Do you want to overcome the cycle of addiction?
Addiction is a tough battle. One that millions of people deal with.
So in this article, we’ll look at what addiction is, why it happens and how the brain works on addiction.
Here’s our ultimate guide to how to overcome the cycle of addiction…
The following blog was written by Dr. Joshua M. Gleason, MD
Table of Contents
Why is Addiction Problematic?
Drug addiction is a chronic relapsing neurobiological disorder, with genetic, environmental, and psychosocial constituents influencing its development and progression.
Genetics and epigenetics, or the impact of gene expression from the environment, account for 40% to 60% of one’s risk of addiction.
Environmental factors that predispose one to addiction include lower socioeconomic status and academic achievement, peer influences, and homes where there is parental drug usage.
Mental illnesses are disorders that affect a person’s mood or behavior, feelings, and thinking.
These conditions may be long-lasting or occasional, and affect their ability to function and relate to others.
Alarming Addiction Statistics
Before getting into the cycle of addiction, it is important to understand how serious the issue of substance abuse is in America today.
It’s estimated that 19.7 million Americans suffer from some form of substance use disorder (SUD). In 2017 there were 70,237 drug overdose deaths in the United States alone.
By far cocaine (966,000 Americans) and heroin (652,000 Americans) are the most addictive drugs in the US.
Alcohol is the 3rd leading cause of preventable death in the United States, causing over 14.5 million Americans suffer from alcohol use disorder each year.
The misuse and abuse of drugs and alcohol has become an epidemic worldwide, costing over $740 billion dollars annually due to healthcare expenditures, loss of productivity, and crime-related costs.
Understanding the Cycle of Addiction
The cycle of is primarily based on the following behaviors:
- Positive reinforcement
- Negative reinforcement
Each of these behaviors is connected to a stage in the cycle of addiction…
Initial Use (Impulsivity)
For many, SUD causes impulsivity, and the inability to resist urges. Impulsivity is one’s tendency to act without the anticipation for consequences as one prioritizes immediate reward.
An example may be when a teenager impulsively drinks alcohol for the first time from peer pressure.
Continued Use and Tolerance (Positive Reinforcement)
If a user’s experience is enjoyable, it positively reinforces the substance use. As a result, the person is more likely to use the substance again because of this association.
This pleasurable or positively reinforcing effect diminishes over time, and is called tolerance.
Tolerance is considered a state of adaptation in which exposure to substances causes changes that result in diminished drug effects over time.
Tolerance has desired and undesired effects of drugs that may develop at different speeds for various effects.
Dependence or Addiction (Compulsivity)
Over time, this behavior switches from impulsivity to compulsivity.
The main motivational drive also changes from positive reinforcement “pleasure” to negative reinforcement “relief”, as one seeks the substance in order to stop the negative feelings and physical illness associated with withdrawal.
Ironically, eventually the person uses the substance not to get “high” but to avoid the “low”.
Compulsivity explains why people SUDs relapse after abstaining from use.
Withdrawal (Negative Reinforcement)
Eventually, a person may experience negative emotions, or feel physically ill in the absence of the substance.
Withdrawal is typically caused by abrupt cessation of the substance, a rapid decrease in dose, a decrease in blood levels of the substance, and or the administration of an antagonist.
Alternatively, a person may take a substance to alleviate negative symptoms such as anxiety, or to cope with stressful situations.
In this case, the temporary relief of negative symptoms negatively reinforces substance use, and also makes the person more prone of substance use in the future.
Useful Resource: 101 Life-Changing Quotes For Stress Relief That Will Help You Relax.
Brain Regions Involved in The Cycle of Addiction
The brain is made of numerous interconnected regions that create a dynamic network of circuitry that is responsible for specific functions such as self-regulation, language, emotion, reward, attention etc.
Three key regions are involved in the development and persistence of SUDs, which include the basal ganglia, amygdala, and prefrontal cortex.
The Basal Ganglia
The basal ganglia is a deep region within the brain responsible for the coordination of movement, and the formation of habits.
