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The two hypothetical systems working on an individual's brain during the experience of addiction are complementary within and between system changes. The first counteradaptation results in a decrease in the transmission of dopamine and serotonin release during withdrawal phases of the cycle (Robinson & Berridge 2001). Effectively, dopamine and serotonin transmission is artificially increased beyond the normative range during drug use, then virtually stopped once the drug has left the body. This intensifies not only the "come down" feeling but also the preoccupation anxieties associated with substance abuse as well as the existing emotional, environmental, or social vulnerability which lead to the initial lapse. Sensitization is the component of addiction which compels an individual to continually seek greater quantities of the substance (Robinson & Berridge 2001). Effectively once the brain has been exposed to a chemical which alters neural transmission, the body attempts to return to a homeostatic state. In the presence of narcotics which artificially increase neurotransmitter levels, the brain depending on frequency of initial use, may then begin to self-regulate with the artificially high as the new baseline. Essentially the brain will come to depend on the release of neurotransmitter associated with drug use, making it impossible for normal means of inducing dopamine or serotonin release to trigger its release, simply nothing except the drug is stimulating enough to cross the increased threshold.
In the event of successful intervention or treatment strategy for a chronic substance abuser, the elements of continuing vulnerability and potential for relapse pose extreme and relevant concerns. Studies show that the activation of the mesocorticolimbic dopamine system are likely in both human and animal models to trigger relapse. This activation is particularly likely in the presence of stressful stimulus further perpetuating spiraling distress which lead to the initial addiction (Robinson & Berridge 2001). The case for rehabilitation though is not hopeless, because of this greater understanding of the mechanism through which addiction occurs and perpetuates, a great deal of research has been done in not only developing behavioral and psychological tools to prevent relapse but chemical ones as well.
Chemical treatment of addiction may initially seem counterintuitive, but the brain circuits which have been altered by the substance abuse must be reverted back to their original state or as close to it in order to affect truly successful rehabilitation. Currently the most promising results are coming from drugs which modulate dopamine and serotonin receptors which inhibit the artificial release of those transmitters as a result of cocaine or heroin use. Additionally, there are drugs being developed for addictions to alcohol and nicotine such as naltrexone which actively work on inhibiting the positive physical effects of the drug enhancing only the negative comedown or withdrawal effects (Robinson & Berridge 2001). Though this is a much more aggressive approach to intervention preliminary data has been positive. It may be that the lack of "high" and very severe side effects such as intense nausea, migraine, cold sweat, uncontrollable shaking may be enough to pair the substance with its negative qualities mitigating the spiraling distress cycle.
Though this model is the most cohesive, addressing both the psychological and the chemical mechanisms of addiction, it does not address the social and developmental aspects of addiction. It is in this regard where more traditional intervention and treatment approaches are potentially more effective (Brown & Miller 1993). Certainly there is more quantifiable statistical data regarding the successful use of neuromodulating drugs, however the use of popular 12- step programs and cognitive behavioral therapy are also important in the actual procedure of rehabilitation from addiction. Take for instance the situation discussed previously, an individual suffers a lapse in self-regulation leading to a use event. If that individual is neither exposed to nor has access to drug or alcohol use, that event will likely not result in substance abuse. Though it is naive to imagine that any adolescent, teen, young adult, or indeed adult in the developed world has not been exposed to such behaviors the fact that the initial lapse is inevitably a modeling behavior is a potential avenue for further research.
Within 12- step and cognitive behavioral addiction therapies, one constant is the removal of the individual from the group which initially supported or facilitated their exposure to the substance of their addiction. The rationale behind this excision is that if they are not exposed to it at all even in the event of stress they will not be able to acquire the substance as an immediate ameliorate for their problem. In times of crisis individuals look to their peer group and role models in order to determine the most effective behavioral response in their situation. With the ever increasing popularity and glamorization of substance use, individuals in emotional states not conducive to controlled use become addicted as a result of conforming behaviors (Botvin et al. 1990). Further, if it is perceived by these individuals that their substance use is being positively socially reinforced by those peer groups any therapeutic or interventional strategy will fail because the individual does not desire change.
While it is important to remember that normal use of legal medications and the use of controlled or banned substances are two very different things, one must look also at the veritable drug culture in which most developed countries exist for at least part of the blame in the chronic addiction rates. Any supermarket is full of a vast range of chemical treatments encompassing nearly every aspect of the human experience. If someone is tired there is undoubtedly a pill for that, likewise if someone cannot pay attention there is a pill for that too. To the younger more impressionable youths of today, it seems that for anything about themselves that they dislike there is an existing chemical bypass which will prevent them from having to actually experience any emotions or conditions they do not wish to experience. What then is there to say that using cocaine or heroin or ecstasy is inappropriate whereas birth control, adderall, and caffeine pills are all entirely acceptable? Unless an individual understands the specific function of these various substances on their body chemistry there is nothing to distinguish a bottle of caffeine pills from a gram of cocaine. In these instances it is the responsibility of peer role models to differentiate between those substances which are safe in moderation, and those which pose a real and present threat to the individual's biological and psychological functioning (Botvin et al. 1990).
This brings my subjective experience of the theory and practice of addiction intervention and treatment full circle. As a result of undergraduate study, information regarding addiction cycles and incentive sensitization were tools I was already equipped with when entering the field. However, the complex emotional and behavioral aspects of addiction were relatively new territory. There is no class which can prepare a clinician for the truthful confession of a client that they actually do not want to stop using because the reality of their life without the substance is too painful and ultimately not something they wish to confront and overcome. How does one take such information on board, yet persist in the treatment of someone who does not want to be treated, yet must be in the interests of preventing their imminent death?
Working in any rehabilitation program, an individual is exposed intimately to the entire experience of addiction; the physical side as well as the emotional. Therapeutic counseling techniques as well as more intensive intervention strategies may facilitate an end to the physical dependence on a substance, however there is then still the emotional dependence and the real and negative ramifications of their chronic addiction. Intensive counseling and life coaching are also necessary aspects of the rehabilitation and intervention because without them the likelihood of relapse is exponentially increased.
Throughout the course of my undergraduate career I believed vehemently that addiction was primarily a physical set of responses to chemical stimuli. Simple intervention and a resetting of the neurochemical mechanisms would ultimately result in an individual free of addiction. In retrospect I realize the naivety of such a point-of-view. It is impossible to divorce the emotional from the biological and both of those factors are directly related to the individual's environment.
It would have been extremely useful to have real clinical experience in the course of my undergraduate education. The two primary contemporary models stressing either maladaptive behavior or biological susceptibility are neither wholly adequate in the assessment of addiction. The spiraling distress model is likely the most accurate representation of addiction however even still this more cognitively aware model does not account for the strictly environmental factors which may result in an aware educated individual choosing to essentially self-medicate in the knowledge that eventually that self-medication will lead to death. More interdisciplinary classes are also recommended as it is easy to separate chemistry and psychology to the detriment of a client. A more holistic approach to therapy which…[continue]
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