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What Did I Learn This Semester about Addiction? Holly M. Hauser UNC Charlotte PSYC 3001-090 Abplanalp December 11, 2013

Over the course of this semester, my knowledge of addiction and its biopsychosocial processes has increased tremendously. I elected this course because addiction is rampant in my family. I wanted to learn how an addicts brain is wired, what makes them do what they do, and why they do it. Also, the chemistry of the substance and how it changes the body is very interesting to me. So, needless to say, I have learned so much over these past few months. Now, I will present a few significant concepts and/or facts from each topic that I have learned and why it is meaningful in my life. Topic 1: In the very first class, we discussed the origin of drugs. Drug usage dates back thousands of years ago, even to the beginning of time. In various cultures, drugs were used to connect to the spiritual world as well as to bring meaning to life. Instead of using drugs to escape from current circumstances, drugs were normally used as a means to enter life on a deeper level. We watched a video that illustrated the drug usage of various cultures throughout time. For example, China is documented for cannabis use in 3000 B.C. because of its medicinal characteristics. Tobacco, believed to be a magical plant, was used by the Native Americans because they believed smoke would carry human prayers to the spiritual world. Also, alcohol was coined by the Europeans and quickly became the Western worlds drug of choice. It is disheartening to see how drug usage has changed over time. In addition to watching the video on ancient drugs, we also watched a short clip of the Vervet monkeys. The behavior of these monkeys is significant to understanding human behavior. These monkeys consume alcohol at about the same rate that humans do. 5% of monkeys do not drink at all (teetotaler), 12% of moneys drink regularly, and 5% drink alcoholically. The rest of the monkeys drink in moderation. Amazingly, these statistics match up with that of humans.

Topic 2: I vividly remember this lecture because you (Kevin) were so fired up about the War on Drugs. It was explained that the goal is to decrease drug usage, but this effort is actually increasing drug usage. Criminalization of drugs is so prevalent in America. In fact, over the past four decades, taxpayers have paid over one trillion dollars on the drug war. Despite this effort, drug usage and incarceration rates continue to climb. The federal and state prisons have an extremely high percentage of drug offenders, while the percentage of inmates for violent crime has decreased. Instead of criminalizing these substances, decriminalization is the better option. In 1998, a Portuguese commission recommended decriminalization to combat addiction problems. What is the result from this? Portugal utilized decriminalization and now has the lowest rate of drug usage. In addition, I also remember the drug scheduling process was discussed. The irrationality of this scheduling system is unbelievable. Marijuana is a schedule one drug? In class, we learned the reasoning behind this faulty system is that the government schedules the drug based pharmaceutical companies and other political reasons. The government fears that marijuana may drive people away from the pharmaceutical companies who are trying to create customers and not cures. Finally, the most meaningful part of topic one for me was when Kevin mentioned that he would rather see the addict treated for the problem at hand, instead of being thrown in jail. I totally agree with this because I believe that incarcerating an addict for the drug usage is not treating the deeper issues of the addiction itself. Therefore, when the addict leaves jail, he or she is most likely going to continue in their old ways. At least give the addict the chance to change and recover in a treatment center (even though relapse is part of the process at times). Topic 3: During this section, we discussed how drugs are absorbed, distributed, metabolized, and excreted in the body. This is called pharmacokinetics. We also learned the

various routes of absorption. The faster the absorption and the quicker the onset, the greater the addictiveness will be. The fastest route of administration is intracerebral or intracerebroventricular. Next are intravenous, intramuscular, subcutaneous, intraperitoneal, and inhaled. Another key concept that I remember is depot binding, especially when we discussed drug testing in class. Depot binding is when the substance binds to the depot sites or silent receptors where fatty tissue is located. Therefore, the depot binding reduces bioavailabilty, slows elimination, and can increase the drug detection window. Marijuana is highly lipid soluble, so it depots in fat cells. Knowing this, many marijuana users attempt every method to clean out their system before their drug test. Nicotine is also highly lipid soluble, which can make it hard to resist the urge to smoke until the nicotine clears the system. Depot-bound drugs can be released during sudden weight loss, which may account for a sudden flashback experience. In addition, we also learned about tolerance in regards to addiction. Tolerance, also known as desensitization, is a decreased response with constant, repeated exposure. The effect of the drug diminishes. Therefore, in order to maintain the same effect, the dosage needs to increase. Tolerance to various drugs can happen quickly or slowly depending on various factors, including the neurotransmitters that the drug excites or inhibits. In class, we watched Mouse Party, a visual simulation that shows how a mouse would behave under the influence of specific drugs. It also explained the various neurotransmitters that are paired with each drug and whether they are excitatory or inhibitory. For example, acetylcholine is paired with nicotine, heroin with dopamine, ecstasy with serotonin, LSD with serotonin, marijuana with dopamine, cocaine with dopamine, methamphetamine with dopamine, and alcohol with GABA and glutamate. Topic 4: The Psychology of the Addict was one of my favorite lectures. I was very excited to come to class to learn about the addict and his/her thought process and chemical

