Term Paper: Drug Usage

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Drug Usage

The use drugs to affect conscious states dates back almost to the origins of humanity. In fact, the pollen of eight medicinal plants was found in a 60,000-year-old tomb in Iraq, and in the Assurbanipal library, researchers found lists of medicinal plants inscribed on tablets (Changeux 1998). Shamans and other mystical and spiritual teachers have long used substances such as opiates, to induce trance-like states in order to communicate with spirits and deities in the 'other' worlds (Changeux 1998). Moreover, both the Old and New Testaments repeatedly refer to the use of wine, from Noah's and Lot's alcoholic stupors to the wedding at Cana and the Last Supper (Changeux 1998). It seems that drugs, whether alcohol or hallucinogenic drugs such as peyote and opiates, have a long history among human beings. Greek philosopher, Epicurus, proposed that human beings are pulled forward toward and by nature to seek pleasure, thus it would seem that the human brain must have pleasure centers that keep humans in constant search of fulfillment (Changeux 1998). However, the explanation for drug usage, particularly drug addiction, is not quite that simplistic. Social environment has long been blamed for drug usage and addiction, yet that did not explain why one family member became addicted, while others did not. Recent studies indicate that drug usage and addiction may be primarily blamed on genetics, thus an individual's genetic make-up may determine whether he or she is vulnerable to drug and/or alcohol addiction.

The word "pharmacon" initially referred to the magic of plants to heal and to the evil spirit or demon that caused the disease within the body (Changeux 1998). Eventually, the mysteries of plants were replaced by rational medicine, and diagnoses were made and remedies proposed based on the active principles of plants that were later defined as chemical substances, and thus pharmacological agents, resulting in a powerful and socially beneficial means of regulating the use of drugs (Changeux 1998).

During the sixteenth century, the recreational use of pharmacologically active derivatives of plants, such as tobacco and coffee, became popular in Western society, yet throughout the nineteenth century, the usage of "artificial paradises," such as hashish and opium, was generally limited to select groups, namely a few societal elites, along with poets and artists (Changeux 1998). Interestingly, many physicians became recreational users of mind-altering drugs when the syringe and hypodermic needle was invented. When author Emile Zola wrote that the compulsive use of alcohol was directly linked to poverty and social distress, his book, L'Abattoir, was a dramatic literary evocation of the drug abuse that plagues Western society today, resulting in global drug trafficking and causing major health problems for individuals and society at large (Changeux 1998).

As drug abuse became more wide-spread, repressive laws were enacted without regard to its social origins. Nineteenth-century laws were directed at preventing criminal use of poisons (as opposed to pharmaceutical use), therefore the usage of substances with euphoric effects was not repressed (Changeux 1998). Although opiates became illegal during World War I, it was sometime during the 1950's before the distinction between the patient and the user was officially established. In 1970, France introduced therapy as an alternative to imprisonment for individuals who were addicted to drugs however it was met with limited success (Changeux 1998). Despite strongly repressive laws throughout the world, and the astronomical amount of monies spent on anti-drug wars, drug abuse remains an alarming health hazard around the globe (Changeux 1998). Illicit drugs are blamed for 35% of new cases of AIDS in the United States alone. Between 1985 and 1994, heroin related deaths in U.S. metropolitan areas rose from 1,300 to 3,500 (Changeux 1998). Thus, even with the threat of imprisonment and the very real inevitability of acquiring major health problems, many individuals appear to simply ignore the warning signs and continue to use drugs. Is the cause environmental or biological?

The National Institute on Drug Abuse defines drug addiction as a "chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain," and like other chronic diseases, drug addiction can have serious effects on the body's organs, resulting in an increase vulnerability to other diseases, such as HIV and viral hepatitis (Science 2006). Often, addiction is the result of abuse, which is the use of illegal drugs or the inappropriate use of legal drugs to produce pleasure, alleviate stress, and/or alter or avoid reality, yet the "risk factors for addiction and protective factors against it can be environmental as well as genetic" (Science 2006).

