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In the twentieth century the human race, daring and brash, achieved unfathomable feats of courage and wonder. We left the gravitational bonds of our tiny blue home and rocketed into the vast vacuum of space, curious about an infinite black that we could see but were never meant to touch. We cured the scourge that was polio, refusing to accept the cruel fate of twisted-legged children, bound forever to wheelchairs. And, we developed the internet-a construct we'd never dreamed of before, and one that would bring us together, tethered like a billion blinking fireflies, communicating at the very speed of light. When we, as a species are at our best there is surely no limit to the wonders we can do. And yet, the sad truth remains that when we are at our worst, we are unconscionable. At our worst we are miserable, we are fragile, and wholly vulnerable to abusing substances that poison our bodies and our minds. We can put a man on the moon, and yet men, women, and children die in our streets every day, ravaged by the pervasive evil that is drug addiction, and failed by a system that didn't know how to adequately help them. Such is the maddening complexity of being "human."
Now that we're well into the twenty-first century, our knowledge of the human brain is further along than it ever has been, but it's still an organ that remains largely shrouded in mystery. However, what we do understand, is that as a species we are uniquely vulnerable to addiction, all due to this most elusive and complicated of organs. Weighing only about three pounds, the human brain is the most complex organ in the human body, and it happens to be at the center of literally everything we do, from driving a car, to walking, to breathing. The brain regulates and controls our every bodily function—both conscious and unconscious--and enables us to interpret and respond to the world around us. Everything we think, feel, and do is because of our brain. Unfortunately, this means that when substances (like drugs or alcohol) reach this great command center, the results can be catastrophic.
All drugs-nicotine, cocaine, marijuana and others-affect the brain's "reward" circuit (known in medical circles as the "basal ganglia.") This is where endorphins are released, which give us feelings of pleasure, euphoria, and happiness, rewarding evolutionarily beneficial behaviors like eating, socialization, and sex-all of which the human race needs for survival. Most illicit drugs target this system, which can also cause large amounts of dopamine—another brain chemical that helps regulate emotions and feelings of pleasure—to flood the brain as well. (The rapid release of endorphins and/or dopamine is what causes a "high.") These pleasurable chemicals released by the basal ganglia make it more likely that we will repeat pleasurable activities over and over again, leading to the formation of a habit. Although initial drug use may be voluntary, drugs eventually alter our very brain chemistry, changing how the brain performs and interfering with a person's ability to make choices. This is how people become addicted.
Since the beginning of recorded time mankind has ingested substances that alter our perceptions of reality. From priests and shamans combining herbs and psilocybin-filled mushrooms to bring them (as they perceived it) closer to their creator, to revered medicine men and women infusing opium into tea to mask pain, our history with mind-altering substances is a storied one. We have always reached out to pluck that which grows from the earth in the hopes of making our lives better in some way.
But the modern era has brought about an entirely new set of circumstances. Modern-day stressors are unlike anything mankind has seen at any earlier time in our history and when looking at them in the aggregate it's easy to see the intense pressure cooker we're all living in. We are now connected 24/7 with handheld devices, computers, and television screens, which has made our attention span as short as the fuse of our tempers. We fight our way through traffic in metal automobiles to get to work, day in and day out, even as we struggle to maintain (or even find) any sort of connection to the natural world. Money, work, and access to healthcare are today all incredible stressors that everyone has to deal with. Could it be that in addition to having brains uniquely vulnerable to drugs, our modern-day circumstances have greatly contributed to our likelihood of addiction?
Another element to our modern-day drug abuse problem is access. Un-like ancient times when shamans or medicine men might scour the forest floor looking for herbs to deliver the chemicals they needed, drugs are now easily obtained on most street corners in big cities, and alcohol is available for purchase 24 hours a day, seven days a week at most gas stations. Drugs are now especially easy to obtain for our children, which is a terrifying realization, since we know that drugs radically alter the chemistry of a growing brain.
In 2017, 16% of American high school students surveyed reported drinking alcohol for the first time before age 13. And, this same study found that 13% of these same high school students reported that they had 4 or more drinks of alcohol in a row (if they were female) or 5 or more drinks of alcohol in a row (if they were male), within a couple of hours, within the last month. This qualifies as binge-drinking. Can you imagine what that did to their young brains? 36% reported using marijuana at least once in the course of their young lifetimes, and 5% reported they've tried cocaine. Easy access to addictive substances is a modern-day problem that no amount of legislation, criminal punishment, or scare tactics have been able to solve.
