He is the former director of the National Institute on Drug Abuse (NIDA), and professor in the Department of Pharmacology and Toxicology at the University of Utah. He is also the director of the Utah Addiction Center. Hanson has a long history of NIDA-funded research and has written 200 scientific research papers on drugs of abuse, in particular methamphetamine (meth) and other psychostimulants. He is studying the effects of these substances on brain chemistry and function. The doctor is a recognized expert and lecturer, both nationally and internationally, on drug abuse. He is the author of a widely recognized ninth edition text on drug abuse titled "Drugs and Society."

Drug abuse is fast becoming the No. 1 health issue in the United States. It is superseding cancer and heart disease in costs and deaths. Over 30,000 individuals die annually as a result of drug abuse and the cost is a roaring $100 billion annually. Prescription drugs account for some of the dependency and abuse. Also, we should note that alcoholism kills 100,000 individuals annually at a cost of $130 billion.

Drug addiction is defined as a "compelling drive to use drugs without attention to the negative consequences." The substances of choice are cocaine and meth; these are known as stimulants. Eventually, meth has numerous side effects such as tremors that are similar to Parkinson's disease. This indicates that there is damage to the brain. Addictive substances such as alcohol, valium, heroin, and narcotics used as pain medications, act as sedatives and hypnotics. Illicit drugs like marijuana, PCP, LSD, inhalants in the form of glue, and anabolic steroids are known as hallucinogens. It is important to note that there is a decrease in the pleasure system with cocaine, meth and alcohol, leading to more and more usage. Often, obesity promotes an increase in the use of these substances, as with food.

Hanson says, "It is a nightmare getting everyone on the same page." Drug abuse is an emotionally-charged problem, especially when it affects family and friends. Oftentimes children are turned away from their families because of the destruction they cause." These addicts appear to actually "fry or cook their brains," says the doctor. Now, there are more effective treatments coming along that are based on science. It is known that the brain is rewired during drug abuse behavior; thus the addictive behavior can occur.

We now know that drug addiction is a chronic disease; relapsing and remission occur. These addicts cannot help themselves. Hope and the will to stop do not work. Jail sentences do no good because there is usually no drug treatment available. Therefore, when the inmate is released, there is no change in the addictive behavior. Science and medication are now fast becoming the basis of treatment; eventually this treatment may become available in the nation's jails.

It is found that some individuals are more prone to be vulnerable to addiction. It is estimated that 10 percent of adolescents will become addicted. The challenge is identifying that 10 percent. Why are some more vulnerable than others? Hanson reports that adolescents, ages 15 to 20, are most likely to become addicted initially smoking marijuana. MRI technology has revealed that the pre-frontal cortex in the brain (containing the decision-making center of the brain) is underdeveloped in these adolescents. Decision making increases with age, and when individuals reach between 23 and 30, the pre-frontal cortex finally matures. comparing a 16-year-old pre-frontal cortex to a 23- to 30-year-old pre-frontal cortex, you will see the decision-making center, called the amygdalia, that suppresses some behaviors and activates others is larger in the older individual. The amygdalia controls impulsive and risky behaviors and is less developed in younger individuals. It is also reported that teenage girls have a faster development in the prefrontal cortex area of the brain than males at that age. This makes them less of a risk taker than their male counterparts.

Addiction appears to cluster in some families, giving rise to the genetic predisposition theory when it comes to alcoholism, smoking and drug abuse. It is hypothesized that the cause of 50 percent of substance abuse is related to the family environment. Scientists now know that there are 20 to 30 genes identified that are connected to addictive behaviors. These genes are inherited. Parental guidance and environment also play a role, of course.

Brain scans have been used to look at the brains of laboratory monkeys. The pre-frontal cortex was stimulated with drugs to determine the effect on behaviors. In the study there were dominant monkeys and subordinate ones. It was found that the subordinate monkeys had a low-level, non-working, pleasure center and repeatedly took the drugs offered to raise their pleasure. The monkeys who had a well-developed pleasure center interacted with the environment and rejected the drugs offered to stimulate them. This finding is applicable to humans.

Often individuals who exhibit mental illness may have an underlying mental disorder that makes them vulnerable to drug abuse. Some of these behavioral disorders listed are attention deficit hyperactive disorder (ADHD), drug abuse and mood anxiety psychosis. It is interesting that 90 percent of these individuals are prone to addictive behaviors such as smoking. Half of substance abuse is associated with a mental disorder. We know now that changes can occur in the brain when drugs are taken. There may also be a decrease in metabolism.

The research on drug abuse has been ongoing since the 1970s, when animal studies were undertaken to explore meth damage in the brain. Some researchers are using the stroke model. This model restores function by transferring to other systems in the body to perform certain motor skills lost because of a stroke. An addict can recover after three to five months, but treatment must begin immediately as the brain adjusts and is trained to suppress the addiction. Heroin addicts are usually treated with methadone that must be continued for the rest of their lives.

Hanson says that we simply cannot throw addicts out the door; we must try again and again. The tough-love model may get the addict into treatment, but jail time just doesn't solve the problem. Detoxification should be the first step. It usually takes five months to rid the body of the drug or drugs. Treatment must diagnose the damage to the brain and include psychiatric treatment. This is a new concept. What we have been doing previously just doesn't work.

Prevention strategies work with people who have ADHD; they usually have decreased function in the cortex of the brain. The difficult problem in drug abuse is that there are very few drug programs that are integrated. This impacts many aspects of public policy. Some programs try to use education to stem drug use, but these are not that helpful. Hanson says "What is necessary is making good decisions."

Education programs that are geared to the 90 percent of individuals who do not have a predisposition to drug abuse are not helpful. The focus should be on the 10 percent of the population most vulnerable to drug abuse and addiction. Therefore, we need to have a list of the genetic issues and behaviors of those who might be vulnerable and treat them, not the mainstream population. Changes in the study of addiction are on the horizon because of the fortitude of those like Hanson who don't give up, and who is engaged in the research and science of the dread scourge that is threatening our society. Maybe in the future, we will be able to intervene and save those who cannot cure themselves.