composition. One of the many reasons I chose to take this class was to see if addiction counseling would be a possible career for me. Also, my father is an alcoholic so I wanted to understand him from a different perspective- a perspective that is more forgiving and compassionate because I am more informed about his disease. I remember we discussed the possible causes for the addict to take their first drug. When I look at the way my dad was raised, I can better understand what drove him to take the first drink. I think his self-concept and selfesteem was consistently lowered as a child because his father was an alcoholic. The problem was also system driven because his family was incredibly dysfunctional, promoting ideas such as money is love and provision is love. Also, the social learning aspect, I believe, had to do with my fathers addiction because he watched his father and grandfather drink. It was seen as a normal behavior. I am unaware if he was abused or if he experienced any trauma, but it is very possible. Lastly, I know that he associated with friends that participated in addictive behaviors. In addition, I learned that addiction is truly like a psychological cancer. The drug creeps into every life system until life only revolves around the drug. Anyone who interferes with the drug usage becomes the enemy. The definition of addiction from the American Society of Addictive Medicine states that it is a primary, chronic, and progressive disease of brain reward, motivation, memory, and related circuity; there is an inability to abstain from using along with cravings. It often involves cycles of relapse and remission. Addiction gives the illusion of control and power to the individual, which is a feeling that brings artificial high. In class, we also discussed the criteria for dependence, which includes tolerance and withdrawal. Tolerance, as mentioned above, is the decreased effectiveness of the drug because of repeated administration; therefore, one needs to increase dosage to maintain the effectiveness. Withdrawal, on the other hand, is a specific maladaptive behavioral change with physiological and cognitive features. Withdrawal

occurs due to cessation of or reduced uses of the drug. It causes great distress and/or impairments, but it is not due to a general medical condition. Finally, one of the hardest concepts for me to grasp was that sometimes relapse is part of the recovery process. We learned that relapse should be welcomed. I know that relapse is expected, but it is very difficult to accept for me at times. The toughest time the addict has is convincing themselves that they cant have the drug like someone else can. Topic 5: In this lecture, the biopsychosocial aspects of addiction were covered. We discussed various types of tolerance, such as pharmacokinetic tolerance, when the body becomes more efficient at metabolizing the substance, and pharmacodynamics tolerance, when the brain is trying to restore the body back to equilibrium with up regulation and down regulation of receptor sites. We also learned about behavioral tolerance, when the repeated drug usage becomes so normal that immunity is established in the system. I remember specifically discussing the issue of brain receptor sites. Some addicts have more receptor sites for specific substances, such as alcohol. It is mind-blowing to me that the body has certain processes, such as the opponent process theory, to compensate for drug usage. In the opponent process theory, after an individual becomes high, there is a process that occurs in the body that wants to lower the extreme effect of the drug. The body wants to naturally restore itself back to equilibrium. That is why repeated drug usage disrupts the users system so dramatically, causing various receptor sites to increase or decrease based on the drug(s) of choice. Therefore, when the addict stops using, withdrawal effects, such as pain, fever, tremors, and nausea occur because the naturally occurring neurotransmitters have been replaced by the drug. In addition, we learned about the nervous system in conjunction with the addict. Many drugs, such as alcohol, are central nervous system depressants, which means that the body begins to slow down various processes. Other drugs in

