"The Etiology of Substance Dependence"

Mike Micoliczyk

We hear, read, watch the television, encounter headlines, know friends, relatives, co-workers, or even relate personally to the subject of substance dependence. Substance abuse & dependency runs rampant in society today. "In 2017, 30.5 million people aged 12 or older used an illicit drug in the past 30 days, which corresponds to 1 in 9 Americans-11.2%. (https://drugwarfacts.org, 2017). Many factors, no single factor alone, will disposition an individual into substance dependence. These factors have an origin or etiology of addiction, which fall under three main theoretical explanations of Biological, Psychological and Sociological classifications.

All the Biological explanations related to drug abuse say that the substances apply “psychoactive effects” by altering brain chemistry, which interferes with the functioning of neurotransmitters. It is supported that most drugs with abuse potential enhance pleasure centers in the brain by releasing one of many specific neurotransmitters like dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulates movement, emotion, cognition, motivation and feelings of pleasure. The overstimulation of this system, which rewards our natural behavior, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior (NIDA, 2008b, p.17). When the brain cells become accustomed to the existence of these neurotransmitters the brain begins to crave them when they are absent. Likewise, when there has been continued or prolonged use of drugs these brain cells can become exhausted and depression or normal pleasure sensors become dulled. This is why it is noted that people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders. (NIDA, Comorbidity: Addiction and Other Mental Illnesses) These individuals often indulge in self-medication to alleviate their symptoms of a existing mental disorder. Some mental disorders may make the brain genetically sensitive to addictive drugs thus the use of drugs by these people would make it very pleasurable and that then can cause or give a higher inclination to a high rate of addiction. Around 1 in 4 individuals with serious mental illness also have a substance use disorder (NIDA 2018 Feb 27)

Another gauge that encompasses the biological factor for substance abuse is the genetics of family members like mom and or dad passing down a inherited trait. Researchers Cloninger, Gohman and Sigvardson conducted extensive research studies that indicate children of alcoholics were likely to grow up to be alcoholics themselves even if they were raised by nonalcoholic adoptive parents from birth. Some studies estimate that drug predisposition due to genetic influences accounts for approximately 38% of all cases and then environmental and social factors account the remaining balance (Uhl et al. 1993)

The Psychological explanation deals with the mental or emotional states that are complicated by social or environmental factors. Some of these explanations can be due to: desire to escape reality or boredom, unable to cope with anxiety, destructive self-indulgence to continually be under the influence, conformity to drug abusing peers, and conscious or unconscious ignorance related to the hurtful effects of drug abuse. There are conflicts & motivations that reside in each of us and our reactions to early events in our lives that may move us to use or abuse drugs. All patterns of drug abuse have a standardized diagnostic category and classification. This diagnostic assistive tool has evolved and been analyzed over the years by professionals in the medical field which brings us to our latest version of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The DSM-5 also assists in distinguishing and separating mental disorders from substance abuse and substance dependency. There is a correlation between personality type and drug use. Although there is a widely varied classification system for personalities nearly all have two common dimensions in common; introversion or extroversion. I myself would be categorized as a extrovert personality. Personality patterns of introversion or extroversion affect how a person reacts to substances. How a person reacts to substances must involve a learning process which links new patterns of behavior with significant reinforcing stimulus to another less significant or neutral stimulus; defined as social learning theory (Bandura 1977) The basic process learning mechanisms can lead a person into drug use is described in the addiction to pleasure theory. It states that “it is biologically normal to continue a pleasure stimulus once started”. Certain areas of the brain, when stimulated produce pleasurable feelings. Psychoactive substances are capable of acting on these sensations. These pleasurable feelings become reinforcers that drive the continued use of these substances” (Gardner 1992, p. 43) I guess this would also be very similar to what drives a sex addict. Then there is the sensation seeking individual who is at highest risk for drug use and addiction because they maintain a constant preoccupation with getting high, seeking new or novel thrills in their experiences and have a relentless desire to pursue physical stimulation or dangerous behaviors. This was a perfect analogy of me with my substance use that progressed into substance dependency. I was always chasing the adrenaline rush or stimulation. If the effects of drug use become personally rewarding or reinforcing through conditioning- where people form expectations and become use to certain behavior patterns, the chances for continued use is greater than stopping.

