Drug addiction hasbeen classed as a disease and more specifically in the recent contemporaryyears, we class addiction may that be of drugs, food or any other activity as amajor mental health issue. However, before we make definite classifications ofthe causes of drug addiction we must look at the overall scientific findingsand draw correlations. We must recognise what the patterns and characteristicsof addiction in general are and try to find similarities in hypothetical or real-worldexamples.
These acts are always clouded by complexity of the human cognitiveprocess which prevent us from clearly determining the stages at which casual orrecreational use stems to addiction (Wise and Koob). In the vignette, we see anadult male struggling to make choices adhering to his aspirations of quittingsmoking or recovering from nicotine addiction. A case which classicallyprogresses from casual nicotine use to a heavy smoker, can be labelled a clearexample of the process of addiction. However, before making definite judgementswe need to analyse the symptoms of John’s case with theoretical models.
Before we move on todissecting the issue of addiction, we must be able to clearly define andunderstand the concept of addiction. We must be able to distinguish it frombeing a ‘lack of self-control’ issue to being a disease just like any otherhuman ailment. A disease is usually classed as a particular abnormal conditionthat affects part or all of an organism and that consists of a disorder of astructure or function, usually serving as an evolutionary disadvantage (Medicineplus).Addiction is defined as the ongoing use of any substances that havemood-altering effects such as alcohol, tobacco or other drugs, despite the considerationof the consequences.
To the brain addiction and disease are virtually the same. Finally, the Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition (DSM-IV) defines substance addition and dependence as a maladaptive pattern of substance use, leading to significantly harmfulhealth issues (Bettinardi-Angres and Angres). We see that drugaddiction usually stems from the relentless consumption of a wide range of legalor illicit drugs such as alcohol, nicotine cannabis or the wide range ofstimulants and opioids we most commonly discuss.
The consumption of suchsubstances is again supplemented with compulsive and irrational behaviour whilsthaving the incapacity of assessing the potential risks and harms. This isaccredited to exponential increase of cravings for the drug after prolongedwithdrawal from administration ultimately spawning the vicious cycle of addiction(Li, Caprioli, and Marchant, 2014). This is clearly demonstrated in John’s caseas he struggles to deal with the withdrawals of nicotine addiction. Aftercontinuing to smoke cigarettes during his social activities and continuednicotine abuse, John experiences the symptoms of craving brought by the effectsof positive reinforcement whilst self-administration.
The abstinence fromnicotine causes John to be agitated and uncomfortable which is a clearindication of the manifestation of ‘cravings’. Cravings can be classed as twotypes, the first being the craving to seek survival reflected in the Kwashiorkorand marasmus model and the other being to seek pleasure irrespective of the self-harmand life-threatening consequences (Sharma et al,2014). The latter is clearlyobservable in John’s case and can be aligned with the concept of positivereinforcement.
The drug-reinforcement theory explains why humans choose engagein drug taking behaviour. The theory suggests that abuse of drugs serve as biological rewards by activating the reinforcement system. Although this theoryis extremely helpful as a psychological and neurobiological perspective,however, it isn’t enough to give us more indication on the motives of the drug usingindividuals motives completely (Bedendo, Andrande,Noto. 2016). To more accuratelyunderstand the motives, we need to look at concepts such as operant andclassical conditioning as these are important for theunderstanding of the neurobiological basis of drug use. Pavlovianconditioning is a phenomenon that can clearly be linked with the concept ofcraving and reinforcement. Pavlovian conditioning involves learning toanticipate (expect) an important biological event (US) from a neutral stimulus(CS) that reliably predicts this event, and anticipation of the US evokes acascade of physiological changes which adapt the organism in preparation forthe US itself.
In John’s case, we see that he has been classically conditionedas his experience with smoking began as a social smoker. We see that over aperiod of time John sharing a cigarette as a social smoker can be attributed tounconditioned stimulus. Social activities such as having a few drinks or combiningalcohol and tobacco are a clear demonstration on a conditioned stimulus which resultsin a conditioned response of ‘craving’ tobacco. This is again shown through hisinability to abstain from the conditioned stimulus of alcohol which Johnconstantly pairs with cigarette consumption. Following on, aconcept that is extremely pertinent to tobacco use is of ‘tolerance’ and the withdrawalproperties that are associated with consuming tobacco.
Tolerance scientificallyhas two mechanisms as neurons employ to protect themselves from super-optimalreceptor binding resulting from chronic drug exposure are receptordesensitisation and down-regulation. Firstly, desensitisation occurs when thenumber of receptors on the cell membrane remains constant but the associatedion channels become insensitive such that binding to the receptor has no impacton the excitation or inhibition of the cell. Secondly, Down-regulation happenswhen there is a decrease in the number of receptors such that neurotransmitterrelease or drug presence has less effect on the excitation or inhibition of thecell (Lecture Material). As a result of both of these there is a reduction ofresponse to the drug and there is a tolerance shift in the dose-response curve.John started off sharing cigarettes to not being able to go more than an hourwithout satisfying his craving.
He now requires consuming larger number of cigaretteswhen consuming alcohol to be able to enjoy the same cognitive effects of the nicotinewith a combination of alcohol. Following on,withdrawal is an important phenomenon that goes hand in hand with an increased toleranceand substance use. More often than not physical dependence is correlated with experiencingthe withdrawal symptoms. This can develop quite early in the course of addictivedrug use. Following on, it is clear that withdrawal does nothing but force theuser to follow the patterns of the core features of withdrawal syndromes of addictivedrugs (Curtin, McCarthy et al). Research shows that withdrawal is an extremely powerful instigator whenit comes to urges and satisfying the craving through self-administration (see Baker et al., 2004). The withdrawal symptoms of nicotineaddiction affect the acetylcholine receptors (cognitive enhancement) (reward) parts of the brain as nicotine affects these areas of ourbrain.
Research shows that smokers generally perform worse than non-smokers,this is consistent with the idea that smoking withdrawals are characterised bythe cognitive deficit due to the acute cognitive enhancing effects of nicotine. Following on, we can see this as a clearand consistent pattern in John’s case. He seems to be constantly agitated andstruggles to focus on tasks without the ‘smoke break’ to relieve him from hisnicotine withdrawal symptom. This follows a vicious cycle of satisfying hiscraving temporarily whilst his neurological balance is disrupted causing him tocrave another dose to be able to function normally. Finally,it is evident through a critical analysis that addiction to any substance can’tsimply be disregarded as an issue of ‘lack of self-control’. Rather, we need totreat any addiction as a disease with particular emphasis on thecharacteristics of the human cognitive system and how a variety of drugs affectthe individual. In John’s case, we see above that nicotine although provided ashort cognitive enhancement, causes more harm through its particularly heavywithdrawal and craving symptoms.
We also explore the process of developing anaddiction through the scientific models such as classical and operantcondition. Even though we might not deem activities responsible for the issuesan individual acquires, they are still extremely relevant in explaining some ofthe causes in the development of addictions.