essay on alcoholism and drug addiction

Binge drinking is a growing public health crisis − a neurobiologist explains how research on alcohol use disorder has shifted

Assistant Professor of Biology, Biomedical Engineering and Pharmacology, Penn State

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Nikki Crowley receives funding from The National Institutes of Health, The Brain and Behavior Research Foundation, and the Penn State Huck Institutes of the Life Sciences endowment funds.

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With the new Amy Winehouse biopic “Back to Black ” in U.S. theaters as of May 17, 2024, the late singer’s relationship with alcohol and drugs is under scrutiny again. In July 2011, Winehouse was found dead in her flat in north London from “death by misadventure” at the age of 27. That’s the official British term used for accidental death caused by a voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the legal intoxication limit in the U.S. – leading her cause of death to be later adjusted to include “alcohol toxicity” following a second coroner’s inquest.

Nearly 13 years later, alcohol consumption and binge drinking remain a major public health crisis , not just in the U.K. but also in the U.S.

Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode . This is well over the amount of alcohol thought to produce legal intoxication, commonly defined as a blood alcohol concentration over 0.08% – on average, four drinks in two hours for women, five drinks in two hours for men.

Among women, days of “heavy drinking” increased 41% during the COVID-19 pandemic compared with pre-pandemic levels , and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking , with no evidence of these trends slowing down. Despite efforts to comprehend the overall biology of substance use disorders, scientists’ and physicians’ understanding of the relationship between women’s health and binge drinking has lagged behind.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie addiction to alcohol . I study how neuropeptides – unique signaling molecules in the prefrontal cortex , one of the key brain regions in decision-making, risk-taking and reward – are altered by repeated exposure to binge alcohol consumption in animal models.

My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so that we can better inform efforts toward both prevention and treatment.

The biology of addiction

While problematic alcohol consumption has likely occurred as long as alcohol has existed, it wasn’t until 2011 that the American Society of Addiction Medicine recognized substance addiction as a brain disorder – the same year as Winehouse’s death. A diagnosis of an alcohol use disorder is now used over outdated terms such as labeling an individual as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, a drug – alter the brain. Often, people consume a drug like alcohol because of the rewarding and positive feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what starts off as manageable consumption of alcohol can quickly devolve into cycles of excessive alcohol consumption followed by drug withdrawal.

While all forms of alcohol consumption come with health risks, binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain. For example, for some people, alcohol use can lead to “ hangxiety ,” the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and drunkenness, coupled with withdrawal, can spiral, leading to relapse and reuse of alcohol. In other words, alcohol use shifts from being rewarding to just trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain engaged by alcohol can shift away from those traditionally associated with drug use and reward or pleasure to brain regions more typically engaged during stress and anxiety .

All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways . Alcohol can affect several dozen neurotransmitters and receptors , making understanding its mechanism of action in the brain complicated.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain’s key communicator, sending both electrical and chemical signals within the brain and to the rest of your body.

What we’ve found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently remodel the brain. Even after a prolonged period of abstinence, conversations between the neurons don’t return to normal .

These changes in the brain can appear even before there are noticeable changes in behavior . This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol.

Researchers like us don’t yet fully understand why some people may be more susceptible to this shift, but it likely has to do with genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Women are forgotten

While researchers are increasingly understanding the medley of biological factors that underlie addiction, there’s one population that’s been largely overlooked until now: women.

Women may be more likely than men to have some of the most catastrophic health effects caused by alcohol use, such as liver issues, cardiovascular disease and cancer . Middle-aged women are now at the highest risk for binge drinking compared with other populations.

When women consume even moderate levels of alcohol, their risk for various cancers goes up, including digestive, breast and pancreatic cancer , among other health problems – and even death. So the worsening rates of alcohol use disorder in women prompt the need for a greater focus on women in the research and the search for treatments.

Yet, women have long been underrepresented in biomedical research.

It wasn’t until 1993 that clinical research funded by the National Institutes of Health was required to include women as research subjects. In fact, the NIH did not even require sex as a biological variable to be considered by federally funded researchers until 2016. When women are excluded from biomedical research, it leaves doctors and researchers with an incomplete understanding of health and disease, including alcohol addiction.

There is also increasing evidence that addictive substances can interact with cycling sex hormones such as estrogen and progesterone . For instance, research has shown that when estrogen levels are high, like before ovulation, alcohol might feel more rewarding , which could drive higher levels of binge drinking. Currently, researchers don’t know the full extent of the interaction between these natural biological rhythms or other unique biological factors involved in women’s health and propensity for alcohol addiction.

Looking ahead

Researchers and lawmakers are recognizing the vital need for increased research on women’s health. Major federal investments into women’s health research are a vital step toward developing better prevention and treatment options for women.

While women like Amy Winehouse may have been forced to struggle both privately and publicly with substance use disorders and alcohol, the increasing focus of research on addiction to alcohol and other substances as a brain disorder will open new treatment avenues for those suffering from the consequences.

For more information on alcohol use disorder, causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism .

• Amy Winehouse
• Binge drinking
• Neurobiology
• Intoxication
• Alcohol consumption
• Alcohol use
• Alcohol use disorder
• COVID-19 pandemic

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Home — Essay Samples — Nursing & Health — Substance Abuse — Impact of Drug Addiction on Society

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Drugs, Brains, and Behavior: The Science of Addiction Preface

How science has revolutionized the understanding of drug addiction.

For much of the past century, scientists studying drugs and drug use labored in the shadows of powerful myths and misconceptions about the nature of addiction. When scientists began to study addictive behavior in the 1930s, people with an addiction were thought to be morally flawed and lacking in willpower. Those views shaped society’s responses to drug use, treating it as a moral failing rather than a health problem, which led to an emphasis on punishment rather than prevention and treatment.

Today, thanks to science, our views and our responses to addiction and the broader spectrum of substance use disorders have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of compulsive drug use, enabling us to respond effectively to the problem.

As a result of scientific research, we know that addiction is a medical disorder that affects the brain and changes behavior. We have identified many of the biological and environmental risk factors and are beginning to search for the genetic variations that contribute to the development and progression of the disorder. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug use takes on individuals, families, and communities.

Despite these advances, we still do not fully understand why some people develop an addiction to drugs or how drugs change the brain to foster compulsive drug use. This booklet aims to fill that knowledge gap by providing scientific information about the disorder of drug addiction, including the many harmful consequences of drug use and the basic approaches that have been developed to prevent and treat substance use disorders.

At the National Institute on Drug Abuse (NIDA), we believe that increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug use and addiction in their communities, and support scientific research that improves the Nation’s well-being.

Nora D. Volkow, M.D. Director National Institute on Drug Abuse

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• Published: 22 February 2021

Addiction as a brain disease revised: why it still matters, and the need for consilience

• Markus Heilig 1 ,
• James MacKillop   ORCID: orcid.org/0000-0003-4118-9500 2 , 3 ,
• Diana Martinez 4 ,
• Jürgen Rehm   ORCID: orcid.org/0000-0001-5665-0385 5 , 6 , 7 , 8 ,
• Lorenzo Leggio   ORCID: orcid.org/0000-0001-7284-8754 9 &
• Louk J. M. J. Vanderschuren   ORCID: orcid.org/0000-0002-5379-0363 10  

Neuropsychopharmacology volume  46 ,  pages 1715–1723 ( 2021 ) Cite this article

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The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. These criticisms state that the brain disease view is deterministic, fails to account for heterogeneity in remission and recovery, places too much emphasis on a compulsive dimension of addiction, and that a specific neural signature of addiction has not been identified. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction. We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives.

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Introduction.

Close to a quarter of a century ago, then director of the US National Institute on Drug Abuse Alan Leshner famously asserted that “addiction is a brain disease”, articulated a set of implications of this position, and outlined an agenda for realizing its promise [ 1 ]. The paper, now cited almost 2000 times, put forward a position that has been highly influential in guiding the efforts of researchers, and resource allocation by funding agencies. A subsequent 2000 paper by McLellan et al. [ 2 ] examined whether data justify distinguishing addiction from other conditions for which a disease label is rarely questioned, such as diabetes, hypertension or asthma. It concluded that neither genetic risk, the role of personal choices, nor the influence of environmental factors differentiated addiction in a manner that would warrant viewing it differently; neither did relapse rates, nor compliance with treatment. The authors outlined an agenda closely related to that put forward by Leshner, but with a more clinical focus. Their conclusion was that addiction should be insured, treated, and evaluated like other diseases. This paper, too, has been exceptionally influential by academic standards, as witnessed by its ~3000 citations to date. What may be less appreciated among scientists is that its impact in the real world of addiction treatment has remained more limited, with large numbers of patients still not receiving evidence-based treatments.

In recent years, the conceptualization of addiction as a brain disease has come under increasing criticism. When first put forward, the brain disease view was mainly an attempt to articulate an effective response to prevailing nonscientific, moralizing, and stigmatizing attitudes to addiction. According to these attitudes, addiction was simply the result of a person’s moral failing or weakness of character, rather than a “real” disease [ 3 ]. These attitudes created barriers for people with substance use problems to access evidence-based treatments, both those available at the time, such as opioid agonist maintenance, cognitive behavioral therapy-based relapse prevention, community reinforcement or contingency management, and those that could result from research. To promote patient access to treatments, scientists needed to argue that there is a biological basis beneath the challenging behaviors of individuals suffering from addiction. This argument was particularly targeted to the public, policymakers and health care professionals, many of whom held that since addiction was a misery people brought upon themselves, it fell beyond the scope of medicine, and was neither amenable to treatment, nor warranted the use of taxpayer money.

Present-day criticism directed at the conceptualization of addiction as a brain disease is of a very different nature. It originates from within the scientific community itself, and asserts that this conceptualization is neither supported by data, nor helpful for people with substance use problems [ 4 , 5 , 6 , 7 , 8 ]. Addressing these critiques requires a very different perspective, and is the objective of our paper. We readily acknowledge that in some cases, recent critiques of the notion of addiction as a brain disease as postulated originally have merit, and that those critiques require the postulates to be re-assessed and refined. In other cases, we believe the arguments have less validity, but still provide an opportunity to update the position of addiction as a brain disease. Our overarching concern is that questionable arguments against the notion of addiction as a brain disease may harm patients, by impeding access to care, and slowing development of novel treatments.

A premise of our argument is that any useful conceptualization of addiction requires an understanding both of the brains involved, and of environmental factors that interact with those brains [ 9 ]. These environmental factors critically include availability of drugs, but also of healthy alternative rewards and opportunities. As we will show, stating that brain mechanisms are critical for understanding and treating addiction in no way negates the role of psychological, social and socioeconomic processes as both causes and consequences of substance use. To reflect this complex nature of addiction, we have assembled a team with expertise that spans from molecular neuroscience, through animal models of addiction, human brain imaging, clinical addiction medicine, to epidemiology. What brings us together is a passionate commitment to improving the lives of people with substance use problems through science and science-based treatments, with empirical evidence as the guiding principle.

To achieve this goal, we first discuss the nature of the disease concept itself, and why we believe it is important for the science and treatment of addiction. This is followed by a discussion of the main points raised when the notion of addiction as a brain disease has come under criticism. Key among those are claims that spontaneous remission rates are high; that a specific brain pathology is lacking; and that people suffering from addiction, rather than behaving “compulsively”, in fact show a preserved ability to make informed and advantageous choices. In the process of discussing these issues, we also address the common criticism that viewing addiction as a brain disease is a fully deterministic theory of addiction. For our argument, we use the term “addiction” as originally used by Leshner [ 1 ]; in Box  1 , we map out and discuss how this construct may relate to the current diagnostic categories, such as Substance Use Disorder (SUD) and its different levels of severity (Fig.  1) .

Risky (hazardous) substance use refers to quantity/frequency indicators of consumption; SUD refers to individuals who meet criteria for a DSM-5 diagnosis (mild, moderate, or severe); and addiction refers to individuals who exhibit persistent difficulties with self-regulation of drug consumption. Among high-risk individuals, a subgroup will meet criteria for SUD and, among those who have an SUD, a further subgroup would be considered to be addicted to the drug. However, the boundary for addiction is intentionally blurred to reflect that the dividing line for defining addiction within the category of SUD remains an open empirical question.

Box 1 What’s in a name? Differentiating hazardous use, substance use disorder, and addiction

Although our principal focus is on the brain disease model of addiction, the definition of addiction itself is a source of ambiguity. Here, we provide a perspective on the major forms of terminology in the field.

Hazardous Substance Use

Hazardous (risky) substance use refers to quantitative levels of consumption that increase an individual’s risk for adverse health consequences. In practice, this pertains to alcohol use [ 110 , 111 ]. Clinically, alcohol consumption that exceeds guidelines for moderate drinking has been used to prompt brief interventions or referral for specialist care [ 112 ]. More recently, a reduction in these quantitative levels has been validated as treatment endpoints [ 113 ].

