A few years ago I saw a young girl on my way to work; she was waiting for the school bus and she stayed a bit away from the others. It was very early in the morning and she was smoking a cigarette. My heart became so heavy because I wondered to myself, how did this girl start smoking? Is she going to graduate from smoking of cigarettes to something stronger. She was a beautiful young girl and I wondered where she got the idea to start smoking. I thought about young people all over the world with no idea of what they are getting into.
That day, I started thinking of what I could do to prevent young people from taking that first cigarette. Maybe if children are taught about the ills of cigarette smoking and other addictions right from kindergarten this might help. I thought about my children especially my younger one who was taught about dinosaurs in kindergarten and then again in the second grade, a whole week was devoted to lessons about dinosaurs. I wondered if devoting that amount of time to teaching the children the short term pleasures and imminent dangers of addiction may be of some significant help.
Today I will be discussing addiction how it starts and probably the knowledge will help parents and children themselves avoid going down the lane of addiction. Addiction is a very complicated issue and it leads from one thing to another. At first the experience is pleasurable but in the end it is always disastrous.
I will first try to talk about the origin of addiction the various types of addictions and probably if people have an understanding of the addiction process and what will happen, maybe they will avoid altogether trying to see what it feels like.
So let’s start by defining addiction. Addiction has been defined by various professional bodies and there is not a final consensus about the real definition. The American Psychiatric Association has defined addiction or substance dependence as a cluster of symptoms indicating that the individual continues the use of the substance despite significant substance-related problems. Others define addiction as a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. Evidence of tolerance and withdrawal symptoms are included in the list of symptoms however neither tolerance nor withdrawal effects is necessary or sufficient for a diagnosis of substance dependence. When you talk of addiction there is physical dependence and psychological dependence these are two different things.
Variables affecting onset and continuation of substance abuse
Now I want to talk about the origins of substance dependence and the many variables that affect the onset and continuation of substance abuse. According to Goodman and Gilman’s (The pharmacological Basis of Therapeutics 11th ed.2006) These variables have been divided into three categories
The first category is the agent that is as the drug itself or the substance itself. For example, opioids or cocaine or cigarettes. The next category is the host, that is the user. And finally the last category is the environment. All these will be discussed in more details
The Agent or Drug Variables
Availability – if an agent is widely available and easily accessible, there is a higher tendency for that agent to become something that people can abuse or be addicted to.
Cost – The cheaper the agent is, the more the likelihood that a larger number of people will favor it.
Potency/purity– The higher the purity or potency of the drug, the faster the onset of addiction in most cases.
Routes of administration – By this I mean how the agent is administered into the body. It could be administered by chewing and then the substance is absorbed in the mouth or it could be swallowed and absorbed in the stomach or intestine. Other routes could be by spraying or snuffing into the nostril or subcutaneous or intramuscular injections. Some substances are injected through the vein straight into the blood circulation and some are inhaled into the lungs. Depending on how the medication gets into a person’s system that would usually affect how fast a person can get addicted.
Speed of onset of effects– The faster the onset of effect, the more desirable the agent is to the user and the greater the tendency for abuse and dependence.
Let us demonstrate this with the example of something like the coca leaves where cocaine was originally derived from. If the coca leaves are chewed, (as was the custom of the Andes mountain people for thousands of years) the cocaine is absorbed slowly through the cheeks in the mouth. It produces very low cocaine levels in the blood and brain and the mild stimulant effect has a gradual onset with little or no abuse or dependence tendency.
In the late 19th century, scientists were able to extract cocaine hydrochloride from the coca leaves and then pure cocaine could be taken by mouth (no need to chew) or nasally at higher doses thereby producing higher levels of cocaine in the blood and brain and producing a faster onset of the stimulant effect. They later found that a solution of Cocaine Hydrochloride could be given intravenously and this produced an even faster onset of action but also a higher likelihood of addiction.
