The common opinion on drug addiction is that it consists of a physical dependence on a substance ((Addiction Science Network, 2000). However, drug addiction is more than mere physical dependence. Indeed, drug addiction could occur without such physical dependence (Addiction Science Network, 2000). The better formulation of drug addiction is as a behavioral syndrome, wherein the drug or substance dominantly influences a person’s behavior (Addiction Science Network, 2000).
Thus, the degree of physical or psychological dependence of a person is not the controlling factor, but the behavior relating to his motivation and the effects of behavioral constraints on him (Addiction Science Network, 2000). Drug addiction necessarily begins from initial drug use (Addiction Science Network, 2000). There are many factors that could influence a person into resorting to drug use, such as peer pressure (Addiction Science Network, 2000). Sometimes his inherent personality characteristics also make him prone to substance use (Addiction Science Network, 2000).
Stress is also recognized as an important factor in one’s development of a substance use disorder, such as alcohol (Sinha, Fox, Hong, Sofuoglu, Morgan ; Bergquist, 2007). It can also perpetuate the cycle of drug dependence. It also influences whether an individual would be able to practice abstinence or go into relapse (Sinha, Fox, Hong, Sofuoglu, Morgan ; Bergquist, 2007). However, these factors are only vital in the initial stages of drug use. These factors take on less significance as drug addiction sets in (Addiction Science Network, 2000).
With continued drug use, a person is exposed to “potent pharmacological effects” of the substance. Thus, his behavior is no longer influenced by his personality or external and social factors (Addiction Science Network, 2000). The chemical action reaches the brain and creates the addiction, whereby the usual psychological and social controls no longer govern the mind of the person (Addiction Science Network, 2000). Thus, it is widely held that the most common feature of drug addiction is “loss of control (Addiction Science Network, 2000). Drug addition has a biological basis (Addiction Science Network, 2000).
The use of drugs influences the specialized brain systems that have long since learned how to function (Addiction Science Network, 2000). These brain systems determine the mood of a person, such as elation or depression. As different substances influence these brain systems, drugs do the same thing, but in an intensified level (Addiction Science Network, 2000). Drugs have the power to chemically change the normal operations of brain systems, such that a person can only crave for drugs and shape his life in accordance with them (Addiction Science Network, 2000). Drug use is not an uncommon problem in many communities and countries.
Most of the dominant users of drugs are adolescents, who are naturally curious to the irresistible temptation that is drugs (Focus Adolescent Services, 2007). Research shows that certain people are more likely to become victims of drug abuse, and some of these are adolescents with a history of substance abuse or depression (Focus Adolescent Services, 2007). While curiosity on the feeling and effects of drug use do not always end up in drug dependence and abuse, there are instances when teenagers were not able to cope with their curiosity (Focus Adolescent Services, 2007).
They thus move on to more dangerous and addictive drugs (Focus Adolescent Services, 2007). Such dependence leads to grave and often, irreparable harm, not only to the health and welfare of the person involved, but also to his family, friends, and society in general. Curious teenagers do not readily try using drugs. Oftentimes they would start with less dangerous substances such as alcohol and tobacco (Common Sense for Drug Policy, 2005). However, these teenagers who have already tried alcohol and tobacco also increase their probabilities of using drugs later on.
Adolescents are also known to use marijuana, cocaine, and club drugs such as ecstasy . These facts lend support to the gateway theory, which holds that people prone to drug abuse are likely to follow an order in their drug use (Common Sense for Drug Policy, 2005; Kandel, 2003). Such order corresponds to a hierarchy of drugs, beginning from legal drugs to those that are no longer sanctioned by society (Common Sense for Drug Policy, 2005). However, this theory has encountered many oppositions, and many studies and reports have been published which negate this longstanding theory on drug abuse.
Whether the gateway theory is true or not, it is sufficient to state that drug abuse by teenagers remains a big problem in society. The gravity of the situation is illustrated by the fact that teen drug use has blown to alarming proportions (Teen Drug Abuse). Indeed, young teens from high schools and middle schools get involved in drug addiction. In 2003, 30. 3% of 8th grade, 44. 9% of 10th grade, and 52. 8% of 12th grade students use drugs illicitly (Teen Drug Abuse). These statistics ought to raise concerns regarding the abatement of illicit drug use among teens.
