Ayden Wilson

Mr. Carlyle

English 4

16 March, 2023

Is Drug Addiction a Brain Disease?

Drug addiction is a brain disease that has plagued the world’s population since the

beginning of time. Choosing this topic came naturally to me. I've always been in discussions

with many people in my life debating if drug addiction is a disease or not. Or is saying it's a

disease to help people come out and admit they are struggling with drug addiction. Addiction

disrupts regions of the brain that are responsible for reward, motivation, learning, judgment, and

memory. They say like diabetes and cancer, addiction is caused by a combination of behavioral

and psychological compartments in your brain. Addictive substances cause your brain to release

high levels of the same chemicals that associate with your reward and natural pleasure. It's

scientifically proven that over time the brain changes its system of reward with this drug.

Medications affect the neuron's ability to send, receive, and process messages via

neurotransmitters. Because some drugs, like heroin and marijuana, have molecular structures that

are similar to those of natural neurotransmitters. In the body, the drugs can activate the neurons.

This enables the drugs to bind to and stimulate the neurons. Even though these drugs mimic the

brain's natural chemicals, they don't activate neurons in the same manner that a natural

neurotransmitter does, which results in the network sending incorrect messages. It is proven that

“the prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert
self-control over impulses. This is also the last part of the brain to mature, making teens most

vulnerable.” This shifts the balance between the circuit of the basal ganglia which makes a

person with a substance use disorder seek drugs compulsively with no control. The orbitofrontal

cortex and the anterior cingulate gyrus are shown to be the most affected part of the brain by

drug use. They are activated during cravings and binging. Then they are deactivated during

withdrawal. This part of your brain is involved in updating and tracking. This could help

showcase that when they withdraw from drug use the brain goes into shock and needs this drug

because it is craving it and you have very little control over it. It's shown that the frontal cortex is

regulated in drug addiction. “We propose that the behaviors and associated motivational states

that are at the core of drug addiction are distinctly the processes of loss of self-directed/willed

behaviors to automatic sensory-driven formulas and attribution of primary salience to the drug of

abuse at the expense of other available rewarding stimuli.” This contributes to you relapsing,

craving, and withdrawing which is a behavioral compulsion and is what your brain goes through

and something you can’t physically change. Evidence supporting this role of the frontal cortex in

craving is shown in a study in which “we have demonstrated higher regional brain glucose

metabolism, including in the orbitofrontal cortex and striatum, in cocaine abusers tested during

early withdrawal (<1 week since last cocaine use) than in normal comparison subjects. These

higher levels were proportional to the craving intensity, such that the higher the metabolism, the

greater the drug craving. A central role for craving in orbitofrontal cortex activation has also

been suggested by the results of a study from our laboratory in which methylphenidate(a

synthetic drug that stimulates the sympathetic and central nervous systems, used chiefly in the

treatment of attention deficit disorder.) increased orbitofrontal cortex and striatal metabolism

only in the subjects in whom it enhanced craving”

characterized by compulsive drug seeking and use despite adverse consequences.” Genetic,

psychosocial, and environmental factors influence the development of the disease. Also,

“substance dependence is defined by three or more of the following occurring at any time in the

same 12-month period. A need for a lot of increased amounts of the substance to achieve desired

[effects, a markedly diminished effect with continued use of the same amount of the substance

and the characteristic withdrawal syndrome for the substance.” What affects you that makes it a

disease is your dopamine synthesis. Which influences personality in addicted patients. Some

speculate that these circuits evolved in the brain for purposes of social attachment and are

activated in addiction. It makes sense that the strong bond that can develop between sober

addicts plays a crucial part in addiction rehabilitation. On the other hand, conditions like

borderline personality disorder that impair these attachment and affiliative systems can make

treating addiction extremely difficult. The reward factor is your brain is the term neuroscience

uses to describe experiences that give you pleasure or relief from some discomfort. Neuroscience

has come a long way in identifying the areas of the brain involved in reward and the

neurochemistry of our feel-good chemicals that create reward responses. Neurotransmitters, such

as dopamine, facilitate communication to the reward center.“The addict’s initial motivation is to

feel pleasure. Eventually, the reward pathway shifts its sensitivities to the substance or behavior

instead of the neurotransmitters. In other words, the brain begins to depend on outside chemicals

for reward.” Now your reward circuitry is not from essential behaviors it is now from drugs that

underlie addiction as a reward which could be caused as a disease over time your brain now

depends on this drug to make you go throughout the day. The initial use of the drug is

“Exaggerated reward Memory of experience stored”, then Continued use is “Depletion of

experience to Further depletion Decreased motivation”, Maintenance use is “Relative withdrawal

(psychological and/or physical) impaired decision making” and Desperation use “Running on

empty.”

