Alright... Here's how it works. I'll try to break this down. Please try to bear with me.
Let's start with behavior. The individual actions we make. Behavior is almost like a program, and that program is supposed to modify itself through time to maximize the chances of survival and well-being.
This program is made out of smaller actions--finding food, finding friends, retaining shelter, keeping an income, etc.
Each little piece of this program has a circuit of interconnected cells, called neurons, that correspond in the brain. Each time an action is made, it is because this particular circuit of neurons has "fired" or displayed what we call an "action potential." Basically that means electricity has flowed through the circuit and "activated" the behavior. We either think the thought it represents, or perform the muscular action it represents, or both.
These circuits will atrophy over time. Circuits of neurons that don't "fire" often enough will fall into disuse, as the neurons either die out or are reallocated to different circuitry. So, something has to exist in the human brain that has the function of keeping the effective circuits from dying. The circuits that keep us alive and feeling well, something has to keep those circuits alive. Something has to assure this vital circuitry of finding food or valuing sleep doesn't fall into disrepair.
That's where the dopaminergic system comes in. More specifically, a dopamine-rich region of the brain called the substantia nigra. This region isn't the only part of the dopaminergic system but it will suffice for this discussion.
The substantia nigra is designed to learn specifically which behaviors have led to immediate gratification or the satiation of some biological need. It does this by releasing large amounts of the neurotransmitter dopamine, when we feel that immediate satiation. What this does is the large amount of dopamine interacts with a protein called BDNF (brain-derived neurotrophic factor). BDNF will be released into the circuitry that just fired (including the substantia nigra itself). BDNF creates a process known as neurogenesis--new neurons will grow, existing neurons will repair, and the circuitry grows and is solidified. Essentially, by feeling "rewarded," our brains are actually trying to record this behavior into our everyday playbook as advantageous.
A lot of jargon for common sense. But this jargon is important to understand how recreational drugs work.
I say recreational because... typically, by definition, the release of any dopamine has the potential to become pleasurable, and all recreational drugs release some amount of dopamine. While the strength of the drug's dopaminergic effect and environmental factors will assure your mileage will vary (meaning not all people find all recreational drugs to be pleasurable), this is generally true across the board.
Addictive drugs all force the release of dopamine in large amounts by some mechanism or another. However, so do all positively reinforcing behaviors. That's why you'll hear people say that sugar or sometimes just food can be addictive "like cocaine." The drug actually doesn't usually cause the activation of any different "pleasurable" pathways than the sugar does. A recreational drug usually causes the release of dopamine in many parts of the brain, and because this release happens to occur in the substantia nigra as well, then it just so happens that the BDNF will released and the behavior will "accidentally" be recorded as advantageous.
To answer the questions:
Do you feel that it's really that easy to obtain a pain pill prescription that could then be resold on the streets at 10x your cost? Or really any drug for that matter?
1. Yes. It is very easy to obtain addictive drugs. The pain killers are a problem because they are very whimsically prescribed, have a strong dopaminergic effect, and can lead to addiction very quickly. The black market for opioids is pretty robust.
People also tend to know very, very little about drugs and express very little desire to learn. So inflated black market prices is extremely common.
Is addiction and abuse a genetic/inheritable trait or does it really have something to do with the environment one is in?
2. Genetics and your environment will both affect how robust your dopaminergic response to positive stimulus is, as well as the BDNF response from the dopaminergic response. You can probably imagine now the amount of variability in a person's susceptibility to substance abuse, but everyone has dopamine and everyone has a substantia nigra. No one is "immune" to addiction and there is no "addiction" gene.
Do you feel that addiction is something that can be totally "cured" or is it something that one has to manage for the rest of their life?
3. You cannot "cure" your own reward pathways doing their job. Removing the reward pathway obviously isn't an option. As stated, there isn't an "addiction gene" either. Addiction is a reward-feedback circuit. Because it is indeed a circuit, the "cure" is to let that circuitry atrophy over time. Yes, this is possible (inevitable even, given disuse).
Also food for thought, things like Nicotine, Caffeine, and Sugar act on the brain much in the way Cocaine does; yet these are legal, commonly consumed everyday things.
Not a question but I did talk about it. I'll just say one more thing: our legal system that has determined which drug is and isn't prohibited, has some wild inconsistencies with the scheduling vs. the risk of using the drug. I wouldn't use our legal system as a gauge for what is and isn't safe, because the federal government says you can drink till you die but if you take one puff of marijuana you've broken the law.
Source: Neuroscience Major
Creator of the Fantasy Sandbox roleplay.
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