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Alcoholism & how it affects people.

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What are the other health consequences of drug addiction?

People with addiction often have one or more associated health issues, which could include lung or heart disease, stroke, cancer, or mental health conditions. Imaging scans, chest X-rays, and blood tests can show the damaging effects of long-term drug use throughout the body.

For example, it is now well-known that tobacco smoke can cause many cancers, methamphetamine can cause severe dental problems, known as meth mouth, and that opioids can lead to overdose and death. In addition, some drugs, such as inhalants, may damage or destroy nerve cells, either in the brain or the peripheral nervous system (the nervous system outside the brain and spinal cord).

Addiction and HIV/AIDS are intertwined epidemics.

Drug use can also increase the risk of contracting infections. HIV and hepatitis C (a serious liver disease) can occur from sharing injection equipment or from unsafe practices such as condom-less sex. Infection of the heart and its valves (endocarditis) and skin infection (cellulitis) can occur after exposure to bacteria by injection drug use.

Does drug use cause other mental disorders, or vice versa?

Drug use and other mental illness often co-exist. In some cases, mental disorders such as anxiety, depression, or schizophrenia may come before addiction. In other cases, drug use may trigger or worsen those mental health conditions, particularly in people with specific vulnerabilities.

Some people with disorders like anxiety or depression may use drugs in an attempt to alleviate psychiatric symptoms. This may exacerbate their mental disorder in the long run, as well as increase the risk of developing addiction. Treatment for all conditions should happen concurrently.

How can addiction harm other people?

The Impact of Addiction Can Be Far-Reaching

Cardiovascular disease

Stroke

Cancer

HIV/AIDS

Hepatitis B and C

Lung disease

Mental disorders

Beyond the harmful consequences for the person with the addiction, drug use can cause serious health problems for others. Some of the more severe consequences of addiction are:

Negative effects of drug use while pregnant or breastfeeding: A mother's substance or medication use during pregnancy can cause her baby to go into withdrawal after it's born, which is called neonatal abstinence syndrome (NAS). Symptoms will differ depending on the substance used, but may include tremors, problems with sleeping and feeding, and even seizures. Some drug-exposed children will have developmental problems with behavior, attention, and thinking. Ongoing research is exploring if these effects on the brain and behavior extend into the teen years, causing continued developmental problems. In addition, some substances can make their way into a mother's breast milk. Scientists are still learning about long-term effects on a child who is exposed to drugs through breastfeeding.

Negative effects of secondhand smoke: Secondhand tobacco smoke exposes bystanders to at least 250 chemicals that are known to be harmful, particularly to children.Involuntary exposure to secondhand smoke increases the risks of heart disease and lung cancer in people who have never smoked. Additionally, the known health risks of secondhand exposure to tobacco smoke raise questions about whether secondhand exposure to marijuana smoke poses similar risks. At this point, little research on this question has been conducted. However, a study found that some nonsmoking participants exposed for an hour to high-THC marijuana in an unventilated room reported mild effects of the drug, and another study showed positive urine tests in the hours directly following exposure. If you inhale secondhand marijuana smoke, it's unlikely you would fail a drug test, but it is possible.

Increased spread of infectious diseases: Injection of drugs accounts for 1 in 10 of cases of HIV. Injection drug use is also a major factor in the spread of hepatitis C, and can be the cause of endocarditis and cellulitis. Injection drug use is not the only way that drug use contributes to the spread of infectious diseases. Drugs that are misused can cause intoxication, which hinders judgment and increases the chance of risky sexual behaviors, such as condom-less sex.

Increased risk of motor vehicle accidents: Use of illicit drugs or misuse of prescription drugs can make driving a car unsafe-just like driving after drinking alcohol. Drugged driving puts the driver, passengers, and others who share the road at risk. In 2016, almost 12 million people ages 16 or older reported driving under the influence of illicit drugs, including marijuana.After alcohol, marijuana is the drug most often linked to impaired driving. Research studies have shown negative effects of marijuana on drivers, including an increase in lane weaving, poor reaction time, and altered attention to the road.

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Addiction and Health | National Institute on Drug Abuse

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What are the other health consequences of drug addiction? People with addiction often have one or more associated health issues, which could include lung or heart disease, stroke, cancer, or mental health conditions. Imaging scans, chest X-rays, and blood tests can show the damaging effects of long-term drug use throughout the body.

