Cocaine Abuse Affects Decision Making and Memory

Drug Addiction: Substance Abuse, Substance Use Disorder, Treatment

Cocaine Abuse Affects Decision Making and Memory

Drug addiction, or substance use disorder, is a brain disease. The drugs affect your brain, making it difficult to stop taking the drugs, even if you want to. The first step to drug addiction treatment is seeing the problem and deciding to get help.

Drug Addiction

Substance abuse disorder, or drug addiction, can be defined as a progressive disease that causes people to lose control of the use of some substance despite worsening consequences of that use. Substance use disorder can be life-threatening.

Addictions are not problems of willpower or morality. Addiction is a powerful and complex disease. People who have an addiction to drugs cannot simply quit, even if they want to. The drugs change the brain in a way that makes quitting physically and mentally difficult. Treating addiction often requires lifelong care and therapy.

What are drugs of abuse?

Drugs that are commonly misused include:

  • Alcohol.
  • Club drugs, GHB, ketamine, MDMA (ecstasy/molly), flunitrazepam (Rohypnol®).
  • Stimulants, such as cocaine (including crack) and methamphetamine (meth).
  • Hallucinogens, including ayahuasca, D-lysergic acid diethylamide (LSD), peyote (mescaline), phencyclidine (PCP) and DMT.
  • Inhalants, including solvents, aerosol sprays, gases and nitrites (poppers).
  • Marijuana.
  • Opioid pain killers such as heroin, fentanyl, oxycodone, hydrocodone, codeine and morphine.
  • Prescription drugs and cold medicines.
  • Sedatives, hypnotics and anxiolytics (anti-anxiety medications).
  • Steroids (anabolic).
  • Synthetic cannabinoids (K2 or Spice).
  • Synthetic cathinones (bath salts).
  • Tobacco/nicotine and electronic cigarettes (e-cigarettes or vaping).

While these drugs are very different from each other, they all strongly activate the addiction center of the brain. That is what makes these substances habit-forming, while others are not.

People feel intoxicated after using drugs of abuse. Over time, the brain is changed by drugs of abuse. The brain becomes desensitized to the drug of abuse so that more of the drug must be used to produce the same effect.

As the person consumes more, drugs start to take over the person’s life. One may stop enjoying other aspects of life. For many people, social, family and work obligations fall to the side. The person with SUD starts to feel something’s wrong if he or she isn’t under the influence of the substance. They may become consumed with the need to recapture that original feeling.

Anyone can develop a substance use disorder. No one thing can predict whether a person may develop an addiction. You may be more prone to drug use due to:

  • Biology: The person’s genetic makeup, gender, ethnicity and mental health issues may raise his or her risk for developing an addiction. About two-thirds of people in addiction treatment are men. Particular ethnicities are at higher risk for substance abuse disorder. This is true for Native Americans.
  • Environment: Surroundings can affect the lihood of developing substance use disorder. For example, stress, peer pressure, physical or sexual abuse and early exposure to drugs can raise the risk.
  • Age: Teenagers who start taking drugs are especially at risk. The parts of the brain that control judgment, decisions and self-control are not fully developed. Teens are more ly to engage in risky behaviors. In a developing brain, drugs can cause changes that make addiction more ly.

Substance use disorder and alcohol use disorder are the leading causes of preventable illness and early death. Research has shown that about 1 in 9 Americans uses illicit drugs (about 11% of the population). The most commonly misused drugs are marijuana and prescription medications.

Drugs affect the brain, especially the “reward center” of the brain.

Humans are biologically motivated to seek rewards. Often, these rewards come from healthy behaviors. When you spend time with a loved one or eat a delicious meal, your body releases a chemical called dopamine, which makes you feel pleasure. It becomes a cycle: You seek out these experiences because they reward you with good feelings.

Drugs of abuse send massive surges of dopamine through the brain, too.

But instead of feeling motivated to do the things you need to survive (eat, work, spend time with loved ones), such massive dopamine levels can lead to damaging changes that change thoughts, feelings and behavior.

That can create an unhealthy drive to seek pleasure from the drug and less from more healthy pleasurable experiences. The cycle revolves around seeking and consuming drugs to get that pleasurable feeling.

