of him and cigarettes were a tangible and significant source of comfort for her during this time. This stressful life event threw her into smoking overdrive and she relapsed.
After about two years of smoking at will, she finally realized that her habit embarrassed her. There were men that she liked that she knew were turned off by her smoking and friends that subtly moved away from her whenever she lit up. Deep down she admitted that she wasn't thrilled with her habit so she decided to quit. She felt fine for the first couple of days and really gave it her all, but about day three or four she began feeling the awful effects of withdrawal. Not only did she feel terrible but she was also irritable and angry. She also noticed that she was coughing more, not less.
Despite the struggle, Heather managed to stay away from cigarettes for a month. She still felt the urge to smoke but felt that she was out of the danger zone, so she went out with friends and after a couple of drinks, gave in and had a cigarette. The next day, she felt guilty and also in need of another cigarette. This was the first time that she felt real fear that she was not going to be able to break her addiction. She relapsed and felt that she did not have the willpower to stop smoking. She was disgusted and disappointed with herself. She tried, failed, tried, failed, and tried again to quit the addiction. She was finally successful although she felt extreme regret and even shame that she had been stupid enough to ever start. To this day, over two decades later, she still craves cigarettes.
Questions About Addiction
Since the beginning of human existence, individuals like Heather have used drugs as a way to alter their mood, thought processes, and behavior – often with significant negative health effects. This part of the book will answer questions about addiction – what it is, what are its causes, and what are some of the psychological effects.
What is addiction?
It was once believed that addiction was an issue of willpower, that people could simply choose to be or not be addicted to a substance.4, 13, 16 However, with the help of science, we now know that addiction, whether it is to nicotine, alcohol, or illegal substances, is a brain disease, not a moral fault.4, 13, 16 In fact, the National Institute on Drug Abuse (NIDA) defines addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”13 Addiction is considered a brain disease because drugs physically change the brain and how it works.13 These changes can sometimes be irreversible and can lead to harmful behaviors that are characteristic of drug abusers.13
Why do people use drugs?
People use drugs for many different reasons. One reason is because drugs initially produce a “high” or pleasurable feeling.4, 13, 16 Trying to replicate the high that is felt with first-time drug use is often the reason why many people use the drug again.4, 13, 16 While first-time drug use is largely voluntary, a person’s ability to control their drug use can quickly vanish.13 Drugs change the brain’s structure and how it works, so important areas of the brain that control judgment, decision-making, learning, memory, and behavior control can be impaired.13 These changes are thought to cause the compulsive and destructive behaviors that are seen in drug addicts.13
Drugs can also be used to self-medicate.4, 13 For example, if someone has social anxiety, they may drink alcohol at parties or other social gatherings in order to feel relaxed and reduce feelings of distress. In fact, stress can be a major factor in beginning or continuing to abuse drugs and can often lead to relapse in people who are recovering from addiction.4, 13, 16 Also, people who feel pressure to improve their athletic or cognitive performance may turn to drugs, such as steroids or stimulants, in order to do so.4, 13 Another common reason people use drugs is out of curiosity or “because others are doing it.”13
What causes someone to become a drug addict?
Figure 1. A biopsychosocial model of drug addiction. The combination and interaction of biological, psychological, and social risk factors in the development of drug addiction.
Biological, psychological, and social factors are all known to play a role in why someone becomes addicted to drugs.4, 12, 13, 16 The combination and interaction of these factors increase one’s risk of becoming an addict (see Figure 1 below).4, 12, 13, 16 Biological risk factors for substance abuse include things like genetics (e.g., having a biological relative who was an addict) or being less sensitive to a drug’s effect. 4, 12, 13, 16 According to NIDA, “genetic factors account for between 40 and 60 percent of a person’s vulnerability to addiction, including the effects of environment on gene expression and function.”17 Psychological factors like one’s personality or temperament style (e.g., the tendency to be impulsive, attracted to excitement, or intolerant of frustration) can also play a role in the development of an addiction. 4, 12, 13, 16 Lastly, social factors can also greatly increase one’s risk of becoming an addict.
For example, stressful life events (e.g., a death in the family, losing a job, or failing a test) or living in an environment that promotes drug use (e.g., living in a neighborhood where drugs are easily accessible or living in a college dorm where binge drinking is commonplace) can all contribute to the development of an addiction. 4, 12, 13, 16
What happens to the brain when someone becomes addicted?
Drugs of abuse activate the natural reward centers of our brain; this is why many drugs of abuse are pleasurable when they are first used.4, 7, 13, 16 There are natural rewards, like food, water, and sex that also activate the reward centers of our brain and produces pleasurable feelings.4, 13 These reward centers help ensure our survival.13 If something feels good to us, our brain will tell us to engage in that behavior again, without us even thinking about it.13 Drugs are also much more powerful rewards than natural rewards like food and sex, as they tend to have quicker and longer-lasting pleasurable effects than natural rewards.13 Therefore, drugs can strongly motivate people to use them again and again and trick our brain into thinking that we need drugs in order to survive.13
When someone continues to use drugs, it dulls the natural reward centers in their brain and makes it difficult for them to experience pleasure naturally.13 Drug abusers often feel depressed and lifeless and in order to feel any kind of pleasure, they have to take larger amounts of drugs in order to activate the reward center in their brain.13 This is known as drug tolerance.13 Similar in the way that they cause tolerance, drugs can cause major changes in the brain’s structure and how it functions.7, 13, 19 These changes diminish one’s self-control and ability to make sound decisions, while sending powerful urges to seek out and take drugs compulsively.13 These kinds of behaviors are characteristic of drug addiction.13 Also, because a drug abuser’s brain associates the pleasurable effects of drugs with the environment where they used drugs, certain environments can trigger drug craving and relapse even after years of abstinence from drugs.7, 13, 19
