What is Substance Use? 

This article discusses substance use, and mental disorders. If you or someone you know is struggling with a substance use disorder, visit SAMHSA’s National Helpline Website or call 1-800-662-HELP (4357.) If you or someone you know is experiencing suicidal thoughts, or just need to talk to someone, call 988, text HOME to 741-741, or visit the 988 Suicide Lifeline Website. You can purchase Naloxone (Narcan) at CVS without a prescription, and the CDC provides online training for administration. You deserve to be here. Have a wonderful day.

This article is a two-part series on addiction; this part is focused on the science of addiction, why people use substances, and misconceptions. The next part will be about unsuccessful programs and initiatives, and better ways to treat substance use disorders (SUDs)

You have a substance use disorder. You knock on a family member’s door. There’s a slight peak through the blinders and a loud sigh even you can hear from the outside. You have been sober for a couple days, and you ask for a place to stay while you recover. As the conversation goes on for several minutes in a confused haze,  an anger-laden discussion develops. They claim once again that they are tired of you, and how you will never change. You say you will change, you do for a day, and you give up sooner or later. You ask for them to listen to you. After yet another argument, they slam the door, claiming that you tore the family apart. It’s a conversation that’s occurred many times before, each time leaving you more defeated than the last.

Familial discouragement is just one of many things that could perpetuate the cycle of substance misuse. Conversely, there are a multitude of reasons why people would try substances in the first place. Some people try substances for the thrill, with a sub-phenomenon being the “forbidden fruit effect.” Others often begin using drugs with friends. There are a myriad of reasons why people would use substances; however, many of them are underrepresented or misunderstood. And unfortunately, it is this stigma that has perpetuated the failure of substance-use recovery programs, such as Alcoholics Anonymous, twelve-step programs, and certain government initiatives. This stigma can often impede, discourage, and potentially endanger people attempting to recover from a substance-use disorder. With September being National Recovery Month, this article will explore the research behind addiction, why people would want to take drugs, and common misconceptions surrounding substance use. 

What is addiction?

Addiction is a serious, chronic dysfunction of the hypothalamus, the amygdala, and hippocampus (i.e.the brain’s reward, motivation, and memory systems). Due to these brain changes, the person feels a compulsive, obsessive need to perform a behavior, or use a substance, often overtaking their ability to function in their interpersonal relationships, or the ability to express concern over the consequences of the behavior. In 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that in people ages 12 and over, 165.4 million people used a substance in the past month. In this pool, 3.0 percent (or 8.3 million people) had at least one illicit —prohibited — drug use disorder in the past year. As a whole, according to the National Institute on Drug Abuse, (NIDA) 20.4 million people in the United States were diagnosed with SUD in the past year.

The brain is where addictions primarily form. This is not necessarily the same as physical dependence, when the person needs the drug to function, often developing a tolerance, thus requiring more of it. Physical dependence does not always mean one is addicted to a substance; drugs such as benzodiazepines, opioids, antidepressants, antipsychotics, and antiepileptics, can also cause one to be physically dependent on a substance. The key difference is the compulsive need for a substance. This compulsive need begins with the brain–the organ responsible for all functions and activities–from eating a nice meal, walking, showering, experiencing a musical, and enjoying a party. Our brain enables us to respond to situations, thereby allowing us to have authentic thoughts, emotions, and behaviors..

 The brain communicates with different parts in order to complete a function, be it basic sustainment, or for an experience of entertainment. Three parts of the brain are affected by drug usage: the brainstem, the cerebral cortex, and the limbic system.

 The brainstem is responsible for all automatic bodily activities, such as breathing, sleeping, heart rate, and blood pressure. The cerebral cortex is responsible for some of the more complex functions in the brain, divided into three parts to carry specific functions. These three areas are the motor areas, the sensory areas, and the association areas. Motor areas control motor activities (i.e.walking, running); sensory areas receive sensory information in the body, such as touch, temperature, or pain; and association areas coalesce the sensory information with the motor information, giving us perception, thought, and decision-making. The frontal part of the brain, the frontal cortex, is the system responsible for our memories, judgment, and attention. 

