Substance Abuse and Addiction

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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Continued drug use is not voluntary most of the time. The voluntary part of it comes in the very beginning, before addiction begins. You voluntarily take the first couple of substances, and after that, the brain changes and the drug quickly becomes a requirement for survival. It’s like a thirst for water or a hunger for food. 
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    The first thing to do if you have a drug relapse is to reach out in your social network, talk to your friends, spouse, family members and doctor to get connected to the right places. Basically, just talk about it. The more people who know about your problem and know you have relapsed, the better your chances of surviving and getting back on your feet. 
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    The criteria to start methadone versus suboxone can be different. To start methadone, you have to be documented as using drugs more than 12 months, whereas the criteria for suboxone are looser, and it’s better if the person has been using for less than 12 months. There is an age limit of 18 on methadone versus an age limit of 16 on suboxone. Counseling is also required to receive methadone; suboxone doesn’t require counseling, but it is highly advised. When it comes to treatment retention, suboxone is pretty good but a little less effective in keeping people clean.
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Studies have shown that detoxification alone is not a sufficient treatment for addiction, and that relapse following detoxification is very common. Therefore, what is advised? Treatment should start with detoxification to clear the person of the chemical substance and then go to abstinence-oriented psychotherapy counseling, potentially combined that with maintenance therapy to prevent a person’s cravings, withdrawals and tendency to relapse. That is the most effective treatment system. 
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Medications can be used to safely prevent drug addicts from relapsing into using opioids and to help them sustain their sobriety. The two most successful are methadone and suboxone. Suboxone is made of two components: the main active ingredient is buprenorphine, and the other ingredient in it that prevents abuse is naloxone. By staying on the maintenance therapy, the individual can continue going to work and living a normal life. 
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Society at large is affected by drug addiction: families and social constructs disintegrate, sexually transmitted diseases become more prevalent and crime rates increase. There may be child abuse or the neglect of children associated with these drugs. There are economic losses from people not showing up to work or being ill due to consuming drugs. There is also an increased demand for illicit substances, which leads to an increase in drug trafficking. 
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Drug addiction is deadly and yet it still is not well understood by both the medical community and the public. In any given year, almost half of the U.S. adult population suffers from a severe addiction, and yet there is still a lot of stigma around addicts or people who suffer from this disease. Even their treatment, such as in methadone clinics, has very negative connotations associated with it. 
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Addiction does begin as a choice, but it quickly changes and becomes a sense of need for survival. As dependence increases, behavior changes. It may become even more compulsive to the point where people are ready to sacrifice anything to feel normal again.
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    When it comes to addiction, there is a big question of nature versus nurture. It might well be a little bit of both, based on what science has shown us thus far. All humans are born with systems of addiction ready to go because we’re wired to feel good and pursue happiness. If something feels good, we go for it -- that’s how our brain works.
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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    Whether withdrawal symptoms exist or not, both substance and behavioral addictions tap into a major pathway called the mesolimbic pathway in the brain. It regulates behavior by a release of dopamine, which is the pleasure and reward chemical of the brain. In addiction, the behavior persists to attain this feeling of pleasure and reward, despite the knowledge of negative consequences. That’s where the abnormality lies in the disorder.