Addiction
In 1964, a researcher named Knestler proposed that specific genes might predispose individuals to addiction. This early hypothesis laid the groundwork for understanding addiction not merely as a moral failing but as a neuropsychological disorder. Modern definitions describe addiction as a persistent and intense urge to use drugs or engage in behaviors that produce immediate psychological rewards. These urges persist despite substantial harm and negative consequences. Repetitive drug use alters brain function in synapses similar to natural rewards like food or falling in love. This phenomenon has led scientists to view addiction as a complex mix of psychosocial and neurobiological factors. Classic signs include compulsive engagement in rewarding stimuli and continued use despite negative outcomes. Habits associated with addiction typically feature immediate gratification coupled with delayed deleterious effects. Examples range from alcoholism and nicotine addiction to behavioral issues like gambling and video game addiction.
DeltaFosB serves as a critical gene transcription factor in the development of virtually all forms of behavioral and drug addictions. Two decades of research into DeltaFosB's role have demonstrated that addiction arises along with its overexpression in D1-type medium spiny neurons within the nucleus accumbens. Chronic addictive drug use causes alterations in gene expression in the mesocorticolimbic projection. The most important transcription factors producing these changes are DeltaFosB, cAMP response element binding protein, and nuclear factor kappa B. DeltaFosB is the most significant biomolecular mechanism because its overexpression is necessary for many neural adaptations seen in drug addiction. It directly regulates drug self-administration and reward sensitization through positive reinforcement while decreasing sensitivity to aversion. Increases in nucleus accumbens DeltaJunD or G9a expression can reduce or block many of the neural and behavioral alterations resulting from chronic high-dose use of addictive drugs. Natural rewards like palatable food and sex also induce gene expression of DeltaFosB in the nucleus accumbens. This leads to a similar pathological addictive state through DeltaFosB overexpression.
Genetic factors account for 40, 60% of the risk factors for alcoholism according to established data. Twin studies provide some of the highest-quality evidence showing that if one twin is affected by addiction, the other is likely to be as well. Family studies suggest that relatives of those with addiction history have much higher chances of developing similar habits compared to those not introduced to addiction at a young age. Adverse childhood events are associated with negative health outcomes such as substance use disorder. Children's neurological development can be permanently disrupted when chronically exposed to stressful events like physical abuse or neglect. Over time, these children may adopt substance use as a coping mechanism due to reduced impulse control during adolescence. In the United States, there were just over 2.8 million new users of illicit drugs in 2013. Among them, 54.1% were under 18 years of age. The National Institute on Drug Abuse cites lack of parental supervision and poverty as key environmental risk factors for substance use among children and adolescents.
The fifth edition of the Diagnostic and Statistical Manual uses the term substance use disorder to refer to a spectrum of drug use-related disorders. This manual eliminates terms like abuse and dependence, instead using specifiers of mild, moderate, and severe to indicate the extent of disordered use. Problem gambling is the only condition included in the behavioral addictions category in this fifth edition. Internet gaming disorder appears as a condition requiring further study within the same document. The eleventh revision of the International Classification of Diseases distinguishes between problems with psychoactive substance use and behavioral addictions. It offers three diagnostic possibilities: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence. Screening tools include the CRAFFT version 2.1 used to identify substance use among adolescents. The Drug Abuse Screening Test measures problematic substance use with responses recorded as yes or no answers scored between zero and 28. A cut-off score of six indicates drug abuse or dependence.
In Asia, internet addiction disorder prevalence reaches 5% according to the Internet Addiction Test and 21% according to the Revised Chen Internet Addiction Scale. Australia reported a 5.1% prevalence of substance use disorder among its population in 2009. By 2019, 11% of people over 14 years old smoked daily while 7.5% of the total population age 14 or older qualified as alcohol dependent. Europe saw mortality rates for alcohol and illicit drugs highest in Eastern Europe during recent surveys. In the United States, 43.7 million people aged 12 or older surveyed by the National Survey on Drug Use and Health needed treatment for addiction. Only about 10%, or slightly over 2 million, receive any form of treatments. One-third of inpatient hospital costs and 20% of all deaths in the US every year result from untreated addictions and risky substance use. Canada found lifetime prevalence of substance use disorders at 21.6% and 12-month prevalence at 4.4% in those 15 and older. Mexico has the highest incidence of opioid use due to its border with the United States.
