If I were to ask you, “How does addiction start?” What would be your answer?
Many people do not understand how and why someone may struggle with an addiction disorder. The National Institute on Drug Abuse defines addiction as “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” Addiction stems from a complex interplay of neurobiological, genetic, and environmental factors.
Neurobiology and Cycle of Addiction
The brain’s reward circuit is an intricate network of neurotransmitters that reinforces behaviors essential for survival, such as eating (Gardner, 2011). However, this same circuit can be hijacked by addictive substances, leading to a cycle of cravings and compulsive use. For instance, dopamine, a neurotransmitter commonly linked to pleasure and reward, plays a key role in this process. Substances like fentanyl, alcohol, cocaine, amphetamines, and nicotine trigger the release of dopamine in the brain. When a substance, such as fentanyl or alcohol is used, dopamine is released, creating feelings of pleasure or euphoria. As this "happy chemical" floods the brain's reward circuit, it reinforces the behavior, increasing the likelihood of continued drug use. Over time, the brain begins to associate the substance more strongly with reward and pleasure, further solidifying the cycle of addiction.
Tolerance develops as the brain adapts to the excess dopamine released during substance use. Over time, the brain's natural ability to produce dopamine decreases, causing the individual to require more of the substance to achieve the same effects. With repeated use, the brain's reward system alters, reducing the pleasure found in everyday activities. When the substance is absent, the individual may experience withdrawal symptoms such as irritability, fatigue, depression, sleep disturbances, restlessness, and anxiety. To relieve these symptoms and regain a sense of pleasure, the person often returns to substance use, perpetuating the cycle of addiction. The chemical imbalances in the brain throughout this cycle increase the likelihood of developing symptoms of depression and anxiety. Sadly, many individuals fall into this pattern without fully realizing what is happening.
Addiction in Adolescents
The prefrontal cortex, responsible for executive functions such as impulse control, decision-making, risk assessment, and evaluating consequences, is the last part of the brain to fully develop in adolescents (Uhl et al., 2019). Because their brains are still maturing, adolescents are not only more prone to risk-taking behaviors, including drug use, but also face greater vulnerability to the effects of substance use. As a result, they are more likely to transition from experimental drug use to developing a substance use disorder (Uhl et al., 2019). Impairment of the prefrontal cortex can make it harder for adolescents to manage cravings and exercise self-control, increasing the likelihood of continued substance use.
The adolescent brain is highly malleable, forming strong associations between substance use and pleasurable experiences. These associations are further reinforced by the amygdala, which processes emotions, and the hippocampus, responsible for memory formation. Because the prefrontal cortex is less developed and has less control, these powerful associations often dominate, increasing the risk of continued substance use.
Difference Between Fentanyl Overdose and Fentanyl Poisoning
Dangers of Fentanyl
Substance use disorders are continuing to rise across the United States. According to the National Survey of Drug Use and Health, over 46 million Americans twelve years and older had a substance use disorder in 2021. Fentanyl, a potent synthetic opioid, has played a significant role in the escalating number of overdose-related deaths. In 2021 alone, over 106,000 overdose-related deaths occurred, with an estimated 70,601 attributed to synthetic opiates like fentanyl.
An overdose occurs when an individual consumes more of a substance than the body has the ability to metabolize. Poisoning involves ingesting a fatal quantity of a substance without awareness of its potency or composition, often resulting in a similar reaction to an overdose. Fentanyl, particularly nonpharmaceutical variants, poses a heightened risk due to its potency and frequent adulteration with other substances.
Nonpharmaceutical Fentanyl is an illegally manufactured synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine with a lethal dose measurable to 10 to 15 grains of table salt. Because of the high potency achieved with small quantities, fentanyl is often mixed in with other substances, such as cocaine, methamphetamine, and heroin.
Increased Risk in Adolescents
The rise of fentanyl poses a significant danger, particularly for adolescents who may be inexperienced with drug use and experimenting with substances that could be laced. An adolescent experimenting with drugs may unknowingly ingest fentanyl if it is mixed into counterfeit pills, powdered substances, or even marijuana. Due to their lower perception of risk, adolescents may not fully understand the extreme danger fentanyl presents. Additionally, their lack of tolerance makes them more susceptible to its effects, and they are less likely to recognize the signs of fentanyl poisoning, which can delay life-saving intervention.
How to Help a Loved One Struggling with Substance Use
Helping a loved one struggling with substance use can begin by identifying protective factors that can reduce risky behaviors and prevent the development of a substance use disorder. The Substance Use and Mental Health Services Administration defines protective factors as “characteristics associated with a lower likelihood of negative outcomes that reduce a risk factor’s impact.” These factors help build resilience and promote healthier coping mechanisms, lowering the chances of substance use disorders. For adolescents, protective factors include positive peer relationships, strong family bonds, involvement in extracurricular activities, community support, education on substance use risks, coping skills, and access to mental health resources.