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Oregon is having a crisis with the addiction of fentanyl

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A new legislative committee convened Wednesday with a look at the state's threadbare treatment system.

A lethal dose of fentanyl, in this image from the U.S. Drug Enforcement Administration.
Courtesy of the U.S. Drug Enforcement Administration

Oregon lawmakers say they're serious about tackling Oregon's addiction crisis - from stanching the supply of fentanyl on city streets to reducing Oregonians' demand for drugs.

That urgent response got off to a slow start Wednesday, as a new joint legislative committee held its first hearing in what leaders say will be a yearslong effort.

"We're here today because the current state of the drug crisis in Oregon is unacceptable," said state Senate Majority Leader Kate Lieber, D-Portland, co-chair of the new Joint Committee on Addiction and Community Safety Response. "People don't feel safe on the streets. Oregonians are not getting the addiction treatment that they need when they need it. We are grappling with cheap deadly fentanyl that has hit our streets in the last three or four years in a big, big way."

Lieber and her co-chair, Bend Democratic Rep. Jason Kropf, have promised the committee will take a holistic look at addressing the factors that have seen overdoses and public drug use surge in recent years, and which appear to have voters ready to roll back the state's pioneering drug decriminalization experiment.

For some longtime public health and addiction experts, the conversation is long overdue.

"I haven't seen this in 19 years," said Debby Jones, a prevention specialist in Wasco County and member of the state's Alcohol and Drug Policy Commission. "I can't thank you enough for coming together and saying we can do something."

But before they do anything, lawmakers want to learn all about the current state of things. For hours Wednesday, the eight-member committee listened to presentations about Oregon's current system for preventing and treating drug addiction. The overarching message: Oregon doesn't have enough treatment beds, detox centers, workers qualified to assist drug users, or pretty much anything else.

"So long as it's easier to get fentanyl than it is to get the treatment for opioid use disorder, we will continue to see a rise in overdose deaths," said Kimberly Sue, an assistant professor at Yale Medical School who has worked with drug users and studied effective treatment strategies.

By many measures, Oregon's outlook is worrisome.

An estimated 19.4% of Oregonians age 12 and up have grappled with substance use disorder in the last year, according to the most recent national survey data, higher than the national rate of 16.5%.

At the same time, the state is among the worst at providing treatment. The survey suggested more than 17% of Oregonians needed but did not receive treatment for addiction in the past year, compared to around 14.5% nationally.

Recently, Oregon has attempted to quantify precisely how many more treatment services it needs in each county. An updated study released earlier this year by the OHSU-PSU School of Public Health found a roughly 50% gap between existing services and what's needed statewide - with the most pronounced shortfalls in Washington and Clackamas counties.

For example, the study found the state should have roughly 12,600 qualified mental health professionals, but currently has just 879, just 7% of what's needed. It's also short 2,000 drug and alcohol counselors and more than 17,700 qualified mental health associates (a position that assists patients with mental health matters but requires less schooling than a mental health professional).

One bit of good news: Oregon no longer ranks as the top state in the nation when it comes to rate of substance use disorder and lack of access to treatment, according to the most recent national survey data. Vermont, New Mexico and others have outpaced the Beaver State on those measures.

Lawmakers heard Wednesday from the Alcohol and Drug Policy Commission, a volunteer group of experts appointed by the governor and tasked with improving the state's response to addiction. The commission intends to come up with recommendations for lawmakers by the end of the year for how to turn the tide of rising overdose deaths.

But the group is wrestling with how best to measure progress in terms of the Legislature's mission of curbing drug addiction in Oregon, said director Annaliese Dolph.

"That's something we are figuring out: What is our measure for success," Dolph said, adding that other states have focused on deaths related to drug use.

According to the Centers for Disease Control and Prevention, Oregon ranked 34th among states in its rate of drug overdose deaths in 2021. But that rate has more than doubled since 2018, and preliminary data suggests it's risen higher since the more official figures were released.

Lawmakers also heard from Sue, with Yale Law School, who sketched out what the response to fentanyl has looked like in states like New York and Massachusetts that have grappled with the drug longer than Oregon.

Sue cautioned lawmakers against forced drug treatment, which she said can increase a person's likelihood of eventually overdosing. She raised the possibility of supervised use centers, which have been rolled out in New York, as one option for curbing public drug use and preventing overdoses. And she emphasized the importance of medication like methadone and buprenorphine in helping wean people off of addiction.

"I would ensure people want to go voluntarily," she said. "Make sure people have the autonomy to go to treatment."

