Drug addictions: Not so much a matter of what but why

     Due to the "opioid epidemic" in the U.S., there has been an increase in studies and general research about addiction. I have a fairly high level of scepticism about individual studies (as per another blog) but that doesn't mean they have no uses and cannot be treated as a group for some type of insight.
     One anomaly that has been known for a long time is that people in severe pain only rarely get addicted to painkillers -- even the "heavy" painkillers such as heroin or other "opioids". The few that have gotten addicted seem to have had caregivers who did not decrease the medication when the pain decreased (and, even then, most did not remain dependent once their pain was overcome). It is the same medicine as that which might be used by a street "junky" -- but one is addicted and the other is not.
     The reality is that there are different types of addictions. There is the physical addiction which directly affects the mind and body and which carries with it the potentially lethal side-effects from overdose and withdrawal. This is often the primary aspect that is discussed -- and is how various addictive substances are listed in severity. With some drugs, it is possible to become physically addicted with the very first usage of the drug -- others take longer and have a constant increasing dosage requirement. No matter how quickly physical addiction takes place or how difficult (and, possibly, dangerous) withdrawal is -- there are beginnings and endings to physical addiction.
     So, there is no physical addiction before the drug is tried and physical addiction is fairly short-lived (assuming the person does live through the withdrawal). Why do they start? Why do they resume? The Alcoholics Anonymous groups talk about one day at a time -- recognizing that each day they do not resume is another day without alcohol. Other physically addictive drugs also tend to be resumed. Why, if the physical addiction can be removed?
     One study among a number of recent studies got a mouse (or rat, I cannot remember) addicted to some substance. They then (without having it go through a withdrawal process) placed it in an environment where it could go and have more of the drug OR go to a different room where it could have access to play activities with a number of other mice. The mouse chose the community playground.
     There are, thus, three phases of addiction -- becoming addicted, physically addicted, and potential relapse to addiction. The middle phase is the most physically dangerous but it is bounded. Pre-addiction is almost completely a social or emotional attitude -- the answer to "why?". The last phase, potential relapse, can be framed more from the question "why not?.
     Three of the potential components of why a person starts with an addictive substance includes behavior of their social group (family and peers), feelings of loneliness and/or hopelessness and/or some other situation earnestly desired to be escaped, and plain old curiosity (although their choice of substance is often socially constrained).
     Social (and, related, income) group is highly related to the type of substance used. In other words, what is popular and what is easily available? The drug of choice, and form, also depends on income levels. Low-cost alcohol for low-income and imported beer, wine, and liquor for higher-income. Tobacco use has decreased from about half of the U.S. population to less than 20% but the distribution is not even -- it is more likely of a choice for those who make less money and have lower amounts of education. In the case of the "opioids", it can depend on the vector of access. If it is prescribed, then certain drugs will be used. If purchased on the street, other drugs are more likely. In some cases, such as with refined sugar or some common household spices, it will meet the dictionary definition of a drug, but it is not considered as such by the general population.
     In all cases, continued use is dependent on finding a degree of pleasure from the experience. Generally, this is involved with dopamine in the brain. Different drugs work differently. Some increase dopamine, some prolong the interaction, and other interactions exist. Heroin is considered to be a highly addictive substance because the effect is so quick.
     At some point, a crossover takes place where the avoidance of withdrawal takes precedence over the attraction of the experience. This is the point that is more often called addiction. It continues, and may intensify, until there is an internal, or external, decision to stop or the person dies. This is not meant to imply that all addictive drugs are fatal though most are harmful to the body with extended use. A person can smoke for a normal lifespan -- it being very dependent on the individual's genetic history. On the other hand, a heroin addiction is not likely to be survived for a long time.
      It is a peculiar side-effect of messing with dopamine actions in the brain that it can also cause memory responses. You can reach the point of hating what you are doing while addicted and yet, after not that long, the memory of hatred fades and the dependency comes to the forefront once again.
     If quitting the addiction was done for an internal reason then the person has taken a strong step towards staying non-addicted. If the decision was imposed externally, then a number of factors are likely to be involved that will make it even more difficult to stay non-addicted. The internal decision has already wrestled with various pro- and con- factors. An external decision avoided such.
     We are now at the "why not" stage. As mentioned before, memories of the negative parts of the addiction are not likely to be very strong. Therefore decisions have to be made based on other factors. If the original attraction was to avoid feelings of hopelessness, is there now more reason to hope? If the original attraction was to avoid feelings of loss, do you now have other, healthier, ways of coping with those feelings? Even with the faded memories, hopefully curiosity is no longer a factor but you may still be surrounded by others who are still involved with the drug. In the case of legal drugs, they may even still be in the process of being advertised. (Note that, often, the primary difference between a drug being legal or illegal is political.) Basically, if the purpose of taking the drug was to avoid something and that something still exists, a return to the road of apparent (not actual) escape can be very, very tempting -- perhaps overwhelming.
     You have out a weighing scale and one side says "become readdicted" and the other side says "stay non-addicted". An outside observer may say "no problem -- it is obvious". It is not always so easy to the person who has passed through the gauntlet.