The final theory of Sociological explanation focuses on factors external to the drug user and how that affects drug use. The adolescent age group is most susceptible to sociological influences. There were just over 2.8 million new users of illicit drugs in 2013, or about 7,800 new users per day. Over half (54.1 percent) were under 18 years of age (NIDA 2015 June 25). Related to this disturbing statistic, some of those outside influences would include the type of family, adopted lifestyles of peer groups, neighborhood and the community in which the drug users reside. Social influences or social pressures that motivate an individual to use drugs fall into: social learning, role of significant others in socialization, labeling, and subculture. Conventional learning takes place through imitation, trail & error, improvisation, rewarded behavior and cognitive mental associations and processes. Whereas the social learning theory relates to how drug use and abuse are learned through interaction with other drug users. There are two types of groups that influence the drug user. The first group share a high amount of intimacy and its members are emotionally bonded, this is the primary group. Such members of this group would include family members, or long-term friends. The second group shares segmented relationships with interaction based on prescribed role patterns. The secondary group would include a neighbor down the block, co-workers or maybe the cashier at the local mimi mart. In social learning of drug use the interaction involves learning specific motives, techniques, and appropriate meanings that are commonly attached to a particular type of drug. Continuing the behavior of drug use involves a sequence of 1. Identifying who & where the drug can be purchased, 2. Maintaining continued contact with the drug dealers, 3. Maintaining the secrecy of use from authority figures and casual non-drug using acquaintances, 4. Assuring yourself that the drug use is still pleasurable, 5. Using with more frequency, 6. Replacing non-drug using friends with drug using friends. Not only are adolescents influenced by external or Sociological factors that bring about drug use, but adults and elderly are taught the motivation for using a particular drug through drug advertising, medical experts, and actors or actresses portraying physicians or nurses. The readers, listeners, and viewers of such advertising are bombarded with necessary motives, preferred techniques, and appropriate attitudes for consuming over the counter drugs.

My journey of substance use was initially fun, exciting, stimulating & glorifying. I look back now as a recovering addict and alcoholic and know with certain belief that my path of substance use disorder started with my first drink. I was somehow wired or biologically dispositioned to fall in love with the effects of alcohol. My parents are not alcoholics, but my grandparents, I strongly know now, abused alcohol. According to the substance use disorder defined by DSM-5 I can’t diagnose them accurately as having a disorder. Then I also take into consideration the psychological factors present. I learned patterns of behavior from the attitudes of others, society and my peers. I was a strong sensation-seeking individual. I also found my substance abuse to be intimate and worthwhile to continue to pursue without regard for my overall wellbeing. Sociological factors definitely had a role in my disease. I had conventional and social learning playing a role in my progression. Learning the effects of drugs and alcohol was rewarding and became very anticipatory to me. There was never one theory that acted alone to bring me into the disease of alcoholism or drug addiction. Each of the three theories seemed to compliment and concurrently support and interact with each other to strengthen the hold on me. I am fortunate that I had the resources, money, support and services available to use; when I became willing. Others will travel with this disease to ultimately their demise. I love William C. Moyers quote “addiction is not a excuse but a explanation” We as a people cannot continue to treat the problem with short sighted solutions. Change must come in legislation, judicial systems, schools, police departments, correction departments, communities, society and most importantly, the family structure.

References

Bandura, A. Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall, 1977

Gardner, E.L. “Brain Reward Mechanisms” In Substance Abuse: A Comprehensive Textbook, 2^nd ed., edited by J.H. Lowinson, P. Ruiz, R.B. Millman, and J.G. Langrod, 60-69. Baltimore: Lippincott Williams & Wilkins, 1992

National Institute on Drug Abuse (NIDA). Drugs, Brains, and Behavior: The Science of Addiction. Bethesda MD: National Institute of Health, US Department of Health and Human Services, 2008b.

National Institute on Drug Abuse (NIDA). Comorbidity: Addiction and Other Mental Illnesses. Research Report Series. Bethesda, MD: US Department of Health and Human Services, 2008a.

NIDA. (2015, June 25). Nationwide Trends. Retrieved from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends on 2018, September 24

Uhl, G., K. Blum, E. Noble, and S. Smith. “Substance Abuse Vulnerability and D-2 Receptor Genes.” Trends in Neurological Sciences 16 (1993): 83-88

Marijuana Reflection Paper

Mike Micoliczyk

Marijuana is a hemp plant that is green, brown or shades of grey mixed of dried, stems, seeds, shredded leaves and flowers. Two main strains exist; Cannabis sativa & Cannabis indica. Cannabis sativa comes from the countries of Colombia,Mexico, Jamaica, South Africa, Thailand & Southeast Asia. It induces energetic uplifting feelings. The Cannabis indica originates from Afghanistan, Pakistan, India, Turkey, Morocco. Kashmir & Tibet. Cannabis indica is usually a shorter plant with wider leaves than the Cannabis sativa. Lots of strains are available with different mixes and combinations of the two with different percentages of mix. Marijuana’s woody stems yield a fiber that can be made into cloth or rope-this part of the plant is known as the “hemp”. George Washington grew marijuana plants at Mount Vernon for medicine & rope making (Hanson, Venturelli, & Fleckenstein, 2015)Marijuana’s medicinal properties along with its practical applications for paper, rope and clothes, and its involvement in Indian religious ceremonies give this plant a very rich history. Even as far back as 2737 BC the Chinese Emperor Shen Nung prescribed it to treat gout, gas pains, malaria and absentmindedness. Currently marijuana is the most lucrative crop to farm at just a little over $300 billion annually (Misulonas, 2017)

