What causes addiction, and why is it so hard to treat? - Judy Grisel

Summary

The video script delves into the complexities of substance abuse disorder, affecting over 36 million people globally as of 2021. It explains how repeated drug use leads to tolerance, dependence, and changes in the brain's reward pathway, altering decision-making and increasing impulsivity. The script also touches on the varying susceptibility to addiction due to life experiences and genetic factors, highlighting the importance of age, trauma, and mental health. It concludes by discussing the challenges of detoxification and the necessity of comprehensive treatment plans for recovery.

Takeaways

• 🌐 As of 2021, over 36 million people globally were estimated to have substance abuse disorder.
• 🧠 Substance abuse disorder involves a patterned drug use that leads to life issues, potentially resulting in addiction.
• 💊 Tolerance develops as the brain adjusts to the regular presence of a substance, requiring more to achieve the same effect.
• 🍺 Alcohol举例, it increases the transmission of pleasure and calmness-inducing neurotransmitters like endorphin and GABA.
• 📈 Dependence on a substance can develop when the body requires it to function comfortably, affecting decision-making and increasing impulsivity.
• 🎯 All addictive substances alter dopamine release in the nucleus accumbens, a key region in the brain's reward pathway.
• 🚀 The addictiveness of a drug is linked to how quickly it reaches the brain and stimulates the reward pathway.
• 💉 Opioids like heroin and morphine have different levels of addictiveness based on their ability to penetrate the blood-brain barrier.
• 🧬 Genetic factors and life experiences, including trauma and mental health conditions, influence susceptibility to substance use disorder.
• 🚭 Using addictive substances before the age of 18 is a strong risk factor due to the sensitivity of younger brains' reward pathways.
• 🛠️ Recovery from addiction involves a complex process that includes detoxing, addressing underlying conditions, and creating supportive environments.

Q & A

How many people were estimated to be experiencing substance abuse disorder as of 2021?

As of 2021, more than 36 million people worldwide were estimated to be experiencing substance abuse disorder.

What is the difference between substance abuse and substance addiction?

Substance abuse refers to a pattern of drug use that causes issues in a person's life, while substance addiction is at the more severe end of this spectrum, indicating a chronic and often relapsing condition.

What is tolerance in the context of substance use?

Tolerance is a condition where the brain adjusts to the regular presence of an addictive substance, requiring more of the drug to produce the same experience over time.

How does alcohol affect the brain's neurotransmitters?

Alcohol increases the transmission of chemical messengers like endorphin and GABA, which promote sensations of pleasure and calmness.

What is the role of the nucleus accumbens in addiction?

The nucleus accumbens is a brain region that is part of the reward pathway, sensitive to experiences that give us pleasure, and is exploited by addictive substances to drive repeated seeking and use behaviors.

How does substance use affect the balance between the brain's cortex and subcortex?

Repeated substance use can decrease the influence of the cortex, responsible for deliberate decision-making, and increase the influence of the subcortex, which is crucial in habit-learning and impulsivity.

What are some factors that make people more susceptible to substance use disorder?

Factors that increase susceptibility to substance use disorder include life experiences, genetically inherited traits, trauma, mental health conditions, and using addictive substances before the age of 18.

How do certain genes increase the risk for nicotine addiction?

Some genes increase the risk for nicotine addiction by making certain receptors more sensitive to nicotine and making withdrawal from it more difficult.

What is the significance of a drug's speed of reaching the brain in terms of its addictive potential?

The faster a drug reaches the brain and stimulates the reward pathway, the more addictive it is, as seen with drugs like heroin that can quickly penetrate the blood-brain barrier.

Why is detoxing from a substance not always advised to be done abruptly?

Detoxing from a substance abruptly can be physically risky and extremely difficult, which is why treatment plans often involve a gradual process to safely manage withdrawal symptoms and address underlying conditions.

What are some components of effective treatment plans for substance use disorders?

Effective treatment plans for substance use disorders prioritize addressing underlying conditions, developing new associations with experiences previously linked with drug use, and creating safe, supportive environments.

Outlines

00:00

💡 Understanding Substance Abuse and Addiction

This paragraph delves into the prevalence and nature of substance abuse disorder, affecting over 36 million people globally as of 2021. It explains the spectrum of drug use issues, from misuse to addiction, and explores why some individuals are more prone to addiction. The explanation includes the physiological effects of addictive substances on the brain, such as the development of tolerance, the impact on neurotransmitters like endorphins and GABA, and the alteration of dopamine release in the nucleus accumbens. The paragraph also discusses how repeated substance use can lead to dependence, affect decision-making and impulsivity, and result in cravings and withdrawal symptoms. It highlights the varying addictive potential of drugs based on their chemical structure and delivery method, and acknowledges the complex interplay of life experiences and genetic traits in susceptibility to substance use disorders. The paragraph concludes by noting the sensitivity of younger brains to addictive substances and the genetic factors that can both increase and decrease resistance to addiction.

