A learned heart can't unlearn

Last year, I was addicted to doomscrolling on YouTube, Instagram, and TikTok. It affected my attention span and focus, so I decided to overcome this addiction. I realized I was mistaken in trying to overcome the addiction by merely fighting its symptoms rather than addressing the root cause. Undergoing a social media detox helped me understand that doomscrolling was just a coping mechanism, not the core issue—it was my life problems that needed addressing. Intrigued by this topic, I wanted to delve deeper since it is a global problem.

During that time, my first question was, "What is addiction?" According to Wikipedia, addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural rewards, despite substantial harm and other negative consequences. Simply put, it occurs when someone continues to engage in something repeatedly, even if it harms their mental and/or physical well-being. It could be a peer who plays video games excessively or an uncle who smokes heavily, with these activities providing a reward for them. The next question naturally follows: Why do we become addicted?

Many people think that only 'weirdos' or 'junkies' get addicted, but this is a false stereotype. Anyone can get addicted to anything. It is not about personality but a combination of genetics, neurobiology, and social environment, according to Maureen Boyle, a public health advisor and director of the science policy branch at the National Institute on Drug Abuse. Overcoming addiction is not as simple as many people think. An addicted person can't just 'stop' to overcome their addiction. So, how does the brain get addicted? When we take any action, our brain's reward system responds by rewarding or punishing us based on the outcome of that action. For instance, when we drink water in hot weather, the reward pathways activate a chemical called dopamine, which returns a sense of joy. Dopamine is a chemical in our brain that helps us feel happy and satisfied. It serves as a messenger to tell our brain what feels good and enjoyable, such as when we eat delicious food, play video games, or listen to music. It helps us learn what feels good so we can do them again to experience that joy and happiness. When a person develops an addiction to a substance or behavior, the brain starts to change. Addictive substances and behaviors trigger ten times more dopamine release than natural rewards. The brain remembers this and connects it with addictive substances and behaviors. With the constant use of addictive substances and behaviors, the brain's circuits adapt and become less sensitive to dopamine. Achieving that dopamine hit becomes the addicted person’s number one life goal. The brain starts to build tolerance, which makes the person consume the substance or engage in the behavior more and more over time to reach the level of high they crave. Addiction negatively impacts memory, focus, learning, decision-making, and judgment. That’s why a drug or alcohol-addicted person continues to consume the substance even if it harms their well-being. This is how the brain gets addicted. There are also a couple of other factors that contribute to the development of addiction.

Genetics

According to the Cleveland Clinic and Wikipedia, if people have first-degree relatives (parents, siblings) who are addicted, they have a 40-60% likelihood of developing substance addiction themselves. There are three specific genes and genetic variations linked to addiction risk:

- Genes affecting drug metabolism, such as variants in genes responsible for metabolizing alcohol and nicotine.

- Genes altering drug receptor function, like variations in nicotinic receptors associated with nicotine addiction.

- Genes involved in general addiction mechanisms, including dopamine receptors, monoamine oxidase A, and the serotonin transporter.

Environment

According to the National Institute on Drug Abuse (NIDA), lack of parental supervision, the prevalence of peer substance use, substance availability, and poverty are risk factors for developing substance addiction among children and adolescents. Additionally, one theory suggests that addiction serves as a coping mechanism against feelings of hopelessness, helplessness, and adverse childhood traumas such as various types of maltreatment and dysfunction. The Adverse Childhood Experiences Study by the Centers for Disease Control and Prevention has demonstrated a strong dose-response relationship between ACEs and numerous health, social, and behavioral problems throughout a person's lifespan, including substance use disorder.

Social control theory

Travis Hirschi suggests that people who had stronger and closer attachments to family, religious groups, and other social institutions are far less likely to get addicted in drug use, behavioral addictions, and so on.

Age

In adolescence, the incentive reward system develops before the cognitive control center, which plays a key role in the decision-making process during this stage of life. Adolescents are more prone to engaging in risky and addictive behaviors before fully considering the consequences. Research indicates that people are most likely to become addicted during their teenage years. In the United States, statistics show that in 2013, there were 2.8 million new users of illicit drugs, and 54.1% of them were teenagers under 18 (source: Wikipedia). Additionally, in 2011, approximately 20.6 million people aged 12 and older were reported to have addiction issues.

