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The addictive nature of drugs varies from substance to substance, and from individual to individual. Drugs such as Codeine or Alcohol , for instance, typically require many more exposures to addict their users than drugs such as Heroin or Cocaine . Likewise, a person who is psychologically or Genetically predisposed to addiction is much more likely to become dependent. Although dependency on hallucinogens like LSD and Psilocybin is listed as Substance-Related Disorder in the DSM-IV , most psychologists do not classify them as addictive drugs. Experts on addiction say that the use of LSD and psilocybin causes neither psychological nor physical dependency. There is anecdotal evidence which emerges of psychological addiction to recreational psychedelics such as MDMA (Ecstasy) and Ketamine. Drug addiction has two components: Physical dependency, and Psychological dependency. Physical dependency occurs when a drug has been used habitually and the body has become accustomed to its effects. The person must then continue to use the drug in order to feel normal, or its absence will trigger the symptoms of Withdrawal . Psychological dependency occurs when a drug has been used habitually and the mind has become emotionally reliant of its effects, either to elicit pleasure or relieve pain, and does not feel capable of functioning without it. Its absence produces intense cravings, which are often brought on or magnified by Stress . A dependent person may have either aspects of dependency, but often has both. "Chipping" is also a term used to describe a pattern of drug use in which the user is not physically dependent and sustains 'controlled use' of a drug. This is done by avoiding influences that reinforce dependence, such that the drug is used for relaxation and not for escape. The basis for addiction Scientists have long accepted that there is a Biological basis for drug addiction, though the exact mechanisms responsible are only now being identified. It is believed that addictive substances create dependence in the user by changing the brain's reward functions, located in the Mesolimbic Dopamine system—the part of the brain that reinforces certain behaviors such as Eating , Sexual Intercourse , Exercise , and social interaction. Addictive substances, through various means and to different degrees, cause the synapses of this system to flood with excessive amounts of dopamine, creating a brief rush of euphoria more commonly called a "high". Although the high may last only a few minutes, it also produces more longer-lasting effects in the Brain . Dopamine signals occurring normally in the reward system (traveling from the Ventral Tegmental Area to the Nucleus Accumbens ) lead to the activation of Proteins designed to calm the initial reaction and foster a continued desire to pursue the behavior responsible. Addictive substances create a greater than normal dopamine release, and the subsequent reactions of the brain are greatly exaggerated as well. The Amygdala , Hippocampus , and Frontal Cortex associate the use of the drug with intense pleasure and well-being; an association that is strengthened with each exposure, and which over time comes to dominate normal thoughts and desires. When cravings for the drug are no longer controllable, the user is considered addicted. (For a contrary view of drug addiction, see Rat Park .) Some in the medical field believe that what we call addiction is self medication for PTSD. In addition Dr. Lonny Shavelson, in his book "Hooked," has reported that 70% of female heroin addicts were sexually abused as children. There also seems to be a genetic component to addiction. It is a little researched but well known secret in practicing medical circles that many addicts are self medicating for what we commonly call anxiety problems. PTSD is thought to be a common cause as is ADD/ADHD, and bipolar. Some research is being done on the subject, more needs to be done. Evolutionary psychology view of addiction It is obvious that genes for addiction would not be directly selected. Since evolution theory claims that every physical and behavioral trait is a direct or side effect of selection, then the capacity to be addicted to drugs must be a side effect of something that was selected. A number of writers including Keith Henson {Link without Title} have suggested that the capacity to be addicted to drugs is a side effect of social attention rewards. It is easy to understand how sensitivity to social rewards would evolve in social primates. For example, Jane Goodall 's observation that chimpanzees who hunt get additional mating opportunities. The proposed evolved mechanism for social rewards is that attention causes the release of endorphins and dopamine into the brain's reward circuits. It is proposed that addictive drugs activate brain reward circuits that are normally activated by attention, without the need to kill a large, dangerous animal and drag it back to camp (or modern equivalents.) The chemicals responsible The CREB protein, a