Defining, Understanding: Tolerance, Dependence, Abuse

When tackling addiction, it’s important to understand that there is no such thing as black and white. Addicts aren’t automatically bad people, and people aren’t all addicted to the same degree.

After all that, it’s still important to take into account personal circumstance, economic status, emotional state and any prior mental illnesses to get a more accurate picture how addiction develops and manifests in any given case.

The last thing addiction needs is stigmatization and misunderstanding. The point of addiction treatment is to offer help, not condemnation – and while there’s a valid argument as to whether addiction is an entirely involuntary brain disease or a choice, vilifying addicts does nothing but drive them further into their rabbit hole.

So, let’s tackle addiction maturely – through inclusivity, and thorough explanation. Today, the topic is how addiction manifests physically, and how the body develops a tolerance and dependence on drugs. Better understanding these functions can help us see how addiction can cascade from an initial high to a serious issue.

What Is Drug Tolerance?

The human body is an extremely capable biological organism. We’re composed of countless well-functioning systems, meant to keep us alive in this world. We have several senses to help us absorb and interpret information on our surroundings, and our bodies react accordingly – often without us noticing.

When it comes to drug use, you have to realize that drugs are for all intents and purposes, poison. More clearly, the body identifies drugs as either toxins or natural chemicals introduced at far too dangerous levels. Alcohol and nicotine, as an example, are toxins to the human body. Opioids and amphetamine manipulate the way the body releases certain neurotransmitters like endorphins. With time, the body figures that the constant endorphin release means it needs to adapt – so it diminishes the effect a drug has.

Too much of any of this at once, though, and we die – alcohol, for example, is a depressant, opposite in nature to cocaine or methamphetamine. It slows the body down severely instead of speeding it up – in the case of alcohol poisoning, it can “turn off” your gag reflex and cause you to choke to death, slow your heartbeat, dehydrate you severely, or even lower your temperature until you go into shock.

To prevent this, increased amounts of moderate alcohol and nicotine ingestion/inhalation lead to faster and more efficient metabolizing of alcohol and nicotine in the body, diminishing their effect (toxicity). Nicotine toxicity through cigarettes doesn’t really occur – it’s like trying to overdose on caffeine through coffee, or theobromine through Hershey’s. But the body still creates a tolerance to it.

On top of diminished toxicity, the body also diminishes the substance’s effects on our brain. Alcohol no longer makes us quite as tipsy the more tolerant we get, and we need more nicotine to hit that “sweet spot” where the stress and anxiety goes away.

Developing a Dependence

And so we satisfy that sudden lack of buzz by upping the dosage. This process of increasing the dosage of a drug as the tolerance increases is what leads to physical dependence – at a certain point, our brain has embedded this feeling of mild euphoria from having a drink or going out for a smoke so thoroughly that if we simply decide to stop – or if we’re coerced to stop – we undergo what is called withdrawal.

On a physical level, what happens is that the body’s functions – the way it relaxes under alcohol or nicotine, or the way it releases euphoria under heroin – only activate in the presence of this drug. When tolerance fails to protect you from the effects of the drug, the body decides to adapt instead and it makes the high its natural state. In other words, once you achieve physical dependence, you’ve reached a point where you’ve trained your body to get used to living within a constant high.

Ending the high for any prolonged amount of time obviously isn’t rewarded by the body at that point. It needs the drug – you taught it to love the drug.

Some drug users understand the neurochemistry and manipulate it by carefully tracking the way they use drugs and develop a tolerance, so they never hit that phase of dependence. But not all drug users have that kind of knowledge – and some are unlucky enough to be born with a natural affinity towards a certain drug due to prior history or sheer misfortune, developing an addiction on the first high.

In either case, attempting to break dependence can lead to a potentially deadly withdrawal.

Improper Detoxification & Withdrawal Can Kill

Withdrawal is no joke. It’s typically non-fatal but extremely unpleasant, including symptoms like severe nausea, migraines, fatigue, fever, and muscle weakness. You basically get an extremely bad flu.

In more severe cases, the sudden absence of alcohol can put you in shock. You can die through a seizure, brain damage, heart palpitations or a heart attack. Withdrawal from benzodiazepines like valium or Xanax (also depressants) can similarly cause your body to stop functioning.

That’s where detoxification comes into play – rehab facilities often perform emergency detoxification in cases of severe addiction, where the body needs to slowly rehabilitate and get “clean”, flushing itself of the influence of the drug in question and slowly weaning off the tolerance.

Drug Abuse on a Brain Level

While the brain becomes used to functioning under a specific high, it can similarly undo the influence of drug use – the same way it developed its tolerance to begin with.

It’s theorized that part of what allowed us to become the apex predator on Earth is our ability to learn. We developed technology as a way to evolve without actual biological evolution, using our brains to adapt to our surroundings and survive – and thrive – at all costs. This same ingenious capacity to learn and adapt is what drugs manipulate, hijacking our ability to feel pleasure through the artificial inducing of pleasure chemicals like morphine.

Unraveling the Brain

Undoing the process is difficult because of how the addiction is based on our very understanding of pleasure, but it’s possible nonetheless. Prolonged sobriety, adaptive coping mechanisms and a healthy lifestyle can help us revert to a healthy physical state and undo the psychological damage through reintroducing new, long-term healthy ways to stay sane and happy.

It’s not a question of magic, spirituality, or willpower – it’s science. If you trust in the science, then rehab and sober living can, with time, revert most cases of addiction. We say most cases, because we mentioned that addiction isn’t black and white. There are no absolutes, and always exceptions.

Cases where people overcome heroin singlehandedly, and cases where rehab and sober living isn’t enough to break the hold of alcohol. Biological factors and psychological factors come together to play a part in the how and why, but that ultimately depends on each individual person.

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