Substance Use Disorder

SUD refers to the DSM-5 diagnosis category that encompasses significant impairment or distress resulting from specific categories of psychoactive drug use. The diagnosis of SUD is operationalized as 2 or more of 11 symptoms over the past year. As a result, the diagnosis is heterogenous, with more than 1100 symptom permutations possible. The diagnosis in DSM-5 is the result of combining two diagnoses from the DSM-IV, abuse and dependence, which proved to be less valid than a single dimensional approach [ 114 ]. Critically, SUD includes three levels of severity: mild (2–3 symptoms), moderate (4–5 symptoms), and severe (6+ symptoms). The International Classification of Diseases (ICD) system retains two diagnoses, harmful use (lower severity) and substance dependence (higher severity).

Addiction is a natural language concept, etymologically meaning enslavement, with the contemporary meaning traceable to the Middle and Late Roman Republic periods [ 115 ]. As a scientific construct, drug addiction can be defined as a state in which an individual exhibits an inability to self-regulate consumption of a substance, although it does not have an operational definition. Regarding clinical diagnosis, as it is typically used in scientific and clinical parlance, addiction is not synonymous with the simple presence of SUD. Nowhere in DSM-5 is it articulated that the diagnostic threshold (or any specific number/type of symptoms) should be interpreted as reflecting addiction, which inherently connotes a high degree of severity. Indeed, concerns were raised about setting the diagnostic standard too low because of the issue of potentially conflating a low-severity SUD with addiction [ 116 ]. In scientific and clinical usage, addiction typically refers to individuals at a moderate or high severity of SUD. This is consistent with the fact that moderate-to-severe SUD has the closest correspondence with the more severe diagnosis in ICD [ 117 , 118 , 119 ]. Nonetheless, akin to the undefined overlap between hazardous use and SUD, the field has not identified the exact thresholds of SUD symptoms above which addiction would be definitively present.

Integration

The ambiguous relationships among these terms contribute to misunderstandings and disagreements. Figure 1 provides a simple working model of how these terms overlap. Fundamentally, we consider that these terms represent successive dimensions of severity, clinical “nesting dolls”. Not all individuals consuming substances at hazardous levels have an SUD, but a subgroup do. Not all individuals with a SUD are addicted to the drug in question, but a subgroup are. At the severe end of the spectrum, these domains converge (heavy consumption, numerous symptoms, the unambiguous presence of addiction), but at low severity, the overlap is more modest. The exact mapping of addiction onto SUD is an open empirical question, warranting systematic study among scientists, clinicians, and patients with lived experience. No less important will be future research situating our definition of SUD using more objective indicators (e.g., [ 55 , 120 ]), brain-based and otherwise, and more precisely in relation to clinical needs [ 121 ]. Finally, such work should ultimately be codified in both the DSM and ICD systems to demarcate clearly where the attribution of addiction belongs within the clinical nosology, and to foster greater clarity and specificity in scientific discourse.

What is a disease?

In his classic 1960 book “The Disease Concept of Alcoholism”, Jellinek noted that in the alcohol field, the debate over the disease concept was plagued by too many definitions of “alcoholism” and too few definitions of “disease” [ 10 ]. He suggested that the addiction field needed to follow the rest of medicine in moving away from viewing disease as an “entity”, i.e., something that has “its own independent existence, apart from other things” [ 11 ]. To modern medicine, he pointed out, a disease is simply a label that is agreed upon to describe a cluster of substantial, deteriorating changes in the structure or function of the human body, and the accompanying deterioration in biopsychosocial functioning. Thus, he concluded that alcoholism can simply be defined as changes in structure or function of the body due to drinking that cause disability or death. A disease label is useful to identify groups of people with commonly co-occurring constellations of problems—syndromes—that significantly impair function, and that lead to clinically significant distress, harm, or both. This convention allows a systematic study of the condition, and of whether group members benefit from a specific intervention.

It is not trivial to delineate the exact category of harmful substance use for which a label such as addiction is warranted (See Box  1 ). Challenges to diagnostic categorization are not unique to addiction, however. Throughout clinical medicine, diagnostic cut-offs are set by consensus, commonly based on an evolving understanding of thresholds above which people tend to benefit from available interventions. Because assessing benefits in large patient groups over time is difficult, diagnostic thresholds are always subject to debate and adjustments. It can be debated whether diagnostic thresholds “merely” capture the extreme of a single underlying population, or actually identify a subpopulation that is at some level distinct. Resolving this issue remains challenging in addiction, but once again, this is not different from other areas of medicine [see e.g., [ 12 ] for type 2 diabetes]. Longitudinal studies that track patient trajectories over time may have a better ability to identify subpopulations than cross-sectional assessments [ 13 ].

By this pragmatic, clinical understanding of the disease concept, it is difficult to argue that “addiction” is unjustified as a disease label. Among people who use drugs or alcohol, some progress to using with a quantity and frequency that results in impaired function and often death, making substance use a major cause of global disease burden [ 14 ]. In these people, use occurs with a pattern that in milder forms may be challenging to capture by current diagnostic criteria (See Box  1 ), but is readily recognized by patients, their families and treatment providers when it reaches a severity that is clinically significant [see [ 15 ] for a classical discussion]. In some cases, such as opioid addiction, those who receive the diagnosis stand to obtain some of the greatest benefits from medical treatments in all of clinical medicine [ 16 , 17 ]. Although effect sizes of available treatments are more modest in nicotine [ 18 ] and alcohol addiction [ 19 ], the evidence supporting their efficacy is also indisputable. A view of addiction as a disease is justified, because it is beneficial: a failure to diagnose addiction drastically increases the risk of a failure to treat it [ 20 ].

Of course, establishing a diagnosis is not a requirement for interventions to be meaningful. People with hazardous or harmful substance use who have not (yet) developed addiction should also be identified, and interventions should be initiated to address their substance-related risks. This is particularly relevant for alcohol, where even in the absence of addiction, use is frequently associated with risks or harm to self, e.g., through cardiovascular disease, liver disease or cancer, and to others, e.g., through accidents or violence [ 21 ]. Interventions to reduce hazardous or harmful substance use in people who have not developed addiction are in fact particularly appealing. In these individuals, limited interventions are able to achieve robust and meaningful benefits [ 22 ], presumably because patterns of misuse have not yet become entrenched.

Thus, as originally pointed out by McLellan and colleagues, most of the criticisms of addiction as a disease could equally be applied to other medical conditions [ 2 ]. This type of criticism could also be applied to other psychiatric disorders, and that has indeed been the case historically [ 23 , 24 ]. Today, there is broad consensus that those criticisms were misguided. Few, if any healthcare professionals continue to maintain that schizophrenia, rather than being a disease, is a normal response to societal conditions. Why, then, do people continue to question if addiction is a disease, but not whether schizophrenia, major depressive disorder or post-traumatic stress disorder are diseases? This is particularly troubling given the decades of data showing high co-morbidity of addiction with these conditions [ 25 , 26 ]. We argue that it comes down to stigma. Dysregulated substance use continues to be perceived as a self-inflicted condition characterized by a lack of willpower, thus falling outside the scope of medicine and into that of morality [ 3 ].

Chronic and relapsing, developmentally-limited, or spontaneously remitting?

Much of the critique targeted at the conceptualization of addiction as a brain disease focuses on its original assertion that addiction is a chronic and relapsing condition. Epidemiological data are cited in support of the notion that large proportions of individuals achieve remission [ 27 ], frequently without any formal treatment [ 28 , 29 ] and in some cases resuming low risk substance use [ 30 ]. For instance, based on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study [ 27 ], it has been pointed out that a significant proportion of people with an addictive disorder quit each year, and that most afflicted individuals ultimately remit. These spontaneous remission rates are argued to invalidate the concept of a chronic, relapsing disease [ 4 ].

Interpreting these and similar data is complicated by several methodological and conceptual issues. First, people may appear to remit spontaneously because they actually do, but also because of limited test–retest reliability of the diagnosis [ 31 ]. For instance, using a validated diagnostic interview and trained interviewers, the Collaborative Studies on Genetics of Alcoholism examined the likelihood that an individual diagnosed with a lifetime history of substance dependence would retain this classification after 5 years. This is obviously a diagnosis that, once met, by definition cannot truly remit. Lifetime alcohol dependence was indeed stable in individuals recruited from addiction treatment units, ~90% for women, and 95% for men. In contrast, in a community-based sample similar to that used in the NESARC [ 27 ], stability was only ~30% and 65% for women and men, respectively. The most important characteristic that determined diagnostic stability was severity. Diagnosis was stable in severe, treatment-seeking cases, but not in general population cases of alcohol dependence.

These data suggest that commonly used diagnostic criteria alone are simply over-inclusive for a reliable, clinically meaningful diagnosis of addiction. They do identify a core group of treatment seeking individuals with a reliable diagnosis, but, if applied to nonclinical populations, also flag as “cases” a considerable halo of individuals for whom the diagnostic categorization is unreliable. Any meaningful discussion of remission rates needs to take this into account, and specify which of these two populations that is being discussed. Unfortunately, the DSM-5 has not made this task easier. With only 2 out of 11 symptoms being sufficient for a diagnosis of SUD, it captures under a single diagnostic label individuals in a “mild” category, whose diagnosis is likely to have very low test–retest reliability, and who are unlikely to exhibit a chronic relapsing course, together with people at the severe end of the spectrum, whose diagnosis is reliable, many of whom do show a chronic relapsing course.

The NESARC data nevertheless show that close to 10% of people in the general population who are diagnosed with alcohol addiction (here equated with DSM-IV “dependence” used in the NESARC study) never remitted throughout their participation in the survey. The base life-time prevalence of alcohol dependence in NESARC was 12.5% [ 32 ]. Thus, the data cited against the concept of addiction as a chronic relapsing disease in fact indicate that over 1% of the US population develops an alcohol-related condition that is associated with high morbidity and mortality, and whose chronic and/or relapsing nature cannot be disputed, since it does not remit.

Secondly, the analysis of NESARC data [ 4 , 27 ] omits opioid addiction, which, together with alcohol and tobacco, is the largest addiction-related public health problem in the US [ 33 ]. This is probably the addictive condition where an analysis of cumulative evidence most strikingly supports the notion of a chronic disorder with frequent relapses in a large proportion of people affected [ 34 ]. Of course, a large number of people with opioid addiction are unable to express the chronic, relapsing course of their disease, because over the long term, their mortality rate is about 15 times greater than that of the general population [ 35 ]. However, even among those who remain alive, the prevalence of stable abstinence from opioid use after 10–30 years of observation is <30%. Remission may not always require abstinence, for instance in the case of alcohol addiction, but is a reasonable proxy for remission with opioids, where return to controlled use is rare. Embedded in these data is a message of literally vital importance: when opioid addiction is diagnosed and treated as a chronic relapsing disease, outcomes are markedly improved, and retention in treatment is associated with a greater likelihood of abstinence.

The fact that significant numbers of individuals exhibit a chronic relapsing course does not negate that even larger numbers of individuals with SUD according to current diagnostic criteria do not. For instance, in many countries, the highest prevalence of substance use problems is found among young adults, aged 18–25 [ 36 ], and a majority of these ‘age out’ of excessive substance use [ 37 ]. It is also well documented that many individuals with SUD achieve longstanding remission, in many cases without any formal treatment (see e.g., [ 27 , 30 , 38 ]).

Collectively, the data show that the course of SUD, as defined by current diagnostic criteria, is highly heterogeneous. Accordingly, we do not maintain that a chronic relapsing course is a defining feature of SUD. When present in a patient, however, such as course is of clinical significance, because it identifies a need for long-term disease management [ 2 ], rather than expectations of a recovery that may not be within the individual’s reach [ 39 ]. From a conceptual standpoint, however, a chronic relapsing course is neither necessary nor implied in a view that addiction is a brain disease. This view also does not mean that it is irreversible and hopeless. Human neuroscience documents restoration of functioning after abstinence [ 40 , 41 ] and reveals predictors of clinical success [ 42 ]. If anything, this evidence suggests a need to increase efforts devoted to neuroscientific research on addiction recovery [ 40 , 43 ].

Lessons from genetics

For alcohol addiction, meta-analysis of twin and adoption studies has estimated heritability at ~50%, while estimates for opioid addiction are even higher [ 44 , 45 ]. Genetic risk factors are to a large extent shared across substances [ 46 ]. It has been argued that a genetic contribution cannot support a disease view of a behavior, because most behavioral traits, including religious and political inclinations, have a genetic contribution [ 4 ]. This statement, while correct in pointing out broad heritability of behavioral traits, misses a fundamental point. Genetic architecture is much like organ structure. The fact that normal anatomy shapes healthy organ function does not negate that an altered structure can contribute to pathophysiology of disease. The structure of the genetic landscape is no different. Critics further state that a “genetic predisposition is not a recipe for compulsion”, but no neuroscientist or geneticist would claim that genetic risk is “a recipe for compulsion”. Genetic risk is probabilistic, not deterministic. However, as we will see below, in the case of addiction, it contributes to large, consistent probability shifts towards maladaptive behavior.