Under Measure 110, the 2020 law that decriminalized possession of small amounts of drugs, the decision to seek treatment is voluntary, with no consequences for users who decide to simply ignore tickets for being caught with drugs. A group of wealthy Portlanders has vowed to push a ballot measure next year that would roll back Measure 110, create harsher penalties for dealers, mandate treatment for people caught using drugs, and much more.

How the testimony will inform policy proposals during next year's legislative session remains to be seen. Both Lieber and Kropf have said all policy options are on the table as they look at ways to address the issue

So far, many of the more prominent proposals are punitive.

In recent weeks, lawmakers have increasingly talked about a bill that would give police the option of stopping people caught using drugs in public - even if the possession of those drugs is not a crime under Oregon law.

That's an approach that Portland city commissioners have clamored for, as public drug use has become more visible. When Oregonians decriminalized possession of small amounts of drugs with 2020′s Measure 110, cities found themselves hamstrung from stopping people from using in public.

"We're clearly going to do something about public use," said state Rep. Rob Nosse, D-Portland, a member of the committee.

Lawmakers are also looking seriously at allowing prosecutors to convict people for dealing drugs more easily, after a recent court ruling that upended three decades of precedent.

The committee plans to meet three more times ahead of the February legislative session. November's meeting will be focused on the state's criminal justice approach to tamping down the supply of drugs.

"Oregonians believe that Measure 110 has been a failure," said Senate Minority Leader Tim Knopp, R-Bend, a committee member. "It is incumbent on us as the Legislature to address this... and I really don't want to wait another year for a ballot measure."

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Oregon lawmakers begin 'urgent' effort to address the state's addiction crisis

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Oregon lawmakers say they're serious about tackling Oregon's addiction crisis - from stanching the supply of fentanyl on city streets to reducing Oregonians' demand for drugs.

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Drugs and Alcohol Can Hijack Your Brain

People with addiction lose control over their actions. They crave and seek out drugs, alcohol, or other substances no matter what the cost-even at the risk of damaging friendships, hurting family, or losing jobs. What is it about addiction that makes people behave in such destructive ways? And why is it so hard to quit?

NIH-funded scientists are working to learn more about the biology of addiction. They've shown that addiction is a long-lasting and complex brain disease, and that current treatments can help people control their addictions. But even for those who've successfully quit, there's always a risk of the addiction returning, which is called relapse.

The biological basis of addiction helps to explain why people need much more than good intentions or willpower to break their addictions.

"A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth," says Dr. George Koob, director of NIH's National Institute on Alcohol Abuse and Alcoholism. "The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you've taken, the more disruptive it is to the brain."

Researchers have found that much of addiction's power lies in its ability to hijack and even destroy key brain regions that are meant to help us survive.

A healthy brain rewards healthy behaviors-like exercising, eating, or bonding with loved ones. It does this by switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviors. In contrast, when you're in danger, a healthy brain pushes your body to react quickly with fear or alarm, so you'll get out of harm's way. If you're tempted by something questionable-like eating ice cream before dinner or buying things you can't afford-the front regions of your brain can help you decide if the consequences are worth the actions.

But when you're becoming addicted to a substance, that normal hardwiring of helpful brain processes can begin to work against you. Drugs or alcohol can hijack the pleasure/reward circuits in your brain and hook you into wanting more and more. Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you're not using the drugs or alcohol. At this stage, people often use drugs or alcohol to keep from feeling bad rather than for their pleasurable effects.

To add to that, repeated use of drugs can damage the essential decision-making center at the front of the brain. This area, known as the prefrontal cortex, is the very region that should help you recognize the harms of using addictive substances.

"Brain imaging studies of people addicted to drugs or alcohol show decreased activity in this frontal cortex," says Dr. Nora Volkow, director of NIH's National Institute on Drug Abuse. "When the frontal cortex isn't working properly, people can't make the decision to stop taking the drug-even if they realize the price of taking that drug may be extremely high, and they might lose custody of their children or end up in jail. Nonetheless, they take it."

Scientists don't yet understand why some people become addicted while others don't. Addiction tends to run in families, and certain types of genes Stretches of DNA, a substance you inherit from your parents, that define characteristics such as your risk for certain disorders, such as addiction. have been linked to different forms of addiction. But not all members of an affected family are necessarily prone to addiction. "As with heart disease or diabetes, there's no one gene that makes you vulnerable," Koob says.