05:01

🌟 The Journey of Addiction Recovery

This paragraph focuses on the process of recovery from addiction, emphasizing the brain's remarkable capacity to adapt. It outlines the components of effective treatment plans, which include detoxification, addressing underlying conditions, forming new associations with experiences, and creating supportive environments. The paragraph underscores that both addiction and recovery are outcomes of the brain's adaptability, suggesting that with the right support and interventions, individuals can overcome substance use disorders.

Keywords

💡substance abuse disorder

Substance abuse disorder refers to a condition where a person has a pattern of using drugs that causes significant problems in their life, such as health issues, relationship troubles, or legal concerns. In the video, it's highlighted that over 36 million people worldwide were estimated to experience this disorder as of 2021, emphasizing the scale and severity of the issue.

💡tolerance

Tolerance is a physiological adaptation that develops when the body becomes accustomed to a substance, requiring higher doses to achieve the same effects. This concept is central to understanding addiction, as it explains why individuals may escalate their drug use over time.

💡dopamine

Dopamine is a neurotransmitter that plays a key role in the brain's reward system. It is associated with feelings of pleasure and is released when we engage in activities that we find enjoyable. Addictive drugs manipulate the release of dopamine, particularly in the nucleus accumbens, leading to the reinforcing effects that drive addiction.

💡reward pathway

The reward pathway is a circuit in the brain that is activated by experiences we find pleasurable and motivates us to seek out those experiences repeatedly. Addictive substances exploit this pathway by artificially stimulating it, leading to a cycle of use and craving.

💡dependence

Dependence is a state in which a person's body has adapted to the presence of a substance, requiring it to function normally. This is different from addiction, which is a behavioral condition, but the two often co-occur. Dependence can lead to withdrawal symptoms when the substance is not available.

💡withdrawal

Withdrawal is the set of physical and psychological symptoms that occur when a person stops using a substance to which they have developed dependence. These symptoms can be severe and are a major barrier to overcoming addiction.

💡opioids

Opioids are a class of drugs that include both legal prescription pain relievers and illegal drugs like heroin. They work by relieving pain and inducing sedation. The script discusses the addictive nature of opioids and the severe withdrawal symptoms associated with them.

💡genetically inherited traits

Genetically inherited traits refer to characteristics that are passed down from parents to offspring through genes. In the context of the video, these traits can influence a person's susceptibility to substance use disorder, with some genes increasing the risk of addiction and others providing resistance.

💡detoxing

Detoxing, or detoxification, is the process of removing toxic substances from the body. In the context of substance use disorder, detoxing refers to the initial stage of recovery where the body is cleansed of the addictive substance, which can be a challenging process due to withdrawal symptoms.

💡recovery

Recovery from substance use disorder is a long-term process that involves more than just the elimination of the substance from the body. It includes addressing underlying conditions, developing new associations with experiences, and creating supportive environments to prevent relapse.

💡nicotine

Nicotine is a highly addictive substance found in tobacco products. It stimulates the release of dopamine in the brain's reward pathway, leading to addiction. The video discusses nicotine's addictive nature and how certain genetic factors can increase the risk of nicotine addiction by making receptors more sensitive.

Highlights

More than 36 million people worldwide were estimated to be experiencing substance abuse disorder as of 2021.

Substance abuse disorder spans a spectrum of patterned drug use that causes issues in a person's life.

At the severe end of the spectrum is substance addiction, which is challenging to treat and understand.

Addictive substances affect the brain by creating tolerance, which diminishes the drug's effect over time.

Alcohol increases the transmission of chemical messengers like endorphin and GABA, promoting pleasure and calmness.

The brain adapts to frequent alcohol use, leading to a decrease in pleasure- and calm-inducing neurotransmitters when alcohol is not consumed.

All addictive substances alter the release of dopamine in the nucleus accumbens, a region sensitive to pleasurable experiences.

Repeated substance use can lead to dependence, where the drug is necessary for comfortable functioning.

Drug use can decrease the influence of the brain's cortex, affecting decision-making and increasing impulsive behaviors.

The subcortex's influence increases with repeated drug use, affecting habit-learning and impulsivity.

These changes can lead to a perceived lack of control over substance use, impacting other facets of life and leading to risks.

Withdrawal symptoms such as cravings, pain, anxiety, and insomnia can occur when the substance leaves the system.

The speed at which a drug reaches the brain and stimulates the reward pathway affects its addictive potential.

