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 seeking, and use despite harmful and often devastating consequences. For more information, visit http://archives.drugabuse.gov/about/welcome/aboutdrugabuse/ (Archives).

 It's true that for most people, the initial decision to take drugs is voluntary.

Over time, however, the brain changes that occur with drug abuse erode a person's self control and ability to make sound decisions, while prompting intense urges to take drugs.

To understand how drugs work in the brain first requires a general understanding of the brain itself - not an easy task, given that that the brain is the most complex organ in the human body. The brain has multiple systems that control how our bodies function - everything from when we sleep, to how we feel, to what we think, to what we like to eat, etc. The brain controls these systems through a far-reaching communications network that uses chemical messengers (neurotransmitters) to transmit messages between nerve cells (neurons). When the brain is exposed to drugs, a variety of systems are compromised, since the communications network that runs them is impaired. There are at least two ways in which drugs disrupt communication in the brain:

• Imitating natural neurotransmitters (chemical messengers in the brain). Because of the similarity in chemical structure between certain drugs (such as marijuana and heroin) and the neurotransmitters naturally produced by the brain, drugs are able to "fool" the neurons into sending abnormal messages via the network.
• Over-stimulating the reward system by flooding the circuit with dopamine, which is a neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure. Nearly all drugs of abuse directly or indirectly increase dopamine signals in the reward pathway. Some drugs, particularly stimulants like methamphetamine, cause nerve cells to release abnormally large amounts of dopamine, whereas others, such as cocaine, prevent the normal recycling of dopamine, which is needed to shut off the signal between neurons

This is a difficult question, and the answer is complex. We know that many factors affect vulnerability to addiction and protection from it. These include: the drug itself and how it is taken (smoked, swallowed, injected), how often, and how easy it is to get; individual differences based on genes, gender, age, and other events in a person's life, including past experiences; and cultural/societal factors related to norms, economics, and legal consequences, for example. And this is only a partial list.

In fact, no single factor can predict whether or not a person will become addicted to drugs - any drugs. However, the more risk factors an individual has, the greater the chance that taking drugs will lead to addiction. For example:

• Biology. People with a family history of addiction to drugs or alcohol may have an increased genetic risk for becoming addicted - it is estimated that genes account for about half of this vulnerability. But it is not only having these genes that matters, it is how they interact with other biological (e.g. gender, ethnicity, mental illness) and environmental (e.g. stress, poverty, drug availability) factors that accounts for a person's vulnerability to addiction. Even with no family history of alcohol or drug addiction, an individual is not safe from addiction; anyone who uses drugs, regardless of family history, is at risk. So while genes play a significant role, they do not by themselves determine whether someone becomes addicted.
• Environment. A person's environment includes many different influences - from family and friends to socioeconomic status to quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person's life.
• Development. Drug abuse and addiction typically begin in adolescence and sometimes even earlier. Research shows that the younger a person is when they start using drugs, the greater his or her chances of developing later drug problems. This may be because the brain does not fully mature until about age 25; thus, exposure to drugs may alter its development. Moreover, the last parts of the brain to develop are the ones responsible for decision-making, judgment, and self-control, which helps explain why adolescents are especially prone to risk-taking behaviors, including trying drugs of abuse.

Understanding why some people become addicted to drugs and others do not is a complex issue and one that our still-evolving science is addressing. In assessing personal risk, it is important to consider family history, social environment, and age, among other factors. Ultimately, the only way to avoid becoming addicted to drugs is not to use them, since it is not possible for a person to predict whether or when they will become addicted and if they do, how ravaged their life will be as a result. In fact, addiction is only one serious consequence that can result from drug abuse - accidents, disease, and other harms can occur even with a single use.

If a person is compulsively seeking and using a drug despite negative consequences, such as loss of job, debt, physical problems brought on by drug abuse, or family problems, then he or she probably is addicted.

The physical signs of abuse or addiction can vary depending on the person and the drug being abused. Each drug has short-term and long-term physical effects. And while some of these effects can be seen, others can not. It is therefore important that if you suspect a loved one is addicted, you suggest they seek professional help to determine if this is the case and, if so, the appropriate treatment.