Other factors can also raise your chances of addiction. "Growing up with an alcoholic; being abused as a child; being exposed to extraordinary stress-all of these social factors can contribute to the risk for alcohol addiction or drug abuse," Koob says. "And with drugs or underage drinking, the earlier you start, the greater the likelihood of having alcohol use disorder or addiction later in life."

Teens are especially vulnerable to possible addiction because their brains are not yet fully developed-particularly the frontal regions that help with impulse control and assessing risk. Pleasure circuits in adolescent brains also operate in overdrive, making drug and alcohol use even more rewarding and enticing.

NIH is launching a new nationwide study to learn more about how teen brains are altered by alcohol, tobacco, marijuana, and other drugs. Researchers will use brain scans and other tools to assess more than 10,000 youth over a 10-year span. The study will track the links between substance use and brain changes, academic achievement, IQ, thinking skills, and mental health over time.

Although there's much still to learn, we do know that prevention is critical to reducing the harms of addiction. "Childhood and adolescence are times when parents can get involved and teach their kids about a healthy lifestyle and activities that can protect against the use of drugs," Volkow says. "Physical activity is important, as well as getting engaged in work, science projects, art, or social networks that do not promote use of drugs."

To treat addiction, scientists have identified several medications and behavioral therapies-especially when used in combination-that can help people stop using specific substances and prevent relapse. Unfortunately, no medications are yet available to treat addiction to stimulants such as cocaine or methamphetamine, but behavioral therapies can help.

"Treatment depends to a large extent on the severity of addiction and the individual person," Koob adds. "Some people can stop cigarette smoking and alcohol use disorders on their own. More severe cases might require months or even years of treatment and follow-up, with real efforts by the individual and usually complete abstinence from the substance afterward."

NIH-funded researchers are also evaluating experimental therapies that might enhance the effectiveness of established treatments. Mindfulness meditation and magnetic stimulation of the brain are being assessed for their ability to strengthen brain circuits that have been harmed by addiction. Scientists are also examining the potential of vaccines against nicotine, cocaine, and other drugs, which might prevent the drug from entering the brain.

"Addiction is a devastating disease, with a relatively high death rate and serious social consequences," Volkow says. "We're exploring multiple strategies so individuals will eventually have more treatment options, which will increase their chances of success to help them stop taking the drug."

To find publicly funded addiction treatment centers in your state, call 1-800-622-HELP, or visit https://findtreatment.samhsa.gov/.

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People with addiction crave and seek out drugs or alcohol no matter what the cost. What is it about addiction that makes people lose control? And why is it so hard to quit?

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when Jekyll took the potion, his brain could have rewarded his system by releasing dopamine (which most drugs do). This release results into an addiciton.

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Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease-people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn't work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient's changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.

Environment. A person's environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction.

Development. Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn't a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient's drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.

Brain changes that occur over time with drug use challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.

Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.

Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.

Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.

No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.

Drug addiction is treatable and can be successfully managed.

More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Learn more

For information about understanding drug use and addiction, visit:

For more information about the costs of drug abuse to the United States, visit:

For more information about prevention, visit:

For more information about treatment, visit:

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

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Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse

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Provides an overview of drug use and addiction, including what happens in the brain during drug use, why some people become addicted while others don't, and the importance of prevention.

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Introducing the Human Brain

The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity-you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. The brain regulates your body's basic functions, enables you to interpret and respond to everything you experience, and shapes your behavior. In short, your brain is you -everything you think and feel, and who you are.

How does the brain work?

The brain is often likened to an incredibly complex and intricate computer. Instead of electrical circuits on the silicon chips that control our electronic devices, the brain consists of billions of cells, called neurons, which are organized into circuits and networks. Each neuron acts as a switch controlling the flow of information. If a neuron receives enough signals from other neurons that it is connected to, it fires, sending its own signal on to other neurons in the circuit.

The brain is made up of many parts with interconnected circuits that all work together as a team. Different brain circuits are responsible for coordinating and performing specific functions. Networks of neurons send signals back and forth to each other and among different parts of the brain, the spinal cord, and nerves in the rest of the body (the peripheral nervous system).

To send a message, a neuron releases a neurotransmitter into the gap (or synapse) between it and the next cell. The neurotransmitter crosses the synapse and attaches to receptors on the receiving neuron, like a key into a lock. This causes changes in the receiving cell. Other molecules called transporters recycle neurotransmitters (that is, bring them back into the neuron that released them), thereby limiting or shutting off the signal between neurons.

