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Prescription Drug Abuse: Who Gets Addicted and Why?

Sex, Drugs, and the Opioid-Addicted Brain continued...

Finding and eating food, drinking water, having sex, caring for children: these and other activities necessary to survival cause the reward system to release a tiny dose of dopamine, a neurotransmitter. "It feels good, and so we're likely to repeat that activity later on," Levounis tells WebMD.

Repeat abuse of opioid drugs floods the system with dopamine, which contributes to the euphoric rush of prescription drug abuse. "From the brain's perspective, this is something worth repeating," says Levounis.

As an addiction-susceptible person uses opioids again and again, the reward system begins to wrongly learn these drugs are as essential to survival as food or water. Experts believe that the nerve cells of the brain actually undergo a change.

"They often can't articulate it, because these brain areas are so far below conscious control," says Saxon, "but on some level they truly believe that if they don't get the drug, they'll die."

This explains the changes in behavior that go along with opioid addiction: neglecting responsibilities to family and friends, performing poorly at work, or losing interest in sex. "When these pathways get hijacked, the salience [importance] of everything else goes down," explains Levounis, "and the person loses control of their life to their drug of abuse."

Opioid Addiction: Hard to Predict

Everyone's brain has a reward system, and millions of Americans use prescription pain pills -- or even misuse them for a short time -- without developing opioid addiction. What determines who becomes addicted, and who doesn't?

Despite opioid drugs' reputation as "happy pills," not all people are wired to enjoy their effects. In many people, nausea and dizziness outweigh any euphoric rush from the drugs. "They don't like it that much, and they have no interest in taking it again," Jamison tells WebMD.

Even more people might experience pain pills like most people do alcohol. It's something pleasurable in moderation, but they have no urge to overdo it.

But according to Saxon, about 5% to 10% of the population have brains that are already primed for addiction. "They take the drug and say, 'Wow, that's fantastic,'" he says. "They really want to feel that feeling again." Soon, they seek further chances to use the drug, and increase the dose.

Can someone know if their brain is vulnerable to opioid addiction? Unfortunately, "there's no blood test, no scan of the brain that can predict who will become addicted," says Levounis. While certain genes have been associated with the risk for drug addiction, "no one gene is responsible," Saxon says, "and we're a long way off from genetic testing to identify people at risk."

Still, certain factors are known to increase the risk for opioid addiction. Altogether, our genes account for 50% of the susceptibility to addiction. Studies of identical twins, who share the same genes, prove the link. If one identical twin develops a drug addiction, there's about a 50% chance the other twin will, too.

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