MD Stein - Just One Look, That's All It Took
Only a small percentage of people who try an addictive substance wind up addicted. Is a new user more likely to become dependent on nicotine, alcohol, or cocaine?
In the year after smoking their first full cigarette, only 2% have trouble quitting. But at some time in their life, 68% of those who smoke that first cigarette will become nicotine dependent. The football-field sized surface area of your alveoli, makes the absorption of nicotine faster than the seeping of alcohol through your GI tract or cocaine through your nasal membranes. Activation of the nicotinic acetylcholine receptor produces diverse effects, many of them attractive—better concentration, improved energy, loss of appetite leading to weight loss. Women are more likely to transition from use to dependence than men, and nicotine’s reduction in circulating estrogen has far-reaching consequences, costing young women cardiovascular disease protection by causing earlier menopause.
The time from first use to problem use is far quicker with cocaine, although fewer Americans try it compared to cigarettes. Cocaine causes problems earlier (7% in year one), perhaps due to its unique effects on brain chemistry and neuronal structure. Cocaine use drives long-term biological changes in the pleasure centers of the nucleus accumbens and dorsal striatum far more dramatically than use of marijuana, for instance, and after a relatively short period of repeated exposure. Twenty-one percent of experimenters will become dependent on cocaine during their lifetimes.
After having a first drink (not a taste or sip), 2% of alcohol users will have problems in year one, about the same number as cigarette experimenters. During their lifetimes, 23% will become dependent, often with devastating effects on behavior, family, employment. Once enjoyed, the exposure to alcohol becomes a regular daytime incitement that is hard to escape or ignore. The legality, social acceptability, and easy secretiveness of drinking provide ample opportunity for those at risk to transition to hazardous use. As with cocaine, men are more likely than women to develop problematic use.
Who’s at risk for drug dependence? Use of or dependence on one substance increases the risk of developing a second or third drug problem. Polydrug use is the rule, not the exception; if one drug is causing problems, another is not far behind. This could be due to the overall enhanced effects of combining psychoactive substances, lack of attention to a particular drug’s negative effects if another can be substituted, or faster neurobiological changes that seal the deal. While genetics influences the transition to addiction (metabolism of nicotine varies by ethnicity, for example), environment plays a larger role; exposed to one drug, you are likely to be exposed to several.
What are other risk factors for making the transition to problem drug use? Smokers who start young, before age 14, have a higher risk than those whose onset is older. Having any psychiatric disorder—depression, anxiety, ADHD—or even having a family history of a disorder puts you at increased risk. These are illnesses associated with stress, heightened impulsivity and risk-taking, and their prevention and treatment decreases the risk of transition to problem drug use.
All psychoactive drugs have the potential for misuse and addiction. Each of these drugs can be quit, but it’s far easier not to start.
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