Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Brain Changes in Substance Abuse: Implications for Treatment

Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Brain Changes in Substance Abuse: Implications for Treatment

Article excerpt

Brain Changes in Substance Abuse: Implications for Treatment

The plight of the chronic substance abuser lies largely in the fact that chronic abuse of drugs produces profound changes in the brain that appear to be very long lasting, if not permanent. These changes make the abuser highly vulnerable to recidivism, even if he or she has undergone extensive rehabilitation treatment. In this article I will describe the cascade of events that occur in the brain as the abuser takes repeated doses. We will see that long-lasting changes occur in several brain systems as the development of drug dependence progresses.

The brain changes that accompany drug abuse have significant implications for the development of appropriate treatments for drug abuse. The burden of these treatments is not only to promote initial recovery from the condition, but also to reduce the likelihood of recidivism once the initial treatment has been completed. Given the high rate of recidivism (over 90% by some estimates), it is clear that most of our treatments could be materially improved. Understanding the neural condition and mental state of the recovered abuser is a crucial element in devising treatments and, more importantly, in influencing policies so that sufficient resources can be allocated to effective treatments.

The Experience of the Abuser

Before looking at brain changes accompanying the development of drug abuse, it's important to consider the changes that occur in the experience of the drug abuser as the problem develops. Depending on the drug of choice, individuals vulnerable to becoming drug abusers typically experience an intense feeling of euphoria on taking the initial few doses of their drug of choice. Stimulant drugs like amphetamine or cocaine often require an initial few doses to sensitize the user, at which point the peak pleasure experience occurs. This initial part of the process can be seen as the reward stage, in which the habit of seeking this intense pleasure state is established.

At some point the user experiences the peak effect of the drug, which is described as extremely pleasurable. However, even during that single dose the peak subsides until a lower intensity pleasure plateau is reached. This plateau then persists until the drug effect wears off, and a mild negative state occurs. This intense pleasure then motivates further drug taking.

Here is where the great irony of the phenomenon of drug abuse becomes clear. Although they are motivated to take more of the drug to duplicate the original high, drug abusers will never again attain that intensity of pleasure. Clearly some reaction in the brain has reduced the effect of the drug. It is interesting that this occurs so rapidly; the brain is a quick study.

This reduction signals the onset of the next stage, known as the transition to addiction. At this point, the drug user begins to take a higher dose, in an attempt to increase the now severely diminished pleasure state. This phenomenon, known as drug tolerance, marks the development of physical dependence on the drug. If the drug doses are no longer available, the abuser begins to experience serious physical effects, known as withdrawal symptoms. These symptoms, known collectively as a withdrawal syndrome, become more severe as the number of doses increases.

It's important to note that the withdrawal symptoms are opposite to the original effect of the drug. Heroin and alcohol as classified as depressant drugs because they reduce the activation of the brain and body. However, withdrawal from these drugs produces an activated body state. Symptoms include restlessness, pain, irritability, and muscle cramps and uncontrollable tremors. In contrast, withdrawal symptoms from stimulants like cocaine and amphetamine include apathy, a loss of sex drive, insomnia, a general lack of energy, and, significantly, mental depression.

To the extent that the habit reduces the drug abuser's quality of life, and induces him or her to take desperate measures to obtain the next dose, the abuser is likely to reach the point where treatment is attempted. …

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