Marijuana is the most widely used psychoactive illicit drug in the world. In 2017, ages 12 and older 122,943,000 respondents have reported using Marijuana in their lifetime (Statista, 2018). There are a reported over 400 chemicals in the cannabis plant. THC (Tetrahydrocannabinol) is the main primary mind-altering psychoactive element in cannabis. Another active element is CBD (Cannabidiol), which is the yin to THC’s yang, in that it acts as a antagonist for shutting off the chemical reactions the psychoactive drug creates. CBD can temper your high, but studies show that CBD can interact with process related to pain, inflammation, anxiety, stress and other symptoms (Namaste, 2018). THC has its highest concentration in the flowering tops and upper leaves of the female plant. Much lower THC levels are found in the stalks and seeds of the cannabis plants. In cultivated marijuana crops male plants are removed so that they cannot pollinate the female plants. This lack of pollination makes the potency of the female plants substantially greater. Sinsemilla-meaning “without seeds” in Spanish, is one of the most potent types. More efficient agriculture, new methods of harvesting & processing has netted variations of types like “hydro” (grown in water) “Sensi Star” and “MK Ultra”. In 1978 the national average of THC content was 1.37%, In 2008-8.49%(ProCon 2012b). Today you can easily fine potencies rising up to the 20% and greater range. Hashish; pronounced hasheesh, is a type of marijuana that composes of the sticky resin from the female flowers that contains the purest form of resin which reaches THC national average potency greater than 20%. People use marijuana by smoking joints (hand rolled cigarettes), with pipes, bongs (water pipes) and now more recently vaping. Users can mix marijuana in food (edibles), such as brownies, cookies, or candy, or brew it as a tea (NIDA, 2018). A new popular method of use is “dabbing”. This is smoking the THC rich resins extracted from the plant in the form of hash oil or honey oil, wax or budder-a soft solid like lip balm & shatter-a hard solid.

When a person smokes marijuana, THC quickly passes from the lungs into the bloodstream. The blood carries the chemical to the brain and other organs throughout the body. THC stimulates the cannabinoid receptors (CBR’s) artificially, disrupting function of the natural, or endogenous cannabinoids. An overstimulation of these receptors in key brain areas produces the marijuana high (Hanson, Venturelli, & Fleckenstein, 2015). As THC enters the brain it causes the user to feel euphoric or high. This acts on the brains reward system in similar fashion as most drugs of abuse do. It stimulates brain cells to release the chemical dopamine. It’s hard to learn while high because THC affects the nerve cells in the part of the brain where memories are formed. This makes it hard for the user to recall recent events. The exact effects of marijuana consumption vary based on: expectations of user, the social setting, route of administration (smoking or eating), previous experiences and potency of THC consumed. Some of these effects of use include: a sense of euphoria, an altered sense of time, altered senses, a sense of wellbeing, relaxation, changes in mood, impaired memory, difficulty in problem solving, red eyes, dry mouth, increased appetite and decreased driving skills. Hallucinations, psychosis & delusions can be experienced if taken in high doses. Responses to marijuana are varied but, contain elements of all three major drug groups of abuse. Marijuana can cause euphoria and paranoia-like stimulants, hallucinations-like psychedelics and, drowsiness and sedation-like depressants.

Because marijuana smoke is inhaled more deeply than tobacco smoke, even more tar residues may be retained with its use (Hanson, Venturelli, & Fleckenstein, 2015). Heavy users encounter respiratory problems like laryngitis, bronchitis, asthma-like conditions, cough, dry throat and, hoarseness. Some of the more specific effects of smoking marijuana cause vasodilation-enlarged blood vessels. Vasodilation is responsible for the eye redness. People with cardiovascular problems seem to be at an increased risk. Because there are many unanswered questions about its effects on the cardiovascular system The National Academy of Sciences suggests users with cardiovascular disease avoid use. In relation to its effects on sexual performance and reproduction marijuana may act as an aphrodisiac by decreasing CNS (central nervous system) inhibitions but, this is dose related. Marijuana affects the sympathetic nervous system by increasing vasodilation in the genitals and delaying ejaculation. High doses over time may lead to libido depression, impotence and low sperm counts. Heavy marijuana use with women has been associated with inhibiting ovulation. Less affirmative research is unavailable on the effects of cannabis on female libido, sexual response and fertile menstrual cycles. Women who smoke marijuana during pregnancy also often us other drugs-such as alcohol, tobacco and cocaine-that are known to have adverse effects on the developing fetus. Because multiple drugs are used, it is difficult to isolate the specific effects of marijuana during pregnancy (Hanson, Venturelli, & Fleckenstein, 2015)