In dismissing the relevance of genetic risk for addiction, Hall writes that “a large number of alleles are involved in the genetic susceptibility to addiction and individually these alleles might very weakly predict a risk of addiction”. He goes on to conclude that “generally, genetic prediction of the risk of disease (even with whole-genome sequencing data) is unlikely to be informative for most people who have a so-called average risk of developing an addiction disorder” [ 7 ]. This reflects a fundamental misunderstanding of polygenic risk. It is true that a large number of risk alleles are involved, and that the explanatory power of currently available polygenic risk scores for addictive disorders lags behind those for e.g., schizophrenia or major depression [ 47 , 48 ]. The only implication of this, however, is that low average effect sizes of risk alleles in addiction necessitate larger study samples to construct polygenic scores that account for a large proportion of the known heritability.

However, a heritability of addiction of ~50% indicates that DNA sequence variation accounts for 50% of the risk for this condition. Once whole genome sequencing is readily available, it is likely that it will be possible to identify most of that DNA variation. For clinical purposes, those polygenic scores will of course not replace an understanding of the intricate web of biological and social factors that promote or prevent expression of addiction in an individual case; rather, they will add to it [ 49 ]. Meanwhile, however, genome-wide association studies in addiction have already provided important information. For instance, they have established that the genetic underpinnings of alcohol addiction only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors [ 50 ].

It thus seems that, rather than negating a rationale for a disease view of addiction, the important implication of the polygenic nature of addiction risk is a very different one. Genome-wide association studies of complex traits have largely confirmed the century old “infinitisemal model” in which Fisher reconciled Mendelian and polygenic traits [ 51 ]. A key implication of this model is that genetic susceptibility for a complex, polygenic trait is continuously distributed in the population. This may seem antithetical to a view of addiction as a distinct disease category, but the contradiction is only apparent, and one that has long been familiar to quantitative genetics. Viewing addiction susceptibility as a polygenic quantitative trait, and addiction as a disease category is entirely in line with Falconer’s theorem, according to which, in a given set of environmental conditions, a certain level of genetic susceptibility will determine a threshold above which disease will arise.

A brain disease? Then show me the brain lesion!

The notion of addiction as a brain disease is commonly criticized with the argument that a specific pathognomonic brain lesion has not been identified. Indeed, brain imaging findings in addiction (perhaps with the exception of extensive neurotoxic gray matter loss in advanced alcohol addiction) are nowhere near the level of specificity and sensitivity required of clinical diagnostic tests. However, this criticism neglects the fact that neuroimaging is not used to diagnose many neurologic and psychiatric disorders, including epilepsy, ALS, migraine, Huntington’s disease, bipolar disorder, or schizophrenia. Even among conditions where signs of disease can be detected using brain imaging, such as Alzheimer’s and Parkinson’s disease, a scan is best used in conjunction with clinical acumen when making the diagnosis. Thus, the requirement that addiction be detectable with a brain scan in order to be classified as a disease does not recognize the role of neuroimaging in the clinic.

For the foreseeable future, the main objective of imaging in addiction research is not to diagnose addiction, but rather to improve our understanding of mechanisms that underlie it. The hope is that mechanistic insights will help bring forward new treatments, by identifying candidate targets for them, by pointing to treatment-responsive biomarkers, or both [ 52 ]. Developing innovative treatments is essential to address unmet treatment needs, in particular in stimulant and cannabis addiction, where no approved medications are currently available. Although the task to develop novel treatments is challenging, promising candidates await evaluation [ 53 ]. A particular opportunity for imaging-based research is related to the complex and heterogeneous nature of addictive disorders. Imaging-based biomarkers hold the promise of allowing this complexity to be deconstructed into specific functional domains, as proposed by the RDoC initiative [ 54 ] and its application to addiction [ 55 , 56 ]. This can ultimately guide the development of personalized medicine strategies to addiction treatment.

Countless imaging studies have reported differences in brain structure and function between people with addictive disorders and those without them. Meta-analyses of structural data show that alcohol addiction is associated with gray matter losses in the prefrontal cortex, dorsal striatum, insula, and posterior cingulate cortex [ 57 ], and similar results have been obtained in stimulant-addicted individuals [ 58 ]. Meta-analysis of functional imaging studies has demonstrated common alterations in dorsal striatal, and frontal circuits engaged in reward and salience processing, habit formation, and executive control, across different substances and task-paradigms [ 59 ]. Molecular imaging studies have shown that large and fast increases in dopamine are associated with the reinforcing effects of drugs of abuse, but that after chronic drug use and during withdrawal, brain dopamine function is markedly decreased and that these decreases are associated with dysfunction of prefrontal regions [ 60 ]. Collectively, these findings have given rise to a widely held view of addiction as a disorder of fronto-striatal circuitry that mediates top-down regulation of behavior [ 61 ].

Critics reply that none of the brain imaging findings are sufficiently specific to distinguish between addiction and its absence, and that they are typically obtained in cross-sectional studies that can at best establish correlative rather than causal links. In this, they are largely right, and an updated version of a conceptualization of addiction as a brain disease needs to acknowledge this. Many of the structural brain findings reported are not specific for addiction, but rather shared across psychiatric disorders [ 62 ]. Also, for now, the most sophisticated tools of human brain imaging remain crude in face of complex neural circuit function. Importantly however, a vast literature from animal studies also documents functional changes in fronto-striatal circuits, as well their limbic and midbrain inputs, associated with addictive behaviors [ 63 , 64 , 65 , 66 , 67 , 68 ]. These are circuits akin to those identified by neuroimaging studies in humans, implicated in positive and negative emotions, learning processes and executive functions, altered function of which is thought to underlie addiction. These animal studies, by virtue of their cellular and molecular level resolution, and their ability to establish causality under experimental control, are therefore an important complement to human neuroimaging work.

Nevertheless, factors that seem remote from the activity of brain circuits, such as policies, substance availability and cost, as well as socioeconomic factors, also are critically important determinants of substance use. In this complex landscape, is the brain really a defensible focal point for research and treatment? The answer is “yes”. As powerfully articulated by Francis Crick [ 69 ], “You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules”. Social and interpersonal factors are critically important in addiction, but they can only exert their influences by impacting neural processes. They must be encoded as sensory data, represented together with memories of the past and predictions about the future, and combined with representations of interoceptive and other influences to provide inputs to the valuation machinery of the brain. Collectively, these inputs drive action selection and execution of behavior—say, to drink or not to drink, and then, within an episode, to stop drinking or keep drinking. Stating that the pathophysiology of addiction is largely about the brain does not ignore the role of other influences. It is just the opposite: it is attempting to understand how those important influences contribute to drug seeking and taking in the context of the brain, and vice versa.

But if the criticism is one of emphasis rather than of principle—i.e., too much brain, too little social and environmental factors – then neuroscientists need to acknowledge that they are in part guilty as charged. Brain-centric accounts of addiction have for a long time failed to pay enough attention to the inputs that social factors provide to neural processing behind drug seeking and taking [ 9 ]. This landscape is, however, rapidly changing. For instance, using animal models, scientists are finding that lack of social play early in life increases the motivation to take addictive substances in adulthood [ 70 ]. Others find that the opportunity to interact with a fellow rat is protective against addiction-like behaviors [ 71 ]. In humans, a relationship has been found between perceived social support, socioeconomic status, and the availability of dopamine D2 receptors [ 72 , 73 ], a biological marker of addiction vulnerability. Those findings in turn provided translation of data from nonhuman primates, which showed that D2 receptor availability can be altered by changes in social hierarchy, and that these changes are associated with the motivation to obtain cocaine [ 74 ].

Epidemiologically, it is well established that social determinants of health, including major racial and ethnic disparities, play a significant role in the risk for addiction [ 75 , 76 ]. Contemporary neuroscience is illuminating how those factors penetrate the brain [ 77 ] and, in some cases, reveals pathways of resilience [ 78 ] and how evidence-based prevention can interrupt those adverse consequences [ 79 , 80 ]. In other words, from our perspective, viewing addiction as a brain disease in no way negates the importance of social determinants of health or societal inequalities as critical influences. In fact, as shown by the studies correlating dopamine receptors with social experience, imaging is capable of capturing the impact of the social environment on brain function. This provides a platform for understanding how those influences become embedded in the biology of the brain, which provides a biological roadmap for prevention and intervention.

We therefore argue that a contemporary view of addiction as a brain disease does not deny the influence of social, environmental, developmental, or socioeconomic processes, but rather proposes that the brain is the underlying material substrate upon which those factors impinge and from which the responses originate. Because of this, neurobiology is a critical level of analysis for understanding addiction, although certainly not the only one. It is recognized throughout modern medicine that a host of biological and non-biological factors give rise to disease; understanding the biological pathophysiology is critical for understanding etiology and informing treatment.

Is a view of addiction as a brain disease deterministic?

A common criticism of the notion that addiction is a brain disease is that it is reductionist and in the end therefore deterministic [ 81 , 82 ]. This is a fundamental misrepresentation. As indicated above, viewing addiction as a brain disease simply states that neurobiology is an undeniable component of addiction. A reason for deterministic interpretations may be that modern neuroscience emphasizes an understanding of proximal causality within research designs (e.g., whether an observed link between biological processes is mediated by a specific mechanism). That does not in any way reflect a superordinate assumption that neuroscience will achieve global causality. On the contrary, since we realize that addiction involves interactions between biology, environment and society, ultimate (complete) prediction of behavior based on an understanding of neural processes alone is neither expected, nor a goal.

A fairer representation of a contemporary neuroscience view is that it believes insights from neurobiology allow useful probabilistic models to be developed of the inherently stochastic processes involved in behavior [see [ 83 ] for an elegant recent example]. Changes in brain function and structure in addiction exert a powerful probabilistic influence over a person’s behavior, but one that is highly multifactorial, variable, and thus stochastic. Philosophically, this is best understood as being aligned with indeterminism, a perspective that has a deep history in philosophy and psychology [ 84 ]. In modern neuroscience, it refers to the position that the dynamic complexity of the brain, given the probabilistic threshold-gated nature of its biology (e.g., action potential depolarization, ion channel gating), means that behavior cannot be definitively predicted in any individual instance [ 85 , 86 ].

Driven by compulsion, or free to choose?

A major criticism of the brain disease view of addiction, and one that is related to the issue of determinism vs indeterminism, centers around the term “compulsivity” [ 6 , 87 , 88 , 89 , 90 ] and the different meanings it is given. Prominent addiction theories state that addiction is characterized by a transition from controlled to “compulsive” drug seeking and taking [ 91 , 92 , 93 , 94 , 95 ], but allocate somewhat different meanings to “compulsivity”. By some accounts, compulsive substance use is habitual and insensitive to its outcomes [ 92 , 94 , 96 ]. Others refer to compulsive use as a result of increasing incentive value of drug associated cues [ 97 ], while others view it as driven by a recruitment of systems that encode negative affective states [ 95 , 98 ].

The prototype for compulsive behavior is provided by obsessive-compulsive disorder (OCD), where compulsion refers to repeatedly and stereotypically carrying out actions that in themselves may be meaningful, but lose their purpose and become harmful when performed in excess, such as persistent handwashing until skin injuries result. Crucially, this happens despite a conscious desire to do otherwise. Attempts to resist these compulsions result in increasing and ultimately intractable anxiety [ 99 ]. This is in important ways different from the meaning of compulsivity as commonly used in addiction theories. In the addiction field, compulsive drug use typically refers to inflexible, drug-centered behavior in which substance use is insensitive to adverse consequences [ 100 ]. Although this phenomenon is not necessarily present in every patient, it reflects important symptoms of clinical addiction, and is captured by several DSM-5 criteria for SUD [ 101 ]. Examples are needle-sharing despite knowledge of a risk to contract HIV or Hepatitis C, drinking despite a knowledge of having liver cirrhosis, but also the neglect of social and professional activities that previously were more important than substance use. While these behaviors do show similarities with the compulsions of OCD, there are also important differences. For example, “compulsive” substance use is not necessarily accompanied by a conscious desire to withhold the behavior, nor is addictive behavior consistently impervious to change.

