Dependence

"I knew this girl once...she was a real addict you know...much more than me."
"She went into rehab and got clean, I heard that, yeah...."
She paused for a second, her eyes darting around.
"Her family shipped her off to some nice little clean neighborhood to live with relatives."
"Next thing I heard, she was gone... she OD'd like the second she got there."
The patient looked down, then spoke slowly, her voice shaking.
"So, how will leaving my neighborhood help me?"
"Where can I go? Even if I get out somehow, there is no where else. I will end up like her anyway."

In behavioral science, we are learning about drug dependence. While I had an idea of why a person becomes addicted to drugs, I had no idea the extent to which their underlying physiology changes, sometimes irreversibly, the first time a drug is used.

In most drug dependencies, the major player is dopamine. Its role as a neurotransmitter is quite varied, from increased levels associated with schizophrenia to decreased levels linked with Parkinsons. Released from the hypothalamus, dopamine also works as a neurohormone, inhibiting prolactin and keeping women (and men) from creating mommy milk in the absence of a baby.

The real kicker, however, is the happy response. Dopamine equals pleasure. If you've ever eaten at the Four Seasons restaurant or had a very exciting sexual experience, then your dopamine levels increased by a factor of about 40. If you take heroin for the very first time, your dopamine levels increase 400 times. That is 10 times more pleasurable than an orgasm. As a result, your "reward center," where all these physiological processes takes place, never forgets that first heroin hit. It is an irreversible modification of your brain and for the majority of people, the 1st or 2nd try is all it takes to become addicted. There is no reversal, no cure, and they become drug dependent for life.

So, how bad can it really be? Well, for lab rats, it is a death sentence. When rats are given a button to push that stimulates their brain to release dopamine, they refuse any and all other rewards: food, water, sexy rats, even freedom. They continue to methodically push that button until they die. Death is better than giving up their dopamine reward.

As if that isn't enough of a battle for addicts, there is also the environmental factor. The neighborhood of an addict, the smell of the house, the vision of their addicted friends, the sound of a match being lit, all of these familiar sights, sounds, and smells that accompany the drug use experience are triggers that prepare the body for the drug before the drug is even taken. The crazy thing is that the body's response is to counteract the pleasure that will ensue. So, if the drug is a stimulant, then the body will become physiologically depressed. Thus, it attempts to protect itself from the intense response it will be receiving from the drug.

In fact, taking a person away from their drug triggers can be deadly. Since the body is somewhat "protected" from the drug by this pre-drug-taking-response to the smell of the crack house, for example, then taking the addict away from the crack house and sticking them in the lavender smelling new house in the burbs will not elicit the same protective response. The amount of drug that made them high in the crack house had a buffer from their protective response. In the new house, there are no drug taking sights and sounds to trigger this physiological buffer. A hit taken in the new place could be so hard, that the person ODs on the same exact amount they took earlier in the day at their musty urine smelling crack house.

So, what makes an addict? Some genetics, some environment, and a lot of opportunity. Just say NO, really really really loud.