Tolerance to cannabis builds rapidly, thus the drug effect becomes less intense with repeated use. Meaning that higher doses must be given to obtain the same intensity that occurred initially with smaller doses. Frequent high doses of THC can produce mild physical dependence. Not all subjects experience mild forms of withdrawal such as irritability, sleep disturbances, weight loss, loss of appetite, sweating and stomach upsets when stopping abrupt usage. Psychological dependence involves an attachment to the subjective euphoric effects, enjoying the presence and social reinforcement of peers, feeling no pain and remaining cognitively unfocused. Treatment interventions are necessary to get the subject into a drug-free state and reunited with non-drug using peer groups.

Addressing the notation that marijuana is a “gateway” drug can be dispelled by considering the age at which opportunities to use marijuana were first introduced and also the willingness, mindset or predisposition to use drugs are better predictors of progression from less addictive to more addictive drugs like heroin, cocaine, alcohol or opiates. A great example quotes “There are only a few thousand opiate addicts in Great Britain, yet there are millions who have tried cannabis” (Gossop 1987, p.9)

I believe we are moving towards legalization of marijuana. I support the legalized medical uses. Marijuana has a 5000-year medical history that came to an abrupt end in the United States by the passage of the Marijuana Tax Act of 1937 (Hanson, Venturelli, and Fleckenstein, 2015). Currently there are 27 legal medical marijuana states with a registered 2,099,480 patients that use marijuana. (Portal, 2018). About 85% of Americans support legalizing medical marijuana (Portal, 2018) Marijuana is very useful in treating Dravet syndrome (a form of childhood epilepsy) multiple sclerosis, Crohn’s disease, PTSD, glaucoma, fibromyalgia, endometriosis, interstitial cystitis and, Parkinson’s disease. In addition, it is great for generating appetite for cancer patients going through chemotherapy and radiation. Assists in easing wasting syndrome associated with HIV. Helpful with irritable bowel syndrome, PMS, menopause, epilepsy, nausea, weight loss, depression, migraines and chronic headaches or inflammation along with significantly alleviating neuropathic pain. In South Africa, native women smoke cannabis to dull the pain of childbirth (Hamid 1998; Solomon 1966) Marijuana isn’t strong enough to treat severe pain like a broken bone or post-surgical pain but, is useful with chronic pain that affects millions of Americans and is much safer and less addictive to use than opiates. Besides, some recent studies show that marijuana is far less sedating and lets patients resume previous activities without feeling disengaged and out of it. One other option without the abuse potential that is legally approved would be Marinol. Beyond Marinol, marijuana can help patients where few other options exist at times. There is no known overdose death due to use of marijuana (Hanson, Venturelli, & Fleckenstein, 2015). In the states where marijuana is medically legal opioid overdose death rates are almost 25% lower than in states with no legal access to marijuana. There is going to be a continuous process of advancement & supported studies for the upside of marijuana medicinal use and recreational use in moderation. I see great upside advances in medicine for cannabis. Despite all the prevention efforts to date, marijuana remains the most popular illicit drug, topped only by alcohol and tobacco, which are licit drugs.

References

Hamid, A. G. (1998). Drugs in America: Sociology, Economics, and Politics. Aspen.

Hanson, G. R., Venturelli, P. J., & Fleckenstein, A. E. (2015). Drugs & Society. Burlington, Massachusetts: Jones and Bartlett Learning.

Hanson, V. F. (2015). Drugs & Society. Burlington, Massachusetts: Jones and Bartlett Learning.

Misulonas, J. (2017). Is Cannabis the Worlds largest Cash Crop? Civilized. Retrieved from https://www.civilized.life/articles/cannabis-worlds-biggest-cash-crop/

Namaste. (2018). What is cannabis made of? A list of chemicals in marijuana. Namaste.com. Retrieved from https://www.namaste.com/blogs/news/what-is-cannabis

NIDA. (2018, July). National Institutes of Health. Retrieved from National Institute on Drug Abuse: https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#ayahuasca

Portal, T. S. (2018). Number of legal medical marijuana patients in the U.S. as of May 2018, by state. Retrieved from https://www.statista.com/statistics/585154/us-legal-medical-marijuana-patients-state/

ProCon.org. (2012, February 7). Is Marijuana Significantly More Potent Now Than in the Past? Retrieved from http://medicalmarijuana.procon.org/view.answers.php?questionID=000336

Solomon, D. e. (1966). The Marihuana Papers. New York: New American Library.

Statista. (2018). Number of people in the U.S. who used marijuana in their lifetime. The Statistics Portal. Retrieved from https://www.statista.com/statistics/611668/marijuana-use-during-lifetime-in-the-us/