Understanding Substance Use Disorders: Brain, Behavior and the Road to Recovery

Many of us have encountered someone who struggles with alcoholism or chain smoking. When asked about it, they often respond with statements like, "I'm trying to quit smoking," or "I'm trying to stop drinking, but I just can't." Despite their efforts, they frequently relapse, which might lead others to question their sincerity or determination. Is quitting really that difficult? The truth is- yes, it is. Addiction is a powerful force that can be incredibly hard to overcome. However, that doesn't mean it's impossible. With genuine commitment, consistency and a strong will, anyone can break free from addiction and reclaim control over their life. 

Substance Use Disorders (SUDs)

Substance use disorders are characterized by the compulsion to use one or more substances, along with the perceived loss of control and a negative emotional state. SUDs are becoming a major concern for the public's health. Studies show that the most commonly used substance in India is Tobacco, alcohol, cocaine and opioids. According to the data of Ministry of Social Justice and Empowerment 2019, there are about 16 crore alcohol users (14.6%), 5.7 crore problematic users (5.2%) and 2.9 crore dependent users (2.7%). 

Let’s take a closer look at how addiction affects the brain, so we can better understand why overcoming it is such a complex and challenging process.

The neurobiology of addiction explains  how addictive substances and behaviors hijack the brain’s reward, motivation and self-control systems. Addiction is not just a lack of willpower-it is a chronic brain disorder involving structural and functional changes in key brain circuits.

Substance and Brain

The Substance Use Disorders affect the reward system which is involved in the reinforcement of behaviors and memory. This can lead to chronic use and dependence on substances. Brain areas involved in addiction are Ventral Tegmental Area (VTA), Nucleus Accumbens (NAc), Prefrontal cortex, Amygdala and hippocampus. These are structures which play a key role in addiction. Dopamine is a neurotransmitter that acts as a reward system and encourages behavior.

Ventral Tegmental Area (VTA)

It is located in the midbrain. VTA produces dopamine, a chemical that signals pleasure and reward. It sends dopamine to other brain areas involved in motivation and decision making.

Nucleus Accumbens (NAc)  

It is central to the brain's reward system. It responds to dopamine and creates the feeling of pleasure or euphoria. NAc reinforces the desire to repeat the behavior.

Amygdala & Hippocampus

It involves memory and emotion. These structures store the emotional memories related to substance use (e.g. craving triggered by environment).

Prefrontal cortex

It is responsible for decision making, impulse control and planning. The prefrontal cortex becomes less active with chronic substance use and weakens self-control.  

Consequences

• It is a major risk factor for non-communicable diseases like hypertension, mental health problems and malignancies.
• SUDs affect the physical, psychological, financial and social health of an individual.
• Substance intake via syringes are highly contributing to the transmission for HIV, Hepatitis B & C.
• Alcohol Use Disorders lower the grey matter volume of the amygdala, insula, cingulate gyrus, orbitofrontal gyrus and thalamus.
• Tobacco Use Disorders lower the grey matter volume of thalamus, cingulate gyrus, prefrontal cortex and cerebellum.

Ways to reduce substance use :

• Supply reduction : Reducing the availability of substances in the illegal markets.

• Demand reduction : Practice highly effective treatment for substance use and prevent initiation of substance use.

• Harm reduction : Reducing the harmful effects associated with the substance use.

• Rehabilitation : Practice rehabilitation for those who quit smoking and help them to lead a normal life without dependence and addiction. And ensure they should not relapse.

Levels of Treatment

Usually in a medical setting three levels of treatment will be given. Such as :

• Primary Treatment

Primary treatment is the preventive phase where awareness about the consequences of using substances will be delivered in a public setting via mimes, campaigns and so on. Including real life case examples of people who recovered from substance use can be highly helpful. Aims to prevent and reduce the risk factor.

• Secondary Treatment 

This treatment involves early identification and providing appropriate treatment thereby reducing the effect of substance intake. It involves safe detoxification of drugs from the body and managing the withdrawal symptoms, identifying the root cause and providing therapy. 

• Tertiary Treatment

Long term chronic use of substances may cause several physical abnormalities. This treatment is provided to reduce the complication caused by the substance use. People at this stage require hospitalization.

What can I do as an individual?

• Listen to those who are overdependent and addicted towards substances. Understand their difficulties behind their failure in withdrawal of substance.
• Don’t mock them. It’s not them that prevents them from overcoming dependence. Addiction is a biological process. It takes time.
• Change won’t happen within a day. Wait patiently and support them with their withdrawal process.
• Stopping substances abruptly in the absence of health care professionals’ supervision is extremely harmful. Seek the help of the therapist or any rehabilitation institute.