the stimulant family, such as methamphetamine and cocaine, speed up various processes in the body and cause extreme alertness. Finally, we learned about dealing with the addict. I enjoyed this part of the lecture because it is always helpful for me to learn more about how to handle active addiction in my family. As a member of Al-Anon, I have already received an abundance of knowledge and information about how to cope, but I can never learn too much. I learned in this class that true recovery must come from the addict. No matter what I say or do, recovery must be desired by the addict or it means nothing. Also, I am relieved to know that I dont owe the addict anything. I can choose when to be around the addict and set up measurable boundaries. Another important truth I learned was that shaming, blaming, and accusing the addict only drives them to increase their usage. Making them feel guilty only heightens their desire to hide and cover up their feelings of guilt by using their drug of choice. The best thing for me to do is to set boundaries, plant seeds, give positive affirmations, and make myself available on my terms. Topic 6: The American Society of Addictive Medicine determines the patient placement criteria by looking at the severity and symptoms of the addicted individual. Treatment levels can be somewhat difficult to determine. For example, does the addict seem to need a highly intrusive level of care, such as inpatient treatment, or a lower intrusive level of care, such as outpatient treatment or a 12-step program? The ultimate goal is to determine the level of treatment that is not too high, but not too low. In some cases, the least intrusive level of treatment is the best option because a high intrusive treatment level may cause a heavier financial burden, friction in the work place, etc. In order to be placed in an appropriate level of treatment, the addict must be examined under the six assessment dimensions: 1. acute intoxication and withdrawal potential 2. biomedical stabilization 3. behavioral stabilization 4. readiness to change 5. relapse potential and 6. recovery environment. As a counselor working with the addict, it is beneficial to encourage

the addict to work a recovery map. This includes questions that the addict can ask themselves about their desire to change and examine their past attempts to quit (what worked and what didnt?). Also, the recovery map helps the addict to establish specific, measurable goals (ex: a quit date), remove triggers from the home and work place, and open up to friends and family members for support. Finally, the stages of change (pre-contemplation, contemplation, preparation, action, and maintenance) were discussed. It is vital that the addict creates a plan to stay sober. By setting up sober supports, the addict can create an accountability system with family members and friends. 12-step programs and outside counseling services may be appropriate to maintain sobriety. Ultimately, every addict is unique and has different needs based on the severity of the addiction. Topic 7: This is the point in the class where we began to learn about individual drugs and their effects on the body, mind, and spirit. The first substance we discussed was alcohol. Formal distillation began in 3000 BC and was consumed by the Chinese, Egyptians, and Assyrians. It is speculated that distilling began even before formal equipment was invented. Although the Chinese experimented with alcohol, they did not take to it. Alcohol is known as the Western worlds drug of choice; therefore, it was not popular in Eastern cultures. Why is alcohol so addictive in the Western world? There are too many reasons to name, but I will mention a few that I learned in class. Alcohol lowers inhibitions, relaxing and numbing the consumer. This makes it easier for the addict to open up socially. Also, drinking alcohol is reinforced in movies, television commercials, magazines, and on social media. Alcohol is everywhere! Drinking is culturally accepted. It is a part of special occasions, anniversaries, bringing in the New Year, football games, and more. There are also drinking games that make drunkenness seem fun and cool, especially for college students. Alcoholism can be extremely hard to identify because

almost everyone drinks. It is estimated that over 15 million people drink to excess. Alcohol can be extremely dangerous when used excessively. It is a central nervous system depressant, slowing down thinking, reasoning, judgment, and reaction time. Other side effects include blackouts, damaged brain cells, various types of cancers, cirrhosis of the liver, dehydration, impotence in males, and more. I remember that Kevin compared alcohol addiction to a psychopharmacological hand grenade because you never know what you are going to get when the addict is drinking. They can be a happy drunk, annoying drunk, angry drunk, obnoxious drunk, etc. When examining the genetic aspect of alcoholism, it seems that a special dopamine receptor, D-2, is found more abundantly in alcoholics than non-alcoholics. Finally, we discussed treatment options. Long-term, chronic alcoholics need to manage their detox because withdrawal and DTs could be deadly. Treatment methods vary based on the symptoms and severity I mentioned earlier. Medical treatments, such as Antabuse, Naltrexone, and Acamprosate are also used to reduce withdrawal effects, decrease the desire to drink, and make the user sick if they choose to drink. For some addicts, an outpatient program or a 12-step program may suffice. Topic 8: The next drug we discussed in detail was Nicotine. Nicotine requires selfadministration routes that in themselves may be habit forming. Smoking itself is a habit of oral fixation. This drug is highly addictive because one must break the habit of putting something in the mouth as well as the addiction of nicotine. There are specific nicotinic acetylcholine receptors in the human body that are excited when nicotine enters the system. Nicotine depots in fat cells, which makes it harder to get the drug out of the system. Usually, withdrawal is over in about 72 hours, but it takes about 1 month to rid the body completely of nicotine. In order to quit, we discussed various cessation aids such as nicotine gum and the nicotine patch. It is not ideal, however, to quit cold turkey. It is speculated that those who quit cold turkey and begin

