For many, it’s hard to wrap your mind around the fact that drug addiction is classified as a mental illness. Many non-addicts view it as something that the person has only “himself or herself to blame”. Addicts do indeed blame themselves, their family, their work or their social circumstances. Overcoming shame and guilt is part and parcel what you deal with in addiction recovery.
Blame and guilt shouldn’t come into addiction even though it does. It’s not productive and it doesn’t marry with the nature of addiction. We now know so much more about the science of substance use disorders (SUDs) than we did before; the science tells us that we’re dealing with a chronic disease rather than an emotional or behavioural experience.
The hallmarks of a mental illness
According to the National Institute of Drug Abuse (NIDA) in an article titled, Addiction Science:
“Drug addiction is classified as a mental illness because addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires, and submitting new priorities connected with procuring and using drugs.
The resulting compulsive behaviours that override the ability to control impulses – despite the harmful consequences – are similar to hallmarks of other mental illnesses.”
Changes in the brain’s structure and function are what cause people to have intense cravings, changes in personality, abnormal movements and partake in risky behaviour. Brain imaging studies of individuals using drugs show changes in the areas of the brain that relate to judgement, decision-making, learning, memory and behavioural control.
These changes in brain functions can last long after the immediate effects of the substance wears off. Repeated substance use can “rewire” brain function so that a person builds up a tolerance to the substance. The result is drug users need larger amounts to feel the effects; whether it’s pleasure, euphoria or calm.
Drugs change the brain in ways that make quitting hard, even if you desperately want to stop using your drug of choice. Fortunately, researchers have found treatments that can help people recover from drug addiction and lead productive lives.
Why it’s a myth that drug addiction is “your fault”
It’s a common mistake to make; assuming that drug addicts lack moral principles or willpower and that they can “stop using drugs simply by choosing to change their behaviour”. The hard reality is; drug addiction is a complex and chronic disease and quitting usually requires medical and therapeutic intervention.
The science of addiction has advanced and we now know how illicit substances work in the brain. We know that it’s a preventable disease, that drug addiction can be successfully treated and people can lead a full and productive life when drug-free. However, it’s not simply a case of “just stop using drugs”.
To understand more about the fact that drug addiction is a mental illness, we need to understand the difference between drug abuse and drug dependence.
The difference between drug abuse and drug dependence
The Diagnostic and Statistical Manual of Mental Disorders (DSM) distinguishes between two types of substance abuse disorders; drug abuse and drug dependence.
Drug abuse centers on the harmful consequences of repeated use but does not include the compulsive use, tolerance or withdrawal that can be signs of addiction.
Drug abuse is when a person continues to use drugs even though they know it is having an adverse effect on their health and well-being. Drug abusers continue to use even though their family, social and work life is falling apart and their health and financial stability is at risk.
Drug abuse is defined by the medical community as one or more of the following:
- use of the drug in question has led to poor performance at school or at work
- the individual uses the drug in situations that are potentially harmful to himself/herself or others (while driving, caring for children, handling equipment etc.)
- the individual incurs legal problems as a result of the drug use
- the individual experiences considerable social problems as a result of the drug use (relationship failures, divorce, losing friends, getting fired, losing your home, bankruptcy etc.)
Drug dependence is what we call addiction. Dependence on illicit substances occurs when a person has built up a tolerance to a particular drug or drugs. This brings on a need to take more and more of the drug in order to achieve the same level of ‘high’. If you have developed a drug dependence problem, you are likely to experience unpleasant withdrawal symptoms when you stop using the drug.
The medical community defines drug dependence as three of the following which occur in a single year:
- building a tolerance for the drug; this may include the need to take more and more of the drug to get its desired effect or a lessening of the effect one gets when they continue to take the same amount of the drug
- withdrawal symptoms; these may include physical and psychological symptoms such as nausea, sleeplessness, irritability, muscle aches, etc. and as a general rule, the symptoms last between two to five days once you stop using the drug(s)
- not able to stop taking the drug(s) in question
- the individual takes more and more of the drug over time; more than he or she originally had any intention of taking
- the individual becomes obsessed with the drug, and buying and consuming the drug overtakes their life
What happens to your brain when you take drugs?
Prescription drugs and hard drugs like heroin and cocaine affect your brain’s reward circuit. Basically, when you take drugs, your brain is flooded with a chemical messenger called dopamine. This is what creates a sense of euphoria in your brain (the high).
Now, in everyday life, the reward pathway in your brain is wired to motivate a person to repeat behaviours needed to thrive, such as eating, lovemaking, and spending time with family and friends. When dopamine surges through your reward circuit when you take drugs, your nervous system cannot tell that this is a “bad thing”. It naturally motivates a person to repeat the behaviour again and again.
If you continue to use drugs and flood your reward circuit with dopamine, your brain eventually adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the euphoria or ‘the high’. At this point, you develop a tolerance to the drug. You either take more of the drug to achieve the same high or change to stronger drugs.
Long-term use of drugs also changes other chemical systems and circuits in your brain which affects functions such as:
Regardless of the harmful and dangerous outcomes, people continue to use drugs because they have succumbed to the nature of addiction. This is when drug usage ramps up to being a chronic mental illness.
Why adolescence is a vulnerable time for drug addiction
Drug abuse and addiction can occur at any time in a person’s life but adolescence is when we’re most vulnerable. This is because significant changes in the brain naturally occur during adolescence. Drugs that are abused affect brain circuits that are involved in learning, memory, reward, decision-making and behaviour control. These brain processes are still maturing from adolescence into early adulthood.
One of the brain areas that is still maturing during adolescence is the prefrontal cortex. This is the part of the brain that enables us to assess situations, make sound decisions and keep our emotions and desires under control.
This critical part of an adolescent’s brain is still a “work in progress”. Using drugs at a young age while the prefrontal cortex is still developing puts adolescents at increased risk for poor decision-making and risky behaviour. The impact of drug use on an adolescent’s brain circuit can have profound and long-lasting consequences.
The science behind why recovering addicts relapse
There’s a reason why drug addiction is known as the “chronic relapsing disease” in medical circles. According to a study published in 2000, relapse rates for addiction in the first year after stopping are between 40 and 60 percent; similar to other chronic diseases such as asthma, hypertension and Type 2 diabetes mellitus.
Sadly, not even the best alcohol and drug addiction treatment programmes can prevent recovering addicts from relapsing. However, if you understand the science of relapse, you’ll know that you need to persevere for reward.
As discussed, addiction is a chronic disease characterised by drug tolerance, drug seeking and compulsive use. The initial decision to take drugs is voluntary for most people. However, repeated drug use leads to brain changes that then makes it a medical condition. These brain changes can be irreversible which is why a recovering addict lives with the threat of relapse for the rest of their lives.
Can addiction be cured?
Brain changes that occur with repeated drug use can be persistent and permanent. This is why drug addiction is considered a ‘chronic relapsing disease’ in the medical world. It’s common for a person to relapse after being ‘clean’ for a long time but that doesn’t mean that the treatment they received at a drug and alcohol rehabilitation centre didn’t work.
You need to remember that addiction is a chronic disease. There generally isn’t a ‘cut and dry’ cure for it, in the same way aging, Alzheimer’s disease, motor neuron disease and muscular dystrophy cannot be cured. Relapse simply indicates the need for more or different treatment.
Research shows that combining addiction treatment medicines with behavioral therapy ensures you have the best chance of success. Treatment methods should be tailored to your drug use patterns and any co-occurring medical, mental and social problems which impact on your long-term recovery.
We’re here to help.
Contact us today if you’d like a confidential and free chat with one of our highly-trained addiction professionals at White River Manor in South Africa.