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The modern era has also given rise to substances that are a great deal more potent than seen in any other time in history. Innovations in distillation have made stronger alcohol, the process of turning cocaine into crack yields a far quicker and more powerful high when smoked, and new forms of chemistry have invented some of the most dangerous substances on earth—like fentanyl—which can kill a human with a dose no larger than a penny. These are dangerous times we live in indeed.
In addition to nature, nurture seems to play an important role in potential drug addiction as well. When we look at our fragile brains, the role of the pre-frontal cortex--which is key for self-regulation, long-term goal-setting, and impulse control—looms large. This area of the human brain is central in making important decisions--such as the decision to take drugs or alcohol in the first place--and evidence shows that the most vulnerable people to drug and alcohol addiction may actually have an abnormally functioning neurocognitive system, making it more likely that they'll try substances they shouldn't. It's been found that a weak prefrontal cortex (whether from genetic factors or from developmental injury) may cause decision-making abilities to develop abnormally, leading to drug use, and then to possible addiction. We know that traumatic injuries or early child abuse can negatively affect development of the prefrontal cortex, thus it's possible that many people who eventually become addicted to drugs may have been predisposed to it. And, studies show that adults who had been mistreated as children are at a significantly higher risk of substance use disorders than adults who have not been mistreated.
Drug addiction comes with a whole host of devastating short- and long-term health effects that can vary depending on the type of drug, how much and how often it's taken and for how long the abuse continues. The truly terrifying reality is that drug abuse can negatively impact almost every organ in the human body.
Side effects of drug addiction can range from a weakened immune system (which increases the risk of serious illness,) to major pulmonary and heart issues, to liver disease, to outright liver failure. It also puts users at elevated risk of seizures, stroke, long-lasting cognitive impairment and devastating brain damage. Drug use can also cause unpleasant changes in a person's physical appearance, such as breast development in men and prematurely aged skin. And of course, though surely it doesn't need mentioning, the most severe potential consequence of drug abuse is death.
In the United States—once called the leader of the free world--the drug overdose death rate (adjusted for age) has more than doubled in fourteen years, from 6.2 per 100,000 persons in 2000 to 14.7 per 100,000 in 2014! And, in the same year, there were approximately one and a half times more drug overdose deaths than deaths from motor vehicle crashes. A more recent study finds that, in 2018, more than 67,300 Americans died from drug-involved overdoses. It's unconscionable that these are the drug statistics of a first-world country. If we can land on the moon and return safely, why can't we save our people from themselves?
More unbelievable yet is the fact that no corner of our great country has been left unscathed. The states with the highest rates of drug overdose deaths in 2014 were West Virginia (35.5 deaths per 100,000 people), New Mexico (27.3 deaths per 100,00 people), New Hampshire (26.2 deaths per 100,000 people), Kentucky (24.7 deaths per 100,000 people) and Ohio (24.6 deaths per 100,000 people). When we investigate further, we find that these states run the gamut in terms of economic resources-systemic drug addiction is not necessarily a class issue.
When we talk about the death rate from drug addiction, we must, in the same breath, speak of the incredible loss of talent we've sustained. Think of all those lives—once young and full of promise—being poured right down the drain. Perhaps among them were the next innovators of this twenty-first century. Perhaps among them was the woman scientist who would cure cancer, or the man who would find a way to harness the awesome power of nuclear fusion, and power us beyond our solar system. Perhaps among them was the person who would find a way to reverse the impending climate change cataclysm that we are wholly unable to escape from. But they won't. Their lives were wasted. Their lives were smoked, drunk, injected away.
Former President of the United States, Lyndon B. Johnson once said, "The Great Society is a place where every child can find knowledge to enrich his mind and to enlarge his talents." We must admit that with the current state of drug addiction in this country, we are falling far short of that most worthy bar. So the question is, where do we go from here? How can we reverse the trend of devastating drug abuse in this modern era, and find peace with ourselves?
The answer to our devastating drug abuse problem may lie in a dogged and continuing commitment to innovating new therapies and treatments. In our modern era we are constantly developing best treatment methods and practices to help people break the crippling yoke of drug addiction and return to live happy, healthy, and productive lives. Let us hope that history will look back upon us fondly for it. Let us hope that when we look back upon the 21st century we can say that when the most vulnerable among us needed help, we chose to turn our focus inward, towards our own people, and protect our most precious resource.
We can help. You can overcome drug addiction and have a better life than you ever thought possible!