Heroin is more addictive than morphine due to its ability to penetrate the blood-brain barrier and bind to receptors quickly.

Nicotine in cigarettes and e-cigarettes is more addictive than nicotine patches and gum due to faster delivery to the brain.

Drugs vary in addictiveness based on their chemical structure and mode of delivery.

Susceptibility to substance use disorder is influenced by a mix of life experiences and genetically inherited traits.

Trauma, mental health conditions, and using addictive substances before 18 increase the risk of substance use disorder.

Some genes increase the risk for nicotine addiction by making receptors more sensitive and withdrawal more difficult.

Certain genes can make people more resistant to substance use disorders by slowing the breakdown of alcohol and causing unpleasant side effects.

Detoxing from a substance can be extremely difficult, and abruptly quitting can sometimes be physically risky.

Recovery from addiction is a long-term process aided by treatment plans that address underlying conditions and create supportive environments.

Transcripts

As of 2021, more than 36 million people worldwide

were estimated to be experiencing substance abuse disorder.

This condition spans a spectrum of patterned drug use

that causes issues in a person’s life.

At the more severe end of the spectrum is substance addiction.

To understand why some people are more susceptible to addiction

and why it can be so difficult to treat,

let’s take a look at how addictive drugs affect the body.

When someone repeatedly uses an addictive substance,

their brain may adjust to account for its regular presence.

This is called tolerance; it diminishes the drug’s effect

and means more is required to produce the same experience.

Alcohol, for instance, increases the transmission of chemical messengers

like endorphin and GABA,

which promote sensations of pleasure and calmness.

When someone uses alcohol frequently, their brain will adapt to its presence.

So when they don’t use it, their brain receives fewer signals

from those pleasure- and calm-inducing neurotransmitters,

which impacts their energy and mood.

In addition to the unique effects each addictive substance has,

all of them alter the release of dopamine

in a brain region called the nucleus accumbens.

This area is part of the brain’s reward pathway,

which is sensitive to experiences that give us pleasure

and drives us to repeatedly seek them out.

The reward pathway is essential to our well-being—

but addictive substances also exploit it.

When someone is repeatedly using a substance

and their body has adapted to its presence,

they may develop dependence

where the drug is necessary for them to function comfortably.

Meanwhile, repeated use can decrease the influence of the brain’s cortex,

which is responsible for driving deliberate decision-making

and limiting impulsive behaviors.

And it can increase the influence of the brain’s subcortex,

which is crucial in habit-learning and impulsivity.

Together, these changes can make someone feel a lack of control

over how they’re using a substance.

This can mean suffering in other facets of their life

and taking risks to continue using it.

If the substance leaves their system, their body's equilibrium is disrupted,

so they may experience cravings that motivate thoughts and behaviors

of seeking and using the drug.

And if they continue without the substance,

they may experience withdrawal.

Opioids, for example, relieve pain and induce sedation.

Withdrawal from them causes heightened pain, anxiety, and insomnia.

The faster a drug reaches the brain and stimulates the reward pathway,

the more addictive it is.

For example, heroin and morphine have similar effects,

but heroin’s chemical structure enhances its ability

to penetrate the blood-brain barrier and bind to specific receptors.

This makes it faster acting and more addictive than morphine.

Meanwhile, compared to nicotine patches and gum,

regular and electronic cigarettes are more addictive

because smoking and vaping deliver nicotine to the brain fastest.

Depending on their chemical structure and mode of delivery,

drugs vary in how addictive they are—

but people also vary in how susceptible they are to substance use disorder.

Scientists think this is due to a mix of life experiences

and genetically inherited traits,

though neither predetermines addiction.

Trauma and mental health conditions appear to make people more susceptible.

And, overall, using addictive substances before 18

is considered a strong risk factor.

This is in part because the reward pathways of younger brains

are especially sensitive.

Many of the genetic factors at play remain unknown,

but some genes do seem to track with certain substance use disorders.

For example, specific genes increase the risk for nicotine addiction

by making certain receptors more sensitive to nicotine

and withdrawal from it more difficult.

At the same time,

some genes actually make people more resistant to substance use disorders,

such as genes that slow the breakdown of alcohol,

leading to unpleasant side effects that make people less interested in drinking.

In fact, one drug that treats alcohol use disorder

operates with this very mechanism.

Detoxing from a substance the body has become dependent on

can be extremely difficult.

And in some cases, abruptly quitting can also be physically risky,

so it isn’t always advised.

Beyond detoxing, quitting is often a long-term process.

It’s aided by treatment plans that prioritize

addressing underlying conditions;

developing new associations with experiences

previously linked with drug use;

and creating safe, supportive environments.

Ultimately, both addiction and recovery are the results of a brain

with an incredible ability to adapt from experience.