Transcription Factor activated by Cyclic Adenosine Monophosphate (cAMP) immediately after a high, triggers Gene s that produce proteins such as Dynorphin , which cuts off dopamine release and temporarily inhibits the reward circuit. In chronic drug users, a sustained activation of CREB leaves the user feeling depressed and dissatisfied, and unable to find pleasure in previously enjoyable activities, often leading to a return to the drug for an additional "fix". It also leads to a short term tolerance of the substance, necessitating that a greater amount be taken in order to reach the same high. Another transcription factor, known as Delta FosB , is thought to activate genes that, counter to the effects of CREB, actually increase the user's sensitivity to the effects of the substance. Delta FosB slowly builds up with each exposure to the drug and remains activated for weeks after the last exposure—long after the effects of CREB have faded. The hypersensitivity that it causes is thought to be responsible for the intense cravings associated with drug addiction, and is often extended to even the peripheral cues of drug use, such as related behaviors or the sight of drug paraphernalia. There is some evidence that delta FosB even causes structural changes within the nuclear accumbens, which presumably helps to perpetuate the cravings, and may be responsible for the high incidence of relapse that occur in treated drug addicts. Regulator of G-protein Signaling 9-2 (RGS 9-2) has recently been the subject of several animal knockout studies. Animals lacking RGS 9-2 appear to have increased sensitivity to dopamine receptor agonists such as cocaine and amphetamines; over-expression of RGS 9-2 causes a lack of responsiveness to these same agonists. RGS 9-2 is believed to catalyze inactivation of the G-protein coupled D2 receptor by enhancing the rate of GTP hydrolysis of the G alpha subunit which transmits signals into the interior of the cell. Mechanisms of effect The mechanisms by which different substances activate the reward system vary among drug classes.
The most common drug addictions are to legal substances such as:
Many Prescription or Over The Counter drugs can become addictive if abused. Steroidal medications, for example, are extremely addictive. In addition, a large number of other substances are currently considered to have no medical value and are not available over the counter or by prescription. Depending on the jurisdiction, these drugs may be legal only as part of a government sponsored study, illegal to use for any purpose, illegal to sell, or even illegal to merely possess. In 1972 , United States President Richard Nixon declared a War On Illegal Drugs in an attempt to control the growing problem of drug addiction and drug-related Crime . It is unclear, though, whether laws against drugs do anything to stem usage and dependency. In jurisdictions where addictive drugs are illegal, they are generally supplied by Drug Dealer s, who are often involved with Organized Crime . Even though the cost of producing most illegal addictive substances is very low, their illegality combined with the addict's need permits the seller to command a premium price, often hundreds of times the production cost. As a result, the addict must often turn to crime to support his habit. Recovery from drug addiction Methods of recovery from addiction to drugs vary widely according to the types of drugs involved, amount of drugs used, duration of the drug addiction, medical complications and the social needs of the individual. Treatment is just as important for the addicted individual as for the significant others in the addicted individuals sphere of contact. One of many recovery methods is the 12 Step recovery program, with prominent examples including Alcoholics Anonymous and Narcotics Anonymous . They are commonly known and used for a variety of addictions for the individual addicted and the family of the individual. Substance-abuse Rehabilitation (or "rehab") centers frequently offer a residential treatment program for the seriously addicted in order to isolate the patient from drugs and interactions with other users and dealers. Outpatient clinics usually offer a combination of individual Counseling and group counseling. Frequently a physician or psychiatrist will assist with Prescriptions to assist with the side effects of the addiction (the most common side effect that the medications can help is anxiety). People interested in not using drugs to detoxify from drugs should consider Acupuncture Detoxification . 