Two areas within the basal ganglia are influential in SUDs:
- Nucleus accumbens – regulates motivation and the experience of reward
- Dorsal striatum – regulates forming habits and routines
The amygdala is responsible for regulating the brain’s reaction to stress (e.g., Fight or flight) and negative emotions (e.g., anxiety and irritability).
It also directly interacts with the hypothalamus, an area of the brain that controls numerous hormones producing glands like the pituitary and adrenal glands.
The prefrontal cortex is responsible for higher cognitive processes or “executive function”.
This is one’s ability to organize thoughts, prioritize tasks, manage time, and make decisions.
Additionally, the prefrontal cortex controls one’s emotions, impulses, and actions.
Why the Cycle of Addiction Continues
Addiction can be further classified as a continuous cycle with three stages associated with the basal ganglia, amygdala.
Over time, this progression eventually results in drug-induced changes in normal brain circuitry.
- Intoxication – stage where experiences rewarding and pleasurable effects with consumption of a substance.
- Withdrawal – stage where one experience negative emotions in the absence of the substance.
- Preoccupation – stage where one seeks substance after a period of abstinence.
During the intoxication stage, the activation of the brain’s reward system by not only produces pleasurable feelings, but also changes the way an individual responds to stimuli associated with those substances.
A person learns to associate a stimulus that is present while using a substance (e.g. people, places, emotions).
Substances such as cocaine, amphetamines, and nicotine activate this “rewarding” neuro-circuitry (nucleus accumbens), which in turn stimulates the production dopamine and naturally occurring opioids.
The release of dopamine and glutamate causes alterations in the dorsal striatum.
As addiction progresses, these changes strengthen substance-seeking behavior and contribute to compulsive substance use.
As these stimuli diminish, it can trigger intense cravings or urges one often experiences after a binge.
During the withdrawal stage in the amygdala a person experiences negative emotions and or physical illness due to diminished basal ganglia reward circuitry and triggering the brains stress system.
Stress neurotransmitters include dynorphin, norepinephrine, and corticotrophin-releasing factor (CRF), which are responsible for negative emotions during withdrawal.
It’s suggested that the removal of these feelings associated with withdrawal negatively reinforce repetitive substance use.
The desire to remove the negative feelings associated with withdrawal is a strong motivational factor for SUD.
As mentioned previously, this desire is strengthened by negative reinforcement, as taking the substance temporarily alleviates the negative feelings of withdrawal.
Undoubtedly, this is cycle takes a physical and emotional toll on one’s wellbeing.
As one takes a substance to negative the symptoms of withdrawal actually causes those symptoms to be worse the next time they stop taking the substance.
During the preoccupation stage an individual will seek the substance again after a period of abstinence.
This is commonly referred to as a “craving” and may go on for hours to days.
The preoccupation stage is characterized by a disruption of executive function in the prefrontal cortex.
The increased activity of glutamate in this region promotes substance use tendencies that are associated with urges and cravings.
Glutamate disrupts dopamine in the prefrontal cortex, promoting impulsive and compulsive substance seeking.
Approaches to Breaking the Cycle of Addiction
During intoxication or the binge stage a physical exam should be performed by a healthcare provide.
This includes details about the type, dose, frequency, and usage.
It’s important to define their perception and readiness to change.
During the medical assessment a medical history, the presence of a family history of SUDs substance, and review of social factors will be reviewed to facilitate treatment.
For each substance or illicit drug, they will be asked several questions that determine patterns of use, last use, frequency (e.g. once or twice a week, daily), and quantity.
Substance use affects virtually every system of the body.
It’s essential to educate patients on medical conditions may develop as a result of toxicity of the substance, route of administration, and high risk behaviors (e.g., needle sharing, unprotected sexual encounters, poor hygiene).
Properly Treating Co-Occurring Disorders
Many people who suffering from SUDs also battle co-occurring disorders, making their cycle of addiction more challenging to overcome.