Critics question the existence of compulsivity in addiction altogether [ 5 , 6 , 7 , 89 ], typically using a literal interpretation, i.e., that a person who uses alcohol or drugs simply can not do otherwise. Were that the intended meaning in theories of addiction—which it is not—it would clearly be invalidated by observations of preserved sensitivity of behavior to contingencies in addiction. Indeed, substance use is influenced both by the availability of alternative reinforcers, and the state of the organism. The roots of this insight date back to 1940, when Spragg found that chimpanzees would normally choose a banana over morphine. However, when physically dependent and in a state of withdrawal, their choice preference would reverse [ 102 ]. The critical role of alternative reinforcers was elegantly brought into modern neuroscience by Ahmed et al., who showed that rats extensively trained to self-administer cocaine would readily forego the drug if offered a sweet solution as an alternative [ 103 ]. This was later also found to be the case for heroin [ 103 ], methamphetamine [ 104 ] and alcohol [ 105 ]. Early residential laboratory studies on alcohol use disorder indeed revealed orderly operant control over alcohol consumption [ 106 ]. Furthermore, efficacy of treatment approaches such as contingency management, which provides systematic incentives for abstinence [ 107 ], supports the notion that behavioral choices in patients with addictions remain sensitive to reward contingencies.

Evidence that a capacity for choosing advantageously is preserved in addiction provides a valid argument against a narrow concept of “compulsivity” as rigid, immutable behavior that applies to all patients. It does not, however, provide an argument against addiction as a brain disease. If not from the brain, from where do the healthy and unhealthy choices people make originate? The critical question is whether addictive behaviors—for the most part—result from healthy brains responding normally to externally determined contingencies; or rather from a pathology of brain circuits that, through probabilistic shifts, promotes the likelihood of maladaptive choices even when reward contingencies are within a normal range. To resolve this question, it is critical to understand that the ability to choose advantageously is not an all-or-nothing phenomenon, but rather is about probabilities and their shifts, multiple faculties within human cognition, and their interaction. Yes, it is clear that most people whom we would consider to suffer from addiction remain able to choose advantageously much, if not most, of the time. However, it is also clear that the probability of them choosing to their own disadvantage, even when more salutary options are available and sometimes at the expense of losing their life, is systematically and quantifiably increased. There is a freedom of choice, yet there is a shift of prevailing choices that nevertheless can kill.

Synthesized, the notion of addiction as a disease of choice and addiction as a brain disease can be understood as two sides of the same coin. Both of these perspectives are informative, and they are complementary. Viewed this way, addiction is a brain disease in which a person’s choice faculties become profoundly compromised. To articulate it more specifically, embedded in and principally executed by the central nervous system, addiction can be understood as a disorder of choice preferences, preferences that overvalue immediate reinforcement (both positive and negative), preferences for drug-reinforcement in spite of costs, and preferences that are unstable ( “I’ll never drink like that again;” “this will be my last cigarette” ), prone to reversals in the form of lapses and relapse. From a contemporary neuroscience perspective, pre-existing vulnerabilities and persistent drug use lead to a vicious circle of substantive disruptions in the brain that impair and undermine choice capacities for adaptive behavior, but do not annihilate them. Evidence of generally intact decision making does not fundamentally contradict addiction as a brain disease.

Conclusions

The present paper is a response to the increasing number of criticisms of the view that addiction is a chronic relapsing brain disease. In many cases, we show that those criticisms target tenets that are neither needed nor held by a contemporary version of this view. Common themes are that viewing addiction as a brain disease is criticized for being both too narrow (addiction is only a brain disease; no other perspectives or factors are important) or too far reaching (it purports to discover the final causes of addiction). With regard to disease course, we propose that viewing addiction as a chronic relapsing disease is appropriate for some populations, and much less so for others, simply necessitating better ways of delineating the populations being discussed. We argue that when considering addiction as a disease, the lens of neurobiology is valuable to use. It is not the only lens, and it does not have supremacy over other scientific approaches. We agree that critiques of neuroscience are warranted [ 108 ] and that critical thinking is essential to avoid deterministic language and scientific overreach.

Beyond making the case for a view of addiction as a brain disease, perhaps the more important question is when a specific level of analysis is most useful. For understanding the biology of addiction and designing biological interventions, a neurobiological view is almost certainly the most appropriate level of analysis, in particular when informed by an understanding of the behavioral manifestations. In contrast, for understanding the psychology of addiction and designing psychological interventions, behavioral science is the natural realm, but one that can often benefit from an understanding of the underlying neurobiology. For designing policies, such as taxation and regulation of access, economics and public administration provide the most pertinent perspectives, but these also benefit from biological and behavioral science insights.

Finally, we argue that progress would come from integration of these scientific perspectives and traditions. E.O. Wilson has argued more broadly for greater consilience [ 109 ], unity of knowledge, in science. We believe that addiction is among the areas where consilience is most needed. A plurality of disciplines brings important and trenchant insights to bear on this condition; it is the exclusive remit of no single perspective or field. Addiction inherently and necessarily requires multidisciplinary examination. Moreover, those who suffer from addiction will benefit most from the application of the full armamentarium of scientific perspectives.

Funding and disclosures

Supported by the Swedish Research Council grants 2013-07434, 2019-01138 (MH); Netherlands Organisation for Health Research and Development (ZonMw) under project number 912.14.093 (LJMJV); NIDA and NIAAA intramural research programs (LL; the content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health); the Peter Boris Chair in Addictions Research, Homewood Research Institute, and the National Institute on Alcohol Abuse and Alcoholism grants AA025911, AA024930, AA025849, AA027679 (JM; the content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health).

MH has received consulting fees, research support or other compensation from Indivior, Camurus, BrainsWay, Aelis Farma, and Janssen Pharmaceuticals. JM is a Principal and Senior Scientist at BEAM Diagnostics, Inc. DM, JR, LL, and LJMJV declare no conflict of interest.

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Heilig, M., MacKillop, J., Martinez, D. et al. Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacol. 46 , 1715–1723 (2021). https://doi.org/10.1038/s41386-020-00950-y

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Research Review: What Have We Learned About Adolescent Substance Use?

Adolescence is a critical biological, psychological, and social developmental stage involving heightened risk for substance use and associated adverse consequences. This review, synthesizing emerging findings on this complex topic, is intended to inform research and clinical care focused on adolescents.

Literature searches were conducted using PubMed, yielding a cross-section of observational and interventional studies focused on adolescent substance use. Findings were organized and categorized to cover key areas of epidemiology, neurobiology, prevention, and treatment.

Adolescent substance-related attitudes and use patterns have evolved over time, informed by adult and peer behaviors, public policy, media messaging, substance availability, and other variables. A number of risk and resiliency factors contribute to individual differences in substance use and related consequences. Advances in observational techniques have provided enhanced understanding of adolescent brain development, and its implications for substance use. Prevention efforts have yielded mixed results, and while a number of adolescent-targeted evidence-based treatments for substance use disorders have been developed, effect sizes are generally modest, indicating the need for further research to enhance prevention and treatment outcomes.

Conclusions

Substance use in adolescence is heterogeneous, ranging from normative to pathological, and can lead to significant acute and long-term morbidity and mortality. Understanding risk and resiliency factors, underlying neurobiology, and optimal developmentally-sensitive interventions is critical in addressing substance-associated problems in adolescence.

Introduction

Adolescence is a critical developmental phase involving significant physical, cognitive, emotional, social, and behavioral changes. The neurobiological alterations underlying these complex developmental processes may predispose adolescents to initiate substance use, to develop substance use disorders, and to experience potentially serious and long-lasting substance-related adverse consequences. Given the high prevalence of problematic substance use in this age range, and given the unique biopsychosocial context, research has increasingly focused on characterizing adolescent substance use disorders, with particular focus on optimizing and disseminating evidence-based prevention, assessment, and treatment interventions. The present review was conducted to provide an overview of recent clinically relevant advances in the field.

Literature searches were conducted via PubMed, and information was compiled to yield an overview of clinically relevant advances in knowledge regarding adolescent substance use, spanning epidemiology, neurobiology, assessment, and interventions.

Epidemiology

Prevalence of use.

Substance use is typically initiated during adolescence. Alcohol is the most commonly used substance among adolescents, with 64% of 18 year olds endorsing lifetime alcohol use, followed by marijuana (45%) and cigarette use (31%) ( Johnston et al., 2017 ). Overall, rates of adolescent substance use have remained relatively stable over the past several years, with a few notable exceptions. Cigarette use has declined dramatically over the past several decades, while e-cigarette use has become more prevalent in recent years. Thirteen percent of teens report using e-cigarettes in the past month, compared to 3% reporting cigarette use, with a concerning increase in the number of never-smoking youth reporting e-cigarette use ( Bunnell et al., 2015 ). Another recent trend includes increased frequency of marijuana use, with 6% of 18 year olds reporting using marijuana daily ( Johnston et al., 2017 ). Attitudes about marijuana use continue to move toward greater acceptance; the perception of risk about using marijuana is at the lowest point ever recorded, with a third of 18 year olds reporting that regular marijuana use is harmful. While overall rates of marijuana use have remained relatively stable over the past several years, decreased perception of harm typically corresponds with increased use. Other drug use is relatively uncommon, with less than 6% of adolescents reporting past month use of other illicit drugs ( Johnston et al., 2017 ). A brief summary of rates of current substance use, by substance and by grade level, among adolescents in the United States is presented in Table 1 ( Johnston et al., 2017 ).

Rates (%) of current (30-day) substance use among adolescents in the United States, by substance and grade level ( Johnston et al., 2017 ).

NR=Not Reported

Prevalence of Substance Use Disorders

Adolescent substance use is heterogeneous, ranging from normative early experimentation with substance use to heavier and higher-risk patterns of use. Most youth who use substances do not become addicted; however, the prevalence of substance use disorders is still quite high, with 15% of youth meeting diagnostic criteria for alcohol abuse and 16% for drug abuse by age 18 ( Swendsen et al. 2012 ). Tobacco, alcohol, and marijuana are typically the first addictive substances that youth try. The likelihood of developing a substance use disorder increases significantly when individuals initiate alcohol and drug use during adolescence. Youth who begin drinking before age 15 have four to six times the rate of lifetime alcohol dependence than those who remain abstinent from alcohol use until age 21 ( Grant & Dawson, 1997 ; SAMHSA, 2014 ). The majority of adults who have a substance use disorder started using before age 18 and develop their disorder by age 20, highlighting the need to delay initiation of substance use for as long as possible ( Dennis et al., 2002 ).

Neurobiology

The brain undergoes significant neurodevelopment between childhood and young adulthood, with maturation continuing until around age 25 ( Pfefferbaum et al., 1994 ; Giedd 2004 ). Brain gray matter, which includes mostly nerve cell bodies and dendrites, tends to decrease during adolescence via synaptic pruning and changes in the extracellular matrix ( Gogtay et al., 2004 ; Paus, 2005 ; Petjanek et al., 2011; Raznahan et al., 2014 ; Sowell et al., 1999 ; Stiles & Jernigan, 2010 ). Concurrently, white-matter volume and white matter integrity increases over this time, which allows for more efficient and rapid communication between brain regions ( Giedd, 2004 ; Lebel et al., 2011 ; 2012 ). Brain regions have time-varying developmental trajectories, with lower-order sensorimotor regions maturing first, and regions associated with higher-order cognitive functioning (e.g., frontal and subcortical brain regions) developing later in adolescence and young adulthood ( Sowell et al., 1999 , 2004 ; Shaw et al., 2008 ; Giedd and Rapoport, 2010 ; Stiles & Jernigan, 2010 ). Healthy brain development throughout adolescence is imperative, with even minor changes in neurodevelopmental trajectories affecting a range of cognitive, emotional, and social functioning ( Nagy et al., 2004 ; Casey et al., 2008 ). Altered brain development due to exposure of neurotoxins during adolescence, particularly alcohol and other drug use, could set the stage for cognitive problems into adulthood, conferring functional consequences throughout life.

Adolescents are known to be particularly vulnerable, compared to children and adults, to initiation of substance use and progression to problematic use. Dopaminergic systems are significantly reorganized in the adolescent brain, with decreases in dopamine in striatal structures such as the nucleus accumbens, in the context of limited inhibitory control, potentially precipitating high-risk behaviors to compensate for dopaminergic void ( Chambers et al., 2003 ; Spear, 2002 ). Theories have suggested an “imbalance” in brain development underlying a propensity for risk behavior, including substance use, during adolescence, with emotion and reward systems (e.g., amygdala, nucleus accumbens) developing before cognitive control systems (e.g., prefrontal cortex) ( Casey et al., 2008 ; Somerville et al., 2010 ). Within the window of this imbalance, adolescents’ decisions may be based on brain processes favoring immediate reward over consideration of longer-term consequences ( Casey & Jones, 2010 ). This theoretical model has been supported by a number of recent experimental studies ( Baker et al., 2015 ; Mills et al., 2014 ; van Duijvenvoorde et al., 2016 ).

