If you know someone struggling with substance use, you might sometimes wonder why that person continues to use drugs or alcohol, even when it is so detrimental to them. You might ask why this person repeatedly chooses to use substances, especially if there have been conversations surrounding this topic or if your loved one has confided in you that they want to stop. These are natural questions to have, and you are not alone in these thoughts.
The reality of the situation is that addiction is not a choice. According to the National Institutes of Health (NIH), addiction, also known as substance use disorder (SUD), rewires the brain, interrupting normal processes associated with motivation, risk assessment, and pleasure. Rather than being indicative of poor character or a weak will, addiction is actually a biological disease that alters the brain. As this disease progresses and the body and brain become dependent on the substance, substance use becomes a way of avoiding intense discomfort rather than seeking pleasure.
How Does Substance Use Disorder Start?
While becoming dependent on substances is not a choice, the action of initially trying drugs is generally voluntary. Sometimes that can involve a person drinking alcohol because they notice it makes them feel less anxious in social situations, but alcohol becomes a crutch for dealing with negative emotions in more and more circumstances.
Other times a person tries drugs for the first time because they have heard that certain drugs can cause emotions and experiences they are curious about. This can lead to the continued pursuit of a “high” and risky behavior associated with it. In other cases, a person might be prescribed pain medication after a surgery or injury but become reliant on it even past the point of healing from the initial ailment.
No matter how it starts, substance use turns into substance abuse when the brain’s circuitry is affected. The brain has naturally occurring chemicals called neurotransmitters that are required for individuals to function. Some of these can include common ones, such as serotonin or dopamine. When drugs are introduced into the body, they interfere with those neurotransmitters. Some of them can mimic neurotransmitters, while others cause the brain to release more or less than the normal amount of a neurotransmitter.
Neurotransmitters help to regulate a person’s mood and mental state, and interfering with these chemicals can have significant consequences. One neurotransmitter, in particular, dopamine, is responsible for training you to seek out pleasurable activities. When you experience something positive, like eating a piece of candy or laughing at a joke, your brain releases a surge of dopamine as a “reward” to alert you that your behavior was beneficial and should be repeated. When someone uses drugs or alcohol and experiences fleeting euphoria or calm, dopamine reinforces that behavior, creating an ever-tightening loop that is physiologically difficult to escape.
Dopamine is also responsible for provoking cravings, as not only is the action of using substances reinforced, but so is the environment. For example, if someone is accustomed to using drugs or alcohol while with a specific person or at a certain place, dopamine connects pleasure with those people or places. This can make it difficult for someone to avoid the urge to use when those stimuli are presented.
Drug use reduces the dopamine reward achieved from other, healthier activities, such as exercising or spending time with friends and family. This can lead to low mood or numbness when not using substances, and substance use can be a way of simply feeling “normal” instead of seeking a high. The longer this continues and the more drugs are reinforced by the body, the higher dose is needed to achieve the desired effects. This is called tolerance, and it contributes to dangerous conditions like alcohol poisoning and drug overdose.
Stopping It Before It Starts
Due to the interaction of drugs and alcohol with the brain, it is important to intervene as soon in the process as possible. Educating yourself about risk factors and identifying early warning signs can put you a step ahead if you are starting to worry about your loved one’s substance use.
Risk factors for substance abuse include the following:
- Being exposed to and/or using substances at a young age
- Genetic predisposition
- Poverty and lack of community resources
- Availability of drugs
- Lack of sufficient supervision
Warning signs for substance abuse include the following:
- Drinking until the point of blacking out
- Drinking or using drugs at increasingly high doses
- Drinking or using drugs alone or hiding those behaviors from others
- Becoming physically sick and/or emotionally distressed when not able to continue drinking/using drugs
- Changes in sleeping patterns, appetite, and/or weight
- Rapid and/or extreme shifts in mood and energy
If you notice that your loved one might fit some or all of these risk factors and warning signs, it is time to take action. Reaching out to a licensed clinician to learn about treatment options is a strong first step toward reclaiming the autonomy that addiction steals.
Even the person with the strongest willpower and utmost discipline is not immune from addiction. Drugs and alcohol affect our bodies and brains on a level we cannot see or control, skewing our perception of what is good for us. When you learn about the biological nature of addiction, you might begin to worry that there is nothing you can to do help yourself or a loved one who is suffering. Fortunately, that is not the case, and help is available. There is evidence-based treatment available for those struggling to overcome addiction, and Family-Centered Services can guide you and your family toward a life free from the hold drugs and alcohol have on the brain. Our team of licensed clinicians will get to know your family and develop solutions for your specific situation, such as case management, family therapy, and sober monitoring. Learn more by calling us at (509) 991-5822.