Chronic misuse of medications is not just a curse of the rich and famous; from young teenage children to laborers to business professionals to senior citizens, no group is immune. Nor is the problem limited to the United States, though much of the data is U.S.-centered. A 2007 article in the Journal of the American Medical Association cites a warning by the United Nations that worldwide abuse of prescription drugs would soon exceed illicit drug use.
As we begin to search out the reasons for such a far-reaching problem, a little science may be helpful. What makes substance abuse so attractive?
The National Institute on Drug Abuse (NIDA) offers some insight. “Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine,” says the institute’s Web site. “Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.”
Two other important neurotransmitters are also involved—serotonin and norepinephrine—and mood disorders occur when the flow of the three chemicals is disrupted in some way. When the system is working properly, however, these chemicals help us perform within a normal range of moods and emotions.
But the complex mass of neurons and nerve cells we know as the brain depends on more than neurotransmitters to regulate what we feel, think and do. Hormones secreted by the endocrine system also play an important role in regulating emotions and various aspects of normal growth and development. Alongside neurotransmitters, hormones are important to the nervous system as well; in fact, the endocrine system and the autonomic nervous system are linked by way of the hypothalamus. This brain structure stimulates the endocrine system to release hormones (such as adrenaline, more commonly known in the United States as epinephrine, and cortisol) in response to specific triggers.
Adrenaline comes to our aid whenever we are stressed, increasing our heart rate and blood pressure in fight-or-flight situations. One of the functions of cortisol is to suppress some of the body’s more demanding functions in order to free up energy—again to deal with perceived threats. Thus even the body’s growth and development processes may be suppressed when we’re under stress, though usually everything returns to normal as soon as the threat has passed. But when we are exposed to long-term stress, adrenaline levels become erratic, driving up the base cortisol levels for unnaturally long periods and interfering with the normal functioning of these systems.
This is especially harmful for infants and children, because they are developing the basis of self-regulation on which normal social and emotional coping mechanisms depend. When high cortisol levels interfere with this development, they are left more vulnerable to later problems in self-regulation, including addiction. But prolonged high levels of cortisol also suppress these functions in the adult brain, inhibiting the flow of dopamine and serotonin in the process. More research is needed to fully understand how all of these factors may work together in promoting—or potentially in preventing—addiction.
In the face of increasing stresses in our modern Western way of life, and having discovered some of the workings of the nervous and endocrine systems, medical research has found that it can help those with emotional or mood disorders by introducing drugs that mimic or influence neurotransmitters. Understandably, these have become hugely popular. However, when drugs are introduced into the human system there is often a downside as well as an upside.
From Use to Abuse
The use of illegal drugs such as heroin, cocaine and marijuana is a long-standing, well-documented and growing problem in the Western world, but authorities are now sounding the alarm for the relatively new development of prescription and over-the-counter (OTC) drug abuse. According to the Institute of Medicine and the National Institutes of Health, while most individuals take medicines only for the reasons for which their doctors prescribe them, about 20 percent of Americans have used prescription drugs for nonmedical reasons.
A prescription drug, as the name implies, is a legal or licensed drug that is prescribed by an authorized practitioner and can be obtained only from a pharmacist. OTC drugs can be readily purchased without a prescription.
Many prescription drugs are prescribed for the purpose of modifying brain function where a deficiency has been diagnosed. Under controlled circumstances patients may find a positive benefit for a real medical problem. However, people without a diagnosed medical condition can also experience an effect on the brain by ingesting prescription and/or OTC drugs. Certain medications target the brain’s reward system and produce feelings that are pleasant—with or without a medical need. NIDA explains that “when some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards do. In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors such as eating and sex. The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well.”
The three categories of most commonly abused prescription and OTC drugs are opioids (pain relievers), central nervous system or CNS depressants (sedatives), and stimulants (amphetamines). Opioids change the way a person perceives pain and additionally affect those areas of the brain associated with the perception of pleasure. CNS depressants decrease brain activity and produce a calming effect, whereas stimulants increase alertness by increasing dopamine, the neurotransmitter associated with feelings of pleasure. When these drugs are taken exactly as prescribed, they can be helpful and of themselves do not usually lead to addiction.