Vaccines for addiction have been investigated since the early 2000s as a possibility to immunize against drug abuse. NicVAX is a conjugate vaccine intended to reduce physical dependence on nicotine developed by Nabi Biopharmaceuticals. TA-CD is an active vaccine used to negate the effects of cocaine created by combining norcocaine with inactivated cholera toxin. As of September 2023, a vaccine had been tested against heroin and fentanyl and was preparing for testing against OxyContin. Recent studies indicate that GLP-1 agonist medications like semaglutide may reduce the risk of overdose and alcohol intoxication. Researchers analyzed nearly nine years of health records from 1.3 million individuals across 136 U.S. hospitals. Those using these drugs showed a 40% lower risk of opioid overdose and a 50% lower risk of alcohol intoxication compared to non-users. Treatment requires pharmacological or biological interventions accompanied by cognitive behavioral therapy and dialectical behavioral therapy. Twelve-step programs and residential treatment facilities remain common components of comprehensive care models.
Artists attempt to change societal perception of addiction from a punishable moral offense to a chronic illness necessitating treatment. Addiction art exhibitions communicate through emotions without relying on intellectually demanding facts and figures. These exhibitions can stand alone, reinforce, or challenge existing facts about substance use disorders. A project by Temple University College of Public Health asked students to create art pieces displayed on a website promoted via social media. Quantitative and qualitative data recorded engagement revealing a change in perspective among student artists. The Formal Elements Art Therapy Scale evaluates drawings created by people suffering from substance use disorders by comparing them to control groups. This scale consists of twelve elements with three found particularly effective at distinguishing drawings of those with SUDs. Art therapists working with children of parents suffering from alcoholism use the Kinetic Family Drawings assessment tool to shed light on family dynamics. Messages encourage policymakers to allocate more resources to addiction treatment and prevention from federal, state, and local levels.
Common questions
What is the definition of addiction according to modern research?
Modern definitions describe addiction as a persistent and intense urge to use drugs or engage in behaviors that produce immediate psychological rewards. These urges persist despite substantial harm and negative consequences.
How does DeltaFosB contribute to the development of drug addictions?
DeltaFosB serves as a critical gene transcription factor in the development of virtually all forms of behavioral and drug addictions. Its overexpression in D1-type medium spiny neurons within the nucleus accumbens is necessary for many neural adaptations seen in drug addiction.
What percentage of alcoholism risk factors are genetic according to established data?
Genetic factors account for 40 to 60% of the risk factors for alcoholism according to established data. Twin studies provide some of the highest-quality evidence showing that if one twin is affected by addiction, the other is likely to be as well.
Which diagnostic manual uses substance use disorder instead of abuse and dependence?
The fifth edition of the Diagnostic and Statistical Manual uses the term substance use disorder to refer to a spectrum of drug use-related disorders. This manual eliminates terms like abuse and dependence, instead using specifiers of mild, moderate, and severe to indicate the extent of disordered use.
What was the prevalence of internet addiction disorder in Asia according to the Internet Addiction Test?
In Asia, internet addiction disorder prevalence reaches 5% according to the Internet Addiction Test and 21% according to the Revised Chen Internet Addiction Scale.
How effective were GLP-1 agonist medications in reducing overdose risks based on recent studies?
Those using these drugs showed a 40% lower risk of opioid overdose and a 50% lower risk of alcohol intoxication compared to non-users. Researchers analyzed nearly nine years of health records from 1.3 million individuals across 136 U.S. hospitals.