In the past 10 years, there has been a proliferation of neuroimaging and neurocognitive studies that have attempted to understand neural risk factors that predate adolescent substance use, as well as determine the effect of substance use on the developing brain. Because alcohol and marijuana are the two most commonly used substances, most existing research has focused on these substances. Several large-scale, multisite longitudinal studies are currently underway to help further understand the consequences of alcohol and marijuana use on cognitive functioning, as well as determine the effects of tobacco and other less frequently used drugs on adolescent brain development. These studies include the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) which is following >800 youth across 5 different sites in the US for at least 10 years ( Brown et al., 2015 ); the IMAGEN study which has followed 2,000 youth from England, Ireland, Germany, and France for the past 8 years ( https://imagen-europe.com/ ); and the recently launched Adolescent Brain Cognitive Development (ABCD; http://abcdstudy.org/ ), which will follow 11,500 youth across 21 US sites for at least 10 years. Existing studies have relatively small, homogeneous samples; therefore, these large scale studies will allow for a more complex understanding how demographic, social, genetic, and environmental factors play a role in the impact of substance use on brain development.

Several neurocognitive features have been identified as risk factors for initiation of alcohol and other drug use during adolescence ( Squeglia & Gray, 2016 ; Squeglia & Cservenka, 2017 ). Findings suggest poorer performance on tasks of inhibition and working memory ( Heitzeg et al., 2015 ; Khurana et al., 2013 ; López-Caneda et al., 2014; Squeglia et al., 2014a , 2017 ), smaller brain volumes in reward and cognitive control regions ( Cheetham et al., 2012 , 2014 ; Squeglia et al., 2014a ; Urošević et al., 2015 ; Weiland et al., 2014 ; Whelan et al., 2014 ), less brain activation during executive functioning tasks, and heightened reward responsivity are important predictors of adolescent substance use ( Dager et al., 2014 ; Heitzeg et al., 2014 ; Mahmood et al., 2013 ; Norman et al., 2011 ; Ramage et al., 2015 ; Squeglia et al., 2012 , 2017 ; Wetherill et al., 2013a ; Whelan et al., 2014 ).

Alcohol and marijuana use during adolescence has been associated with poorer performance on a range of cognitive domains. In a sample of 234 healthy adolescents, greater alcohol and marijuana use between approximately ages 13 to 17 was associated with poorer verbal memory, visuospatial functioning, and psychomotor speed ( Nguyen-Louie et al., 2015 ). Gender specific effects have also been found, with heavy-drinking girls showing worsening performance on tests of visuospatial functioning compared to non-using girls, and alcohol-using boys showing poorer attention compared to alcohol-naïve boys ( Squeglia et al., 2009 ). In a 10-year longitudinal study, treatment-seeking youth who continued to use alcohol and other substances showed poorer verbal learning and memory, visuospatial functioning, and working memory and attention by age 25 ( Hanson et al., 2011a , 2011b ). A dose-dependent relationship was found, with heavier use patterns and greater hangover and withdrawal symptoms relating to poorer cognitive functioning. Youth who were in remission from alcohol and drug use performed similarly to those who continued to meet criteria for a substance use disorder, suggesting substance use during adolescence could have persisting effects into adulthood ( Hanson et al., 2011b ).

There is some suggestion that cognitive domains are differentially impacted by marijuana use in adolescence, with attention, declarative memory, and cognitive control particularly affected ( Randolph et al., 2013 ). In a longitudinal study of marijuana and alcohol-using youth, substance use was related to worsening performance on several cognitive domains when compared to non-using youth, including worse performance on tests of complex attention, memory, processing speed, and visuospatial functioning, with early use (before age 16) relating to worse performance ( Jacobus et al., 2015 ). A large longitudinal birth cohort study from New Zealand (N=1,037) found that persistent adolescent-onset marijuana use was associated with an IQ decline of more than 5 points in the most persistent marijuana-use group, with deficits persisting into adulthood ( Meier et al., 2012 ). However, a recent longitudinal twin study found that IQ deficits observed in marijuana users may be attributable to confounding factors like familial and environmental influences rather than the direct neurotoxic effect of marijuana ( Jackson et al., 2016 ). The follow-up assessment periods for these studies differed, with the Meier study ending at age 38 and the Jackson study following youth until age ~20; regular use over a prolonged period may result in more deleterious effects.

Adolescent alcohol and marijuana use has also been associated with a range of structural and functional brain changes. In the largest prospective study to date on this topic ( N =134), alcohol-using adolescents showed abnormal neurodevelopmental trajectories when compared to continuously non-using controls, including accelerated decreases in gray matter volume (particularly in frontal and temporal regions) and attenuated increases in white matter volume over the ~5 year follow-up ( Squeglia et al., 2015 ), replicating earlier studies with smaller sample sizes ( Luciana et al., 2013 ; Squeglia et al., 2014b ). These findings suggest potentially non-beneficial pruning or, alternatively, premature cortical gray matter decline in alcohol-using youth. In a study examining white matter development, adolescents with extensive marijuana- and alcohol-use histories showed worsening white matter integrity over an 18 month (Baba et al., 2013) and 3-year follow-up ( Jacobus et al., 2013a , 2013b ) in a number of important white matter tracts when compared to non-using youth, as well as poorer performance on tests of neurocognitive functioning. In conjunction with structural changes, adolescent alcohol and marijuana use appears to also affect brain functioning. On several functional MRI studies, youth who initiated heavy alcohol use during adolescence have shown increasing brain activation over time on tests of visual working memory ( Squeglia et al., 2012 ) and inhibition ( Wetherill et al., 2013a , 2013b ), when compared to non-using peers.

Risk Factors

Several factors increase the likelihood of an individual developing a substance use problem, including familial, social, and individual risk factors ( Whitesell et al., 2013 ). Vulnerability for developing substance-related problems is especially heightened among individuals with a family history of substance use disorder ( Cservenka, 2016 ). A recent meta-analysis of twin and adoption studies found that alcohol use disorder is approximately 50% heritable ( Verhulst, Neale, & Kendler, 2015 ); however, identifying specific genes has been challenging, highlighting the complexity and heterogeneity of the disorder ( Hart & Kranzler, 2015 ; Tawa, Hall, & Lohoff, 2016 ). Findings suggest there are a number of genes, each with relatively small effects, that interact with each other and with the environment ( Enoch, 2012 ) to make an individual more or less susceptible to having a substance use disorder ( Meyers & Dick, 2010 ). While specific genes have not been consistently identified, youth with a family history of alcohol use disorder are 3–5 times more likely to develop an alcohol use disorder than youth without a family history of alcoholism ( Cotton, 1979 ).

Males tend to have higher rates of substance use than females ( SAMSHA, 2014 ). Other important risk factors for adolescent substance use include environmental factors such as early exposure to traumatic life events ( Dube et al., 2006 ), prenatal exposure to alcohol and other drugs ( Enoch et al., 2011 ), lack of parental supervision and monitoring ( Nash et al., 2005 ), sleep problems (Shibely et al., 2008), being involved in romantic relationships ( Squeglia et al., 2017 ; Whelan et al., 2014 ), and peer substance use ( Leung et al., 2014 ). Co-occurring psychopathology, including ADHD and depression have been shown to significantly increase the risk of adolescent alcohol use ( Charach et al, 2011 ; Lee et al., 2011 ; Libby et al., 2005 ; Rao et al., 1999 ; Taylor, 2011 ; Wu et al., 2008 ). Additionally, childhood depression and conduct disorder symptoms predict persistence of substance dependence in adulthood ( Meier et al., 2016 ). Other research suggests that externalizing, but not internalizing, mental health problems in childhood predict later substance use in males and females, while among females adolescent substance use predicts internalizing disorders in adulthood ( Miettunen et al., 2014 ).

Prevention science is grounded in the premise that modulation of risk and protective factors may affect the probability of later problems ( Coie et al., 1993 ). Applied to adolescent substance use, this has been implemented across a number of modalities and settings, with the goal of reducing modifiable risk factors and enhancing/reinforcing modifiable protective factors ( Harrop & Catalano, 2016 ). Most commonly, programs have been developed and evaluated in school, family, and community settings. Evidence is mixed amid heterogeneity of methodology and outcomes between studies, but there is some support for parenting-focused ( Allen et al., 2016 ), school-based teacher-led ( Lize et al., 2017 ), and peer-led prevention programs ( MacArthur et al., 2016 ).

Screening and Assessment

Despite the serious implications of adolescent substance use, many clinical providers do not conduct routine screening, and most that do fail to utilize a validated screening method ( Harris et al., 2012 ). In light of this, considerable recent effort has focused on developing and disseminating efficient and reliable screening methods for adolescent substance use ( Levy et al., 2016 ). Screening tools can potentially be used across a number of settings where adolescents are present, though to date most research in this area has focused on primary care practice. The ideal tool would be both sensitive and specific to substance use and related problems, and would guide subsequent in-depth assessment and intervention when appropriate. This must be balanced with the need for time efficiency amid busy clinical practice in which a wide variety of health screening assessments are indicated.

Two brief screeners have strong evidence of achieving the balance of the aforementioned goals, and can be delivered via interview or electronic administration. The Screening to Brief Intervention (S2BI), which queries the adolescent regarding frequency of using 8 types of drugs in the past year, yields high sensitivity and specificity for identifying use and substance use disorders ( Levy et al., 2014 ). Similarly, the Brief Screener for Tobacco, Alcohol, and Other Drugs (BSTAD) queries frequency of use in the past year, with optimal cutoff points for identifying substance use disorders as ≥6 days of tobacco use, ≥2 days of alcohol use, and ≥2 days of marijuana use ( Kelly et al., 2014 ). Both screeners can be delivered electronically, which is a preferred method for adolescents. In practice, adolescent patients can complete the screener via mobile electronic device in the waiting area, and the results can be delivered to the provider in anticipation of the visit and interview.

Initial screeners such as the S2BI and BSTAD can be complemented with subsequent brief assessments to evaluate level of substance involvement and severity of substance-related problems. These assessments can help determine the level and modality of treatment that may be needed, spanning from psychoeducation and/or brief intervention in the primary care office to more intensive service referrals. The CRAFFT (Car, Relax, Alone, Friends/Family, Forget, Trouble), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) and GAIN (Global Appraisal of Individual Needs) are all validated for this purpose. The CRAFFT and ASSIST serve as adolescent-validated analogues to the adult screener CAGE, the latter of which is not developmentally appropriate for adolescents ( Gryczynski et al., 2015 ; Knight et al., 1999 ). The GAIN assesses for both substance use disorders and potentially associated mental health disorders, including four subscales assessing substance use, internalizing disorders, externalizing disorders, and crime/violence ( Dennis et al., 2006 ).

When more thorough and formal evaluation is indicated (i.e., when brief screening is highly suggestive of substance-related problems requiring intervention), diagnostic evaluation via the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5), may be undertaken ( American Psychiatric Association, 2013 ). Within this framework, problematic substance use may be diagnostically categorized as a substance use disorder (e.g., Cannabis Use Disorder), with severity of mild, moderate, or severe, depending on the number of substance use disorder symptoms endorsed for a given substance. Diagnostic evaluation should be complemented by functional behavioral analysis, in which substance use is evaluated as a problem behavior with antecedents and consequences which may be unique to a given adolescent’s substance use. The functional analysis framework is used to determine what antecedents and consequences are potentially modifiable to reduce the likelihood of ongoing problem behavior ( Randall et al., 2001 ).

Laboratory testing, most commonly urine drug testing, is often used to complement self-report when evaluating adolescent substance use; it is, however, not generally supported as a standalone screening or assessment for substance use ( Hadland & Levy, 2016 ). Particularly in situations when trust has been eroded within a family and the veracity of an adolescent’s self-report is in doubt, urine testing may serve as a useful, though imperfect, method for objective assessment. With some exceptions, most studies have shown reasonable agreement between adolescent self-report and urine drug test results ( Gignac et al., 2005 ). Parental report is comparatively less consistent with urine testing, reflecting that parents may not often be aware of the adolescent’s day-to-day substance use patterns. Variations in detection times due to substance, dose, chronicity of use, cutoff used, and metabolism of user, should be noted as potential limits of urine testing. Additionally, some “designer” and synthetic substances may not be included among commonly available urine drug testing panels. Home drug testing kits are widely available, but often lack informational guidance to inform parents/guardians of empirically supported strategies to incorporate them as a part of treatment and monitoring, indicating that clear guidance by the provider is critical when considering drug testing at home rather than in clinic ( Washio et al., 2014 ).

Treatment development for adolescent substance use disorders has focused primarily on psychosocial interventions, spanning individual, group, and family modalities. The intensity and duration of investigated treatments has varied from brief (even single-session) interventions to extended multimodal strategies. The majority of studies have evaluated office-based outpatient interventions, many of which were developmentally adapted from established adult-targeted treatments.

Despite the considerable appeal of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, standalone brief interventions have demonstrated very limited effects when provided to adolescents with substance use disorders ( Young et al., 2014 ). This is similarly the case with brief school-based interventions ( Carney et al., 2016 ) and brief standalone motivational interviewing approaches ( Li et al., 2016 ). These strategies appear more useful when provided as a component of multimodal intervention with increased overall intensity and duration.