Addiction to drugs changes the brain over time. It affects how the brain works and even the brain’s structure. That’s why healthcare providers consider substance use disorder a brain disease.

The first use of a drug is a choice. But addiction can develop, creating a very dangerous condition. Drugs affect your decision-making ability, including the decision to stop drug use.

You may be aware there’s a problem but unable to stop. With addiction, stopping drug use can be physically uncomfortable. It can make you sick and even become life-threatening.

People may begin using drugs for several reasons. They may:

  • Enjoy the pleasurable experience.
  • Want to change or blunt their unpleasant feelings.
  • Want to improve their performance at work, school or athletics.
  • Be curious or give in to peer pressure.

Symptoms of drug addiction include:

  • Bloodshot eyes and looking tired.
  • Changes in appetite, usually eating less.
  • Changes in physical appearance, such as having a poor complexion or looking ungroomed.
  • Craving drugs.
  • Difficulty completing tasks at work, school or home.
  • Engaging in risky behaviors, despite knowing negative consequences (such as driving while impaired or having unprotected sex).
  • Inability to reduce or control drug use.
  • Issues with money.
  • Weight loss.

The first step to diagnosing a drug addiction is recognizing the problem and wanting help. This initial step may start with an intervention from friends or loved ones. Once someone decides to seek help for addiction, the next steps include:

  • Complete exam by a healthcare provider.
  • Individualized treatment, either inpatient or outpatient.

Several therapies exist for treating substance use disorder. Even for a severe disorder, treatment can help. Often, you’ll receive a combination of these therapies:

  • Detoxification: You stop taking drugs, allowing the drugs to leave the body. You may need healthcare supervision to detox safely.
  • Medication-assisted therapies: During detox, medicine can help control cravings and relieve withdrawal symptoms.
  • Behavioral therapies: Cognitive behavioral therapy or other psychotherapy (talk therapy) can help deal with addiction’s cause. Therapy also helps build self-esteem and teaches healthy coping mechanisms.

Medication may be part of your treatment plan. Your care team figures out the best medications for you. Medication-assisted treatments are available for:

  • Opioids: Methadone, buprenorphine and naltrexone are FDA-approved for the treatment of Opiate Use Disorder.
  • Alcohol: Three FDA-approved drugs include naltrexone, acamprosate and disulfiram (Antabuse®).
  • Tobacco: A nicotine patch, spray, gum or lozenge can help. Or your doctor might prescribe bupropion (Wellbutrin®) or varenicline (Chantix®).

Is treatment for drug addiction inpatient or outpatient?

Both inpatient and outpatient treatment plans are available, depending on your needs. Treatment typically involves group therapy sessions that occur weekly for three months to a year.

Inpatient therapy can include:

  • Hospitalization.
  • Therapeutic communities or sober houses, which are tightly controlled, drug-free environments.

Self-help groups such as Alcoholics Anonymous and Narcotics Anonymous can help you on the path to recovery. Self-help groups are also available for family members, including Al-Anon and Nar-Anon Family Groups. Participation in 12-step based recovery work has been proven to improve outcomes.

There is no cure for drug addiction. People can manage and treat addiction. But there is always a risk that the addiction will return. Managing substance use disorder is a lifelong job.

Yes. Preventing drug addiction starts with education. Education in schools, communities and families helps prevent misusing a substance for the first time. Other ways to prevent substance use disorder:

  • Don’t try illegal drugs, even one time.
  • Follow instructions for prescription medications. Don't ever take more than instructed. Opioid addiction, for instance, can start after just five days.
  • Dispose of unused prescriptions promptly to reduce risks of misuse by others.

Many people have both a mental health condition and a substance use disorder. Sometimes, mental illness is there before the addiction happens. Other times, the addiction triggers or worsens a mental health disorder. When both conditions are treated properly, the chances for recovery improve.

Addiction is a lifelong disease. But people can recover from addiction and lead full lives. Getting help is essential to recovery. Different tools work for different people, but ongoing therapy and self-help groups such as Narcotics Anonymous help many.

Are there long-term effects of addiction?