Quick Tips
Individual Resources
- Boxed Breathing: Boxed breathing is a technique to pace breathing when feeling overwhelmed.some text
- Breathe in through your nose for 4 seconds, slowly filling up your lungs.
- Hold your breath for 4 seconds. Don’t breathe in or out during this time.
- Breathe out through your mouth for 4 seconds, letting the air flow out steadily.
- Hold your breath again for 4 seconds before starting the next breath.
- Urge Surfing: Urge surfing is a technique to help you manage strong cravings or urges without giving in to them. Think of an urge, whether it's for something like using a substance, eating junk food, or any impulse, as a wave in the ocean. Just like waves, urges start small, build up, and then eventually fade away. The idea behind urge surfing is to "ride the wave" instead of letting it crash over you.some text
- Notice the urge – When you feel a craving or impulse, recognize it. Instead of immediately acting on it, take a moment to observe how strong it feels and where you feel it in your body (like in your stomach, head, or chest).
- Stay with it – Imagine the urge as a wave rising. You don’t have to act on it, just ride it out. Tell yourself it will peak and then eventually fade, just like a wave does.
- Breathe through it – Focus on your breathing. Take slow, deep breaths, and stay mindful. This helps you ride out the discomfort without reacting to it.
- Watch the urge fade – As time passes, you’ll notice that the urge starts to decrease. It might feel hard at first, but urges don’t last forever, and they lose their power if you don’t feed them by acting on them.
- Distress Tolerance: Distress tolerance skills can be used to help manage intense emotions or situations without making harmful decisions. Below is an example:some text
- Five Senses some text
- Sight: Look at something calming or beautiful.
- Hearing: Listen to music you enjoy or calming sounds.
- Taste: Eat something you like mindfully, paying attention to the taste.
- Touch: Hold something soft, wear cozy clothes, or cuddle a pet.
- Smell: Smell something pleasant, like a candle or essential oil.
Community Resources
- Family Support: Create a safe and open environment where the adolescent feels comfortable talking about their experiences, feelings, and reasons for using drugs. Ask open-ended questions and listen actively. Make it clear that your primary concern is their well-being and safety. If possible, Engage the entire family in the adolescent’s recovery process. Family therapy can improve communication, reduce conflict, and create a more supportive home environment.
- Friend Support/Peer Pressure: Having friends who engage in healthy behaviors and avoid substance use reduces the likelihood of an adolescent experimenting with drugs or alcohol. Peer groups that value academic success, extracurricular involvement, and healthy activities exert positive peer pressure.
- School Resources: School counselors can provide one-on-one support, listen to the student’s concerns, and help them develop coping strategies. They can also connect students with additional resources like outside counseling services or substance use programs. Many schools also have peer mentoring or support groups where students can talk openly about their struggles in a safe, non-judgmental space.
Professional/Support Groups
- Online and In-person Support Groupssome text
- Alcohol Anonymous (AA) some text
- Narcotics Anonymous (NA)some text
- Al-Anon/Alateen - support group for those who have been affected by a loved ones substance usesome text
- Contracting a Therapist: Encourage the adolescent to visit a healthcare provider, such as a pediatrician, psychologist, or addiction specialist, who can assess the level of substance use and determine the most appropriate course of treatment.
References
Dernbach, M. R., & Carpenter, J. E. (2023). Overdose or self-poisoning: Considerations for consistency in language. Clinical Toxicology, 61(11), 1009–1009. https://doi.org/10.1080/15563650.2023.2281254
Di Chiara, G., & Imperato, A. (1988). Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Neurobiology, 85, 5274-5278.
Fentanyl addiction statistics: Fentanyl Statistics in the U.S. American Addiction Centers. https://americanaddictioncenters.org/fentanyl-treatment/addiction-statistics
Gardner, E. L. (2011). Addiction and brain reward and Antireward Pathways. Advances in Psychosomatic Medicine, 22–60. https://doi.org/10.1159/000324065
Risk and protective factors - SAMHSA. (n.d.). https://www.samhsa.gov/sites/default/files/20190718-samhsa-risk-protective-factors.pdf
Uhl, G. R., Koob, G. F., & Cable, J. (2019). The Neurobiology of Addiction. Annals of the New York Academy of Sciences, 1451(1), 5–28. https://doi.org/10.1111/nyas.13989
U.S. Department of Health and Human Services. Drug overdose death rates. National Institutes of Health. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
U.S. Department of Health and Human Services. Understanding drug use and addiction drugfacts. National Institutes of Health. https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction#:~:text=Drug%20addiction%20is%20a%20chronic,intense%20urges%20to%20take%20drugs