Drug Addiction Treatment and Treatment Outcomes Persons who have become addicted to drugs should undergo treatments specifically designed to treat such addiction. The differences in treatment are based on the kind of drugs to which a person is addicted and the personality of the patient (National Institute on Drug Abuse, 2005). It is widely accepted that drug dependence is a chronic condition that has no simple cure. Indeed, relapse is expected in almost all drug dependents (Anglin ; Hser, 1990).
Since drug dependence is affected by various psychological, biological, economic and sociocultural factors, its treatment is not considered as simple medical issue (Anglin ; Hser, 1990). Drug addiction treatments, which could consist of behavioral therapy, treatment medications, or, a combination of both, depend on the circumstances in each case (National Institute on Drug Abuse, 2005). There are various factors that need to be considered before choosing one specific treatment, such as the mental, health, occupational, or psychological factors that influence a person’s behavior (National Institute on Drug Abuse, 2005).
Drug addiction treatments could also differ in terms of their duration and settings (National Institute on Drug Abuse, 2005). It is common for drug addiction treatments not to consist in a single, short-term treatment, because by drug addiction by nature is a recurring or chronic disorder (National Institute on Drug Abuse, 2005). Since patients are often besieged by relapses, drug addiction treatments often involve a long-term engagement that consists of many interventions (National Institute on Drug Abuse, 2005).
Since long-term use of drugs messes up the brain system of an individual, it is quite difficult for a drug addict to simply stop using drugs on his own (National Institute on Drug Abuse, 2005). The drugs have the effect of changing the brain functions on an individual, which causes significant behavioral changes (National Institute on Drug Abuse, 2005). Moreover, the nature of drug addiction is such that it is aggravated by biological and social factors, which could further hinder recovery or rehabilitation (National Institute on Drug Abuse, 2005).
Thus, the relevance of undergoing long-term and proper drug addiction treatments becomes apparent (National Institute on Drug Abuse, 2005). Medication treatments can consist of a wide range of prescription medicine, such as mood stabilizers and antidepressants (National Institute on Drug Abuse, 2005). These medications can sometimes ensure success, especially for patients who have mental health-related complications, such as depression, psychosis, and anxiety disorder (National Institute on Drug Abuse, 2005).
One common treatment approach to drug dependence under this category is the methadone maintenance program, wherein methadone, a licit opiate, is substituted under controlled conditions for illicit opiates like heroin (Anglin ; Hser, 1990). This is often used to treat opiate addicts (Anglin ; Hser, 1990). One example of this treatment approach is permitted consumption of alcohol, which is not a prohibited substance, although it can also lead to substance dependence. Since the social norm permits its consumption, treatment of dependence only consists in the establishment of certain controls in the environment (Anglin ; Hser, 1990).
Other forms of medical treatment are detoxification programs, which involve the medical management of drug withdrawal (Anglin ; Hser, 1990). Unfortunately, these programs do little to provide long-term therapeutic effects (Anglin ; Hser, 1990). Therefore, their use is limited to providing short-term effects and opening doors to more intensive treatments in the future (Anglin ; Hser, 1990). On the other hand, behavioral therapy may include psychotherapy, cognitive therapy, or counseling (National Institute on Drug Abuse, 2005).
All of these tools help patients cope with their desire to use drugs (National Institute on Drug Abuse, 2005). More importantly, behavioral therapy helps patients avoid relapses, or battle them in case they occur (National Institute on Drug Abuse, 2005). On the other hand, treatment under therapeutic communities involves the provision of controlled residential environment wherein patients are engaged in intensive personality-restructuring (Anglin ; Hser, 1990). Usually, this approach is used to treat heroin addicts (Anglin ; Hser, 1990).
A combination of both, arrived at through a careful evaluation of relevant circumstances of the patient (National Institute on Drug Abuse, 2005), holds a lot of potential for helping him be on the road to full rehabilitation. A successful drug addiction treatment shall hopefully help a patient get back on track, especially in terms of his relationship with his family and the rest of society (National Institute on Drug Abuse, 2005). Literature Review Many studies and investigations have been conducted to test new treatment options and their efficacy in preventing relapse and promoting abstinence.