A recent comprehensive review indicated that the most well established efficacious treatments include ecological family-based treatment, group cognitive-behavioral therapy (CBT), and individual CBT, while fair evidence supports behavioral family therapy and motivational enhancement therapy (MET) ( Hogue et al., 2014 ). Substantial evidence supports combined treatment approaches, incorporating elements from the aforementioned modalities and others to enhance outcomes. Given that adolescent substance use disorders are heterogeneous and multidetermined, treatment approaches that address multiple biopsychosocial targets are often indicated. Among combined treatments, strong evidence supports combined MET and CBT, as well as combined MET, CBT, and behavioral family-based treatment ( Hogue et al., 2014 ). Outcomes are further enhanced by complementing the aforementioned treatments with contingency management (CM), a behavioral treatment based on operant conditioning principles, in which tangible rewards are provided for objectively confirmed desired behaviors (e.g., token provided for negative urine drug test) ( Stanger et al., 2015 , 2016 ). In general, evaluated treatments in large-scale trials have demonstrated short-term substance reduction and/or cessation, but adolescents with substance use disorders, even with the best evidence-based care, rarely achieve long-term abstinence ( Dennis et al., 2004 ; Hogue et al., 2014 ; Waldron & Turner, 2008 ).

Pharmacotherapy is an established complement to psychosocial treatment for adults with substance use disorders, with several medications receiving United States Food and Drug Administration (FDA) approval for treatment of alcohol, tobacco, and opioid use disorders. While the neuropathology of adolescent substance use disorders is increasingly recognized, relatively little work has focused on developing pharmacotherapies for this age group. To date, only buprenorphine-naloxone possesses FDA approval for opioid use disorder in youth ages 16 and older. Other medications have been studied at least preliminarily for youth alcohol, tobacco, cannabis, and opioid use disorders, yielding mixed results ( Hammond & Gray, 2016 ). Findings from randomized controlled trials, though not yet exhaustive, indicate that select pharmacotherapies may be considered as adjunctive treatments to psychosocial interventions: buprenorphine-naloxone maintenance to improve treatment retention and outcomes for opioid use disorder ( Marsch et al., 2005 ; Woody et al., 2008 ), N -acetylycysteine as an adjunct to cessation counseling and contingency management for cannabis use disorder ( Gray et al., 2012 ), and nicotine patch or bupropion SR to improve tobacco cessation rates ( Gray et al., 2011 , Moolchan et al., 2005 ; Muramoto et al., 2007 ).

Given the ubiquity of mobile technology among adolescents, and the considerable logistical barriers to office-based care (e.g., transportation, accessibility), recent research has focused on translating evidence-based care for delivery via electronic platforms. A meta-analysis revealed a small positive effect size for text messaging interventions for youth with substance use problems ( Mason et al., 2015 ), and a pilot study demonstrated the feasibility of using smartphones to provide recovery support for adolescents after discharge from residential treatment ( Dennis et al., 2015 ). Ongoing work is focused on combining ecological momentary assessment and smartphone application intervention in adolescents with substance use and co-occurring psychiatric disorders ( Benarous et al., 2016 ).

Limitations

This review provides a general overview of a broad, complex topic area, with multiple lines of ongoing research. The methodology of the review was by design not structured or meta-analytic, but rather a general cross-section of recent advances and findings. Additionally, the review focused largely, but not exclusively, on data derived from United States samples. As such, caution should be taken in interpreting findings, acknowledging the potential for limitations in generalizability across populations, policies, and cultural and environmental factors.

Recent research has significantly advanced the understanding of substance use in adolescence. Survey-based epidemiological studies have identified trends in substance-related attitudes and rates of use of various substances, while emerging longitudinal neuroimaging studies have elucidated the neurobiology underlying adolescents’ propensity for substance initiation and progression to substance use disorders, with potentially lasting substance-related adverse consequences. A variety of prevention programs have been implemented across settings with varying degrees of success. Novel screening and assessment instruments have been developed to efficiently identify youth with particular risk for serious substance-related problems, and a number of evidence-based treatment approaches have been shown to be effective in reducing substance use and substance-related problems. Unfortunately, adolescents with substance use disorders rarely achieve long-term abstinence even with the most robust evidence-based treatments, indicating that further work is needed to optimize methods to understand and address this important public health issue.

• ▪ Adolescents, amid rapid biopsychosocial development, are more prone than children or adults to initiating substance use and suffering lasting substance-related adverse consequences
• ▪ Recent research has elucidated the neurobiological processes underlying substance use risk in adolescents, as well as substance-related neuropathology among adolescents with substance use disorders
• ▪ Advances in prevention, screening, assessment, and treatment research have yielded evidence-based interventions to address adolescent substance use disorders
• ▪ Further research is needed to enhance outcomes and reduce the considerable public health burden of adolescent substance use disorders

Acknowledgments

Dr. Gray has received research support (medication only) from Pfizer.

Dr. Squeglia reports no competing interests.

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108 Drug Abuse Essay Topic Ideas & Examples

🏆 best drug abuse topic ideas & essay examples, 👍 good essay topics on drug abuse, 💡 most interesting drug abuse topics to write about, ❓ drug abuse research questions.

Drug abuse essays are an excellent way to learn about the issue and its influence on various groups and populations while demonstrating your understanding.

Various substances, including alcohol, narcotics, and other mind-altering products, are a popular method for recreation in some communities.

However, they are prone to result in addiction, psychological as well as mental, and lead the person to pursue another dose before anything else.

In doing so, he or she can eventually ruin his or her life, which is why most drugs are currently banned around the world. This article will offer you some tips that will help you write an excellent essay and receive the top grade.

Youth is a major demographic that is affected by addiction issues due to drug consumption. Young people are impressionable and prone to search for new sensations. Drugs can offer a sense of novelty and provide an experience they have not had before, leading to considerable appeal.

Considering that young people are generally not wealthy and have to focus on work to succeed in life, essays on drug among youth can use a variety of excellent topics. You can offer your ideas on the reason for the phenomenon’s existence and ways in which it can be prevented.

However, remember that the purpose of the programs should be to help the people who are at risk.

There are many other drug abuse essay topics that you can explore, with poverty being a prominent example. Despite their conditions, many people turn to substance abuse to try and escape the unpleasant aspects of their life.

These population segments are more likely to suffer after acquiring a drug habit than young people because they generally receive less attention.

Furthermore, poor neighborhoods with relatively low amounts of surveillance by law enforcement are likely to house drug dealers who prey on vulnerable people.

You can discuss this topic or discuss a variety of other ones, as the relationship between poverty and poor outcomes has been researched deeply.

Here are some additional tips for your essay:

• Try to use examples to illustrate your points about various aspects of the issue. Drug addiction essay quotations from people who are affected by the condition or have overcome it can offer valuable insights. They also legitimize your findings by providing parallels with the real world.
• Alcohol essays are an excellent choice, as the substance is legal and available to everyone without much difficulty. Nevertheless, its effects can be devastating, especially if a person’s consumption is chronic.
• Try to write a drug abuse essay outline before starting work, as it will help you to organize the essay. Select some prominent ideas that you want to discuss and organize them in a manner that represents a logical progression. You do not have to discard all of the other concepts, as you can make them sub-headings under your main titles.
• Be sure to include a drug abuse essay introduction and conclusion in your work. They will help you provide a structure to the essay and make it easier for the reader to understand your ideas. The introduction should describe the topic and provide the thesis, and the conclusion should restate your main points.

Visit IvyPanda for drug abuse essay titles, and other useful samples on various subjects to help you with your writing work!