If you continue to misuse drugs, brain structures and functions can change. Substance use disorder alters how you:

  • Behave.
  • Deal with stress.
  • Learn.
  • Make judgments and decisions.
  • Store memories.

Can addiction come back?

Substance use disorder is a “relapsing disease.” People who are in recovery from this disease have a higher chance of using drugs again. Recurrence can happen even years after you last took drugs.

Because of the possibility of relapse, you need ongoing treatment. Your healthcare provider should review your treatment plan with you and change it your changing needs. If you have a problem with prescription drugs, including opioids, inform your healthcare providers. They can help you find other options to manage pain.

Is drug addiction fatal?

Substance use disorder can kill. If left untreated, you could die from overdose or engaging in dangerous behavior under the influence of drugs. Treatment can help people recover from addiction and prevent serious consequences.

Avoiding drugs is the best way to take care of yourself. Once you experiment with substance use, it becomes harder to quit. If you think you have substance use disorder and want to stop, talk to a healthcare provider who can guide you on next steps.

What else should I ask my healthcare provider?

If you or a loved one is experiencing substance use disorder, ask your healthcare provider:

  • How can I stop taking drugs?
  • What is the best treatment plan for me?
  • How long will the withdrawal symptoms last?
  • How long does therapy take?
  • What can I do to prevent a relapse?
  • What community resources can help me during my recovery?

A note from Cleveland Clinic

Substance abuse, or substance use disorder, is a brain disease. Drugs affect your brain, including your decision-making ability. These changes make it hard to stop taking drugs, even if you want to.

If you or a loved one has a substance use disorder, talk to a healthcare provider. A trained provider can help guide you to the treatment you need.

Usually, a combination of medication and ongoing therapy helps people recover from addiction and get back to their lives.

Last reviewed by a Cleveland Clinic medical professional on 09/03/2020.

References

Источник: https://my.clevelandclinic.org/health/diseases/16652-drug-addiction

Drug Misuse and Addiction | National Institute on Drug Abuse

Cocaine Abuse Affects Decision Making and Memory

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.† It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.11

Addiction is a lot other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable. If left untreated, they can last a lifetime and may lead to death.

Modified with permission from Volkow et al. 1993.

Note: These PET scans compare the brain of an individual with a history of cocaine use disorder (middle and right) to the brain of an individual without a history of cocaine use (left).

The person who has had a cocaine use disorder has lower levels of the D2 dopamine receptor (depicted in red) in the striatum one month (middle) and four months (right) after stopping cocaine use compared to the non-user.

The level of dopamine receptors in the brain of the cocaine user are higher at the 4-month mark (right), but have not returned to the levels observed in the non-user (left).

Why do people take drugs?

In general, people take drugs for a few reasons:

  • To feel good. Drugs can produce intense feelings of pleasure. This initial euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the high is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opioids such as heroin is followed by feelings of relaxation and satisfaction.
  • To feel better. Some people who suffer from social anxiety, stress, and depression start using drugs to try to feel less anxious. Stress can play a major role in starting and continuing drug use as well as relapse (return to drug use) in patients recovering from addiction.
  • To do better. Some people feel pressure to improve their focus in school or at work or their abilities in sports. This can play a role in trying or continuing to use drugs, such as prescription stimulants or cocaine.
  • Curiosity and social pressure. In this respect, teens are particularly at risk because peer pressure can be very strong. Adolescence is a developmental period during which the presence of risk factors, such as peers who use drugs, may lead to substance use.

If taking drugs makes people feel good or better, what's the problem?

When they first use a drug, people may perceive what seem to be positive effects. They also may believe they can control their use. But drugs can quickly take over a person's life.

Over time, if drug use continues, other pleasurable activities become less pleasurable, and the person has to take the drug just to feel “normal.” They have a hard time controlling their need to take drugs even though it causes many problems for themselves and their loved ones.

Some people may start to feel the need to take more of a drug or take it more often, even in the early stages of their drug use. These are the signs of an addiction.

Even relatively moderate drug use poses dangers. Consider how a social drinker can become intoxicated, get behind the wheel of a car, and quickly turn a pleasurable activity into a tragedy that affects many lives. Occasional drug use, such as misusing an opioid to get high, can have similarly disastrous effects, including impaired driving and overdose.