Length of withdrawal and the severity of physical symptoms vary with the type of drug and how long it has been taken. For example, physical symptoms of highly addictive drugs, such as heroin, may not only include difficult physical symptoms that may last for several days, but also general depression, or dysphoria (opposite of euphoria), that can last for weeks. In many cases, withdrawal can be treated with medications to ease the symptoms, but treating withdrawal symptoms and/or detoxifying the body from drugs is not the same as treating addiction - it is only the first step and should be followed by treatment with a behavioral-based therapy and/or a medication, if available.

http://www.drugabuse.gov/news-events/public-education-projects/hbo-addiction-project/hbo-addiction-project-frequently-asked-questions#12

Drugs produce abnormally large surges in dopamine in the brain's reward structures that lead to the "high" drug users often refer to. In response, the brain becomes less reactive to the drug, and the user feels less and less of a "high" from the same amount of the drug - an effect known as tolerance. In addition, because drugs tap into the same parts of the brain involved with natural rewards - such as seeing a good friend or eating a delicious meal - the brain also becomes less sensitive to these types of everyday non-drug-related events and activities. As addiction deepens, the drugs become less an added positive experience and more a necessity for the brain (and the abuser) merely to feel "normal."

In addition to the dopamine-release system, or the reward system, long-term drug abuse changes other brain chemical systems that control the ability to learn, to remember, and to exert control over one's behavior. With repeated abuse, a type of conditioning (or non-conscious memory formation) occurs in which a person becomes highly sensitive to environmental cues associated with drug-taking. These cues can include people, places, or even mood states linked to the drug experience. They can trigger uncontrollable drug cravings, even when the drug itself is not available, and lead to relapse in formerly abstinent drug abusers.

All of the changes that take place in the brain from repeated exposure to drugs constitute addiction. Brain imaging studies of drug-addicted individuals show such changes in brain areas critical to judgment, decision-making, learning and memory, and behavior control. These changes are what drive an abuser to seek out and take drugs compulsively despite catastrophic adverse consequences.

Pregnant women who abuse drugs place themselves and their developing fetuses at risk for negative health effects. Since the fetus' health is directly related to the health of the mother, it is important to consider the negative health affects that drugs have on all people, including pregnant women.

In addition, a pregnant woman who abuses drugs may have other risk factors that could adversely affect the health and well being of her child. These can include poor nutrition and health care, lack of prenatal care, and a chaotic home environment. Further, alcohol, nicotine, and other drugs of abuse can directly affect the developing fetus because they travel across or through the placenta.

For many drugs of abuse, the long-term health effects are not yet known, or are tangled up with other adverse environmental circumstances associated with drug abuse. Nevertheless, studies show long-term behavioral effects and vulnerabilities to addiction in the offspring of mothers who used drugs (including nicotine and alcohol). Pregnant women should be encouraged to abstain from these substances, or to get treatment as early as possible in their pregnancies.

Yes. Research shows that combining addiction-treatment medications, where available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches tailored to address each patient's drug abuse patterns and co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse. It is important to remember, however, that drug addiction is a chronic, relapsing disease - like diabetes, asthma, or heart disease - that can be managed successfully. Treatment helps people to counteract addiction's powerful disruptive effects and regain control of their lives. And just as with other chronic diseases, relapses may occur but do not signal failure; rather, they indicate that treatment should be reinstated or adjusted to help the person fully recover.

Treatment will vary for each person, depending on the type of drug(s) abused. Often, multiple courses of treatment may be needed to achieve success. NIDA's Principles of Drug Addiction Treatment: A Research-Based Guide describes 13 basic principles that underlie effective drug addiction treatment based on 30 years of research. NIDA has also recently released a treatment guide for criminal-justice involved populations, with research-based principles aimed at decreasing drug abuse and criminal recidivism: Principles of Drug Abuse Treatment for Criminal Justice Populations - A Research Based Guide.