The limbic system is responsible for our behavioral and emotional responses, with particular regard to eating, socializing, and fight-or-flight responses. It is also where the amygdala, hippocampus,and  hypothalamus are housed. It is where our brain’s dopamine system is located. When we engage in pleasurable behavior, the reward system encourages us to continue engaging in that behavior. Just as dopamine is engaged by eating and socializing, it is also engaged when using substances, such as marijuana or alcohol. But unlike eating or socializing, dopamine is produced two to ten times more with substances, arousing our pleasure circuit to want more of the substance(s) in question. 

When substances are used, they go through the brain’s communication system, obstructing the communication of neurons. Typically when neurons are communicating, each nerve cell sends and receives signals, sending it off to other neurons once the message is processed. The messages are then typically carried by neurotransmitters(i.e. chemicals in the brain). The neurotransmitter then connects to the receptors, specialized receivers that only function with a specific neurotransmitter. After this process, the neurotransmitters are recycled by transporters. When using drugs however, the sending, receiving, and processing of these messages are impeded. Substances such as heroin and marijuana can mimic the structure of neurotransmitters, allowing them to latch onto neurons, resulting in abnormal messages being sent to the nerve cells, resulting in a high. Other substances, such as methamphetamine or cocaine, cause the neurons to release large amounts of natural neurotransmitters, preventing the transporters from functioning, resulting in a greatly amplified high. All drugs interact with the limbic system in some way, often resulting in a euphoric feeling. This euphoria opens up the potential for repeated use of a substance, requiring more of it when a tolerance is built, 

Why do people use drugs?

As an increasing amount of statistics come out about substances, people become understandably fearful. For instance, American teenagers are twice as likely to use an illicit substance than European teens. Though rates of cigarette smoking have decreased from 20.9 percent in 2005 to 12.5 percent in 2020, and a decrease in teenage vaping from 19.6 percent in 2020 to 11.3 percent in 2021, there has been a sharp increase in fentanyl, cocaine, methamphetamine, and opioid deaths from 1999-2019, resulting in over half a million more deaths than two decades ago. As substance use damages communities and significantly hurts loved ones, many people become confused when trying to understand why someone would want to take a substance. 

A substance use disorder (SUD) can develop in a multitude of ways. Many people begin using substances as a way to feel good, with the aforementioned euphoria brought about by substances. The subsequent effects following the euphoria are also a reason why people take a substance. Depressants like heroin, for example, cause people who use the drug to experience a “rush” — a feeling of warmth, reduced anxiety, and detachment. It also acts as a sedative, with other reasons for use being lower physical and emotional pain. With stimulants such as methamphetamine, the “high” typically elicits wakefulness, heightened self-confidence, and energy. 

Of course, there are side-effects due to repeated substance use: constipation, nausea, and respiratory depression for heroin; and increased blood pressure, irregular heart rate, and  convulsions for methamphetamine. However, many people using either of these substances have either become physically or emotionally dependent on the substance. With physical dependence, many people comprehend that if they quit using the substance, they will experience severe withdrawals, thus making them physically ill for a period of time. Others feel a sense of stability and comfort with the substance, resulting in emotional resistance to quit the substance. 

In that respect, some people use substances in order to cope with struggles in their lives. Many people struggling with depression, bi-polar disorder, personality disorders, post-traumatic stress disorder (PTSD), anxiety or panic disorder, attention-deficit hyperactivity disorder (ADHD), and extreme stress may turn to drugs as a way to reduce their symptoms and feel more at ease. With regard to social anxiety, the reduced inhibition that many substances provide gives a new sense of confidence. If the person becomes entertaining and outgoing, then they feel more well-liked and can find a sense of community; if the person does something embarrassing or outrageous, they can attribute it to the substance. With regard to PTSD, this comorbidity typically forms at the same time, creating a cyclical relationship. PTSD also mimics some of the brain alterations in substance abuse. The U.S Department of Veterans Affairs reports that nearly three-quarters of those surviving violent or abusive trauma report alcohol-use disorders. Depression and substance use are also two illnesses that feed off each other; coming off of a substance can lead to depression, with depression being a leading factor in substance use. In a study of people with bi-polar disorder, approximately 60% had some history of substance abuse, although the reasons why are still unsettled.

 The findings of comorbidity for substance abuse and mental illness are substantial, making it important to find clinical settings that treat a dual diagnosis. With dual diagnosis, integrated care is found to yield the best results, by treating the substance use and the mental disorder at the same time. According to SAMHSA, an integrated treatment plan coordinates both mental health and substance use in the individual’s treatment plan, by bringing in other providers who can personally tailor to the individual’s physical and emotional needs from both conditions. By completing this treatment, it reduces the need to be hospitalized, discontinues substance use, and reduces arrests. 