What is particularly alarming is the age of many prescription drug abusers. A 2011 NIDA factsheet reveals that 7.7 percent of American youths (from 12 to 17 years old) reported nonmedical prescription drug use during the previous year. Another report by the Office of National Drug Control Policy indicates that nearly one-third of people aged 12 and over who used drugs for the first time in 2008 began by using a prescription drug non-medically, and that each day, 2,500 youths abuse prescription painkillers for the first time. More teens abuse prescription drugs than any illegal drug except marijuana. This has led some to refer to this age group as Generation Rx.
While painkillers have become the drug of choice—particularly for a younger clientele—they are supplemented with depressants (sleeping pills and anti-anxiety medications), stimulants, and OTC cough and cold remedies. Very often these drugs are taken in combination, accompanied by binge drinking.
Causes and Effects
The big issue is why. Why are young people in the prime of their physical lives feeling the need to take chemicals that alter the way their brain functions? Obviously people take drugs to achieve a desired effect. As noted, many drugs produce pleasurable feelings in varying degrees of intensity.
Vision asked Rod Colvin, author of Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding, about what leads young people into abusing medications. He remarked that a combination of factors typically play a role, but that significant among them is “the need to escape—to feel good—the same factor that motivates adults to start using drugs to ‘feel good.’” He went on, “People often want to escape because they have undiagnosed depression or other stressors in their lives, and a simple pill seems to deliver them from that feeling.” Of course, “the feel-good lasts for a while, but then the descent into chaos (with addiction) begins.”
In other words, substance abuse in teens can be a signal that they are experiencing mental issues more serious than “ordinary” adolescent mood swings, although the motivation for taking a drug may also be as simple as wanting to have more fun—to derive more pleasure from life. Or it may be to fit in with the crowd or to overcome some form of stress such as social anxiety or peer pressure. In addition, some students casually take stimulants to temporarily enhance mental (and thus academic) ability.
In a 2006 statement to the House Subcommittee on Criminal Justice, Drug Policy and Human Resources, NIDA director Nora D. Volkow agreed that the reasons for increasing prescription drug abuse in America are multifaceted. She listed “significant increases in the number of prescriptions; significant increases in drug availability; aggressive marketing by the pharmaceutical industry; the proliferation of illegal Internet pharmacies that dispense these medications without proper prescriptions and surveillance; and a greater social acceptability for medicating a growing number of conditions.” Volkow warned, “The fact that doctors are prescribing these drugs legitimately and with increasing frequency to treat a variety of ailments leads to the misguided and dangerous conclusion that their non-medical use should be equally safe.”
Colvin also comments on the “lack of awareness about the dangers of the drugs that initially make one feel good.” He notes that among young teens “there is a belief that pills are not as bad as street drugs or alcohol, but many times the long-term effects are the same, if not worse.” For example, adolescent use of drugs can result in long-term effects on brain function. According to a NIDA research report, “one of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that enables us to assess situations, make sound decisions, and keep our emotions and desires under control. The fact that this critical part of an adolescent’s brain is still a work in progress puts them at increased risk for poor decisions (such as trying drugs or continuing abuse). Thus, introducing drugs while the brain is still developing may have profound and long-lasting consequences.”
Taking the feel-good pills Colvin refers to is part of a destructive cycle that exacts an enormous physical and emotional price. In a press release for his book, he commented that “millions of Americans from every demographic group have fallen into the addiction trap, and it is shredding the emotional fabric of families across the nation. Not only are families losing loved ones, but addiction takes an emotional toll on the entire family—no one escapes the pain and chaos when a loved one is destroying himself or herself with prescription drugs.”
Deaths from drug overdose are classified as “poisoning” on death certificates, with the National Center for Health Statistics reporting that “in 2008, poisoning became the leading cause of injury death in the United States.” What is especially noteworthy, however, is that “nearly 9 out of 10 poisoning deaths are caused by drugs.” The agency attributes the increase at least in part to a higher use of prescription painkillers and sedatives.
