Addiction

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It is an all-too-common scenario: A person experiments with an addictive drug like cocaine. Perhaps he intends to try it just once, for "the experience" of it. It turns out, though, that he enjoys the drug's euphoric effect so much that in ensuing weeks and months he uses it again -- and again.

But in due time, he decides he really should quit. He knows that despite the incomparable short-term high he gets from using cocaine, the long-term consequences of its use are perilous. So he vows to stop using it. His brain, however, has a different agenda. It now demands cocaine. While his rational mind knows full well that he shouldn't use it again, his brain overrides such warnings. Unbeknown to him, repeated use of cocaine has brought about dramatic changes in both the structure and function of his brain.

In fact, if he'd known the danger signs for which to be on the lookout, he would have realized that the euphoric effect derived from cocaine use is itself a sure sign that the drug is inducing a change in the brain -- just as he would have known that as time passes, and the drug is used with increasing regularity, this change becomes more pronounced, and indelible, until finally his brain has become addicted to the drug. And so, despite his heartfelt vow never again to use cocaine, he continues using it. Again and again.

His drug use is now beyond his control. It is compulsive. He is addicted. While this turn of events is a shock to the drug user, it is no surprise at all to researchers who study the effects of addictive drugs. To them, it is a predictable outcome. To be sure, no one ever starts out using drugs intending to become a drug addict. All drug users are just trying it. Every drug user starts out as an occasional user, and that initial use is a voluntary and controllable decision.

But as time passes and drug use continues, a person goes from being a voluntary to a compulsive drug user. This change occurs because over time, use of addictive drugs changes the brain -- at times in big dramatic toxic ways, at others in more subtle ways. The fact is, drug addiction is a brain disease. While every type of drug of abuse has its own individual "trigger" for affecting or transforming the brain, many of the results of the transformation are strikingly similar regardless of the addictive drug that is used -- and of course in each instance the result is compulsive use.

The brain changes range from fundamental and long-lasting changes in the biochemical makeup of the brain, to mood changes, to changes in memory processes and motor skills. These changes have a tremendous impact on a person's behavior. In fact, in addiction the drug becomes the single most powerful motivator in the life of the drug user. He will do virtually anything for the drug.

While we haven't yet identified all the triggers for the changes in the brain's structure and function that culminate in addiction, It is virtually inevitable that prolonged drug use will lead to addiction. From this we can soundly conclude that drug addiction is indeed a brain disease. It should be stressed, however, that to assert that drug addiction is a brain disease is not the same as saying that those addicted to drugs are not accountable for their actions, or that they are hapless victims of the harmful effects that use of addictive drugs has on their brains, and in every facet of their lives.

Just as their behavior at the outset was pivotal in putting them on a collision course with compulsive drug use, their behavior after becoming addicted is just as critical if they are to be effectively treated and to recover. But this can pose an enormous challenge. The changes in their brain that turned them into compulsive users make it a daunting enough task to control their actions and complete treatment.

Preventing addiction is easier than curing it. The same chemical processes that make people want to experiment with drugs are responsible for the biological changes that lead to addiction.

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