• Social Media Impact on Drug Abuse Thus, social media platforms definitely contribute to the misuse of various drugs by romanticizing their consumption and making “social drug use” acceptable among users.
• Drug Trafficking and Drug Abuse Drug trafficking contributes to drug abuse in the society. Drug trafficking also contributes to increased criminal activities that affect the security of citizens.
• Drug and Alcohol Abuse For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. This paper highlights the problems of drug abuse and alcohol drinking […]
• Drug Abuse and Current Generation Drug abuse also breeds an array of behavioral problems among young people, which may affect their suitability to fit in the society.
• Consequences of Drug Abuse The endless stream of drugs, obtainable to the individuals with little or no restrictions, poses a serious inquiry. When assessing the advantages of using pharmaceutical drugs, it is essential to consider the severity of health […]
• Drug Abuse & Its Effects on Families Focusing on the family seems to be by far, the most known and effective way of finding a solution with regards to the “war on drugs” since it more promising to end the vicious cycle […]
• Merton’s Argument of Deviance: The Case of Drug Abuse The most prominent example in support of Merton’s argument in relation to drug abuse is that cultural and social circumstances play a crucial role in defining people’s desire to engage in drug use.
• Teenage Drug Abuse in the United States The problem of teenage drug abuse inflicts a threat to the future society and health state of the overall population in the United States.
• Drug and Substance Abuse Many experts consider addiction as a disease as it affects a specific part of the brain; the limbic system commonly referred to as the pleasure center.
• Drug Abuse in Adolescents and Its Causes Scientific research shows that the development factors for adolescent drug abuse are not limited to a set of three to five causes, but are usually linked to the integration of destructive environmental conditions.
• Drug Abuse Among the Youth Essentially, this case study will allow the evaluation of the prevailing cases of drug abuse among the youth. In this regard, the pain and peer pleasure cannot be persevered to allow an explicit cure of […]
• Drug Abuse in High School and College With respect to social work and the problem of substance abuse, research has been carried out in terms of investigating the relationship between drug abuse and poverty, the effects of drug abuse on the society.
• “Cocaine: Abuse and Addiction” by National Institute on Drug Abuse The literature provides us with a report of a research that has been conducted in the US regarding the topic of cocaine and drug abuse.
• Drug Abuse in Lake County, California The topic of drug abuse is essential for discussion due to the need to develop strategies to prevent and minimize the dangerous consequences of drug abuse in different regions.
• Community Intervention Practices Against Drug Abuse The key features that result in successful community-based intervention on drug abuse are integrated for effectiveness and efficiency. On the other hand, drug abuse refers to the consumption of substances that elicit particular feelings and […]
• Drug Abuse and Prevention Strategies When specialists deal with preventative factors, they pay attention to both mental and physical ways to resist the drug. The symbiosis of these procedures is exceptionally efficient in terms of the drug rehabilitation process when […]
• A New Alcohol and Drug-Abuse Rehabilitation Center in Liverpool Hospital, Sydney The hospital, in response to this distress, has decided to bring help closer to the people of Liverpool by the construction of the annex facility.
• Music Analysis: Drug Abuse in Music So in this song the artist is also lamenting the dangers of drugs and the theme of the music is one that advocates against tackling the problem with issues of drug abuse by arguing the […]
• Drug Abuse. “Nine Years Under” Book by Sheri Booker The book is thought provoking and important because it allows representing the difficult social situation and the problems of gang violence and drugs in the United States from the personal point of view.
• Impact of Drug Abuse on Adolescent Development Therefore, it is important for counselors to consider these stages to help them address the issue of substance abuse among adolescents. In the habitual stage, most adolescents take drugs to help them modify their moods.
• Reasons Behind Youth’s Engagement to Drug Abuse in the 21st Century Although youths in the 21st century engage in drug abuse due to several factors, it suffices to declare factors such as the rising unemployment status, peer pressure, and their hiked tendency to copy their parents’ […]
• Drug Abuse as a Social Problem This poses as problem to the society because many of the people who are unemployed will resort to different ways of seeking money and pleasure.
• Drug Abuse and Its Psychological Effects The purpose of this paper is to explore in more depth the psychological effects of addiction on the family and inner circle of the addict.
• Drug Abuse, Aggression and Antisocial Behavior The use of abusive drugs can cause anger in people because of the effect they have on the brain. An example of how alcohol can cause aggression in a person is that it impairs an […]
• Policies for Pregnant Women With Drug Abuse Thus, out of all the offered policies, financial support for therapy is the best one, as it motivates prevention and treatment, which, in turn, causes the improvement of this situation.
• The Formative Evaluation: Program of Addressing Drug Abuse in Schools The proposed program sought to educate students about the challenges of drug abuse, its impacts on academic performance, and the best techniques to avoid the vice.
• Alcohol and Drug Abuse in Canada Therefore, it contributes as a central factor in the essence of the character, and it is crucial to understand the core definition and the elements that foster the ideology.
• Mitigating Drug Abuse in Pine View School The inclusion of professionals in the fields of health care, counseling, and drugs is expected to promote the delivery of desirable results.
• Drug Abuse and Its Negative Effects This paper aims to highlight what the field of psychology says about the negative effects of drugs and why people continue using despite the consequences. The main effect is that it creates a memory of […]
• Prevention Programs: Drug Abuse Resistance Education This program focuses on handling peer pressure among youths, a crucial cause of drug abuse in the country. The program is also grounded on sound research, which offers the critical elements vital to handling the […]
• Drug Abuse Among Homeless Young Adults in New Jersey The reason why young adults in New Jersey get involved in drugs and alcohol after becoming homeless is to manage their situations in an attempt to attain the tentative pleasure of life despite their problems. […]
• Drug Abuse Effects on Health and Nervous System These numerous damages severely affect the quality of the brains work and the health of the nervous system. While discussing the effects of drug addiction, it is essential to notice that it has a devastating […]
• Substance Abuse: Prevention Strategies and National Benchmarks Still, this desire to get away from problems by means of substances instead of making effort to improve an individual’s environment contributed to the evolution of the challenge of substance abuse into a real public […]
• Alcoholism, Domestic Violence and Drug Abuse Kaur and Ajinkya researched to investigate the “psychological impact of adult alcoholism on spouses and children”. The work of Kaur and Ajinkya, reveals a link between chronic alcoholism and emotional problems on the spouse and […]
• Monitoring the Future: National Survey Results on Drug Use National survey results on drug use obtained by Monitoring the Future have a significant value to the development of various approaches with regard to the prevention of drug abuse.
• The Health Issues Associated With Drug Abuse It is therefore imperative to develop strategies for health promotion to reduce the number of teenagers, the most at-risk family member when it comes to drug abuse.
• Fentanyl – Drug Profile and Specific and Drug Abuse The drug has the effect of depressing the respiratory center, constricting the pupils, as well as depressing the cough reflex. The remainder 75% of fentanyl is swallowed and absorbed in G-tract.
• Cases of Drug Abuse Amongst Nursing Professionals It is noteworthy that at the top of the information, the date posted is Monday, February 14, 2011, yet against the information, the date is February 11, 2011.
• The Treatment of Drug Abuse Any medical practitioner treating a drug abuse patient has to be careful in many aspects, like: He has to be careful on the issue that if the addiction has effected the brain of the patient.
• Drug Courts and Detoxification: Approach to Drug Abuse Treatment However, since 1989, the US federal system has been providing the majority of drug abusers with proper treatment or education with the help of a drug court option.
• Drug Abuse in Adolescents Aged 15-19 Years Old: A Public Health Menace In addition, the objectives of the paper are as follows: the first aim is to analyze the collected data and produce a review of the information.
• Drug Abuse and Addiction Holimon has succeeded in reviving some of her family relations, and she is still putting a lot of effort to get ahead in this area to the fullest extent possible.
• Sports as a Solution to Youth Substance Abuse: Dr. Collingwood’s View His comments made me realize that it would be unwise by the end of the day for any parent to leave their children under the mercy of the media where they learned that doing drugs […]
• Intervention Techniques Focusing Drug Abuse and Alcoholism A technique of Family Intervention needs the concern, care and supremacy of love to penetrate the denial and start the treatment.
• Critical Issues in Education: Drug Abuse and Alcoholism For this case, the ministry concerned has a very hard task of ensuring there are no critical issues that are left unsolved that relate to education, failure to which will affect the performance of students […]
• The DARE (Drug Abuse Resistance Education) Program’s Effectiveness While evaluating the effectiveness of the DARE program analysis in accordance with the methodologies and evaluation criteria used, the given assessments refer to various methods of the analysis of participants, as well as various data […]
• Depression and Drug Dependence Treatment and Support She states that her father was the main person who was able to give the right pieces of advice and she was not afraid of making the wrong decision.
• Drug Abuse and Dependence: Insights from Clients and Professionals If either the client or the professional wishes to determine the extent to which an individual is dependent on drugs, the only thing he or she would have to do is read the individual’s behavior.
• Biopsychosocial Experience in Drug Abuse Treatment There has to be a preventive strategy in every intervention procedure to avoid the occurrence of a disease. I find the course of treatment in this intervention beneficial for the creation of the needed preventive […]
• Addictive Behavior Programs and Drug Abuse Trends The involvement of stakeholders is an essential condition for the effectiveness of this model of work and its results, and all the roles should be allocated in accordance with the capabilities of the program’s participants.
• Substance Misuse in American Youth: A Socio-Cultural Analysis The paper analyzes studies regarding some of the most widespread types of substances, as well as discusses the role of the rap culture in the growing number of young addicts in the U.S.
• Social Behaviour as a Science: Drug Abuse in Youth Thus, the application of social psychology to the phenomenon of youth drug abuse helps to explain how social factors impact the prevalence of and risk for drug abuse.
• ACTIQ Prescription Drug Abuse The fast-acting characteristic of ACTIQ is a result of being absorbed in the mucosal lining of the mouth. ACTIQ is a synthetic drug that is available as lozenges/lollipops, which are designed to be sucked in […]
• Prescription Drug Abuse and Lebanon Students The first two authors are the representatives of the Department of Epidemiology and Population Health at the American University of Beirut, and Martins is from the Department of Mental Health, the John Hopkins University.
• Financial Planning for Drug Abuse Prevention in Virginia Estates Therefore, the first preferred sources for the program are the County Commission and the Alabama Department of Corrections. The program can be financed by the Montgomery County Commission in the short term and Alabama Department […]
• Addressing the Drug Abuse in Parolees and Probationers The aim of the program is to address the drug abuse in parolees and probationers during their probations and decrease the use of drugs in them.
• Problem of Drug Abuse in Schools The research worked on the hypothesis that the treatment would reduce or result in the total cessation of drug use, and better relations with family and friends.
• Youth Drug Abuse Among, Education, and Policies Although drug abuse encompasses improper use of drugs disregarding the prescriptions of medical practitioners, the principal challenges of drug abuse occasion from abuse of drugs such as cocaine, heroin, and marijuana.
• Prescription Drug Abuse in the United States The combination of Ibuprofen and acetaminophen are effective for the patients, who want to reduce and control the level of pain.
• Drug Use Among Parolees and Probationers: A Comprehensive Plan To reduce drug use in probationers and the probability of a new crime, the approach to drug testing needs to be changed.
• Drug Abuse and Medicaid Program The emergence of alcohol and drug abuse as a problem and the intensification of people with mental health problems, have exposed the society to the likelihood of involvement of the population in substance abuse.
• Drug Abuse: Age, Gender and Addictive Susceptibility This incorporates the aspects of gender where males and females possess varying biological constitutions that might affect the prescribed treatments in the realms of addiction. It is important to consider the rapidity and susceptibility of […]
• Prevention Research: The Fight Against Drug Abuse It is agreeable that US’s ‘War on Drugs’ has been an effective substance abuse prevention plan despite the hiccups that the program faces and its inability to attain some of its designated mandates within the […]
• Drug Abuse Prevention Programs Additionally, it is possible to prospect the success of the program in case the required readiness from the community can be unveiled prior to the program execution.
• The Cultural Context and Ethics of Prevention of Drug Abuse The first prevention strategy outlined in the document is the involvement of young people in all levels of the prevention program establishment. Concurrently, it is crucial to relate this technique with the subject of culture […]
• Use of Psychotropic Medications in the Treatment of Drug Abuse This is because the mental illness is, literally, the one that sustains the abuse of drugs and thus after it is healed; the patient will have no reason to continue abusing the drugs.
• Drug Abuse: Awareness Amongst the Youths This project is going to carry out a public awareness campaign with the aim of educating the young people on the hazards related to the vice of drug and substance abuse. The awareness campaign is […]
• Spirituality Effect on Drug Abuse Treatment Programs The hypothesis of the study was that spirituality is appropriate in the formal treatment of addiction; the study confirmed this hypothesis.
• Drug Abuse and Religious Spirituality Concept Particularly, this high rate of relapses was determined by Olmstead et al.as a direct result of a degree of failure on the part of drug abuse treatment programs to sufficiently address the primary reason why […]
• Drug Abuse and Harmful Health Effects The principle recognizes the importance of helping drug addicts out of the activity but also sees the importance of protecting their rights to health matters if the country is to realize economic development.
• The Extent of Drug Abuse Among People in America Toronto Mayor Rob Ford Said He Lied about Crack Cocaine Use Because He Was Embarrassed Mayor lied about the use of crack cocaine The article titled “Toronto Mayor Rob Ford said he lied about crack […]
• Drug Use and Abuse in America: Historical Analysis The new law was similar to the Boggs Act of 1951 in that it employed the same formula of using perceived increase in drug use in the country.
• Drug Abuse as an Ethical Issue On the side of duties and obligations, the societal norms stipulate that individuals should be caring to other members of the society especially the children and the old.
• Drug Abuse and Society Regardless of the many intervention measures that can be adopted to solve this problem of drug abuse, the most effective intervention measure is to create awareness to youths to enable them change their behaviors and […]
• Prescription Painkillers, the New Drug Abuse of Choice Studies attribute the recent increase in the misuse of prescription drugs to an increase in the use of the Internet, which facilitates the growth of illegitimate online drug stores and uncontrolled online prescription drug sales.
• Drug Abuse: Comprehensive Review The effects associated with drug abuse tend to vary depending on an individual’s age and the phase of drug abuse that the person is in.
• Adolescent’s Drug Abuse and Therapy Success When one accepts to put up with negative peer pressure, they end up giving up the personal trusts and values thus the pressure becomes a form of a negative force.”Does peer pressure affect the decision […]
• What Are Influences That Cause Drug Abuse on Youth?
• What Are Some Solutions to Drug Abuse?
• What Are the Primary Causes and Effects of Alcoholism and Drug Abuse Among Young People?
• What Causes Teenage Drug Abuse?
• What Does Drug Abuse Truly?
• Why Do Children Need to Be Educated About Drug Abuse?
• Why Has the American Government Not Managed to Stop Drug Abuse All These Years?
• How Does Drug Abuse Affect Personal Development of Hong Kong Teenagers?
• How Does Pericarditis Form Due to Drug Abuse?
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• What Is the Drug of Abuse?
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• Which Is an Example of Drug Abuse?
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• What Are the Effects of Drug Abuse on Youths?
• What Is the Connection Between Adolescents From Divorced Families and Drug Abuse?
• Are Alcohol and Drug Abuse the Most Common Issues of Today?
• What Is Athletes’ Motivation for Performance-Enhancement Drug Abuse?
• What Is the Correlation Between Parietal and Adolescent Drug Abuse?
• How Is Dealing With Teenage Drug Abuse?
• What Is the Difference Between Drug Use and Drug Abuse?
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How We Get Hooked: Understand Alcohol Misuse

Uncover how perceived benefits shape our relationship with alcohol..

Posted May 18, 2024 | Reviewed by Ray Parker

• What Is Alcoholism?
• Find a therapist to overcome addiction
• Explore how early alcohol experiences shape our perceptions of alcohol.
• Dive into how social learning reinforces drinking behaviors.
• Replace judgment with understanding, using a drinking diary to cultivate healthier alcohol consumption.

“I don’t know why I keep drinking.” I threw myself onto my therapist’s bright yellow couch on a hot summer day.

“I am sure you had a reason,” my therapist replied.

I remembered looking up at her with disbelief. It was not the response I imagined I would get.

This pivotal moment was the beginning of my journey to understanding the deeper reasons behind alcohol consumption, a journey I now navigate with my clients. Six years have passed since then, and having become a therapist myself, the exchange above has also become one that takes place often between me and my clients.

Every Behavior Serves a Purpose: Perceived Benefits

People who come to me to work on their alcohol consumption often feel perplexed by their own behaviors. They see all the good reasons to drink less, yet for some reason, they just can’t seem to figure out how.

“Is there something wrong with me?” many of them end up asking. My answer to that question is a definitive “No.”

No. There is nothing wrong with you. You drink for a reason.

Here is the thing: behind each of our behaviors, there is a motive. Our behaviors serve purposes. They are driven by perceived benefits. We take a shot before walking up onto the stage for a boost of confidence ; we pour a glass of wine before initiating intimacy to soften the moods; and we reach for that fourth beer because we believe the more we drink, the more fun we will get. Behind each sip we take, there is always something that we hope to get. Recognizing these patterns has led me to explore the initial allure of alcohol and the perceived benefits that often go unnoticed.

The Power of Perception: The Initial Perceived Benefits

As we scratch our heads wondering why someone can’t stop drinking despite all the negative consequences, we often fail to acknowledge the perceived benefits. You see, if drinking was really just “all bad,” very few of us would ever get hooked. The tricky thing about alcohol is that it often starts with benefits—perceived benefits, at least.

Imagine a young man at his first college party, feeling awkward and out of place—until he has his first drink. Suddenly, the edges soften, the room seems friendlier, and he feels like he belongs. Or a teenage girl who is going through her first breakup. As the cold beer pours down her throat, the sadness in her chest slowly dissipates. (That girl was me.)

Our early encounters with alcohol often set the tone for our relationship with it, creating powerful perceptions. According to the expectancy theory, we make choices based on the expected outcome of our actions. After the initial encounters, the young man learned to pop open a beer every time he felt unease at a party, and the teenage girl learned to pour herself a glass whenever sadness arose in her chest.