Epigenetics

It is the study of how our genetics can be turned on or off without changing DNA sequences. When someone consumes drugs, it can cause changes called epigenetic changes in their DNA. These changes make the brain’s reward system more sensitive, which might increase someone's likelihood to enjoy and become addicted to drugs

Transgenerational Epigenetic Inheritance

Epigenetic changes can be passed from parents to their children. This means that if a parent experiences certain environmental factors, like drug use, these changes can affect their children's behavior and response to drugs. These changes are not in the DNA sequence itself, but in how genes are turned on or off. Research in animals suggests that some epigenetic changes caused by drug addiction can be passed to the next generation. These changes can either increase or decrease the likelihood that children will develop an addiction. Scientists are still studying these effects in humans to better understand them.

Treatment and management

Behavioral therapy

Effective treatment of addiction cannot rely solely on medications or biological treatments; cognitive behavioral therapies, psychotherapies, and behavior modification strategies are also crucial. A biosocial approach to addiction treatment considers how social factors influence an individual's health and recovery journey. Behavioral therapies are effective in overcoming addiction by viewing it as a learned behavior influenced by environmental factors and specific thought patterns. They integrate well with other treatments to achieve the same goal.

Techniques such as cue exposure and contingency management utilize conditioning theories to modify addictive behaviors. Recovery groups employ vicarious learning, where individuals emulate rewarding behaviors observed in their social groups or those perceived as higher status.

For children, addiction treatment involves comprehensive behavioral therapy, including family and school-based interventions. Consistent aerobic exercise, particularly endurance activities like marathon running, can prevent and treat drug addiction by altering brain chemistry related to addiction, reducing drug use, and lowering relapse rates.

Medication

Alcohol addiction can lead to physical dependence and withdrawal symptoms such as delirium tremens, similar to opioids. Treatment for alcohol addiction aims to address both dependence and addiction. Benzodiazepines, which are depressants, are commonly used to safely manage alcohol withdrawal and are considered the preferred method for detoxification. Medications like naltrexone, disulfiram, acamprosate, and topiramate are also considered effective for treating alcohol addiction. The goal of these medications is not to replace alcohol but to reduce cravings and induce negative feelings when the substance is consumed. They can be effective when taken regularly. Naltrexone, in particular, has shown effectiveness in treating alcoholism, with benefits that can last several months after treatment ends.

Opioids can lead to physical dependence, so treatment focuses on addressing both dependence and addiction. Replacement drugs such as buprenorphine (found in Suboxone and Subutex) and methadone are utilized to manage physical dependence. These medications help control pain and cravings, enabling individuals to function normally without resorting to illegal substances. Treatment typically involves stabilizing the prescribed dosage, followed by transitioning to maintenance or tapering phases.

In the United States, opioid replacement therapy is closely regulated in clinics under legislation like DATA 2000. Some countries utilize other opioids like dihydrocodeine, dihydroetorphine, or even heroin as substitutes based on individual needs. Baclofen has also shown effectiveness in reducing cravings for substances such as alcohol and opioids, thereby alleviating withdrawal symptoms. However, there is a risk of overdose during detoxification, which remains a significant concern in treatment.

My own thoughts

These are some unofficial statistics about addictions:

- Approximately 11% of American males (about 18 million individuals) are addicted to pornography.

- According to the World Health Organization in 2019, around 400 million people aged over 15 live with alcohol use problems.

- According to the United Nations Office on Drugs and Crime, 39 million people around the world suffer from drug use disorders.

These statistics represent significant numbers. It appears that addictions, especially alcoholism, have a profound impact in developing countries. In Uzbekistan, for example, alcohol addiction is often cited as a core reason for many family divorces. Many men use alcohol as a coping mechanism for economic challenges, childhood traumas, and other reasons. Moreover, a high percentage of men become addicted to alcohol at a young age, which makes it more challenging to overcome in adulthood.

If you haven't experienced alcohol or drug addiction in your own family, it can be difficult to understand its profound impact. As human beings, we have a responsibility to support those who are struggling with addiction to improve their quality of life and make the world a better place. Unfortunately, there is no quick-fix medication or treatment for addiction; most existing treatments require significant time and commitment. Consequently, many patients do not complete treatment successfully and overcome their addiction.

Additionally, the cost of medications and treatments can be prohibitive for working-class families, further complicating access to care. Cultural stigma also plays a significant role in many societies, where addiction is often seen as making someone 'different' or 'other'. Overcoming these barriers is essential to effectively support individuals and enhance their quality of life.

Seoul, Korea

26/06/2024