How do drugs work in the brain?

Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter in the body. This allows the drugs to attach onto and activate the neurons. Although these drugs mimic the brain's own chemicals, they don't activate neurons in the same way as a natural neurotransmitter, and they lead to abnormal messages being sent through the network.

Other drugs, such as amphetamine or cocaine, can cause the neurons to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals by interfering with transporters. This too amplifies or disrupts the normal communication between neurons.

What parts of the brain are affected by drug use?

Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that marks addiction. Brain areas affected by drug use include:

The basal ganglia, which play an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain's "reward circuit." Drugs over-activate this circuit, producing the euphoria of the drug high. But with repeated exposure, the circuit adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.

The extended amygdala plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high.

The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala make a person with a substance use disorder seek the drug compulsively with reduced impulse control.

Some drugs like opioids also disrupt other parts of the brain, such as the brain stem, which controls basic functions critical to life, including heart rate, breathing, and sleeping. This interference explains why overdoses can cause depressed breathing and death.

How do drugs produce pleasure?

Simple activities in everyday life can produce small bursts of neurotransmitters in the brain bringing pleasurable feelings. Drugs can hijack that process.

Pleasure or euphoria-the high from drugs-is still poorly understood, but probably involves surges of chemical signaling compounds including the body's natural opioids (endorphins) and other neurotransmitters in parts of the basal ganglia (the reward circuit). When some drugs are taken, they can cause surges of these neurotransmitters much greater than the smaller bursts naturally produced in association with healthy rewards like eating, hearing or playing music, creative pursuits, or social interaction.

It was once thought that surges of the neurotransmitter dopamine produced by drugs directly caused the euphoria, but scientists now think dopamine has more to do with getting us to repeat pleasurable activities (reinforcement) than with producing pleasure directly.

How does dopamine reinforce drug use?

The feeling of pleasure is how a healthy brain identifies and reinforces beneficial behaviors, such as eating, socializing, and sex. Our brains are wired to increase the odds that we will repeat pleasurable activities. The neurotransmitter dopamine is central to this. Whenever the reward circuit is activated by a healthy,

pleasurable experience, a burst of dopamine signals that something important is happening that needs to be remembered. This dopamine signal causes changes in neural connectivity that make it easier to repeat the activity again and again without thinking about it, leading to the formation of habits.

Just as drugs produce intense euphoria, they also produce much larger surges of dopamine, powerfully reinforcing the connection between consumption of the drug, the resulting pleasure, and all the external cues linked to the experience. Large surges of dopamine "teach" the brain to seek drugs at the expense of other, healthier goals and activities.

Cues in a person's daily routine or environment that have become linked with drug use because of changes to the reward circuit can trigger uncontrollable cravings whenever the person is exposed to these cues, even if the drug itself is not available. This learned "reflex" can last a long time, even in people who haven't used drugs in many years. For example, people who have been drug free for a decade can experience cravings when returning to an old neighborhood or house where they used drugs. Like riding a bike, the brain remembers.

Why are drugs more addictive than natural rewards?

For the brain, the difference between normal rewards and drug rewards can be likened to the difference between someone whispering into your ear and someone shouting into a microphone. Just as we turn down the volume on a radio that is too loud, the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals. As a result, the person's ability to experience pleasure from naturally rewarding (i.e., reinforcing) activities is also reduced.

This is why a person who misuses drugs eventually feels flat, without motivation, lifeless, and/or depressed, and is unable to enjoy things that were previously pleasurable. Now, the person needs to keep taking drugs to experience even a normal level of reward-which only makes the problem worse, like a vicious cycle. Also, the person will often need to take larger amounts of the drug to produce the familiar high-an effect known as tolerance.

Long-term drug use impairs brain functioning.

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Drugs and the Brain | National Institute on Drug Abuse

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shows how more people are going to addiction, like the potion, these addictions are very hard to remove from your life

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San Diego - The Department of Alcoholic Beverage Control (ABC) has issued a 45-day suspension of Beverage House Liquor, located at 1370 East Vista Way, in the city of Vista, after an investigation found the business sold alcohol twice to a 20-year-old minor on March 22, 2022. The minor shared the alcohol with a group of underage friends and one of the minors drove under the influence and caused a fatal car crash. The business cannot sell alcohol for the next 45 days, and if any similar violations occur within the two-year stayed period, ABC has authority to revoke the license permanently.