How Genetics and Epigenetics play a role in the disease of drug addiction. How do some

people become addicted while others don’t? First, let me give you the definition of genetics.

Genetics is the study of genes. “Our genes carry information that gets passed from one

generation to the next. For example, genes are why one child has brown hair like their mother,

while their sibling has blonde hair like their father.” An example of genetics playing a role in

addiction is cannabis use disorder. It is estimated that 30% of marijuana users have a cannabis

use disorder. The risk of it is having a strong genetic component. There was a study about which

genes were at risk for cannabis use. They studied 2,387 cases and 48,985 controls and replicated

their findings in another large group. “They had identified a genetic locus on chromosome 8 that

controls the levels of the gene “CHRNA2'' which is the gene that provides instructions for

making one part of a larger protein called a neuronal nicotinic acetylcholine receptor (nAChR).”

Low levels of expression of the gene CHRNA2 in the cerebellum are found to be associated with

cannabis use disorder. Also, it was discovered that genetic traits linked to educational attainment

were protective against the condition. The findings give a possible target for future preventative

measures, treatments, and pharmaceuticals by indicating that underexpression of CHRNA2 in the

cerebellum (and possibly other brain regions) is associated with cannabis use disorders.

Why is it we call drug addiction a brain disorder? In Dr. Nora Volkow’s article, she began to

track and document unique pictures of the brain, her colleagues and she realized that the images

provided the first evidence in humans that there were changes in the brain of addicted individuals
that could help explain the compulsive nature of drug taking. When they researched, the changes

were so stark that in some cases it was also possible to identify which person suffered from

addiction and who didn’t by just looking at their brain images of them. Americans no longer

view addiction as a moral failing. Some claim that viewing addiction this way minimizes its

important environmental causes and social causes, and recognizes the complex interactions

between biology, behavior, and environment. This article helps depict the tracking and

documentation of brains that provide evidence that changes in the brain are caused by addiction

and can be easily seen. Sadly this article does not give much detail in percentages of if every

time they look at the brain they can fully tell this person has been addicted to drugs before or if

they were ever wrong once. Gene variants that confer resilience or increase the risk of addiction

are being studied, as are early-life environmental factors that influence that risk. The

development of precisely tailored prevention and treatment measures will be made possible by

this knowledge, just as it is enabling the broader field of personalized medicine. A considerable

portion of those who do become addicted eventually recovers without receiving medical care, as

some detractors also note properly. A person may replace drug use with other priorities over the

course of years or decades, or it may happen naturally as they "age out" of a disorder that started

when they were younger. They still don't understand all the factors that make some people

recover better than others or what neurobiological mechanisms that support the recovery. “More

than 174 people die every day from drug overdoses.” To say that because some people recover

from addiction unaided we should not think of it as a disease or disorder would be medically

irresponsible.

An article from the University of Indiana Health Is addiction a disease, they talk about if

addiction is a disease or if it is a matter of choice. There was a 19-year-old boy who was once a
laughing family prankster who had a full-ride college scholarship right after high school which

he lost to drugs, his mother doesn’t feel like this is the son she has raised. That “Severe substance

use disorder happens when a person has an intense focus on using a certain substance such as

alcohol, tobacco, or illicit drugs, to the point where the person's ability to function in day-to-day

life becomes challenging.” People keep using the substance even when they know it is causing or

will cause problems. Which hurts your day-to-day life, showing up as struggles at work or in

school, money problems, and conflicts in relationships. Addiction changed the way the brain

works, rewiring its structure. Drugs hack into your brain’s communication system and interfere

with how nerve cells send, receive, and process information. This is useful for my question on if

drug addiction is a disease because drugs hack your brain's communication system and rewrites

nerve cells which could be a cause of being addicted and could be why addiction is a disease.

That the brain reward system activates now with that certain addiction which is a certain drug.