In fact, research indicates that genetic factors (including environmental effects on these genes) account for 40-60% of an individual's vulnerability to addiction (Science 2006). Recent studies are beginning to uncover which genes are responsible for making a person more vulnerable, which genes protect against addiction, and how an individual's genes and environment interact. Moreover, there is evidence that people with mental disorders have a greater risk of drug abuse and addiction that the general population (Science 2006).

The National Institute on Drug Abuse cautions that addiction is a complex disease, and no single factor can predict who will become addicted to drugs because addiction is influenced by a myriad of factors including genes, environment and age of first usage (Science 2006). The NIDA refers to addiction as a developmental disease, meaning that it generally begins in adolescence, at a time when the brain is undergoing continuous changes. The prefrontal cortex, which governs judgment and decision-making functions, is the last part of the brain to develop, perhaps explaining why teens are prone to risk-taking and are especially vulnerable to drug abuse, thereby increasing the likelihood of becoming an addict in the future (Science 2006). In one experiment, rats pressed a lever in response to a cue that had originally indicated access to cocaine even though it had been a year since the cocaine had stopped being administered, indicating a strong association in the brain between drug experience and the setting of the drug experience (Science 2006). Thus, long-dormant cravings may be triggered by encountering a particular environment.

In 2005, it was reported that researchers had identified several single nucleotide polymorphisms (SNPs), "small but meaningful allelic variants that result in changes to the shape or structure of a specific receptor or enzyme that relate directly to addiction problems" (Goldman 2005). According to Dr. Wade Berrettini, of the University of Pennsylvania, there is a set of SNPs that influence the binding affinity of the mu (beta) endorphin receptors, of which some are proving to have some predictive value for alcohol and nicotine addiction, as well as for response to addiction treatment (Goldman 2005).

As of the 2005 article, researchers had identified some 25 SNP variants in the gene coding for the mu receptor, however none constitutes a 'gene' for addiction, yet some do seem to alter how the mu receptor functions (Goldman 2005).

Although Berrettini and his colleagues have not yet identified any single variant that shows an increased prevalence among addicts, compared to non-addicts, they have found some differences. For example, they found some alleles in 10% of the African-American population that they did not find in people of European ancestry, which underscores an important guiding principle: "When looking at the influence of small genetic variation on the risk of a given disease state, it is important to compare ill vs. well people of the same racial and ethnic background" (Goldman 2005).

While Berrettini did not identify a specific mu receptor SNP that correlated with heroin addiction, Swedish researchers found a variant called A118G that seems to predict risk of heroin dependence (Goldman 2005). Other studies suggest that the mu receptor may play a part in alcohol dependence because ethanol triggers a release of / 3-enforphin, the key ligand for the mu receptor (Goldman 2005).

In a series of studies looking at multiple mu receptor SNPs in alcohol dependent individuals treated with naltrexone, Berrettini found that in patients who had either the A/G or G/G variants of the Asp40 allele, only 10% relapsed after three months of post-treatment follow-up (Goldman 2005). According to Berrettini, patients with the A/A variant had higher relapse rates, and outcomes were no better for naltrexone than placebo, suggesting that response to the drug may be largely determined by genetic variants in a specific receptor (Goldman 2005). Berrettini "estimated that 25% of the alcoholic population is either homozygous or heterozygous for the G. allele, and it predicts better response to naltrexone" (Goldman 2005). This type of research is opening the door for the possibility of designing treatment protocols based on a person's genetic predispositions and likelihood of responsiveness to specific medications, thus individualized therapy based on pharmacogenomics may ultimately become standard care (Goldman 2005).

Many in the biomedical community consider addiction to be a brain disease caused by persistent changes in brain structure and function, a view that has generated quite a bit controversy, especially among those who think in polarized ways (Leshner 2001). Many people believe that biological and… [END OF PREVIEW]

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