Some of these studies are discussed below. Long periods of abstinence is said to be affected by opioid injections, which cause some rewarding effects (Bozarth ; Wise, 1984). Indeed, it is presumed by many investigators, and such conclusion is based on the theory that opioids can relieve the distress of withdrawal consequent to long-term drug use (Bozarth ; Wise, 1984). One study conducted by Bozarth and Wise shows that the rewards provided by opioids are not related to physical dependence on drugs (1984).
This conclusion supports the observation that opioids retain their potent rewarding effects even after long periods of drug abstinence (Bozarth ; Wise, 1984). The experiment, which was conducted on rats that were administered with morphine to reduce physical dependence on drugs, showed that “at least one rewarding consequence of opioids does not involve the dependence mechanism (Bozarth ; Wise, 1984). ” This study provides a relevant theory in drug treatment and treatment outcomes, as it challenges common belief that drug abuse is characterized by physical dependence (Bozarth ; Wise, 1984).
The finding that relief from withdrawal symptoms are observed, even among subjects that were formerly non-dependent, shows the need to remove the emphasis of theories of addiction on dependence (Bozarth ; Wise, 1984). Moreover, Bozarth and Wise suggest that treatment programs should not be evaluated for efficacy based on the alleviation of withdrawal discomfort (1984). Relapse is a major cause of problem in the rehabilitation of drug abusers (See, Fuchs, Ledford, ; McLaughlin, 2003).
Applied to drug dependence and treatment, it is defined as “the return to drug-seeking and drug-taking behavior after a prolonged period of abstinence (See, Fuchs, Ledford, ; McLaughlin, 2003). ” Indeed, there are many reports about the high rates of relapse to drug use subsequent to drug detoxification (See, Fuchs, Ledford, ; McLaughlin, 2003). Relapse is primarily attributed to the influence of craving, which is an “intense desire for a specific object or experience (See, Fuchs, Ledford, ; McLaughlin, 2003). ” Craving is always measured in studies on drug relapse (See, Fuchs, Ledford, ; McLaughlin, 2003).
However, its precise meaning and role in relapse are still unsettled and subject of debate (See, Fuchs, Ledford, ; McLaughlin, 2003). The role of craving in relapse is even more weakened with the establishment of evidence showing that there could be multifarious internal and external stimuli that could trigger heightened motivation towards relapse or drug-seeking behavior (See, Fuchs, Ledford, ; McLaughlin, 2003). For instance, there is an observed correlation between certain environmental cues associated with drugs that are able to elicit drug craving (See, Fuchs, Ledford, ; McLaughlin, 2003).
This causes relapse or drug-seeking and drug-taking behavior (See, Fuchs, Ledford, ; McLaughlin, 2003). These responses are also observed in people’s craving for other substances, such as alcohol, opiates, and cocaine (See, Fuchs, Ledford, & McLaughlin, 2003). This observation leads to the belief that stimuli that were previously considered neutral acquire incentive-motivational properties due to the process of associative learning (See, Fuchs, Ledford, & McLaughlin, 2003).
This associative learning is a result of repeated pairing of the drug with the neutral stimuli (See, Fuchs, Ledford, & McLaughlin, 2003). This is a helpful theory to drug treatment and treatment outcomes, because it provides conditioned stimuli as an explanation to ongoing drug-seeking behavior and abstinence (See, Fuchs, Ledford, & McLaughlin, 2003). This is in addition to the theory of craving as the motivation for further drug use and relapse (See, Fuchs, Ledford, & McLaughlin, 2003).
Another literature worthy of note is the study conducted by Sinha, Fox, Hong, Sofuoglu, Morgan, and Bergquist. They focused on cocaine dependence and its implications fro women’s susceptibility to experience relapse (Sinha, Fox, Hong, Sofuoglu, Morgan ; Bergquist, 2007). In particular, these authors focused on the female part of the population of drug dependents because they observed that women tend to possess “greater subjective levels of distress and a higher heart rate response to stress” than men (Sinha, Fox, Hong, Sofuoglu, Morgan ; Bergquist, 2007).