Which normally would be eating a piece of food you enjoy or going out and partying which is a

reward that comes in the chemical dopamine. Drugs trigger the release of dopamine.

“Genetically if addiction runs in the family you have up to a 60% greater chance of becoming

addicted too.” Genes account for 60 percent of the tendency to become addicted and 54 percent

of one's ability to quit. All addictive drugs act on the brain by activating certain reward

pathways. These pathways are necessary to reward behaviors that contribute to our survival.

Also, parents-wise, if they were ever addicted to anything during their life like a substance or

exhibited a behavioral addiction their children are more likely to exhibit addictive personalities

themselves. Which is a genetic predisposition. genetic predisposition is an “increased chance or

likelihood of developing a particular disease based on the presence of one or more genetic

variants and/or a family history suggestive of an increased risk of the disease. Having a genetic
predisposition does not mean an individual will develop the disease.” It is just a possibility

because of the increased risk of the disease because of your family history.

My interviewee is Jorbona Santiago. She believes that drug addiction is a brain disease,

and she has 22 years of sobriety. She has dealt with addiction for 22 years actively. She has also

worked for years in sober living homes helping others recover. She believes it is a brain disease

because there was no right reason for the things that she had let go, of and the things that she let

suffer because of her addiction. The most important thing to her was filling that addiction. But

Jorbona honestly thinks that some people might be turned off by being told they have a brain

disease because of drugs. She thinks that when people that are addicted learn that it's a disease,

suddenly things start making sense. Like, “wow I'm really not this jerk who has just let

everything go to waste to fill this addiction” when you say brain addiction. Nine times out of ten

a person with addiction is dual diagnosed with depression or some kind of other things. It's

usually triggered by some kind of trauma that they experienced, usually in younger life but

sometimes up to a year ago. Jorbona thinks that some people get turned off by the term “brain

disease”, it's suddenly easier for them to wrap their heads around that. “That's been my

experience.” Jorbona thinks that you don't get addicted straight away or get a “brain disease”

from just trying it a few times, that it's circumstantial in their experience. She doesn't think u try

it once or twice and then you're addicted. People mostly try it first because of a social meet like

our youth. She thinks the first time people try it to get away from their trauma they get addicted.

She feels that when you use it to escape or get away from your problems it becomes an issue.

Jorbona thinks there are 3 types of drug addicts when it comes to quitting or stopping drugs. One

uses it for social stuff, one uses it but can quit if their health is at risk, and one “which I was”

who no matter what has to get their next fix. Jorbona thinks that medical intervention can help
but in all of her experiences, you have to hit bottom which can be different for everyone. “I think

that medical intervention can help many but not necessarily everybody.”

They talk about how many people don’t understand why or how other people become

addicted to drugs. That drug addiction is a disease, and quitting usually takes more than a strong

will, “They may mistakenly think that those who use drugs lack moral principles or willpower

and that they could stop their drug use simply by choosing to. In reality, drug addiction is a

complex disease, and quitting usually takes more than good intentions or a strong will. Drugs

change the brain in ways that make quitting hard, even for those who want to. Fortunately,

researchers know more than ever about how drugs affect the brain and have found treatments that

can help people recover from drug addiction and lead productive lives.” Addiction is a chronic

disease, the initial decision to take drugs is voluntary for most people, but repeating drug use can

lead to the brain changes that challenge a person's addiction and self-control with their ability to

resist taking drugs. Drugs affect the brain's “reward circuit”, causing euphoria and flooding the

messenger dopamine. Which makes people repeat behaviors. As the person continues to use

drugs, the brain adapts by reducing the majority of cells in the reward circuit to respond to the

drug. This reduces the high which is called a tolerance. This may have the person take more of

the drug to try and achieve the same high. Long-term use of a drug causes the brain's chemical

systems and circuits to change over time affecting the functions of, learning, judgment, stress,

memory, behavior, and decision-making. This is useful for people to get a deeper understanding

of how a drug affects the brain, changing how it works which could make it a disease. To give

you an idea of if this is a disease compared to addiction over time. The limitations would be not

having proof that it actually affects the brain or if a drug automatically changes the brain. When

talking to or about people with substance use disorder(SUD), we should make sure not to use
words that aren’t stigmatizing. Discrimination against a certain group of people, a location, or a

country is known as stigmatizing or stigma. The stigma around those who struggle with

substance use disorders might include false or unsubstantiated assumptions that they are

dangerous, unable to manage their treatment, or responsible for their disease.

