“Janna Raine became addicted to heroin two decades ago after taking prescription pain pills for a work injury. Last year she was living in a homeless encampment under a Seattle freeway.”

“Nearly one of every 20 adults worldwide is addicted to alcohol… In response to the crisis, the first ever U.S. surgeon general’s report on addiction was released in November 2016. It concluded that 21 million Americans have a drug or alcohol addiction, making the disorder more common than cancer” states a recent National Geographic article (36). Why can’t addicts just stop using drugs? Why do some people become alcoholics and others don’t? Why do some people grow up in poverty and abuse but persevere and become successful while some people are given a multitude of educational, financial, and social opportunities but turn to a life consumed by drugs and alcohol? What exactly makes an addict an addict? The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) now defines addiction by stating, “the essential feature of a substance use disorder (SUD) is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems” (483). It goes on to provide four major groupings of symptoms that define a SUD: impaired control, social impairment, risky use, and pharmacological criteria. What leads up to such a diagnosis is not as easily defined. Addiction is the result of three broad primary risk factors: environmental, psychological, and biological. Like any illness, it is not possible to pinpoint all causes and contributing factors. It may stem from one primary factor or a combination of various factors.

When looking at the first cause, environmental, two main categories exist: family and society. Family consists of people in the home, housing conditions, a person’s upbringing, and how they were nurtured or neglected. Personal experiences such as trauma and abuse often set the stage for an individual to choose alcohol and drugs as a coping mechanism. Society consists of a person’s community, schools, friends, peers, neighborhood, and city. Poor economic surroundings make alcohol and drugs more accessible. How an individual is raised can have an extremely large impact on whether or not they develop some form of addiction. Exposure to alcohol and drugs as a child or adolescent increases chances that an individual will become addicted. When discussing risk factors, the National Institute on Drug Abuse (NIDA) mentions early use, “although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems”(9).

Psychological factors play a significant role in the development of substance use disorders. As mentioned previously, those who have suffered abuse, whether physical, sexual, or emotional, or have endured traumatic experiences, such as exposure to violence, are at a higher risk for addiction. These experiences can lead to an individual developing mental disorders such as depression, anxiety, and post-traumatic stress disorder. Individuals with mental disorders are at a much higher risk of becoming dependent on alcohol and drugs. NIDA states “people with mental disorders are at greater risk of drug abuse and addiction than the general population” (8). Co-occurring disorders, when an individual has a mental disorder and a substance use disorder, are very common and each condition is exacerbated by the other. Mental & emotional difficulties like stress, sadness, and anger that are a normal part of life increase an individual’s likelihood of abusing substances. Common, but severe, stress factors like divorce, financial strain, illnesses, and death of a loved one can lead individuals to increase substance use. This type of coping is referred to as self medicating which is an attempt to relieve emotional and/or physical pain through the abuse of alcohol and drugs. In addition, some individuals use alcohol and drugs to aid in cognitive difficulties by increasing concentration, alertness, and creativity.

“By analyzing brain scans of recovering cocaine addicts, clinical neuroscientist Anna Rose Childress, a professor at the University of Pennsylvania, studies how subliminal drug cues excite the brain’s reward system and contribute to relapse.”

Finally, but considered by some to be most important, biological & physiological factors determine the outcome of addiction. “Scientists estimate that genetic factors account for between 40 and 60 percent of a person’s vulnerability to addiction” NIDA explains. Just like some individuals are naturally at higher risk for illnesses such as diabetes, heart disease, and cancer, some individuals are genetically predisposed to addiction. This is where science of the brain comes in. The DSM-5 states, alcohol and drugs activate “the brain reward system, which is involved in the reinforcement of behaviors and the production of memories” (481). Alcohol and drugs interfere with communication in the brain in various ways. Depending on the drug, it may replicate neurotransmitters, cause release of large amounts of neurotransmitters, or block the depletion of neurotransmitters. The most common of these neurotransmitters is dopamine, which is responsible for regulating movement, emotion, motivation, and feelings of pleasure. When manipulated by drugs it produces euphoric effects, getting “high.” NIDA has studied brain activity before, after, and during drug use and have found “brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control” (7). Changes in brain chemistry and function like this lead to tolerance and dependence on substances. These studies are so important that in September, the cover of National Geographic was dedicated to “The Science of Addiction” including a 25 page story exploring addiction research all over the world (Padua, Italy; Vancouver, Canada; Moscow, Russia; Seoul, South Korea; Paris, France; and numerous cities in the United States). Amongst its cited studies and statistics, it makes this paramount point, “the surgeon general’s report reaffirms what the scientific establishment has been saying for years: Addiction is a disease, not a moral failing. It’s characterized not necessarily by physical dependence or withdrawal but by compulsive repetition of an activity despite life-damaging consequences. This view has led many scientists to accept the once heretical idea that addiction is possible without drugs” (37).

September, 2017 issue of National Geographic

For purposes of this analysis, looking back at Jeffrey Jerome Cohen’s published work, Monster Theory, the primary “monster” cause of addiction is Cohen’s Thesis VI: The Fear of the Monster Is Really a Kind of Desire. It says, “the monster is the abjected fragment that enables the formation of all kinds of identities…” (19). As discussed previously, a major factor in addiction is mental and emotional difficulties. For substance users, engaging with addictive substances makes it possible for them to escape mentally (stress, anxiety, sadness, fear), fulfill emotional desires (euphoria, confidence, relaxation), and allow for certain behaviors that they are unable to accomplish otherwise (social interactions, sexuality).

In summary, addiction is the result of three primary risk factors: environmental, psychological, and biological. Substance use disorders are caused by a few or a multitude of elements in these three broad categories. As time goes on, science is understanding more and more how addictions develop, how they work in the brain, and how they can be effectively treated and prevented.

 

Annotated Bibliography

American Psychiatric Association. “Substance-Related and Addictive Disorders.” Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed., American Psychiatric Publishing, 2013, pp. 481–589.

This book is the basic text for the diagnoses and classification of mental disorders. It is used for reference by clinicians, researchers, and others in the healthcare profession and the social sciences. It is compiled by the APA, the largest psychiatric organization in the world and is used worldwide. It is used in this essay to present a general understanding of addictive disorders from a scientific, evidence based perspective.

Cohen, Jeffrey Jerome. “Monster Culture (Seven Theses).” Monster Theory: Reading Culture, University of Minnesota Press, 1997, pp. 3–25.

The chapter of this book breaks down the literary theory of monsters in seven key points. The text thoroughly explains how and why the concept of monsters in our culture exist.  The author received his PhD in English and American Literature and Language from Harvard University and is a professor of English and the Director of the Medieval and Early Modern Studies Institute at George Washington University. It is used in this essay to explain the chosen monster subject of addiction.

NIDA. “Drugs, Brains, and Behavior: The Science of Addiction.” National Institute on Drug Abuse, 1 Jul. 2014, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction. Accessed 10 Dec. 2017.

This source comes from the United States’ National Institutes of Health. It explains what addiction is, why people abuse drugs, the effects drug abuse can cause, and treatment for drug abuse and addiction. It is used as the main source of information in this essay to explain the causes of alcoholism and drug addiction.

Smith, Fran. “The Addicted Brain.” National Geographic, Sept. 2017, pp. 30–55. Photos: https://www.nationalgeographic.com/magazine/2017/09/the-addicted-brain/ Accessed 10 Dec. 2017.

This article is the feature story for the September 2017  edition of the magazine National Geographic. The cover reads, “The Science of Addiction: How new discoveries about the brain can help us kick the habit.” Its text and photos are used as the primary source in this essay, representing the monster addiction.