Do people choose to keep using drugs?

The initial decision to take drugs is typically voluntary. But with continued use, a person's ability to exert self-control can become seriously impaired. This impairment in self-control is the hallmark of addiction.

Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control.12 These changes help explain the compulsive nature of addiction.

No single factor determines whether a person will become addicted to drugs.

Why do some people become addicted to drugs, while others do not?

As with other diseases and disorders, the lihood of developing an addiction differs from person to person, and no single factor determines whether a person will become addicted to drugs.

In general, the more risk factors a person has, the greater the chance that taking drugs will lead to drug use and addiction. Protective factors, on the other hand, reduce a person's risk.

Risk and protective factors may be either environmental or biological.

Risk Factors Protective Factors
Aggressive behavior in childhood13,14Self-efficacy (belief in self-control)15
Lack of parental supervision14,16Parental monitoring and support16-18
Low peer refusal skills13,17,18Positive relationships17,19
Drug experimentation14,20,21Good grades17,22
Availability of drugs at school21,23School anti-drug policies17
Community poverty24,25Neighborhood resources26

What biological factors increase risk of addiction?

Biological factors that can affect a person's risk of addiction include their genes, stage of development, and even gender or ethnicity.

Scientists estimate that genes, including the effects environmental factors have on a person's gene expression, called epigenetics, account for between 40 and 60 percent of a person's risk of addiction.

27 Also, teens and people with mental disorders are at greater risk of drug use and addiction than others.28

Children's earliest interactions within the family are crucial to their healthy development and risk for drug use.

What environmental factors increase the risk of addiction?

Environmental factors are those related to the family, school, and neighborhood. Factors that can increase a person's risk include the following:

  • Home and Family. The home environment, especially during childhood, is a very important factor. Parents or older family members who use drugs or misuse alcohol, or who break the law, can increase children's risk of future drug problems.29
  • Peer and School. Friends and other peers can have an increasingly strong influence during the teen years. Teens who use drugs can sway even those without risk factors to try drugs for the first time. Struggling in school or having poor social skills can put a child at further risk for using or becoming addicted to drugs.30

What other factors increase the risk of addiction?

  • Early use. Although taking drugs at any age can lead to addiction, research shows that the earlier people begin to use drugs, the more ly they are to develop serious problems.31 This may be due to the harmful effect that drugs can have on the developing brain.

    32 It also may result from a mix of early social and biological risk factors, including lack of a stable home or family, exposure to physical or sexual abuse, genes, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.

  • How the drug is taken.

     Smoking a drug or injecting it into a vein increases its addictive potential.33,34 Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense high can fade within a few minutes.

    Scientists believe this powerful contrast drives some people to repeatedly use drugs to recapture the fleeting pleasurable state.

Images of Brain Development in Healthy Children and Teens (Ages 5-20)

As the brain matures, experiences prune excess neural connections while strengthening those that are used more often.

Many scientists think that this process contributes to the steady reduction in gray matter volume seen during adolescence (depicted as the yellow to blue transition in the figure).

As environmental forces help determine which connections will wither and which will thrive, the brain circuits that emerge become more efficient. However, this is a process that can cut both ways because not all patterns of behavior are desirable or healthy.

The environment is an artist who creates a sculpture by chipping away excess marble; and just bad artists can produce bad art, environments with negative factors ( drugs, malnutrition, bullying, or sleep deprivation) can lead to efficient but potentially harmful circuits that conspire against a person’s well-being.

The brain continues to develop into adulthood and undergoes dramatic changes during adolescence

One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that allows people to assess situations, make sound decisions, and keep emotions and desires under control.

The fact that this critical part of a teen’s brain is still a work in progress puts them at increased risk for trying drugs or continuing to take them.

Introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences.

† The term addiction as used in this booklet is equivalent to a severe substance use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 2013)

NIDA. 2020, July 13. Drug Misuse and Addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

NIDA. «Drug Misuse and Addiction.» National Institute on Drug Abuse, 13 Jul. 2020, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

NIDA. Drug Misuse and Addiction. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction. July 13, 2020

Источник: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

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