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Substance abuse and addiction exert considerable cost pressures on the contemporary society. Millions of dollars are spent on treating numerous health complications of substance abuse as well as criminalizing and punishing drug abuse behaviors. At present, the United States has a well-developed system for criminalizing and punishing drug abuse and addiction, while the infrastructure to treat substance abuse as a medical condition is virtually absent. The society perceives addiction as a social rather than a medical problem, although the body of evidence supporting the disease view of substance abuse is quite compelling (Dackis & O’Brien, 2005). Substance abuse and addiction is a brain condition that incorporates behavioral and social elements and calls for the development of complex pharmacological approaches for the benefit of public health.

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Evidence that addiction is a treatable brain condition has been abundantly documented. However, at first, a widespread confusion between the terms “dependence” and “addiction” needs to be cleared up. According to Dackis and O’Brien (2005), dependence entails the process of adaptation that occurs in cells and systems in response to excessive drug use. Such adaptation eventually results in the development of physical and emotional withdrawal symptoms (Dackis & O’Brien, 2005). By contrast, addiction is closely associated with compulsive symptoms (Dackis & O’Brien, 2005). Many drugs and substances can lead to dependence without producing addiction (Dackis & O’Brien, 2005). These conceptual differences indicate that substance abuse and addiction should be considered primarily in neurobiological terms.

Substance abuse is a treatable brain disease that calls for the need to develop and use pharmacological rather than criminal justice approaches. Although different drugs produce different impacts on humans, addiction always follows the same pathway within the human brain (Leshner, 1997). “This pathway, the mesolimbic reward system, extends from the ventral tegmentum to the nucleus accumbens, with projections to areas such as the limbic system and the orbitofrontal cortex” (Leshner, 1997, p. 46). When activated, this system prevents drug users from taking another dose (Leshner, 1997). The use and abuse of drugs modifies the patterns of this system. The longer is the period of substance abuse, the more pervasive such changes become. Even after the individual stops using the drug, these changes continue to persist (Leshner, 1997).

The brain cycle of addiction is quite straightforward. People use an addictive drug to improve their mood, but they may not be able to stop even in the presence of serious negative health and behavioral consequences (Hyman & Malenka, 2001). When used for the first time, the drug affects brain pleasure centers, which create a sense of euphoria (Dackis & O’Brien, 2005). Addictive drugs usually increase the levels of dopamine and affect DA receptors (Dackis & O’Brien, 2005). The latter are the natural pleasure centers located within the human brain. Once the individual experiences euphoria, he/she naturally wants to use the addictive drug again. Repeated drug use leads to the development of dependence and, later addiction. Individuals with a genetic predisposition for drug addiction tend to experience greater pleasure than the individuals without such genetic traits (Dackis & O’Brien, 2005). For these individuals, the use of drugs is associated with an exaggerated endorphin response (Dackis & O’Brien, 2005). With time, drugs disrupt the regular reward mechanisms within the human brain, leading to hedonic dysregulation, craving, and withdrawal symptoms (Dackis & O’Brien, 2005). In the meantime, drug use and abuse leads to the development of specific neuroadaptations, including DA hypoactivity (Dackis & O’Brien, 2005). In severely addicted individuals, survival-related behaviors etched in frontal and middle brain come to dominate rationality and reasonable decision making (Dackis & O’Brien, 2005). In addition, drug abuse disrupts the normal brain circuits that are responsible for various bodily functions such as blood pressure (Dackis & O’Brien, 2005).

Certainly, drug addiction is too complex to be regarded as a purely physiological process. Leshner (1997) is right declaring that no brain disease can be considered as simply biological. All brain diseases necessarily involve social and behavioral complexities (Leshner, 1997). This is probably why it was easier to treat the heroin addicts who came from Vietnam than those who had developed their addiction by using the drugs bought in the American streets (Leshner, 1997). In other words, the contextual conditions play a serious role in the development of drug addiction but, still, drug abuse remains a biological relapsing disorder, which should be treated appropriately.

The fact that substance abuse is a physiological condition has profound implications for public health. Traditional approaches to substance abuse need to be changed. The most difficult will be changing the public beliefs about substance abuse as a psychological, behavioral, and social disorder. Unfortunately, without accepting substance abuse as a neurobiological disorder, the society will have few chances to cope with its complications. Due to the misconceptions surrounding the problem of substance abuse, the healthcare system lacks resources that could be invested in the development of effective pharmacological treatments. Many treatment strategies have never been put into clinical practice (Dackis & O’Brien, 2005). Individuals who experience addiction problems have the right to obtain relevant medical treatment, because addiction is a relapsing brain disease that should be treated adequately.


In conclusion, substance use and abuse is a brain disease that calls for the use of relevant pharmacological treatments. Criminalization of drug abuse will never do any good to the developed society. Drugs disrupt normal brain circuits, leading to the development of dependence and, later, addiction. The latter is associated with compulsive symptoms. Unfortunately, a common public misconception is based on the opinion that drug abuse is a problem of behavior and unfavorable social conditions. Due to the confusion surrounding the issue of substance dependence, the system does not have enough resources to invest in the development of an effective treatment infrastructure. In reality, individuals who experience problems with substance use have the right to obtain relevant pharmacological treatment.

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