Then came the illegal introduction of crack cocaine to the American public in the 1980s which was ridiculously cheap and affordable to anyone. The inhalation of crack cocaine produced blood levels comparable to intravenous cocaine.
However, while agent or drug variables are important, they do not fully explain the process of addiction so we will be looking at the next variable.
The User Variables
When we talk about user variables, what we find is that different people react to different substances in different ways. This could be attributed to heredity or the different genes that people have. It has been found that children of Alcoholics have a higher tendency to become alcoholics but that does not mean that they definitely will become alcoholics. Some particular races might be more susceptible to becoming alcoholics due to some things in there physical or chemical makeup. Some individuals have more tolerance to nicotine than others and some have more tolerance to alcohol than others.
People who have an underlying psychiatric tendency may end up actually developing the psychiatric problem when trying to experiment with addictive substances that were intended to overcome things as simple as shyness. There are also some individuals who just love to take risks and end up with substance abuse or drug dependence.
Starting and continuing illegal drug are usually influenced greatly by the social norms and peer pressure. In some communities, drug dealers and users are role models when the youth have no one else to look up to. Lack of better recreational activities, jobs or access to quality education are other factors that help foster an addiction culture.
Not all addictive substances are illegal
So, not all addictive substances are illegal and that is the main problem. If you read my article on pain you will see how a lot of young people have been reported as starting their addiction to opioids. Some patients are prescribed opioids legally to treat their pain. Some are prescribed benzodiazepines to treat their anxiety or lack of sleep. These medications are good in the short-term however with long term use they can become addictive.
The danger starts when an individual becomes tolerant to the medication. If a medication is being taken for sleep the individual may keep increasing the dose because it is no longer working at the dose that was originally working. The medication may not be producing the effect of sleep but it might still be reducing the person’s ability to breathe normally, meaning that when you take a higher dose you might be able to fall asleep however it will also affect your breathing.
That is what usually occurs with medications like diazepam. People take a higher dose and then because they’re no longer breathing the end up dying in their sleep. So the tolerance was developed to the sleeping effect but not to the breathing effect. The situation is worse when the person takes the diazepam with alcohol.
In recent years recreational and medical marijuana are now legal in many states in the US and I am worried about terrible effects we are going to see in a few years.
So why don’t people just stop using these substances if they are harmful?
That is a good question. Once an individual becomes physically dependent on a substance, it is characterized by terrible withdrawal effects (that is the feelings the individual experiences when they stop using the substance). Below are a list of common substances and there withdrawal effects.
Alcohol Withdrawal syndrome
Irritability and tremor
seizures 6 to 48 hours after last drink
Delirium tremens 48 to 96 hours after last drink characterized by severe agitation, confusion, fever and profuse sweating, tachycardia, nausea and diarrhea, and dilated pupils.
Benzodiazepine withdrawal syndrome
Following moderates dose usage we have:
Anxiety and agitation
Increased sensitivity to light and sound
Paresthesias (pins and needles) and strange sensations
Myoclonic jerks (sudden muscle contractions)
Following high-dose usage we have:
Nicotine withdrawal symptoms
Irritability impatience hostility
Dysphoric or depressed mood
Decrease heart rate
Increased appetite or weight gain
Opioid withdrawal symptoms and signs
Craving for opioid, restlessness irritability
Increased sensitivity to pain
Insomnia and anxiety
Dilation of the pupil
Goosebumps or Goose flesh
Tachycardia (fast heart rate)
Increased blood pressure
Changes in weight
Cocaine withdrawal signs and symptoms
Dysphoria (a state of unease or generalized dissatisfaction with life)
Bradycardia (slow heart rate)
Marijuana withdrawal syndrome
Nausea and cramping
Hopefully that young girl did not go the way of addiction and has become a responsible member of the society. But this article is an attempt to warn the public of the dangers of resorting to addictive and harmful substances whether they are legal or illegal.
Thanks for reading and stay healthy.