Human ingenuity is a double-edged sword. Weapons made for protection can be used for murder, and technology developed for sharing information can steal privacy. Similarly, advancements in the fields of chemistry and medicine – ostensibly for healing and improving physical health – can also be turned around and used to poison and corrupt a mind and body.
When it comes to addiction, science is there to tell us how to treat a compulsive need for dangerous substances, and science can tell us how to develop those dangerous substances.
Sigmund Freud made many contributions to psychology, and his theory that there is a simple human tendency to seek pleasure and avoid pain is at the core of what drives addiction. After all, any kind of addiction – a substance abuse addiction, a gambling addiction, a sex addiction, a shopping addiction, or an eating addiction – involves an addict trying to numb negative feelings (such as depression, shame, and guilt) and provide a temporary boost to their state of mind and mood.
While some of these addictions require minimal or no resources (apart from money), there is an entire science and industry behind the development of the substances in a substance abuse problem. The industry comes from knowing that an addict will be willing to pay dearly for another hit of their drug of choice; the science comes from creating that drug of choice.
Drugs have existed in the natural world for millennia, but the idea of isolating the powerful chemical components of those drugs is where the science comes in. For example, the opium poppy was called the “flower of joy” by Sumerians, one of the oldest civilizations in the world; but when the opium is mixed with lime in boiling water, filtered, boiled, and reheated with ammonia, what was once a pretty purple flower is now a brown paste – morphine, which can then be further processed to make heroin. PBS explains that the first recorded instance of heroin production took place over a basic oven stove. Today, the creation of heroin requires “a complicated series of steps in a good laboratory.”
The development of heroin may have been a surprising discovery, but some drugs are not made by accident, and they’re not made with good intentions; some drugs are made for no other purpose than to dive deeper into the depths of substance abuse. That’s the story behind a drug that decays skin cells to the point where they make an addict’s flesh looks like the hard, brittle scales of a crocodile, which is probably where the drug got its name — “krokodil.” Drug addicts in rural Russia, too impoverished to obtain regular heroin, throw codeine and paint thinner, gasoline, and alcohol together and inject the mixture directly into their veins.
Forbes magazine pulled no punches in calling krokodil a “corrosive acid with opiate effects,” comparing it to battery acid.
Like heroin, krokodil – or desomorphine, as it’s clinically known – goes back a long way. Desomorphine was first developed in 1932 as a more potent derivative of morphine, but the homemade synthesis from over-the-counter codeine led to the clandestine production of krokodil in places where heroin was too much to ask. Reporting on “the world’s deadliest drug,” TIME magazine explains that the science of making krokodil is not elaborate: Addicts can manufacture the drug with ingredients and tools bought from local hardware and pharmacy stores.
Synthesis of Krokodil from Codeine
Crack cocaine isn’t that different. As with most drugs, cocaine was developed with a number of legitimate applications in mind: anesthetic, medicine, tonic, etc. When the reality of its addictiveness and negative effects on health became evident, cocaine was driven from the mainstream, but it remained a popular poison for those who could afford it. After the hippie movement of the 1960s, cocaine enjoyed a resurgence in the 1970s and 1980s, forcing drug manufacturers to come up with a cheaper alternative because they could not keep up with demand.
The solution required nothing more than a basic understanding of chemistry. Creating crack, says Salon, is “very simple,” and in the same way household items can cook up a lethal dose of krokodil, all it takes is sodium bicarbonate – baking soda – to strip cocaine of its purity and make it cheaper to manufacture. With the simplest of tools, a new drug epidemic was unleashed.
Crystal Meth By Psychonaught (Own work) [CC0], via Wikimedia Commons
For the production of methamphetamines, “anyone,” says Vice magazine, “can be taught to cook meth, regardless of chemistry education.” Perhaps for that reason, meth labs do not have to be pristine and clinical; they can be filthy, dirty places, found in every type of neighborhood on the socioeconomic spectrum. Meth labs can even be set up in the trunk of a car or a recreational vehicle, such is the “accessible” nature of the science of creating methamphetamine.
Some drugs of abuse require a little more craft. Ecstasy is a popular drug among the rave and nightclub scene, but for drug users who have developed a tolerance and are chasing their next high, it isn’t enough. According to CNN, laboratories in China extract the methylenedioxymethamphetamine (MDMA) in Ecstasy and sell the chemical on the deep web (the black market of the Internet, where any manner of drugs and other illegal services can be advertised and purchased), where buyers cut it with other substances and market the final product as “Molly.”
Ecstasy MDMA Molly By Psychonaught (Own work) [Public domain], via Wikimedia Common
The fact that Molly is created with so many other products (despite being marketed as “pure Ecstasy”) is what makes it so hard to control. As soon as one compound is identified and summarily banned, criminal chemists simply make another one, responding to a demand that they are confident will never go away. In 2012, for example, synthetic marijuana accounted for 20 percent of the US market, even as the government was moving to expand the list of scheduled (controlled) drugs. Fire Engineering magazine said the speed with which these new drugs appeared was “alarming,” concluding that the designer drug industry is expanding and diversifying to stay beyond the reach of law enforcement, as much as it is to satisfy rabid customer needs.