ABC opened a Target Responsibility for Alcohol Connected Emergencies (TRACE) investigation immediately after the incident to determine the source of the alcohol that was illegally sold. ABC agents determined that Beverage House Liquor employee Eugenio Canada, sold distilled spirits on two separate occasions in the same evening to the underage customer without ever checking ID. The customer then furnished the alcohol to his underage friends.

The group of minors drove to the city of San Diego where they shared the alcohol. On the way back to Vista, the driver crashed into another vehicle. One passenger died, and the driver and remaining passengers suffered serious injuries.

"Preventing underage drinking is a public safety priority," said ABC Director Joseph McCullough. "It is important for licensees to check IDs to prevent tragedies like this from occurring."

ABC filed disciplinary action against Beverage House Liquor's alcoholic beverage license for furnishing alcoholic beverages to a minor resulting in great bodily injury and death. Beverage House Liquor settled the action and agreed to a 45-day suspension of their liquor license, with a two-year revocation stayed.

The TRACE program is made possible by a grant from the California Office of Traffic Safety (OTS) through the National Highway Traffic Safety Administration (NHTSA). The grant provides funding for ABC investigations of alcohol-related incidents that involve a person under 21 causing great bodily injury or death, or anyone charged with vehicular manslaughter that was under the influence of alcohol regardless of their age.

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San Diego Liquor Store Suspended for Underage Alcohol Sales

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Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters.

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Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters.

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brain’s own chemicals, they don’t activate neurons in the same way as a natural

neurotransmitter, and they lead to abnormal messages being sent through the network.

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People with addiction often have one or more associated health issues, which could include lung or heart disease, stroke, cancer, or mental health conditions.

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Drug use and other mental illness often co-exist. In some cases, mental disorders such as anxiety, depression, or schizophrenia may come before addiction. In other cases, drug use may trigger or worsen those mental health conditions, particularly in people with specific vulnerabilities

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The basal ganglia, which play an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain’s “reward circuit.” Drugs over-activate this circuit, producing the euphoria of the drug high. But with repeated exposure, the circuit adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.

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The extended amygdala plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high

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The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala make a person with a substance use disorder seek the drug compulsively with reduced impulse control.

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"His terror of the gallows drove him continually to commit temporary suicide, and return to his subordinate station of a part instead of a person; but he loathed the necessity, he loathed the despondency into which Jekyll was now fallen, and he resented the dislike with which he was himself regarded. Hence the ape-like tricks that he would play me, scrawling in my own hand blasphemies on the pages of my books, burning the letters and destroying the portrait of my father; and indeed, had it not been for his fear of death, he would long ago have ruined himself in order to involve me in the ruin."

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"This, then, is the last time, short of a miracle, that Henry Jekyll can think his own thoughts or see his own face (now how sadly altered!) in the glass. Nor must I delay too long to bring my writing to an end; for if my narrative has hitherto escaped destruction, it has been by a combination of great prudence and great good luck."

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"It was no longer the fear of the gallows, it was the horror of being Hyde that racked me."

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"My devil had been long caged, he came out roaring. I was conscious, even when I took the draught, of a more unbridled, a more furious propensity to ill. It must have been this, I suppose, that stirred in my soul that tempest of impatience with which I listened to the civilities of my unhappy victim; I declare, at least, before God, no man morally sane could have been guilty of that crime upon so pitiful a provocation; and that I struck in no more reasonable spirit than that in which a sick child may break a plaything."

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Men have before hired bravos to transact their crimes, while their own person and reputation sat under shelter. I was the first that ever did so for his pleasures. I was the first that could plod in the public eye with a load of genial respectability, and in a moment, like a schoolboy, strip off these lendings and spring headlong into the sea of liberty

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A healthy brain rewards healthy behaviors—like exercising, eating, or bonding with loved ones. It does this by switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviors. In contrast, when you’re in danger, a healthy brain pushes your body to react quickly with fear or alarm, so you’ll get out of harm’s way. If you’re tempted by something questionable—like eating ice cream before dinner or buying things you can’t afford—the front regions of your brain can help you decide if the consequences are worth the actions.

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“The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.”