Many people also use substances to increase their performance in academics or athletics. Caffeine is widely known for its use for cognitive enhancement. Globally, it is the most commonly consumed psychoactive substance and is considered to be highly addictive. Though coffee has adverse side effects, such as heartburn, increased cholesterol, insomnia, and nerves, it is generally not considered dangerous, and not in the same vein as other stimulants, such as cocaine or amphetamines. Using prescription stimulants without a doctor’s notice, such as adderall or ritalin, is a practice most infamously known by college students who seek a theoretical academic edge. Using Adderall without a prescription has been unsoundly apotheosized for its ability to improve focus and study longer. In 2016, a study suggested that out of 141 college students, thirty percent experimented with Adderall without a prescription, with college seniors having the highest reported use at fifty-one percent. In a study by Michigan State University, over twenty-five percent of students admitted to using Adderall for studying. However, research suggests that using Adderall as a performance enhancing substance for non-ADHD students may actually hurt academics. In neurotypical students, though it may improve focus, it could actually damage your memory, lead to psychosis, anxiety, or depression, and have fatal consequences when mixed with other substances. 

A final major group of reasoning behind substance use is human curiosity, rebellion, or peer pressure. Peer pressure is an often misunderstood reason for why people would want to use substances. In the media, adolescent peer pressure is often associated with a nervous, indecisive teenager who had never been exposed to substance paraphernalia being told that the substance is cool and that everyone is trying it. However, it is typically more common for a teenager who has already been exposed to substance paraphernalia, or observed family members who have used a substance, to have a desire to take the substance in the first place. In tandem, the aforementioned group of teenagers are typically more likely to surround themselves with people who are using substances, making exposure often inevitable. This is the main problem with peer pressure; a person who has wanted to try a substance or behavior before, and who is now mainly doing it because their friends are there. 

Misconceptions on Substances 

One of the misconceptions of drug addiction is that it’s a choice, one where the user can quit anytime they would like to only if they were not so lazy or selfish. In actuality, drug addiction is like many other diseases. It affects all facets of life, seriously affects other organs, and is deadly if left untreated. A substance-use disorder significantly alters brain chemistry overtime, leaving a person unable to quit, even if/when they want to. This is why it is important to treat a friend or a family member with an SUD not as a burden, or as a failure, but as a person with a disorder. It is not necessarily as easy as deciding to go to bed earlier. Disorders take a long time to recover from. Not listening to what the person is saying, or calling them harsh names, is not going to make the person get better. It discourages a person from seeking help and sinks them into their problem further. 

Another common misconception is that people can become addicted to substances on their first use. You cannot become addicted to a substance on your first use. To develop a substance-use disorder, the use has to be repeated for a significant amount of time. As well as that, there has to be sustained use despite damage to interpersonal relationships and intrapersonal commitments. 

As well as that, many people are under the impression that marijuana is a “gateway drug.” There is little evidence that people who use marijuana go on to try harder substances, such as cocaine or heroin. Though using marijuana may increase the likelihood of becoming addicted to other drugs, many of those who try another substance do not. This is because marijuana is one of the most accessible drugs in the United States, meaning that those who have used heroin or cocaine, have also probably used marijuana. Typically, people who use marijuana do not go on to try other substances. Conversely, some researchers even suggest it can even help people who are coming off of an opioid-use disorder.

In tandem, many people believe the use of some substances, such as marijuana, can cause mental illnesses such as schizophrenia. Typically, if a substance brings about a mental health issue, the person was genetically predisposed to a mental health condition. In an otherwise healthy adult, using marijuana and other substances does not bring about a mental health condition.

A final misconception for this portion is that prescription drugs are not as addictive or harmful as illicit drugs. In actuality, prescription drugs are some of the most heavily misused substances, second to marijuana. Most frequently, prescription painkillers and opioids are the most frequently misused. Opioids are often misused to deal with emotional pain or stress, with particular regard to depressants like Xanax, which can cause an uncoordinated, drowsy feeling.

Conclusion

The topic of substance use disorders is a multifaceted issue. This article was meant to lay the groundwork for a discussion on SUDs. The next part will tackle misconceptions and stigma, how stigmatization has been perpetuated by government initiatives and some treatment programs, and general information on how to help treat SUDs.