12 Step programs are the most common and well-known, but there are many other types of treatment programs. These other programs may use Cognitive-Behavioral Therapy, Rational-Emotive Therapy, or other types of psychological behavior modification methods. Other forms of treatment involve replacement drugs such as Methadone . Although methadone is itself addictive, opium dependency is often so strong that the gradual tapering of a less-addictive substance is the only way to reliably treat the user. Other treatments, such as Acupuncture , may be used to help alleviate symptoms as well. Determining the best type of recovery program for an addicted person depends on a number of factors, including: personality, drug(s) of addiction, concept of spirituality or religion, mental or physical illness, and local availability and affordability of programs. Many different ideas circulate regarding what is considered a "successful" outcome in the recovery from addiction. It has widely been established that abstinence from addictive substances is the generally accepted . Medical definitions The 1957 World Health Organization (WHO) Expert Committee on Addiction-Producing Drugs defined addiction and habituation as components of Drug Abuse : ''Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical dependence on the effects of the drug; and (iv) detrimental effects on the individual and on society.'' ''Drug habituation (habit) is a condition resulting from the repeated consumption of a drug. Its characteristics include (i) a desire (but not a compulsion) to continue taking the drug for the sense of improved well-being which it engenders; (ii) little or no tendency to increase the dose; (iii) some degree of psychic dependence on the effect of the drug, but absence of physical dependence and hence of an abstinence syndrome {Link without Title} , and (iv) detrimental effects, if any, primarily on the individual.'' In 1964, a new WHO committee found these definitions to be inadequate, and suggested using the blanket term 'drug dependence': ''The definition of addiction gained some acceptance, but confusion in the use of the terms addiction and habituation and misuse of the former continued. Further, the list of drugs abused increased in number and diversity. These difficulties have become increasingly apparent and various attempts have been made to find a term that could be applied to drug abuse generally. The component in common appears to be dependence, whether psychic or physical or both. Hence, use of the term 'drug dependence', with a modifying phase linking it to a particular drug type in order to differentiate one class of drugs from another, had been given most careful consideration. The Expert Committee recommends substitution of the term 'drug dependence' for the terms 'drug addiction' and 'drug habituation'.'' The committee did not clearly define dependence, but did go on to clarify that there was a distinction between physical and psychological ('psychic') dependence. It said that drug abuse was "''a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis.''" Psychic dependence was defined as a state in which "''there is a feeling of satisfaction and psychic drive that requires periodic or continuous administration of the drug to produce pleasure or to avoid discomfort''" and all drugs were said to be capable of producing this state: ''There is scarcely any agent which can be taken into the body to which some individuals will not get a reaction satisfactory or pleasurable to them, persuading them to continue its use even to the point of abuse — that is, to excessive or persistent use beyond medical need.'' The 1957 and 1964 definitions of addiction, dependence and abuse persist to the present day in medical literature. It should be noted that at this time (2006) the Diagnostic Statistical Manual (DSM IVR) now spells out specific criteria for defining abuse and dependence. In 2001, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine jointly issued "Definitions Related to the Use of Opioids for the Treatment of Pain," which defined the following terms: ''Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.'' ''Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.'' ''Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.'' ''Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may “clock watch,” and may otherwise seem inappropriately “drug seeking.” Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated'' Addiction and drug control legislation Most countries have legislation which brings various drugs and drug-like Substance s under the control of licensing systems. Typically this legislation covers any or all of the opiates, canaboids, cocaine, barbiturates, hallucinogenics and a variety of more modern synthetic drugs, and unlicensed production, supply or possession is a criminal offence. Usually, however, drug clasification under such legislation is not related simply to addictiveness. The substances covered often have very different addictive properties. Some are highly prone to cause physical dependency, whilst others rarely cause any form of compulsive need whatsoever. Also, under legislation specifically about drugs, Alcohol is not usually included. Although the legislation may be justifiable on moral or public health grounds, it can make addiction or dependency a much more serious issue for the individual: reliable supplies of a drug become difficult to secure, and the individual becomes vulnerable to both criminal abuse and legal punishment. Literature
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