Also “Another view on substance addiction is a brain disease, although widely accepted in the

neuroscience community, has become subject to acerbic criticism in recent years.” is that

denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing

access to healthcare and treatment, the consequences of which are catastrophic. They respond to

the objections and offer a modern version of the idea of addiction as a brain disorder.

Additionally, offer justifications for this position. Most crucially, they contend that the biological

basis for both addiction and the ability to modify behavior is the brain, calling for a more

intensive neuroscientific investigation of recovery. When we acknowledge these substances use

brain disorders we can positively influence public norms that there are these disorders as brain

diseases produce positive results on people's attitudes and behavior toward people with substance

disorders. Have them more open up to admitting they struggle with substance abuse over time.

We transmit that drug addiction is a brain disease, into everyone's living room, so you can build

empathy and get people to understand this as a health condition. Be able to explain it at school or

even at work to be able to talk about this as a health condition. When talking to or about people

with a substance use disorder we should use words that aren’t stigmatizing. Like “using

person-first language, which focuses on the person—not their illness. It focuses on removing

words that define a person by their condition or have negative meanings. For example, “person

with a substance use disorder” Or "have a brain disease has a neutral tone and separates the

person from his or her disorder” Also we can “Let people choose how they are described. If
you’re not sure what words to use, just ask! Check-in with friends or loved ones about how they

refer to themselves and how they would like others to refer to them.”

Work cited
- "Drugs, Brains, and Behavior: The Science of Addiction." National Institute on

Drug Abuse, Advancing Addiction Science, July 2020, nida.nih.gov/

publications/drugs-brains-behavior-science-addiction/drugs-brain. Accessed

19 Mar. 2023.

- Psychiatry, Am J. "Drug Addiction and Its Underlying Neurobiological Basis:

Neuroimaging Evidence for the Involvement of the Frontal Cortex."

National Library of Medicine, National Center for Biotechnology

Information, 13 Sept. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1201373/.

Accessed 19 Mar. 2023.

- Angres, Kathy Bettinardi. "Understanding the Disease of Addiction." Ncsbn,

www.ncsbn.org/public-files/Understanding_the_Disease_of_Addiction.pdf.

Accessed 11 Mar. 2023.

- "Genetics: The Blueprint of Health and Disease." National Institute on Drug

Abuse, Advancing Addiction Science, Aug. 2019, nida.nih.gov/

publications/drugfacts/genetics-epigenetics-addiction. Accessed 19 Mar.

2023.

- Volkow, Dr. Nora. "What Does It Mean When We Call Addiction a Brain

Disorder?" National Institute on Drug Abuse, 23 Mar. 2018,

nida.nih.gov/about-nida/

noras-blog/2018/03/what-does-it-mean-when-we-call-addiction-brain-disorder.

Accessed 20 Feb. 2023.

- - Indiana University Health. "Is Addiction Really a Disease?" Indiana University

Health, 14 Nov. 2022, iuhealth.org/thrive/is-addiction-really-a-disease. Accessed

- "National Cancer Institute." Genetic Predisposition, NIH, www.cancer.gov/

publications/dictionaries/genetics-dictionary/def/genetic-predisposition.

Accessed 19 Mar. 2023.

- "Understanding Drug Use and Addiction DrugFacts." National Institute on Drug

Abuse, National Institutes of Health, 2018, nida.nih.gov/publications/

drugfacts/understanding-drug-use-addiction. Accessed 21 Mar. 2023.

- "Words Matter: Preferred Language for Talking about Addiction." National

Institute on Drug Abuse, National Institutes of Health, 23 June 2021,

nida.nih.gov/research-topics/addiction-science/

words-matter-preferred-language-talking-about-addiction. Accessed 21 Mar.

2023.

- Heilig, Markus, et al. "Addiction as a Brain Disease Revised: Why It Still

Matters, and the Need for Consilience." Neuropsychopharmacology, 22 Feb.

2021, www.nature.com/articles/s41386-020-00950-y. Accessed 18 Feb. 2023.

- Jorbona, Santiago, Interviewee “Is addiction a brain disease” Mar 22, 2023 ,

Mar 24, 2023 .