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smoking again will smoke more than before. I remember Kevin telling the class the he quit by self-titrating with gum. He would smoke normally, but replace a few cigarettes with nicotine gum until he was completely hooked on the gum. Then, he replaced the nicotine gum with Altoids. Now, he is addicted to Altoids. In addition, during this lecture we discussed tips to help one quit smoking. Cigarettes are everywhere, making it extremely hard to quit smoking. A few tips to quit include working out, increasing water intake, cutting down on stimulant intake, and ceasing to drink alcohol while attempting to quit smoking. Also, it is good to have a support system. If possible, tell family members and friends about the attempt to quit so they may provide encouragement. Topic 9: Cannabis, also known as delta-9-tetrahydrocannabinol, was noted in 2011 as the most common illicit drug in America. Back in the 1800s, cannabis was used to treat a variety of illnesses and ailments. It was known as an anticonvulsant and an appetite stimulant. Today, 22.5 million people admit to using marijuana on a daily basis. Also, about 40% of high school students admit to having used marijuana at least once. Although marijuana is listed as a schedule one drug, there are several benefits that it provides. Marijuana has been known to reduce anxiety, help with glaucoma, nausea, tremors, loss of appetite, and loss of sleep. Why dont pharmaceutical companies prescribe cannabis to help their sick patients? These companies work on terms of politics and finances. If they sold a drug that actually works and benefits the patients health, then they would lose business. Their goal is to gain the customers dependence for a lifetime. Also, since cannabis is a plant it cannot be patented. Therefore, it makes since in their eyes to schedule marijuana as one of the most dangerous drugs. In addition, I also learned that marijuana is highly lipid-soluble. It also contains 70% more carcinogens than cigarette smoke. Cannabinoid receptors bind to several neurotransmitters: norepinephrine, dopamine, serotonin,

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acetylcholine, and GABA. Although marijuana interacts with various neurotransmitters, it does not raise dopamine levels. This means that marijuana is not as addictive as other drugs that heighten dopamine levels, such as heroin and cocaine. Lastly, I learned why marijuana is considered the gateway drug. Since marijuana is illegal, users must purchase this drug from criminals who sell other drugs. Also, marijuana reinforces drug taking behavior. Finally, when an individual uses marijuana for the first time, he or she may start to question the DARE program, asking themselves if this program was really true or a bunch of lies. Topic 10: The human body has natural pain killers, but when opiates are brought into the system everything changes. Opiates, such as heroin and oxycontin, are highly addictive substances that down regulate the bodys natural pain killers. Because of the drug usage, the body doesnt need as many receptors. The deadliest opiate, heroin, tends to kill more people through overdose than any of the drugs that Ive mentioned so far. Sadly, some drug users become so desperate to use that they do not truly know the solution and composition of the drug. The biggest issue with heroin is its purity. Many drug users step on the drugs by adding other substances to the drug. So, a heroin addict, for example, may be used to taking heroin with a 30% solution of heroin. If this user decides to change drug dealers, they could get heroin with 60% solution and overdose. This is why heroin and other opiates are extremely dangerous. Side effects include an intense euphoric high, constipation, flushed/sweaty appearance, inability to repair bodys DNA, small pupils, contractions of the bladder sphincter, malnutrition, and more. Opiate addicts experience intense cravings and an intense withdrawal. Most opiate addicts become addicted through pain killers or because the individual is looking to end emotional pain, trauma, and/or abuse. Detox needs to be medically managed because of the intense withdrawal. I distinctly remember from the textbook the example about conditioned tolerance and heroin