Fortunately, for all the nefarious applications of science, there has been an equal amount of effort put forward in developing a greater understanding of the mechanics of addiction, and how they can be countered with pharmacology and psychology.
For instance, knowledge of how the different parts of the brain function and communicate proves crucial in seeing how different drugs go about wreaking havoc. The cooks in illegal drug labs may not know the difference between neurotransmitters and receptors, but doctors do. Thanks to advances in brain imaging, doctors and scientists can see what a drug-infected brain looks like and derive insight that will lead to new approaches of treatment and prevention.
It’s because of brain imaging techniques, like magnetic resonance imaging and positron emission tomography scans, that we know about how drugs trigger a neurotransmitter called dopamine, which affects the brain processes responsible for the control of motivation, emotional response, and the ability to experience pleasure.
When we experience something we enjoy – anything from a sexual encounter to a glass of wine – the brain activates the dopamine transmitters. We feel good, positive, and rewarded for engaging in those experiences. After a while, the dopamine activation ceases so we can go on with life, but we remember those feelings. The next time the opportunity to enjoy those experiences arises, we are inclined to partake because of what we felt the first time – and what we felt were the dopamine neurotransmitters at work.
Because of brain imaging, we know that most drugs target the brain’s reward center by forcing the dopamine neurotransmitters to stay active for longer periods of time than is normal and healthy. Laser-scanning microscopy – high-resolution optical images – tells us that continued consumption of these drugs changes the chemical composition of the brain, effectively cutting off any other way a user can experience pleasure.
When drug addicts experience cravings or withdrawal, brain imaging techniques show relevant changes to the brain’s chemistry, allowing for the doctors to prescribe the right medications, in the right dosages, that will properly and efficiently alleviate the symptoms.
Probably most crucially to the science of treating addiction, brain imaging has “firmly established that drug addiction is a disease of the brain,” according to an article published in the Science and Practice Perspectives journal. This is significant, because for hundreds of years, it was accepted that addiction was more of a moral issue than a medical one. With drug actions and consequences actually being observed in a patient’s brain, doctors can accurately and safely prescribe medications to counter the effects of illicit drugs, and start gradual chemical rehabilitation.
The most commonly used medication in this category is the benzodiazepine family of drugs (lorazepam and diazepam, among others).
Benzodiazepines work by boosting the effect of a particular neurotransmitter in the brain, the GABA neurotransmitter, which is responsible for reducing electrical and chemical excitability throughout the nervous system.
Illustration about the molecular function of GABA neurotransmitter in the brain
When an addict is going through the pain and torment of withdrawal symptoms, the careful administration of benzodiazepines stimulate the GABA neurotransmitters into producing a calming and sedating effect, thereby easing the detoxification process.
Science has also helped researchers understand the complex relationship between genetics and addiction. While there was once a school of thought that put forward the idea that the children of an addict were guaranteed to follow in their parent’s footsteps, science has demonstrably shown that, in the words of the University of Utah, “susceptibility does not mean inevitability.” Discoveries in the field of genetics have shown that addiction is influenced by a number of genetic factors:
In the words of a study published in the Clinical Pharmacology and Therapeutics journal, “[g]enetic studies […] help destigmatize addiction, leading to more prompt treatment.” By establishing the origins of the addiction, genetics can shed light on individual treatment programs and larger therapeutic goals.
There is even an entire field of medicine dedicated to the prevention, screening, intervention, and treatment of substance abuse problems. Addiction medicine covers two approaches to treating substance abuse disorders: the medical approach, which deals with the pharmacological element of rehabilitating a patient, and addiction psychiatry, which covers the psychological dynamic of treatment. Addiction medicine and addiction psychiatry often overlap: the medicine specialist will initiate the detoxification process with an eye on preparing the patient for psychotherapy; a psychiatrist will have to be knowledgeable of the kind of drugs prescribed during the detoxification process.
Understanding more about human thought patterns and behaviors is the last scientific checkpoint on the road to sobriety. It could also be the most important checkpoint. The National Institute on Drug Abuse is very clear on the importance of behavioral-based therapy following detox, saying that treatment is incomplete without that step.
The science of psychology plays a determining role in safeguarding the mental well-being and sobriety of an addict when he steps out of the umbrella of formalized treatment. Take that away, and the patient has no idea how to respond to the triggers that might have once driven him to taking a drink or snorting a line of cocaine, and the patient has no idea how to control his thoughts and behaviors when temptation inevitably comes calling. Mental health disorders and substance abuse go “hand in hand,” according to The Fix, and this is where psychotherapy can play an even greater role: helping the patient understand that relationship, and teaching him coping skills to take control of his life. With the danger of relapse a constant shadow on the horizon, the resources and strategies that established and clinical psychotherapeutic methods bring to the table make this a critical element of treatment.
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