Patients with SUDs are at higher risk of experiencing:
- Bipolar disorder
- Anxiety disorders
- Posttraumatic stress disorder
- Eating disorders
- Attention deficit hyperactivity disorder
SUD risk is increased among individuals with personality disorders, such as borderline personality disorder and antisocial personality disorder.
Patients actively going through withdrawal may present with anxiety, agitation, sleep disturbances, and behavioral changes.
Each patient should be assessed for suicidal and homicidal ideation.
For these reasons comprehensive mental health history will identify past and concurrent psychiatric disorders.
A mental status exam is unremarkable except in cases of current intoxication or withdrawal (e.g. psychosis), and when chronic substance use has caused impaired cognitive function or dementia.
It is important to recognize the hallmark signs a person might be misusing drugs.
Warning signs for drug misuse include:
- Changes in mood or behavior
- Being more sleepy than normal
When someone take drugs for a long time or suddenly stop or reduce the dose sharply, they often get withdrawal symptoms, which may include:
- Feeling anxious or restless
- Trouble sleeping
If you experience any of these symptoms after stopping a drug, it is imperative to talk to a healthcare provider, as they can prescribe medicines to treat these symptoms.
Medicines can also prevent more severe symptoms, such as seizures.
Medication Can Help with Recovery
There is a medicine called naloxone that is used to treat people who overdose on opioids.
If you or someone at home misuses opioids, you may want to have naloxone available.
Naloxone is a prescription and comes as a nasal spray or a shot made simple so that anyone can administer it.
It is important to note that naloxone only works for opioid overdose, and will not help if someone has overdosed from a different drug.
In order to prevent preoccupation and relapse of addiction, treatment revolves around continuing care.
Continuing care for addiction includes routine assessment and treatment customized to the needs and preferences of the individual patient.
Patients receive training in self-management skills and linkage to other sources of professional and community support.
How Often Does A Patient Require Checkups?
Individuals with chronic addiction vary in their clinical status and needs.
Some patients are at high risk for relapse and need long-term, highly structured continuing care.
Patients who have been abstinent for long periods may only need brief, periodic check-ins to monitor for changes in substance use or risks of replace.
Patients at intermediate risk of relapse may need more active treatment and more frequent monitoring of progress.
Risk factors for relapse in substance use disorder (SUD) patients during periods of abstinence include:
- Co-occurring psychiatric illness
- Sustained sleep difficulties
- Poor social support
- Low motivation for recovery
- High levels of personal stress
- History of multiple prior treatments with relapse
The frequency of SUD continuing care should be adjusted over time as patients go through alternating periods of abstinence.
Counseling is provided via face-to-face, telephone, or group sessions.
Counseling sessions range from 30 to 60 minutes for individual sessions and 60 to 90 minutes for groups. A brief check-in is 15 minutes.
Treatment for chronic addiction prepares patients to manage their health and health care.
It involves assisting them to develop skills and motivation in:
- Goal setting
- Identification of barriers to achieve goals
- Development of plans to overcome these barriers
Setting goals will provide patients to engage in healthy behaviors, such as a diet and exercise, and basic tasks of good self-care.
Continuing care for addiction provides linkage to community-based and professional resources.
Outreach Programs as a Form of Aftercare
So what are outreach programs for?
They’re basically to maintain contact with patients over extended periods of time, and provide opportunities for treatment after relapse.
This could include telephone calls, home visits, care managers, and couples counseling.
Other continuing care interventions for addiction have demonstrated evidence of efficacy to monitor patients following acute treatment:
- Case management for SUDs for individuals on public assistance
- Home visits by a nurse practitioner over 12 months
- Mindfulness-based relapse prevention provided weekly for 8 weeks following treatment
- Mobile texting recovery support three months following initial treatment
- Automated intervention by interactive voice to monitoring of alcohol consumption
- Smartphone-based recovery support
Some patients are reluctant to receive treatment of a SUD in specialty settings, which they associate with stigma.
Continuing care for addiction is often provided in some primary care clinics and in other sites by a behavioral health clinician.