Addicted: Why Do People Get Hooked?

Mounting evidence points to a powerful brain chemical called dopamine

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Realistically, no one believes better medications alone will solve the drug problem. In fact, one of the most hopeful messages coming out of current research is that the biochemical abnormalities associated with addiction can be reversed through learning. For that reason, all sorts of psychosocial interventions, ranging from psychotherapy to 12-step programs, can and do help. Cognitive therapy, which seeks to supply people with coping skills (exercising after work instead of going to a bar, for instance), appears to hold particular promise. After just 10 weeks of therapy, before-and-after pet scans suggest, some patients suffering from obsessive-compulsive disorder (which has some similarities with addiction) manage to resculpt not only their behavior but also activity patterns in their brain.

In late 20th century America, where drugs of abuse are being used on an unprecedented scale, the mounting evidence that treatment works could not be more welcome. Until now, policymakers have responded to the drug problem as though it were mostly a criminal matter. Only a third of the $15 billion the U.S. earmarks for the war on drugs goes to prevention and treatment. "In my view, we've got things upside down," says Dr. David Lewis, director of the Center for Alcohol and Addiction Studies at Brown University School of Medicine. "By relying so heavily on a criminalized approach, we've only added to the stigma of drug abuse and prevented high-quality medical care."

Ironically, the biggest barrier to making such care available is the perception that efforts to treat addiction are wasted. Yet treatment for drug abuse has a failure rate no different from that for other chronic diseases. Close to half of recovering addicts fail to maintain complete abstinence after a year — about the same proportion of patients with diabetes and hypertension who fail to comply with their diet, exercise and medication regimens. What doctors who treat drug abuse should strive for, says Alan Leshner, director of the National Institute on Drug Abuse, is not necessarily a cure but long-term care that controls the progress of the disease and alleviates its worst symptoms. "The occasional relapse is normal," he says, "and just an indication that more treatment is needed."

Rafael Rios has been luckier than many. He kicked his habit in one lengthy struggle that included four months of in-patient treatment at a residential facility and a year of daily outpatient sessions. During that time, Rios checked into 12-step meetings continually, sometimes attending three a day. As those who deal with alcoholics and drug addicts know, such exertions of will power and courage are more common than most people suspect. They are the best reason yet to start treating addiction as the medical and public health crisis it really is.

— With reporting by Alice Park/New York

For more on addiction and alcoholism, go to time.com/alcoholism

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