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Substance Abuse and Addiction Health Center

Prescription Drug Abuse: Who Gets Addicted and Why?

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Sex, Drugs, and the Opioid-Addicted Brain

Opioids, like all commonly abused drugs, stimulate the areas of the brain that perceive pleasure. This results in the initial euphoria or sense of well being that many opiates produce. But these areas do more than just make us happy, according to Petros Levounis, director of the Addiction Center of New York and an associate professor of psychiatry at Columbia University. "Activity here tells us what's important in the world," he says.

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.

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