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"I knew well that i risked death; for any drug that so potently controlled and shook the very fortress of identity"

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we can start talking about how drugs can get you hooked very easily and then someone can bring up a quote from the last chapter where Jekyll is talking about how he was fortified on all sides and he was starting to profit from the drug

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An anti-narcotics poster at customs at the Golden Triangle Special Economic Zone in north-west Laos [Alastair McCready/Al Jazeera]

Vientiane, Laos - Keo remembers the day he consumed so much yaba that he "lost his mind."

The 37-year-old from Laos took more of the drug - a potent combination of methamphetamine and caffeine - than he had ever done before.

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"I took 10 pills and I was totally lost. I didn't recognise my family, I didn't even recognise my children," the father of two told Al Jazeera at the Transformation Center, a drug rehab facility 25km (16 miles) outside the Lao capital Vientiane, where he is receiving treatment.

"I couldn't sleep at all. I didn't drink, I didn't eat. I felt powerful."

Drug-free for just four days, Keo cut a frail and subdued figure as he explained that yaba, which means "crazy medicine" in Thai, helps him "escape all the thoughts".

He said it was his family who made him seek help. A yaba user for 17 years, he said the Southeast Asian country's drug landscape has transformed in that time.

"When I started, drugs were not this common," he said. "Now there's more and more; it's everywhere now, even in Vientiane."

The growing availability of methamphetamine in Laos, as witnessed by drug users like Keo, is part of a nationwide surge in supply that has today reached "unprecedented" levels, United Nations experts told Al Jazeera.

Part of the problem is neighbouring Myanmar, where the 2021 coup has created a violent conflict and a vacuum in law and order that has allowed drug syndicates to thrive.

In Laos, the poorly-resourced police are facing a deluge of narcotics as the country has become a vital trafficking corridor in Asia's drug trade. The surge has pushed prices down to record lows, with front-line workers saying pills are now being sold for as little as $0.24 cents each -cheaper than most basic necessities like food and water and making the drug affordable to all in one of Asia's poorest countries.

Bounme, the assistant director at the Transformation Center, one of only two privately-run rehabilitation centres in the country, told Al Jazeera that while "everything got more expensive" in Laos during COVID-19, "drugs got cheaper, a lot cheaper." He preferred to be identified only by one name.

"Drug users tell me one piece of yaba is 5,000 to 7,000 kip [$0.24 to $0.34] now," said Bounme, who interviews new patients entering the clinic. "If you buy a pack of 200, you can get it as cheap as 2,500 [$0.12] per pill."

'A recipe for disaster'

The Golden Triangle, the remote area in which the borders of Thailand, Myanmar and Laos meet, has long been one of the world's major drug-producing hotspots. Historically, it was notorious for opium, but recent years have seen drug syndicates turn to producing methamphetamine pills and crystal meth - a distilled, more potent and expensive variety of the drug.

Groups in Myanmar are at the heart of this trade, most prominently Shan state - a war-torn region in the country's east sharing a long, porous border with Laos. For decades, the drug trade has provided vital funds for ethnic armed groups and military-aligned militias in the troubled state, with narcotics flowing across the border into China, Laos, and Thailand and onto the international market.

The coup in Myanmar has only accelerated the industry's output.

The generals' removal of the democratically-elected National League for Democracy government drove widespread protests and the military's brutal response pushed the pro-democracy movement into a nationwide armed resistance.

With growing lawlessness and intensified fighting across the country, the anti-narcotics efforts of certain ethnic armed groups and the Myanmar authorities have been hampered. More militias under the command of the military have also reportedly turned to drugs to fund food and salaries for their soldiers.

In Shan state, these post-coup conditions have created a "perfect storm" for drug production, according to Jeremy Douglas, the United Nations Office on Drugs and Crime's (UNODC) regional representative for Southeast Asia and the Pacific.

"You have the breakdown of security in Shan state, an acceleration [of drug production] post-coup, and a massive and very porous border along the Mekong river between Shan and Laos," he told Al Jazeera. "It's a recipe for disaster."

The chaos has resulted in record flows of narcotics over the border into Laos, with Douglas saying that the country, as the "path of least resistance," has become a "major gateway" for drugs into the region.

"When you look at drug supply, it's at unprecedented levels, there's no doubt about that. Laos has never seen the volumes that they see now," he said. "Traffickers are using Laos to move massive quantities of drugs from Shan out to regional and international markets, and larger volumes of chemicals back the other way."

Lao authorities have registered several high-profile wins in their battle against the traffickers. Notably, in October 2021, they conducted Asia's largest-ever drug bust, intercepting a beer truck in Bokeo province carrying 55 million methamphetamine tablets and 1.5 tonnes of crystal meth.

