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What is drug addiction? Considerable confusion exists regarding the nature of addiction. The most common misunderstanding is that addiction refers to a state of physical dependence on a drug whereby discontinuing drug intake produces a withdrawal syndrome consisting of various somatic disturbances. Addiction is better defined as a behavioral syndrome where drug procurement and use seem to dominate the individual's motivation and where the normal constraints on behavior are largely ineffective. This condition may or may not be accompanied by the development of physical dependence on the drug. This condition has also been described as a "psychological" addiction (thus distinguishing it from physical dependence archaically termed "physical" addiction), but confusion is minimized by using the term addiction to refer to the behavioral syndrome described above and the term physical dependence to refer to the condition associated with somatic withdrawal reactions. The distinguishing feature of the condition commonly referred to as addiction is the ability of the drug to dominate the individual's behavior, regardless of whether physical dependence is also produced by the drug.
Many factors influence a person's initial drug use. Personality characteristics, peer pressure, and psychological stress can all contribute to the early stage of drug abuse. These factors are less important as drug use continues and the person repeatedly experiences the potent pharmacological effects of the drug. This chemical action, which stimulates certain brain systems, produces the addiction, while other psychological and social factors become less and less important in influencing the individual's behavior. When the pharmacological action of a drug dominates the individual's behavior and the normal psychological and social control of behavior is no longer effective, the addiction is fully developed. This self-perceived "loss of control" is a common feature of drug addiction and reflects the biological nature of the problem.
Specialized brain systems have evolved to ensure survival of the species. These systems direct behavior by rewarding actions that promote survival of the individual and of the species. Intake of nutrients and procreation are governed by specific brain systems; for example, the interaction of various substances in foods (e.g., sugars, fats) activate taste receptors which in turn activate brain reward mechanisms. Activation of brain reward systems produces changes in affect ranging from slight mood elevation to intense pleasure and euphoria, and these psychological states help direct behavior toward natural rewards. Some chemicals activate brain reward systems directly, bypassing the sensory receptors mediating natural rewards. The caffeine from coffee and tea, the alcohol from fermented beverages, and the nicotine from tobacco all activate brain reward mechanisms directly. Moderate use of these substances has gained widespread acceptance over the centuries, although their use has been periodically prohibited (e.g., alcohol during prohibition) or restricted (e.g., cigarette smoking currently). Other drugs much more potently activate brain reward systems. Initial use of these substances is usually accompanied by mood elevation and other affective changes that lead to their recreational use. (Some drugs have actions that produce other desirable psychological effects, such as relaxation.) Much like moderate caffeine and alcohol use, addictive drugs activate brain reward systems. But the activation is much more intense causing the individual to crave the drug and to focus their activities around taking the drug. The ability of addictive drugs to strongly activate brain reward mechanisms and their ability to chemically alter the normal functioning of these systems can produce an addiction.
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