Moreover, these factors are affected by exclusively women’s physiological characteristics and makeup, such as the menstrual cycle and the changing levels of gonadal hormones (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007). Noting studies that conclude that cocaine relapse outcomes are predicted by stress-induced craving for the drug and stress-related HPA responses, Sinha, Fox, Hong, Sofuoglu, Morgan and Bergquist theorized that many factors may influence the development of a stress-related functional state in abstinent cocaine dependent individuals, which is related to their susceptibility to relapse (2007).
This hypothesis is based on previous research data showing that cocaine craving and physiological arousal for the drug are caused or increased by exposure to emotional stress or various forms of drug cues (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007). Moreover, former cocaine dependent individuals who have gone abstinent found themselves increasingly sensitive to stress, which causes craving, negative emotions, anxiety, and cardiovascular arousal for the drug (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007).
Thus, they determined to find out if there is any relevant difference to the causes and treatment of drug dependence based on the sex of the dependents, seeing that there are many possibilities that may be useful in treating drug dependence (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007). One specific example of a difference in drug dependence treatment is the observed lack of efficacy of Disulfram in treating cocaine dependence in women, but the opposite effect is true with men (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007).
After studying nineteen subjects composed of women who were seeking treatment for cocaine dependence, which sample excluded those who were already receiving treatment or medication, the group observed the possible effects of female physiological properties such as the menstrual cycle phase and sex hormones on drug dependence (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007). They utilized subjective measures to determine the level of drug cravings and used the Critikon Dinamap Monitor to assess the pulse and blood pressures of the subjects.
The study yielded positive results, and established that the menstrual cycle and the fluctuation in sex steroid hormones are relevant factors in influencing cocaine craving caused by drug cues and stress (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007). Moreover, drug cue exposure influenced the anxiety and blood pressure responses of the women subjects of this study (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007).
These findings are relevant in the study of drug dependence, because then experts would have a clearer basis in formulating treatment specifically designed for women who have heightened sensitivity to cocaine craving (Sinha, Fox, Hong, Sofuoglu, Morgan & Bergquist, 2007). It is worth noting that some kinds of treatment may not be effective and may even cause the exacerbation of the problem (Anglin & Hser, 1990).
For example, treatment of drug abuse often leads to complications such as psychiatric disorders, social adversities, criminal involvement, and involvement with related issues such as alcohol abuse and polydrug use (Anglin & Hser, 1990). Recently, the amygdala has been the focus of attention in many investigations, specifically on the matter of its role in the processes that lie beneath the acquisition and perpetuation of chronic drug dependence (See, Fuchs, Ledford, & McLaughlin, 2003).
Such investigations are moved by findings that “the amygdala has multiple connections and interactions that uniquely contribute to the regulation of affective behavior (See, Fuchs, Ledford, & McLaughlin, 2003). ” However, recent studies still fail to establish with certainty the role of the amygdala in conditioned-cued relapse for drugs abuse (See, Fuchs, Ledford, & McLaughlin, 2003). Therefore, there is a need to further study and understand relevant transmitter systems that subserve drug-seeking behaviors (See, Fuchs, Ledford, & McLaughlin, 2003).
This should enable investigators to discover new pharmacological treatment approaches that could prevent relapse and break patterns of repetitive, compulsive drug use (See, Fuchs, Ledford, & McLaughlin, 2003). Conclusion. It must be remembered that the efficacy of any of these treatment methods, and the evaluation of treatment outcomes, depend in large part to various factors, such as client characteristics and the characteristics of the treatment-programs themselves (Anglin & Hser, 1990).
It appears futile to classify drug users because such classifications have little or nothing to do with the efficacy of different types of treatment programs (Anglin & Hser, 1990). Moreover, the identification of factors that claim to predict patterns of relapse or posttreatment abstinence yielded less than definitive results and findings (Anglin & Hser, 1990).
One important aspect to pursue, in addition to substitution therapy, is relapse prevention training, wherein the former drug dependent is trained to “insulate the carefully cultivated attitudes, skills, and intentions derived from the treatment process against the corrosive influences that ay exist in the personal circumstances and immediate communities of the user (Anglin & Hser, 1990). ” Under this program, clients and program staffs alike are trained into identifying events and situations that serve as stimuli to foster relapse (Anglin & Hser, 1990).
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