Editorial: Science-Based Views of Drug Abuse and Addiction

By Leshner, Alan I. | The Israel Journal of Psychiatry and Related Sciences, January 1, 2002 | Go to article overview

Editorial: Science-Based Views of Drug Abuse and Addiction


Leshner, Alan I., The Israel Journal of Psychiatry and Related Sciences


Drug abuse and addiction exact an enormous toll on the health, well-being and safety of citizens in every country. These disorders are not only complex, costly, and widely misunderstood, but pose many challenges to the research community as well. Fortunately the dramatic advances that have been made over the past two decades in both the neurosciences and the behavioral sciences have virtually revolutionized the fundamental views of drug abuse and addiction and have lead to the development of effective strategies for their prevention and treatment.

Rethinking Addiction

Contrary to popular belief, addiction is not just a lot of drug use. Science demonstrates that drug addiction is in fact a biologically based chronic relapsing disease that results from the prolonged effects of drugs on the brain (1, 2). This is particularly evident when one uses advanced neuroimaging capabilities and looks at brain scans of addicts versus the brain images of drug-free individuals. Prolonged drug use causes pervasive changes in brain function that persist long after the individual stops taking the drug. The effects can be seen at all levels, including molecular, cellular, structural and functional (3, 4). Additionally, researchers have found that even acute drug use can modify brain function.

Acute drug use has been found to affect the dopamine system (5, 6). Although each drug class may have its own specific mode of action, in tracing the pathways through which a variety of drugs exert their effects certain commonalities for all drugs of abuse have emerged. Data suggest that there is one common reward pathway in the brain where all drugs of abuse act. Almost every known drug of abuse - be it heroin, cocaine, nicotine or amphetamine - has been found to increase levels of the transmitter dopamine in the mesolimbic reward system, the neural pathways that control pleasure. When drugs begin to interfere with the body's delicate mechanisms through which nerve cells transmit, receive and process the information critical for daily living, the individual begins to lose some ability to control his or her own life. The more a person uses these drugs to induce feelings of pleasure, the more the person tends to repeat the drug-taking behavior and the more the brain needs drugs to evoke pleasure. The continued use of these drugs alters the brain in such a way that the individual no longer experiences pleasure from the drugs. Eventually drugs may begin to have the opposite effect of their intended use. Chronic drug use may decrease dopamine levels resulting in feelings of depression as well as terrible cravings for the drug when drug use is discontinued (7, 8). This is all part of the biological underpinnings of addiction. Although addiction is biologically based, studies have shown that there is more to addiction than just biological factors; there are many behavioral and social context factors as well.

Addiction: The Quintessential Biobehavioral Disorder

In fact, because of the qualities associated with addiction, addiction is often thought of as the quintessential biobehavioral disorder. In addition to chronic drug use altering the brain and changing an individual's behavior, there are ways that environmental and behavioral factors may alter brain function and influence a drug's effects. These environmental cues, such as people, places and things that have been associated with their drug use, can become an integral part of the addiction process, even in the absence of the drugs themselves. These can trigger tremendous drug craving and can interact with the biological factors to hinder attainment of sustained abstinence and can drive an ex-addict into relapse even after years of successful abstinence.

Once addicted, it is almost impossible for most people to stop the spiraling cycle of addiction on their own without treatment. Total abstinence for the rest of one's life is a relatively rare outcome; having relapses is more the norm. …

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