But where are children and teens getting these drugs? In most cases they don’t have to look far. In-home medicine cabinets regularly provide a selection of drugs for the young to choose from. Those surveyed overwhelmingly identified a friend or (unwitting) relative as their source and confirmed that they had obtained the drugs for free. Many teens begin abusing drugs by sampling their parents’ prescription or OTC medications. In other words, finding a cheap source is not difficult. As more and more human behaviors and conditions are classified as disease and therefore chemically treatable, medicine cabinets are increasingly stocked with an array of enticing drugs.
It's All About Choice
Growing concern about the extent and consequences of prescription and OTC drug abuse is causing government agencies to go beyond reporting the problem to find ways to stem the tide. Drug awareness campaigns are certainly helpful to a point, but the issue needs to be addressed at its roots. NIDA has published a number of guides identifying risk factors that can lead to prescription drug abuse. They point out that the initial decision to take drugs is mostly voluntary. At some point a person makes a conscious decision to try a drug.
This is where the soundness of a child’s moral foundations comes into play. “Children’s earliest interactions within the family are crucial to their healthy development and risk for drug abuse,” says the NIDA guide. It further states that chief among protective factors are self-control, positive relationships, and parental monitoring and support (for more on this subject, see “Teaching Children the Art of Self-Control”).
All the causative factors contributing to drug abuse are interdependent, of course, and they prompt certain questions. If young people take a drug to feel good, then why aren’t they feeling good to begin with? What is going on in their life that tempts them to try to feel better through the use of a chemical? While a small percentage of people may have genetic predispositions that can work against them, environment is now known to play a part in whether specific genes are expressed. (This is at the heart of current research on the long-standing question of “nature versus nurture.”) And while some may simply be acting out as a result of normal adolescent hormonal ups and downs, the problem is clearly larger than can be explained by normal behaviors.
This is a problem of life-and-death proportions, and we cannot depend on legislation to solve the problem. New laws won’t change an individual’s thoughts, nor his or her ability to face life and all its challenges. The solution to the epidemic of drug abuse must focus on the individual—on the personal choices each one of us makes; no government can control people’s thought processes. A healthy morality has to be developed from within rather than be enforced from without. This requires an environment in which developing minds can learn to make healthy lifestyle choices, and that environment is ideally provided in the home (see “Eeny, Meeny, Miny, Mo: Teaching Children Decision-Making Skills”).
Where do parents begin? The best place to start, of course, is during infancy, when the foundations for self-regulation are most readily formed. Columbia University’s National Center on Addiction and Substance Abuse (CASA) has long urged prevention efforts aimed at young children. They advocate parental engagement as an important means of prevention. CASA founder Joseph Califano Jr. writes, “Parent power is the most potent, the least appreciated, and the most underutilized resource we have in the struggle to raise children free of drug and alcohol abuse and addiction.”
Parents of older children and teens needn’t throw up their hands, however. Many online sites are available to help parents (and teens) become responsibly educated about prescription drug use and abuse. They should educate themselves on the nature and extent of the problem and should work to establish and maintain good communication with their children—not just talking but listening. This serves as a preventive measure well before abuse might be suspected, but it can make a world of difference as you work through a known problem as well. Proper monitoring and supervision of medicines in the home is a must. And be aware of your child’s friends, watching for the usual signs of possible drug use.
If you have a problem or you suspect someone close to you does, get help. Professional advice and support are as close as your phone or the Internet.
In the end, it’s all about learning individual responsibility. What we’re suggesting is nothing less than a societal change in the way we view families and their role in the development of young minds. As the ancient proverb says, “Train a child in the way that he should go, and when he is old he will not turn from it” (Proverbs 22:6, NET Bible).
A healthy, stable family is a perfect organism for the development of morality. It provides young minds with access to mature minds that will nurture their development with love and concern. It provides the structure that young people need in their lives. It provides the positive environment for developing emotional maturity. Healthy thought patterns are established by parental training and example and are reinforced by love. Parental love provides the feeling of self-worth and security that young minds need to develop the physical foundations of morality within the brain’s structures. It comes down to this: morality is best established with the framework of moral families.
While it’s true that prescription drugs could be controlled more tightly by physicians, dispensing pharmacists and adults in the home, the real and long-term answer to our prescription drug abuse problem is to address the role that family should play in the moral development of future generations.