In 2023, the death rate from drug overdoses in the United States exceeded 112,000 over a 12-month period for the first time, according to the Centers for Disease Control and Prevention. Most drug deaths now result from the synthetic opioid fentanyl, which is commonly mixed with other street drugs. Federal researchers now report that drug overdoses are a leading cause of death among Americans ages 18-45. As a result, many veterinarians have had experience with the pain and trauma of drug abuse within their families, work teams, or clientele.
According to Nora Volkow, MD, of the National Institute on Drug Abuse, “Drug addiction is a brain disease that can be treated.” Scientific research has shown addiction is a medical disorder that affects the brain and changes behavior. Researchers have identified many biological and environmental risk factors for addiction and are also identifying genetic variations that might contribute to its development. Sadly, for many decades addicts were largely viewed as weak people lacking in self-control, or worse. Those views shaped society’s harsh response to drug use as a moral crime rather than a health problem, resulting in an approach favoring punishment over prevention and treatment.
Neurobiology of Addiction
At the 2018 AAEP Convention, Joseph Garbely, D.O., DFASAM, FAPA, a physician from the Caron Treatment Centers in Pennsylvania (www.caron.org), spoke at length about the neurobiology of the disease of addiction, saying, “Addiction is a chronic disease with a consistent pattern of signs and symptoms.” It is neither caused by a person being evil nor by lack of moral fiber, he said. According to the American Society of Addiction Medicine (ASAM), addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction of these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. People experiencing addiction pathologically pursue reward and/or relief through substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
“The frontal cortex of the brain and underlying white matter connections between the frontal cortex and circuits of reward, motivation, and memory are fundamental in the manifestations of altered impulse control, altered judgment, and the dysfunctional pursuit of rewards seen in addicts,” Garbely said. Because the frontal lobes are important in inhibiting impulsivity and appropriately delaying gratification, addicts, who have diminished frontal lobe performance, continue to engage in substance use and other addictive behaviors despite experiencing many cumulative adverse consequences. Garbely reported that because frontal lobe connectivity and functioning continue to mature until age 20 in females and 26 in males, early exposure to substance use is a significant factor in the development of addiction.
Addiction Recovery
Recovery is hard work, but it is possible. One year of abstinence is necessary before the likelihood of relapse is less than 50%. After five years “clean,” a former addict has similar risk to the general population of becoming addicted again. Treatment for addiction must include therapy to address previous trauma or emotional wounds that lead a person to feel inadequate, anxious, shamed, and “defective.” Therapy can also address issues such as the need to be perfect, hearing an inner negative voice, and feeling compelled to hide emotions to be accepted or loved. Like treatment for other chronic diseases, such as heart disease or asthma, addiction treatment is not a cure but a way of managing the condition. Treatment enables people to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives.
Learn more at https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction and www.caron.org.
