Why do people get addicted to drugs while others manage to consume alcohol or other addictive substances without developing an addiction?
Well, there is no single predictor for addiction, but several known risk factors can heighten the risk. These include:
- Genetics: NIDA (National Institute on Drug Abuse) reports that up to half your risk profile for addiction is genetic.
- Mental health disorders: Research shows that many mental health disorders increase your risk of subsequent substance abuse.
- Environment: Your friends and family, economic status, and your overall quality of life can all impact how likely you are to become addicted to drugs. Physical or sexual abuse, peer pressure, stress, early exposure to drugs, easy availability of addictive substances, and parental guidance can all affect your susceptibility to drug addiction.
- Early substance use: When first substance use occurs at any early age, this is one of the strongest predictors for addiction.
To determine how people become addicted to drugs, we’ll start with a basic definition of addiction.
What Is Drug Addiction?
Substance use disorder is the clinical descriptor for drug addiction.
According to NSDUH 2020 (National Survey on Drug Use and Health), 40 million people in the U.S. have substance use disorder, a significant increase on the previous year.
NIDA defines addiction as a chronic and relapsing disease. Addiction is characterized by drug seeking and drug use that is compulsive and hard to control, despite obviously negative outcomes. This means that while the initial decision to use drugs may often be voluntary, habitual substance use leads to functional and structural brain changes interfering with your self-control and your ability to resist cravings for drugs.
Relapse rates for addiction are between 40% and 60%, in line with relapse rates for most other chronic conditions. Like other chronic conditions, substance use disorder treatment should be ongoing and adjusted when necessary. Relapse during recovery does not mean that treatment is ineffective, rather that the treatment plan needs tweaking.
In many cases, drug addiction begins with the experimental use of addictive substances in a social setting.
For others, drug addiction starts with exposure to prescription medications like opioids or benzodiazepines. Both medications are highly effective for certain applications but carry a strong risk of abuse and addiction.
Why do some people get addicted to drugs and not others, then?
Well, the risk of drug addiction and the speed of onset varies by substance. Some drugs – opioids, heroin, and cocaine – have a higher risk for addiction, addiction that can take hold rapidly.
With the sustained use of an addictive substance, you will need more of the drug or more frequent dosages to feel normal. This occurs due to tolerance building. When you become physically dependent on an addictive substance, its absence will trigger intense cravings and unpleasant withdrawal symptoms.
Substance use disorder is classified as a brain condition in DSM-5-TR, the latest edition of APA’s Diagnostic and Statistical Manual of Mental Disorders. You will be asked variations on these eleven questions concerning your substance use over the previous twelve months:
- Do you often take more drugs than intended or use drugs for longer than you planned?
- Have you tried more than once to moderate or discontinue use of addictive substances?
- Are you spending lots of time obtaining and using drugs, as well as recovering from the effects?
- Have you experienced cravings for drugs?
- Is your substance use interfering with your personal and professional obligations?
- Do you continue using drugs despite problems in your interpersonal relationships?
- Are you spending less time doing things you once enjoyed in favor of substance use?
- Do you take drugs in dangerous situations?
- Has tolerance formed so you need more of the substance to achieve the same effects?
- Are you still using drugs despite substance use causing or inflaming a physical or psychological condition?
- Have you experienced drug withdrawal symptoms?
Substance use disorder is diagnosed according to the number of criteria present as follows:
- Mild drug addiction: 2 or 3 criteria
- Moderate drug addiction: 4 or 5 criteria
- Severe drug addiction: 6 or more criteria
How Do People Get Addicted to Drugs?
The sustained use of addictive substances changes the way your brain functions. Drugs impact how your brain communicates. Addictive substances can also influence how nerve cells send and receive then interpret information.
NIDA reports the following two ways in which brain disruption is triggered by substance use:
- By imitating brain neurotransmitters (chemical messengers).
- By exciting your brain’s reward circuit, causing overstimulation.
The brain responds differently depending on the drug of abuse.
Some drugs like marijuana have a similar makeup to the neurotransmitters in your brain. When you ingest a substance like marijuana, this can trick your brain, resulting in abnormal messages being sent and received.
Other drugs like cocaine and meth cause the nerves in your brain to overreact, releasing unusually large quantities of neurotransmitters.
Drugs can also disrupt the way your brain recycles chemicals, leading to an overload of dopamine. This neurotransmitter and hormone is associated with pleasure and pain, as well as emotions and movement. Your body starts to seek more of the pleasurable feelings caused by dopamine overload, leading to continued substance use.
Over time, your body will adjust to the sustained delivery of any addictive substance. When tolerance builds, you’ll need more of the drug to get the same effects or you’ll need to take the drug more often. Tolerance is one of the main reasons for substance abuse progressively escalating.
The probability that you will develop an addiction after the long-term use of any drug depends on the following variables:
- Speed at which dopamine release occurs.
- Intensity of dopamine release.
- Predictability of dopamine release.
The long-term use of addictive substances also causes the following changes to brain systems and circuits:
What can you do if it’s too late to moderate substance use and you are already addicted to drugs?
What to Do If You Are Addicted to Drugs
While there is no cure for addiction, substance use disorder typically responds positively to treatment. You have the following options for recovery:
- Inpatient rehab: Also known as residential rehab, inpatient treatment is ideal for those with severe addictions, co-occurring disorders, or unstable home environments. You remain at the treatment center for 30 to 90 days.
- Outpatient rehab: If you are looking for flexible, affordable addiction treatment, outpatient treatment is available at several levels of intensity. IOPs (intensive outpatient programs) provide 12 to 15 hours of weekly therapy sessions, while PHPs (partial hospitalization programs) are full-time outpatient programs providing between 30 and 35 hours of weekly therapy sessions. Between sessions, you return home or to a sober living community.
- Virtual rehab: For anyone unwilling or unable to attend an addiction treatment center, virtual rehab offers remote therapy via videoconferencing software.
Regardless of the type and intensity of treatment that makes the best fit, you’ll first need to detox from drugs.
A supervised detoxification at a licensed medical detox center will streamline the withdrawal process. Medications can reduce the severity of cravings and withdrawal symptoms. You will benefit from around-the-clock clinical and emotional care, making drug detox as safe and comfortable as possible. After 7 to 10 days, you’ll be ready to engage with treatment.
Opioid use disorder and heroin use disorder respond positively to MAT (medication-assisted treatment). FDA-approved medications can help alleviate cravings and inhibit further use of opioids.
To unpack the fiercely psychological component of addiction, you’ll have access to the following therapies:
- Individual counseling
- Group counseling
- Family therapy
- Psychotherapy (talk therapies like CBT and DBT)
- Holistic therapies
When you complete your course of treatment, you should leave rehab with an aftercare and relapse management plan in place, ready to embrace sustained sobriety.