AddictionThe complexities of drug addiction are oft-overlooked and/or plain misunderstood. One need only switch on the television to realise this, as it assaults us with simplistic phrases such as ‘Say nope to dope’, ‘Hugs not drugs’ and ‘Don’t choose the booze’. My own experience with prescription painkillers makes these slogans seem almost comically naive. The use of opiates was not a choice for me initially, but rather a necessity. This may equally apply to recreational drug use, depending on how strictly you define the term ‘choice’. To what extent is one free to choose if genetically predisposed to addiction, as some studies claim? One might say that freedom of choice is impinged upon in cases involving peer pressure and exposure to environmental factors conducive to substance abuse. In the strictest sense, for the most part we are all free to make our own choices. We ultimately decide, but a multitude of factors contribute to the choices we make, whether they are social, biological, psychological, and so on. This essay will discuss the various approaches to addiction and the extent to which progress is contingent upon an integrated approach .In order to investigate the subject of addiction it is necessary to first define what is meant by the term ‘addiction’. Definitions range from simple one-sentence descriptions to in-depth diagnostic criteria. Depending on the source, terms such as ‘abuse’, ‘addiction’ and ‘dependence’ are used interchangeably or defined separately (Altman, 1996). For the sake of simplicity and because it would be impossible to accommodate all of the various definitions, this essay will use one of the definitions favoured by Altman (1996, p.286): addiction is ‘...a relatively extreme, pathological state in which obtaining, taking and recovering from a drug represents a loss of behavioural control over drug taking which occurs at the expense of most other activities and despite adverse consequences.’ What are the causes of drug addiction? The answer to that question depends on whom you ask or the addict to whom you are referring, given the potentially large number of interrelated factors that may contribute to addiction (Teesson, 2002). These factors are mostly covered by 3 major approaches to the subject: biological, psychological, and sociological (Altman, 1996; Teesson, 2002). The biological perspective focuses on neurological and genetic factors (Teesson, 2002). We now know a great deal about how the various addictive substances interact with the brain. Research suggests that the mesolimbic dopaminergic pathway plays a crucial role in these interactions. Experiments involving the intracranial self-stimulation (ICSS) of rats first demonstrated what is now referred to as ‘the dopamine hypothesis’, as mild electric shocks in certain areas of the brain proved to be pleasurable (Goldstein, 2001, p.63). Further experiments involving human participants confirmed these findings and it was discovered that the release of dopamine in these areas was chiefly responsible for the reinforcing effects of drugs that interacted with neurons in this pathway (Goldstein, 2001). Pleasure-seeking alone cannot account for addiction, however. This would simply lead to the notion of addiction as a ‘disease of the will’, which is now an antiquated concept (Orford, 2002, p.1). Most agree that there are more important factors to be considered (Orford, 2002; Teesson, 2002; Goldstein, 2001).Neuroadaptation has been suggested as one possible contributing factor to drug addiction (Teesson, 2002). This process involves changes in brain chemistry as a result of repeated exposure to a given stimulus. In the context of addiction, the brain is responding to the state of disequilibrium that results from repeated drug use. To illustrate this, I will use my own experience with co-codamol as a possible example. The repeated use of this opiate increases dopamine levels in the brain. In order to redress the balance, the brain seeks to inhibit the release of dopamine by increasing GABA transmission. The result of this is the need to administer higher doses of co-codamol in order to achieve the high to which I had become accustomed. Neuroadaptation also negatively reinforces the continued use of co-codamol in the event that drug use ceases. Having altered brain chemistry to oppose the increased dopamine levels, the brain is in a less desirable state of disequilibrium now that the changes go unopposed. This theory has been suggested as an explanation for the withdrawal symptoms experienced by drug addicts (Teesson, 2002).It has been suggested that addiction may be inherited. Various family and twin studies have been undertaken in order to determine the heritability of addiction (Teesson, 2002); however, family studies are inherently flawed due to environmental factors that cannot be discounted. So while alcohol addiction was shown to be higher in cases where family members were also addicted, there must be an asterisk that accompanies these findings (Teesson, 2002). Adoption studies involving twins (both identical and fraternal) do not share this problem and several have demonstrated the possible existence of genetic factors contributing to addiction, particularly concerning alcohol use. Despite this, genes that may be implicated in addiction heritability are yet to be identified (Teesson, 2002). What also needs to be addressed is how genetic factors contribute to addiction. In other words, the nature of the relationship needs to be clarified. Sociological and psychological factors are also likely to play a role in addiction. As Orford (2001, p.342) says, ...’some of the strongest determinants [of addiction] are ecological, socioeconomic or cultural...’ The role of peer pressure was touched upon earlier, for example. Individuals can potentially be persuaded to try drugs for the first time, which could lead to addiction even it does not cause it. However, there are reinforcing environmental factors once substance abuse does develop, such as increased likelihood to associate with other drug abusers (Orford, 2001; Teesson, 2002). One must also consider the role of poverty and the potential use of drugs as an escape. There is obvious merit to the notion that simple pleasure-seeking can lead to addiction, even though it cannot explain it. The influence of parents’ drug use is also deemed to increase a child’s chance of developing substance addiction (Teesson, 2002). There are various other theories of addiction that are within the realm of psychology. The role of classical conditioning has been particularly influential in the areas of withdrawal symptoms and reinforcement through association (Berridge and Robinson, 1995). Similarly, certain personality types have been linked with drug addiction (Altman, 1996), which can likely be tied in with genetic and environmental factors.As can be seen, there are many potential factors to consider when it comes to drug addiction. Interestingly, they may all be correct. The addiction of one individual could develop as a result of genetic predisposition; the addiction of another might be the result of the environment to which he/she was exposed; while the addiction of someone else could be the result of some combination of the factors discussed. Hypothetically, addiction may start with trying a drug because of peer pressure, develop because of a genetic predisposition, be exacerbated by neuroadaptation and continually reinforced through environmental cues that have developed through associative learning. With that in mind, could it be any clearer than an integrated approach is required in order to attain a better understanding of drug addiction?