Many people are under the impression that drinking alcohol is not as serious as using illicit drugs like heroin, cocaine or marijuana. Likewise, they may think that if a physician prescribes a drug, it cannot be abused or lead to addiction. The fact of the matter is that alcohol addiction often results in serious short- and long-term health side effects and withdrawal can be more dangerous than it is with many other drugs. As for prescription drugs, the intentional and accidental abuse of prescription opioids alone caused 15,000 overdose deaths in the U.S. in 2015, with methadone, oxycodone and hydrocodone the three biggest culprits.1 Two of the most common drug addiction questions relate to the effects of drugs and alcohol on the brain and whether everyone who abuses substances is addicted. These topics and other frequently asked drug questions and alcohol questions provide a basic foundation of knowledge and will help you separate fact from fiction.
How Do Drugs and Alcohol Impact the Brain?
Drugs can alter important areas such as the brain stem, cerebral cortex and limbic system, all of which play key functions and many of which are life-sustaining. The brain stem controls basic functions such as heart rate, breathing and sleeping. The cerebral cortex, divided into different areas controlling specific functions, impacts all the senses. The frontal cortex or forebrain is the thinking center of the brain. The limbic system holds the brain’s reward circuit, linking a number of brain structures controlling and regulating the ability to feel pleasure. It is responsible for humans’ perception of positive and negative emotions, which explains the mood-altering properties of many drugs. The nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex, has been consistently tied to pleasure, thereby leading to the region being called the brain’s pleasure center.1,2
Most drugs flood the brain with dopamine, a type of neurotransmitter that helps control the brain’s reward and pleasure centers. This overstimulation induces feelings of euphoria and happiness, causing the intensely pleasurable “high” responsible for many people misusing drugs or alcohol repeatedly. With continued drug use, the brain adjusts to the excess dopamine by making less of it and/or reducing the ability of cells in the reward circuit to respond to it. The high the person experiences decreases and they develop a tolerance, requiring more of the substance to achieve the dopamine high they now crave. Long-term substance abuse also affects brain functions controlling learning, judgment, decision-making, stress, memory and behaviors.3
Is There a Difference Between Substance Abuse and Addiction?
Yes, there are key differences. Substance abuse may lead to addiction, although not everyone who abuses drugs becomes addicted. Abuse involves an intense desire to use increasing amounts of a particular drug or several substances, despite negative consequences impacting various aspects of one’s life. At this end of the substance abuse spectrum, the brain and body are not addicted to the drug. When a person is addicted, he or she is unable to limit or cease substance use and develops an irresistible urge to continue seeking and taking the drug despite serious negative consequences. Drug dependence and addiction are related, although non-addictive prescription drugs can also produce dependence. In other words, when a person stops taking them, they can experience troubling symptoms. Likewise, a person can develop drug tolerance, although that does not mean they are addicted. Addiction is a disease that is believed to have several underlying components, which helps explain why some people are prone to it and others are not. Potentially addictive drugs have a powerful impact on the brain’s reward pathways, ultimately causing many people to become addicted.4,5
Is It Safe to Abruptly Quit Drinking Alcohol?
If a person is a heavy drinker and has been abusing alcohol for some time, quitting abruptly (aka cold turkey) can be dangerous. The body compensates for the depressive effect of alcohol by increasing production of hormones and brain chemicals such as serotonin, epinephrine and dopamine. When a person stops drinking alcohol cold turkey, the body becomes flooded with abnormally high levels of these chemicals. This causes the brain to undergo rapid adaptive changes in an attempt to maintain normal functioning. Severe complications include dehydration, vomiting, abnormal heart rhythms and a condition called delirium tremens (DTs). An estimated 30% to 40% of people who experience seizures progress to DTs. Considered a medical emergency, DTs typically start 24 to 48 hours after the last drink. The condition is characterized by confusion, delirium and seizures. Unattended, people can suffer head injuries, lethal dehydration, heart attack and stroke or can choke on their own vomit. An estimated 15% of DT cases are fatal.6,7
Do You Have to Be Addicted to Develop Health Problems?
No, you do not have to be diagnosed with substance addiction to suffer the ill effects of substance use. Many people who abuse alcohol or drugs are subject to a host of health problems even when they are not chemically addicted. For example, anyone who regularly consumes alcohol in excessive amounts can eventually develop moderate, severe or life-threatening side effects. Research indicates students who engaged in repeated episodes of binge drinking were more likely than other students to experience memory impairment when intoxicated. Excessive alcohol consumption and binge drinking negatively impact many bodily systems and functions, making one vulnerable to specific types of cancer and more prone to involuntary and intentional injuries.8,9
- Prescription Opioid Overdose Data. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/data/overdose.html Updated December 16, 2016. Accessed March 6, 2017.
- Understanding Addiction. Help Guide website. https://www.helpguide.org/harvard/how-addiction-hijacks-the-brain.htm Accessed March 6, 2017.
- Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain Updated July 2014. Accessed March 6, 2017.
- Understanding Tolerance, Dependence, and AddictionDrug Abuse website. http://drugabuse.com/library/tolerance-dependence-addiction/ Accessed March 6, 2017.
- Drug Dependence and Abuse. eMedicineHealth website. http://www.emedicinehealth.com/drug_dependence_and_abuse/article_em.htm Updated April 21, 2016. Accessed March 6, 2017.
- Parker-Pope T. Amy Winehouse and the Perils of Alcohol Withdrawal. The New York Times. http://well.blogs.nytimes.com/2011/08/03/amy-winehouse-and-the-perils-of-alcohol-withdrawal/?_r=1 August 3, 2011. Accessed March 6, 2017.
- Delirium Tremens (DTs) Clinical Presentation. Medscape website. http://emedicine.medscape.com/article/166032-clinical Updated: April 14, 2016. Accessed March 6, 2017.
- What Happened? Alcohol, Memory Blackouts, and the Brain. National Institute on Alcohol Abuse and Alcoholism website. http://pubs.niaaa.nih.gov/publications/arh27-2/186-196.htm Published July 2004. Accessed March 6, 2017.
- Alcohol’s Effects on the Body. National Institute on Alcohol Abuse and Alcoholism website. https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body Accessed March 6, 2017.