A June report by UNODC also showed a second successive record-breaking year for seizures of methamphetamine tablets in Laos in 2022, with 144 million pills intercepted. In 2019 and 2020, this figure stood at just 17.7 million and 18.6 million respectively.

But while large seizures make for good headlines, the criminal networks facilitating the shipments have been left untouched, according to an international observer with close knowledge of Laos. The source, who requested anonymity due to the sensitivity of his work, told Al Jazeera that "philosophical differences" with Western anti-narcotics approaches, combined with a "lack of capacity", means "there doesn't seem to be any real effort to identify drug networks".

"The drug seizure is the goal [for Lao police] and the seizures seem to be ad hoc in nature," he said. "More troubling, authorities often don't make an arrest at all; very often they don't even arrest the driver of the vehicle."

The Lao government could not be reached for comment.

The source said that, while collusion between officials and criminal networks does occur, he generally believes there is a "sincere" effort by Lao authorities to crack down on drug trafficking.

But he says he is concerned the current approach is misguided because the amount of drugs being seized is probably only a tiny fraction of the total entering the country.

"We see a lot of seizures, but that doesn't actually give a real sense of the volume that's not being detected," the source said. "There's a clear oversupply, so whatever efforts are being made to limit the intake is not having an impact. The falling price is a great indicator of that."

Some of the world's cheapest meth

That price has fallen so far that Douglas said Laos now offers "close to the cheapest" meth in the world - alongside Myanmar and parts of northern Thailand. This is part of a "total price collapse" around the drug as the region has been flooded with pills.

"Meth tablets are probably a third or maybe a quarter of what they were five or six years ago," he said. "Laos may not be a wealthy country but you don't need much money to use yaba these days. It's cheaper than beer and fried rice."

Karen Peters, a regional drug and health programme officer at UNODC who has supported community-based drug rehabilitation projects in Laos for eight years, told Al Jazeera that while methamphetamine is now "ridiculously cheap", the extent to which this has translated to wider drug use in the general population remains unclear in the absence of reliable statistics.

The Lao National Commission for Drug Control and Supervision estimates there were about 90,000 drug users as of 2023, or about 1 percent of the population, based on government surveys. Peters said these figures should be taken "with a pinch of salt" given the country's highly punitive approach to drug use. She added that it was "impossible to get accurate data" in the absence of more nuanced collection methods like wastewater testing and anonymous online surveys.

"[In Laos], drug use can land you in a compulsory treatment centre or prison," she said. "If I have a government official knocking on my door asking about the number of people that use drugs in my house, why would I admit it?"

But while the link between falling prices and increased availability with the growth in drug users across Laos is yet to be established, what is clear to Bounme at the Transformation Center is that these factors have tightened the drug's grip on those already addicted.

"People these days seem to use more," he said. "Some people take two or three, maybe five pills a day."

Bounme oversees a holistic treatment programme at the centre - including daily tasks like cooking, cleaning and tending to a small farm with ducks, chickens and geese - intended to instil a sense of responsibility and structure in the men. A separate centre provides help to women and children who use drugs.

For newly-arrived Keo, he hopes his time at the Transformation Center will be a turning point but he is aware of the grip yaba has had on him for almost all of his adult life.

"I've tried several times to quit but I wake up and start using again," Keo said. "But someone from my village came here and now he's free. I want to be like that."
Additional reporting by Lamxay Duangchan

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'Cheaper than beer': Laos meth prices plummet as Myanmar chaos fuels trade

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Front-line workers say methamphetamine pills are being sold for as little as $0.25 each.

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"I felt younger, lighter, happier in body; wither I was conscious of a heady recklessness, a current of disordered sensual images running like a millrace in my fancy, a solution of the bonds of obligation, an unknown but not an innocent freedom of the soul. I knew myself, at the first breath of this new life, to be more wicked, tenfold more wicked, sold a slave to my original evil; and the thought, in that moment, braced and delighted me like wine."

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“ I was stepping leisurely across the court after breakfast, drinking the chill of the air with pleasure, when I was seized again with those indescribable sensations that heralded the change; and I had but the time to gain the shelter of my cabinet, before I was once again raging and freezing with the passions of Hyde. It took on this occasion a double dose to recall me to myself; and alas! six hours after, as I sat looking sadly in the fire, the pangs returned, and the drug had to be re-administered”