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usage. The body can become conditioned to using drugs in a certain area or location that a tolerance starts to build up. In the textbook, an example was given of an addict who used in a different area than normal. This individual overdosed and died. Heroin, oxycontin, and other pain killers are extremely dangerous, frightening drugs. Topic 11: The next category of drugs is methylxanthines. This drug is found in coffee, tea, soft drinks, energy drinks, medicine, and food additives. Theophaline is specifically in tea; Theobromine is found in cocoa. Coffee was first discovered in Ethiopia, but was made famous by William Harvey. Tea was discovered in China and was sold by 780 c.e. The cocoa tree was cultivated by the Aztecs, Mayans, and Incans. Caffeine and other methylxanthines are the most widely self-administered drug in the world. The average caffeine consumption is 70 mg of caffeine per person per day. Why is coffee, tea, and other sources of caffeine so addictive? Caffeine is a central nervous system stimulant. Therefore, adrenaline levels increase, heart rate increases, alertness increases, productivity increases, and performance/behavior increases. Although caffeine has beneficial effects, its harmful effects include a greater risk for heart attack (6+ cups/day), anxiety (5-10 cups/day), and bone density loss in post-menopausal women (2-3 cups/day). High levels of caffeine may also damage chromosomes causing reproduction trouble. Overall, caffeine is so common worldwide that it isnt seen as a harmful substance. Overconsumption of caffeine can lead to a diagnosis of caffeine dependence syndrome. In addition, there are thousands of caffeine toxicity cases in the US every year. Ultimately, in this section, I learned that caffeine should not be abused because the damages can be traumatic to ones health and well-being. In this lecture we also talked about psychomotor stimulants, such a cocaine, methamphetamine, and khat. The neurotransmitters that are associated with stimulants are

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epinephrine, norepinephrine, dopamine, and serotonin. Much like caffeine, these drugs increase concentration, alertness, blood pressure, and heart rate. They decrease sleep and appetite stimulation. Many psychomotor stimulant addicts perform a behavior called punding. This is a repetitive movement or performance of some act for an extended period of time (ex: cleaning). These drugs are highly addictive because of the increased dopamine levels. Also, tolerance develops rapidly. Withdrawal symptoms include a major crash and/or depression. The initial phase may last for up to a week. Treatment may include cognitive behavioral therapy or forms of pharmacotherapies (medicine such as Naltrexone, Oral D-Amphetamine, and Bupropion). Topic 12: Next, we learned about hallucinogens. These drugs do not follow the model of dependence, but still can cause harm to the body. Some familiar hallucinogens that we discussed were ecstasy and LSD. Basically, these drugs provide an overload of sensory input, making it difficult to hold on to direct thoughts when communicating. All rationale goes out the window. Some refer to getting high off of hallucinogens as the tourist in reality effect. Another common phrase associated with hallucinogens is set, setting, sitter. This is the basic idea that the user should pay attention to where he/she uses, their frame of mind before using, and if he/she has someone to supervise and make sure he/she is okay. Hallucinogens are known to cause deep, emotional realizations and visions in the users. Once the user takes the drug, the experience he/she had while high will be like none other. Many individuals who choose to take hallucinogens with other drugs, such as marijuana and alcohol, experience different effects. If the drug is taken with alcohol, an exorbitant amount of alcohol can be consumed without getting drunk. If taken with marijuana, on the other hand, the experience from the hallucinogen will heighten the excitement of the user. Even though these substances are not addictive and usually not taken frequently by the user, they are still dangerous and even deadly.

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Topic 13: The last group of drugs we covered was inhalants, club drugs, and date rape drugs. This is when three teaching assistants presented their lessons on these drugs. The first presenter discussed the various types of inhalants. I was not very familiar about inhalants. An inhalant is any volatile substance used to become high, such as nitrous oxide, gasoline, and paint thinner. There are many groups of inhalants: adhesives, aerosols, solvents, cleaning agents, food products, and gases. These drugs can be administered through sniffing, huffing, bagging, and dusting. During class, we watched a brief clip from Intervention about a woman addicted to inhaling keyboard dusters. The effects from inhalants can lead to sudden sniffing death syndrome, kidney failure, brain damage, and bone marrow loss. Next, we learned about date rape and club drugs, such as LSD, MDMA, GHB, Ketamine, and Rohypnol. Many of these drugs are slipped into drinks or distributed with an unknown solution of the drug. These drugs can be mixed with unknown chemicals. It is extremely dangerous for users because one may never know what drug they are taking. The most common date rape drugs are GHB, Ketamine, and Rohypnol. These drugs lower inhibitions, reduce anxiety, and may even cause an out of body experience. With continued use, these drugs can become addictive. Addiction is a mind-boggling concept to grasp. It is easy for uninformed humans to judge the addicts ways. Many individuals may not experience an addiction to a drug, but there is something in their life that serves that purpose, whether it is shopping, gambling, sex, food, video games, etc. The human brain is far too complex for me to understand the entirety of addiction. I am thankful that I took this class and that I was able to increase my knowledge about various drugs and addicts. I hope to use this material in my everyday life to understand those around me better.

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Sources McKim, W., & Hancock, S. (2013). Drugs and behavior. (Seventh ed.). New Jersey: Pearson.