[Noozhawk’s note: This article is part of Day 3 in Noozhawk’s 12-day, six-week special investigative series, Prescription for Abuse. Related links are below.]
In the past, the study of addiction has often been focused on substances — like heroin, marijuana and alcohol. But experts in the field now believe that addiction begins with the “reward circuitry” in the brain rather than the substances themselves. Understanding just how addiction works may offer clues to getting control of the growing problem of prescription drug abuse.
In August, the nonprofit American Society of Addiction Medicine released an official definition of addiction that categorized it as a “chronic disease of brain reward, motivation, memory and related circuitry.” An individual with addiction will pathologically pursue reward and or relief by substance use and other behaviors, the statement said.
“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,” the organization stated. “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.
“Addiction is not, at its core, just a social problem or a problem of morals. Addiction is about brains, not just about behaviors.”
John Gabbert, senior program director at the Santa Barbara Rescue Mission, puts it another way.
“I define addiction as any behavior that an individual will continue to do regardless of the negative consequences of that behavior,” he said.
A strong genetic component also exists with addiction, which helps explain why some people react to certain drugs and others don’t. According to the American Society of Addiction Medicine, genetic factors account for about half of the likelihood that a person will experience addiction.
Two local addiction experts weighed in on what they see every day in their practice. Drs. Joe Frawley and Sherif El-Asyouty are the co-founders of Santa Barbara’s Recovery Road Medical Center, which specializes in helping patients overcome addictions. The center is located at 3891 State St., Suite 205.
How rewarding a drug is to a person is one factor, while how much the person’s nervous system can adapt to the drug is another.
“If you take an 18 year old and he can handle five drinks very well without much effect, he’s more likely to have a problem 10 years later than someone who says ‘My head was spinning with the five drinks,’” Frawley said. “In those people who can handle it well, there is a much higher family history of addiction. They have a nervous system that has adapted to alcohol.”
Age is also a strong indicator.
Prescription drug abuse is most consistent among young adults aged 18 to 25 years old, according to data from the Substance Abuse & Mental Health Services Administration, a division of the Health and Human Services Department.
That age group is most likely to abuse prescription opioids, like oxycodone and hydrocodone, and these drugs are the most common drugs used at initiation, second only to cannabis, or marijuana, according to SAMHSA.
Compounding the issue is that people perceive prescription medications to be safe.
“People give a couple of pain pills out to someone like you would give them a pen,” Frawley said. “It’s that casual.”
Frawley and El-Asyouty also say there’s a strong connection between substance dependence and untreated mood and anxiety disorders; people will self-medicate with prescription drugs to feel “normal.”
A prime example is a 21-year-old Santa Barbara woman named Lynn, who spoke to Noozhawk on the condition of anonymity. Lynn said she started taking OxyContin while in a physically abusive relationship. A friend noticed bruises down the back of her arms and offered her a pill.
“I was in such a mental state that I really didn’t care,” she said. “I was so unhappy with myself and the relationship I was in.”
Family and friends would try to intervene when they saw the signs of physical abuse, like a black eye, but “I thought that I was above it,” she said.
Lynn said she liked how OxyContin and oxycodone, sometimes known as “roxies” on the street, made her feel, and after she ended the relationship, she was physically addicted and continued to use the medications for two years. She said she had enough friends taking the same drugs, so buying them was easy.
She said she would freebase the drugs for a faster high, but then the pharmaceutical company changed the chemical makeup of the pills, which prevented her from crushing and smoking them. The change prompted her to switch to heroin, which she used for about six months.
Abuse of opioid prescriptions may be a precursor to injection drug usage and drugs like heroin, according to a study published earlier this year in the International Journal of Drug Policy. Out of 150 young adults surveyed for the study, more than 80 percent initiated opioid misuse prior to heroin, which occurred two years earlier on average.
Lynn was eventually arrested last Halloween in Isla Vista, and she was charged with possession and sales of heroin and possession of cocaine.
Today, she is several months into a court-mandated treatment facility, Project Recovery run by the Santa Barbara Council on Alcoholism & Drug Abuse, and is taking a year off from UCSB to get clean. The program will last 12 to 18 months, depending on how well she does, but she hopes to return to school after treatment and finish her bachelor’s degree in environmental studies.
“I was resistant to the whole recovery thing, because I thought ‘If I really want to beat this, I can,’” she told Noozhawk. “Anything I’ve truly put my mind to, I haven’t failed at, so this was a really big life lesson.”
It’s important to remember that none of the medications are bad, said El-Asyouty, and they have a specific medical purpose when prescribed in a certain amount by a doctor.
“They become drugs when they are used for different reasons than what was intended, or in larger amounts or when you get them outside the prescribing source,” he said.
El-Asyouty said he thinks the majority of doctors mean no harm when they prescribe a medicine.
“The trick is once you start to notice (signs of addiction), it’s important to re-evaluate and not to be afraid of having those people treated,” he said.