WHAT NEW SCIENCE IS TELLING US ABOUT THE CAUSES OF ADDICTION AND HOW WE CAN TREAT IT
According to Addiction, a documentary from The Passionate Eye, overdose is the number one cause of death for people under 50 in the United States. It killed more than 70,000 Americans in 2017 alone. “We have hospitals that are overwhelmed with people who need help. We have a prison system that is filled with people who actually need treatment,” says former state health commissioner for West Virginia Rahul Gupta.
It’s a huge problem here in Canada, too. According to a recent study from Statistics Canada, an average of 10 Canadians died from an illicit drug overdose every day in the two years leading up to March 2018.
The problem is even more significant in scale when you add in all the people struggling with and dying as the result of other addictions, from alcohol to smoking, gambling to food. “The entire fabric of our society is being destroyed as a result of addiction,” says Gupta.
Addiction looks at what the science of substance use disorders can tell us about what causes them and what doctors can do to help. Here are a few key takeaways from the film.
Drug use rewires the brain
“Individuals struggling with addiction are actually battling millions of years of evolution because our brains are exquisitely evolved to seek rewards,” says Robert Malenka, a researcher and professor at Stanford University.
Dopamine is the chemical that’s associated with reward in the brain, and drugs (and other rewarding substances, like food) push dopamine levels up. Long-term drug use can alter the brain by decreasing the number of receptors for the chemical. The consequence is that more and more dopamine is needed — even for the brain to function at a normal level.
“Eventually, you can’t even get enough dopamine produced [by your own body] to get out of bed, let alone produce good relationships and good decision making,” says Dr. Corey Waller from the American Society of Addiction Medicine.
Addiction may run in families and start early
Research suggests that addiction runs in families, with genetics playing a key role. One study found that people with a family history of drug use disorders faced an eight times higher risk of developing an addiction themselves.
Studies also suggest that addiction starts early in life. The U.S. organization Center on Addiction reports that 90 per cent of adult Americans with addictions started smoking or using alcohol or other drugs before the age of 18 when their brains were still forming.
Scientists are currently studying how genes can play a role in making one person vulnerable to addiction or in protecting another from it. A better understanding of the biology of addiction may help personalize treatments in the future.
Abstinence-based treatments are ineffective for many
Traditionally, people with addictions have been referred to abstinence-based programs, such as “12-step” programs. In use for the last 70 years, says Waller, these programs are based on self-help and group therapy. But they exist outside of the traditional medical system, and some studies suggest that they only work for about one in 15 people who try them.
This treatment also may not be suited for every kind of addiction. “Abstinence-based programs, really, for opioid-use disorder, are setting people up to fail and to relapse,” says Laura Kehoe, a primary care doctor at Massachusetts General Hospital, who believes that this approach can be particularly dangerous in these cases.
Facing a lack of effective treatment, many people relapse and find themselves back on the streets using illicit drugs. Emergency departments can provide medicine — in the case people suffering from opioid addictions, naloxone — which saves their lives but does little to address their long-term health issues. “This [is a] human tragedy, really. It’s a human rights issue. The last thing we should be doing is kicking people out of care. That’s when they are in crisis,” says Kehoe.
That’s where supervised injections sites come in. In Vancouver, Insite was the first legal program in North America to provide people with clean needles for drug injection and access to medical supervision and treatments.
According to one study, overdose deaths in Vancouver’s Downtown Eastside neighbourhood decreased by 35 per cent after Insite opened. “The most important thing about supervised injection sites is that it implicitly says that these lives are worth saving, these people are valuable to us,” says Darwin Fisher, harm reduction manager at Insite.
Not only can these sites save lives, but they can also save money. According to Gupta’s analysis, every dollar spent on harm reduction saves seven dollars in medical costs. “The costs are really unsustainable if we continue along this path … We’ve got to be smart about addressing addiction,” he says.
Drugs can curb cravings
Drugs, like Suboxone, can help individuals with certain addictions deal with the cravings by activating opioid receptors. Massachusetts General Hospital runs one of the few programs in the U.S. that offers patients these medications after an opioid overdose.
“This is a treatable illness … We’re seeing people come that day and engage in care, and the vast majority of them, 75 to 80 per cent, are returning,” says Kehoe.
According to the film, these drugs can reduce the risk of death by opioid overdose by half. Once cravings are under control, people with addictions can take advantage of therapy and other programs to help them rebuild their lives.
Recovery from addiction is possible
Rita Goldstein from the Mount Sinai Friedman Brain Institute says “the ability of the brain to heal and to recover is amazing. So, definitely, there’s a lot of hope.”
According to Addiction, there is evidence that dopamine receptors can come back with recovery, and Goldstein has seen evidence that grey matter can increase in the brains of people recovering from addictions, too.
“People recover from addiction,” says Fisher, adding that “they need basic stability … they need housing; they need a sense of future that they can look forward to. When we offer people things like that, they get better.”