Counselling psychologist Niamh Delmar on why we need to understand the neuroscience of drug addiction in order to help those in need.

Drug addiction, referred to as substance abuse disorder, negatively affects the individual's brain and behaviour. Once addicted, the user continues to use the drug despite adverse risks.

Symptoms and behaviours include the need to use the drug regularly, intense urges to use, needing more for the same effect, spending money, engaging in other risky behaviours, failing to stop using and experiencing withdrawal when attempting to stop taking the drug.

There are a wide range of drugs that people get addicted to including prescription drugs, stimulants, club drugs, hallucinogenics and opioids.

Drugs are misused to relax, switch off, sedate, forget, for a high, to boost energy or to enhance performance. Polysubstance use refers to the use of various drugs at the same time and can involve illicit and legal drugs.

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The neuroscience of addiction

Pleasure–seeking activities infiltrate our daily existence, such as shopping for new clothes, going on holidays, going to the gym or enjoying a meal out. For some, this pleasure-seeking gets out of control and crosses over to addiction to porn, alcohol, food, drugs and other self-harming activities.

Understanding the neuroscience of addiction is an essential part of responding to and treating those addicted. The ventral tegmental in the brain is the reward –seeking centre. When something is pleasurable, dopamine is released here, creating euphoria. The behaviour is repeated to re experience that state.

As dependence deepens, coming down from the 'high’ results in dopamine levels crashing causing nausea, heart palpitations, shaking and other distressing symptoms. The brain associates other aspects of the person’s life with getting high, such as people to use with and places to use at. Reminders of the drug become all-consuming and take up thinking, money, time and the person’s life. The drug comes first. Addicted individuals are not having fun and are hijacked by the drug.

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Symptoms of drug addiction

Symptoms of drug addiction include psychological, behavioural and physical effects, and vary depending on the type of drug used. This ranges from feeling euphoric, hyped up, paranoid, sedated, slow or speeded up speech and movements to altered states and hallucinations. Psychological symptoms include mood swings, angry outbursts, agitation, poor judgement, inability to focus or concentrate, memory issues and an exacerbation of mental health conditions.

Behavioral and social signs include lying, a decline in school or work performance, dropping favourite activities, money problems, engaging in risky or illegal activities and withdrawal.

Physical signs involve a decline in self-care, neglected appearance, appetite changes, and disrupted sleep. Eyes, nose, blood pressure, heart rate and a wide range of physiological changes ensue.

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Risk factors of becoming addicted

So what are the risk factors for becoming addicted? It is multifactorial, involving biological, psychological and social contributing factors. According to the Mayo Clinic, there may be a genetic disposition, a family history and or a mental health disorder. It can start with experimental use in social situations and escalate quickly depending on the type of drug.

A family history of drug addiction increases the risk of becoming addicted. Influence from the person’s social circle has been found to be a significant factor in misusing drugs, especially among young cohorts. Stressful family dynamics, a lack of supervision and early use of drugs increase vulnerability.

Poverty, multi- generational unemployment and a lack of community facilities have been associated with drug abuse in areas. However substance abuse among the middle class has escalated, and is evident, and sometimes lethal, among the rich and famous.

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Availability of drugs increases use, as is evident from the period with Covid-19 restrictions. A HSE survey during that time reveals changes in illicit drug use. While cannabis use increased, other drugs were used less due to fewer opportunities.

The Behavioural and Clinical Neuroscience Institute in Cambridge have been conducting drug addiction research into the consequences of chronic drug use on mental performance and brain activity.

Taking a highly addictive drug can lead to psychosis, seizures, death, brain damage, unsafe sex, physical health conditions, increased risk of suicide, family and relational problems, school and work issues, court cases, dealing drugs, custodial sentences and financial losses.

A mental health disorder, such as depression or PTSD, is another risk factor for substance abuse disorder. The person uses the drug to alleviate distressing symptomatology. Exposure to traumatic experiences, especially during childhood, has been linked to drug addiction.

Research evidence has shown a strong correlation between trauma and substance abuse among adolescents. Addiction expert Gabor Maté advocates a compassionate approach towards addiction, and sees it as an escape from the emotional distress from past trauma.

He asserts that nobody chooses to be an addict and that self-awareness, opening up and addressing traumatic childhood experiences are key to recovery.

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Drug policy & social attitudes

With all this latest addiction research involving neuroscience and psychology, there is a still a long way to go. Drug policy can’t just focus primarily on methadone treatment programmes and counselling alone may not be enough.

Societal attitudes to heroin addicts from lower socio economic groups can differ from how rock stars, movie stars or celebrities are perceived. Negative views of those addicted to drugs and references to "crackheads" and "junkies" will not be a part of the solution, nor will glorification of drug use by famous role models. The way people are referred to can create or uphold stigma.

While behaviours of those addicted may be problematic, we can’t dehumanise those with substance abuse disorders. Drug addiction is a serious and complex public health issue that can’t be responded to solely with reactive measures. Trauma screening and trauma informed therapy is essential.

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Many individuals in recovery report interventions that helped such as motivational interviewing, evidence based individualised treatment, addressing childhood trauma and mental health disorders, developing a new social circle, coping strategies, life skills, support, courses, work opportunities and compassion.

Cuan Mhuire have treatment centres around the country and offer educational programmes and after care. Tiglin offers rehabilitation programmes for people in addiction or homelessness. They provide training to transition people back into society.

An example of this is The Rise at the Cove café in Greystones, a social enterprise café. Initiatives like these work. As well as effective treatment programmes such as these, preventative measures are needed.

The high rates of traumatic childhood experiences in addiction research indicate how multi- disciplinary services for children and adolescents are vital. If there is no support for them to turn to, they are at risk of turning to drugs.

If you have been affected by issues raised in this story, please visit: www.rte.ie/helplines