These early perceptions often overshadow the delayed negative consequences. The immediate perceived benefits reinforce the behavior, making it easy to overlook the hangover the next day, the occasional throw-up by the sidewalk, or the long-term impact on one’s health and well-being. As these early experiences shape our perceptions, they lay the groundwork for new associations that reinforce our drinking habits over time.

Reinforcement and New Associations: How Alcohol's Appeal Grows

As we continue navigating through life, the perceived benefits we have around alcohol slowly multiply. Perhaps you were originally drawn to alcohol by the alleviation of discomfort in social situations. Over time, as you continue to drink during parties and gatherings, your brain starts to associate drinking with having a good time.

Moreover, our observations about others around us continue to add layers of perceived benefits to our understanding of alcohol. According to social learning theory , we learn by observing and imitating others. When we watch a housewife on TV pour herself a glass of “mommy’s juice” by the end of the day, we learn to associate alcohol with relaxation and stress relief. When we see our friend pair a Cabernet Sauvignon with a hearty steak, we learn to see wine as a part of fine dining. The observations create more and more perceived benefits we associate with the liquid in the bottle.

These perceived benefits keep us reaching for a drink even when the negative effects start to pile up. Grappling with dissatisfaction with attempts to cut down, many people become trapped in a sense of self-blame.

Replace Self-Blame With Understanding

Understanding the "why" behind our drinking can make a crucial difference, as shame and guilt often hinder our ability to understand and make changes. When we get caught up in painful questions like “What’s wrong with me,” we become distracted from constructive questions such as “How can I create changes?” Insights and awareness are often the first steps to change.

You had reasons to drink. Understanding those reasons gives room for you to learn how to drink less.

Inside my 7-Day Toolkit, you can find my favorite tool, the 3-minute drinking diary , to help you uncover the hidden perceived benefits of drinking.

Jeanette Hu, AMFT , based in California, is a former daily drinker, psychotherapist, and Sober Curiosity Guide. She supports individuals who long for a better relationship with alcohol, helping them learn to drink less without living less.

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May 17, 2024

Binge drinking is a growing public health crisis − here's how research on alcohol use disorder has shifted

The act of consuming several drinks within a short time frame can permanently remodel the brain..

All forms of alcohol consumption come with health risks, but binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain.

With the new Amy Winehouse biopic "Back to Black " in U.S. theaters as of May 17, 2024, the late singer's relationship with alcohol and drugs is under scrutiny again. In July 2011, Winehouse was found dead in her flat in north London from "death by misadventure" at the age of 27. That's the official British term used for accidental death caused by a voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the legal intoxication limit in the U.S. – leading her cause of death to be later adjusted to include "alcohol toxicity" following a second coroner's inquest.

Nearly 13 years later, alcohol consumption and binge drinking remain a major public health crisis , not just in the U.K. but also in the U.S.

Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode . This is well over the amount of alcohol thought to produce legal intoxication, commonly defined as a blood alcohol concentration over 0.08% – on average, four drinks in two hours for women, five drinks in two hours for men.

Among women, days of "heavy drinking" increased 41% during the COVID-19 pandemic compared with pre-pandemic levels , and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking , with no evidence of these trends slowing down. Despite efforts to comprehend the overall biology of substance use disorders, scientists' and physicians' understanding of the relationship between women's health and binge drinking has lagged behind.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie addiction to alcohol . I study how neuropeptides – unique signaling molecules in the prefrontal cortex , one of the key brain regions in decision-making, risk-taking and reward – are altered by repeated exposure to binge alcohol consumption in animal models.

My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so that we can better inform efforts toward both prevention and treatment.

The biology of addiction

While problematic alcohol consumption has likely occurred as long as alcohol has existed, it wasn't until 2011 that the American Society of Addiction Medicine recognized substance addiction as a brain disorder – the same year as Winehouse's death. A diagnosis of an alcohol use disorder is now used over outdated terms such as labeling an individual as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, a drug – alter the brain. Often, people consume a drug like alcohol because of the rewarding and positive feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what starts off as manageable consumption of alcohol can quickly devolve into cycles of excessive alcohol consumption followed by drug withdrawal.

While all forms of alcohol consumption come with health risks, binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain. For example, for some people, alcohol use can lead to " hangxiety ," the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and drunkenness, coupled with withdrawal, can spiral, leading to relapse and reuse of alcohol. In other words, alcohol use shifts from being rewarding to just trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain engaged by alcohol can shift away from those traditionally associated with drug use and reward or pleasure to brain regions more typically engaged during stress and anxiety .

All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways . Alcohol can affect several dozen neurotransmitters and receptors , making understanding its mechanism of action in the brain complicated.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain's key communicator, sending both electrical and chemical signals within the brain and to the rest of your body.

What we've found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently remodel the brain. Even after a prolonged period of abstinence, conversations between the neurons don't return to normal .

These changes in the brain can appear even before there are noticeable changes in behavior . This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol.

Researchers like us don't yet fully understand why some people may be more susceptible to this shift, but it likely has to do with genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Women are forgotten

While researchers are increasingly understanding the medley of biological factors that underlie addiction, there's one population that's been largely overlooked until now: women.

Women may be more likely than men to have some of the most catastrophic health effects caused by alcohol use, such as liver issues, cardiovascular disease and cancer . Middle-aged women are now at the highest risk for binge drinking compared with other populations.

When women consume even moderate levels of alcohol, their risk for various cancers goes up, including digestive, breast and pancreatic cancer , among other health problems – and even death. So the worsening rates of alcohol use disorder in women prompt the need for a greater focus on women in the research and the search for treatments.

Yet, women have long been underrepresented in biomedical research.

It wasn't until 1993 that clinical research funded by the National Institutes of Health was required to include women as research subjects. In fact, the NIH did not even require sex as a biological variable to be considered by federally funded researchers until 2016. When women are excluded from biomedical research, it leaves doctors and researchers with an incomplete understanding of health and disease, including alcohol addiction.

There is also increasing evidence that addictive substances can interact with cycling sex hormones such as estrogen and progesterone . For instance, research has shown that when estrogen levels are high, like before ovulation, alcohol might feel more rewarding , which could drive higher levels of binge drinking. Currently, researchers don't know the full extent of the interaction between these natural biological rhythms or other unique biological factors involved in women's health and propensity for alcohol addiction.

Looking ahead

Researchers and lawmakers are recognizing the vital need for increased research on women's health. Major federal investments into women's health research are a vital step toward developing better prevention and treatment options for women.

While women like Amy Winehouse may have been forced to struggle both privately and publicly with substance use disorders and alcohol, the increasing focus of research on addiction to alcohol and other substances as a brain disorder will open new treatment avenues for those suffering from the consequences.

Nikki Crowley , Assistant Professor of Biology, Biomedical Engineering and Pharmacology, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article .

Nikki Crowley, Penn State

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Understanding Addiction to Support Recovery

At a glance.

• Addiction can happen to anyone.
• There are safe and effective ways to recover.
• Finding the right treatment option can be the key to someone's recovery journey.

Addiction can happen to anyone

One in 6 Americans reports experiencing a substance use disorder. 1 There is not one single driving factor that leads to addiction. Some people may use drugs as a way to cope with stress, trauma, or mental health issues. Some people may even develop opioid use disorder after misusing opioids they are prescribed by doctors. In any case, using drugs over time makes it easier to become addicted. 2

Drug use and effects on the brain

When people take drugs, the brain is flooded with chemicals that take over the brain's reward system and cause them to repeat behaviors that feel good but aren't healthy.

The brain adapts to continued drug use by developing a tolerance, which means it takes more of a drug to feel the same result.

Not only does this lessen the brain's ability to resist intense urges to take drugs, but it can also affect the amount of pleasure a person receives from healthy activities like enjoying food or the company of others.

Substance use disorder (SUD)

Substance use disorder (SUD) is defined as a problematic pattern of substance use leading to clinically significant impairment or distress. Education and awareness around the harm of using substances, along with the support of friends, parents, and caregivers, can help prevent SUDs.

Opioid use disorder (OUD)

Opioid use disorder (OUD) is defined as a problematic pattern of opioid use that causes significant impairment or distress. In 2022, 6.1 million people aged 12 and older had an opioid use disorder. 1 Prescription drug monitoring programs , state prescription drug laws, and education around safe storage and disposal can help in prevent prescription opioid misuse, OUD, and overdose 3 .

Stimulant use disorder

Stimulant use disorder is defined as a problematic pattern of stimulant use (e.g., cocaine, methamphetamine, or prescriptions stimulants) that causes significant impairment or distress. About 4.5 million people in the U.S. have a stimulant use disorder. 1

Addiction is a treatable disease

Overcoming a SUD is not as simple as resisting the temptation to take drugs through willpower alone. Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy. It may require checking into a rehabilitation facility. 4 5 Recovery can be challenging, but it is possible.

Recovery options

There are safe and effective ways to recover from SUDs. Finding the right treatment option can be the key to a successful recovery journey.

Medications for opioid use disorder (MOUD)

Many people with opioid use disorder benefit from treatment with medication. Medications for opioid use disorder (MOUD) can help with cravings and withdrawal symptoms. 5 MOUD is effective in helping people overcome addiction, stay in recovery longer, and prevent reoccurrence of use. 6 7 8 MOUD medications approved by the Food and Drug Administration (FDA):

• Buprenorphine

Taking these medications during treatment doesn't mean taking the easy way out; it means finding something that works best for that individual.

Additional treatment options

Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the situations in which they're most likely to use drugs.

Contingency management uses positive reinforcement such as providing rewards or privileges for remaining drugfree, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.

Motivational enhancement therapy uses strategies to make the most of people's readiness to change their behavior and enter treatment.

Twelve-step facilitation therapy is an individual active engagement strategy designed to encourage people to accept drug addiction as a chronic, progressive disease and prepare them to begin a 12-step mutual support program. 9

Outpatient counseling can help people understand addiction, their triggers, and their reasons for using drugs. This form of treatment can be done at a doctor's office or via telehealth appointment.

Inpatient rehabilitation at a full-time facility provides a supportive environment to help people recover without distractions or temptations.

Find help today‎

Reoccurrence of use is not a sign of failure.

Reoccurrence of use may happen to people who use drugs and can happen even years after not taking the substance. More than anything, reoccurrence of use may be a sign that more treatment or a different method is needed. A routine review of one’s treatment plan may be necessary to determine if another method could be more effective.

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• Rx Awareness: Real Stories from real people who have shared their personal accounts about dealing with prescription opioids.
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• https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf
• https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
• https://store.samhsa.gov/sites/default/files/pep21-02-01-004.pdf
• https://www.asam.org/quality-care/clinical-guidelines/stimulant-use-disorders
• SAMHSA. 2022, March 22. Medications, Counseling, and Related Conditions. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
• https://store.samhsa.gov/sites/default/files/pep21-02-01-002.pdf
• NIDA. 2021, April 13. How do medications to treat opioid use disorder work?. Retrieved from https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work on 2023, April 6
• https://nida.nih.gov/nidamed-medical-health-professionals/treatment/opioid-use-disorder-treatment
• Donovan DM, Ingalsbe MH, Benbow J, Daley DC. 12-step interventions and mutual support programs for substance use disorders: an overview. Soc Work Public Health. 2013;28(3-4):313-32. doi: 10.1080/19371918.2013.774663. PMID: 23731422; PMCID: PMC3753023

Every day, drugs claim hundreds of lives. The Stop Overdose website educates drug users on fentanyl, naloxone, polysubstance use, and dealing with stigma.

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By the numbers: There are now more daily marijuana users in the US than daily alcohol users

FILE - A man smokes marijuana in lower Manhattan outside the first legal dispensary for recreational marijuana in New York on Thursday, Dec. 29, 2022. Daily and near-daily marijuana use is now more common than similar levels of high-frequency drinking in the U.S., according to an analysis of survey data over four decades, according to research published Wednesday, May 22, 2024, in the journal Addiction. (AP Photo/Ted Shaffrey, File)

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New research based on data from the National Survey on Drug Use and Health, published Wednesday in the journal Addiction, compares Americans’ use of cannabis and alcohol over the past 40 years. Here are some of the findings and other notable numbers.

— An estimated 17.7 million people reported using marijuana daily or near-daily in 2022, up from less than 1 million in 1992.

— An estimated 14.7 million used used alcohol daily or near daily in 2022, up from about 9 million in 1992.

— 42% of people who say they’ve used marijuana in the past month say they do so daily or near daily.

— 11% of alcohol users drink daily or near daily.

— 62 million Americans, about 20% of the U.S. population ages 12 and older, reported using marijuana at least once in the past year, according to the survey .

— About 3 in 10 people who use cannabis have cannabis use disorder , according to the U.S. Centers for Disease Control and Prevention.

— 177 million Americans reported that they drank in the past year .

— 29.5 million Americans had an alcohol use disorder as of 2022.

— Recreational marijuana is legal in 24 U.S. states .