As we have learned, psychopharmacology has come a long way in learning how drugs interact in the brain such as when and how they interact. It has remained a controversial topic in public discourse. Although it is controversial, medical, psychological, and social understandings of addiction have evolved rapidly over the past century, and contemporary addiction research and treatment is becoming increasingly interdisciplinary (Hunt, 2014). Studies now try and integrate not only psychological, neurobiological, and genetic components but also environmental, social, and spiritual components into the research. There is still much more research to be done to figure out how we can have an effect drug without so many side effects. Also, doctors and psychiatrists should be trained more adequately in looking for certain signs and trying other alternatives before prescribing drugs to their patients.
Addiction in general has become a multi-disciplinary construct that necessitates a wide range of understanding from contemporary practitioners, and as this understanding expands, this professional obligation to maintain a consistent and regulated standard of practice becomes significantly more challenging. According to the global estimates of the United Nations Office on Drugs and Crime (2017), .6 percent of the global adult population suffer from drug use disorders. Drug use is ubiquitous, and the social meanings drugs acquire often transform their effects, their uses, and their users (DeGrandpre, 2006).
Drug Action and Addiction/Abuse
Addiction is a complicated illness that is characterized by compulsive and uncontrollable cravings to seek out and consume a drug. It has been conceptualized as a complex and chronic relapsing of drug seeking (Baconi, Ciobanu, Vl?sceaunu, Cobani, Negrei, & B?l?l?u, 2015). Dependence on drugs can be accredited not only to the pharmacological effects of the drug, but also to their intercommunication with each distinct neurological and psychological structure. The craving for altered states of awareness is a normal motivation among human beings. By midcentury, these drugs have been fractured into three parts: the “illegal drugs” of the black market, the “ethical medicines’ of the pharmaceutical market, and the drugs of the gray market, which by the end of the century included alcohol, tobacco, and caffeine (DeGrandpre, 2006). Abuse of and addiction to alcohol, nicotine, and illicit and prescription drugs cost Americans more than $700 billion a year in increased health care costs, crime, and lost productivity (National Institute on Drug Abuse, 2016). The National Institute (2016) explains that illicit and prescription drugs and alcohol contribute to the death of more than 90,000 Americans, while tobacco is linked to an estimated 480,000 deaths per year.
The use of drugs under any situation, therapeutic or otherwise, can be associated with problems, though the environment and scale of these are diverse. Pharmacologicalism, the myth that pharmacological potentialities contained with the drug’s chemical structure overwhelmingly determine drug outcomes, offers no explanation for how the same drug might coexist as both good and bad (DeGrandpre, 2006). This is why studying the neuropharmacology and neuroanatomy of the brain reward with these drugs is so important.
It has been recently discovered that even a single pharmacologically relevant dose of various drugs of abuse induces neuroplasticity in selected neuronal populations, such as the dopamine neurons, which persist long after the drug has been excreted (Korpi, den Hollander, Farooq, Vashchinkina, Rajkumar, Nutt, Hyytiä, & Dawe, 2015). Changes in the brain correlate with addiction and its intake. It also correlates to the stress-induced return of wanting more of the drug. Alcohol may have the most impairing and devastating effects on the brain during fetal development. Heavy exposure to drugs of abuse in adults are usually needed for neurotoxicity and for persistent and emotional and cognitive alterations.
Cultural environment and social structures can influence drug-use behaviors through a number of mechanisms. Patterns of drug use are directly influenced by social structural factors, cultural factors, and drug availability and drug functions (Spooner & Hetherington, 2004). Each of the factors are interconnected and influences between the other factors. The influence of the media on individuals about substance use is only recently becoming more recognized. Social media in particular has grown exponentially over the past years. There have been reports of it being used as a strategy for selling drugs, with hashtags facilitating the process of pairing buyers with sellers and the fact that drugs are being glorified by celebrities and others on social media (Costello & Ramo, 2017).
There are various programs and therapies that can help manage drug addiction and abuse. One of these is to have school-based prevention programs in place for children and adolescents. These types of programs are the more likely help decrease later drug use. A type of therapy might include Cognitive Behavioral Therapy (CBT) which helps clients recognize their own triggers for drug use and learn strategies to handle those triggers (European Monitoring Centre for Drugs and Drug Addiction, 2016). Contingency management is also helpful with helping people to follow treatment and achieve social reintegration. It is a set of interventions involving concrete rewards for clients who achieve target behaviors (European Monitoring Centre for Drugs and Drug Addiction, 2016).
Having adequate help for individuals with problems dealing with addiction and abuse are necessary to help them reintegrate back into society and become active members of society. This will help with the feeling of belonging that was taken away when they became addicted to the drugs. Destigmatizing addiction and abuse is also essential so these individuals are more open to receiving treatment and adequate support. Without this, many still are relentless in receiving the help necessary from fear of what others will think of them. Also, implementing more programs in schools and online that talk to children and adolescents at a young age is beneficial in addressing this problem and letting them know that they are not alone.
Psychiatric Drugs and Therapy
Medications receive FDA approval for use with specific illnesses but are also commonly used for other illnesses. These substances can have adverse effects if they are used in the wrong way. In general, medications prescribed should be started at the lowest dose possible and gradually increased to the lowest effective dose for each patient. Slowing decreasing the dose when stopping a medication will help prevent the risk of discontinuation symptoms that come with stopping abruptly.
There is evidence that psychiatric medications may be helpful over the short-term, and there are some people who fare well on the drugs long-term (Whitaker, 2015). The regular use of these drugs has fueled an increase in the number of adults and children diagnosed with certain illnesses. These illnesses include, but not limited to, bipolar, schizophrenia, depression and anxiety. This is a trend that has been growing over the years and is not helping people thrive over the long-term.
The approval of psychotropic drugs with different mechanisms of action has been uncommon in recent years. There is a need to enhance drug discovery in neuropsychopharmacology. It would be beneficial to develop drugs that would target the pathophysiology that underlies the disease. This would help increase the likelihood of identifying effective agents rather than symptomatic treatments. A better understanding of the disease pathway may facilitate both the selection of therapeutic targets and the development of relevant models for screening drug candidates.
Psychodynamic and cognitive-behavioral concepts recommend different methods for therapy. Many times they are contradictory forms of intervention. Drug therapy is only one aspect of patient treatment. Additional measures such as counseling, family support, psycho education, supportive psychotherapy and addressing relevant social factors must be considered (de Jong, 2011). De Jong (2011) also states that use of psychotropic drugs is associated with tolerance and may lead to dependence and withdrawal symptoms when drugs are stopped and that there is a risk of creating iatrogenic addictions. Consideration of these addictions should always be thought thoroughly before prescribing. Different groups of people also require different considerations when doctors prescribe them any kind of drug. It is helpful to take into consideration the age of the patient and, if prescribed to women, if they are pregnant or breastfeeding.
During the nineteenth century the federal government was not involved in restricting or regulating the distribution and use of drugs. Although the federal government was not involved with this, some state and local governments were involved. One such example is the Anti-Opium Smoking Act that was enacted in San Francisco in 1875 to prohibit opium dens (NAABT, 2016). This in turn, encouraged states to enact similar bans on smoking opium. Also, there were no agencies that regulated medical and pharmaceutical practice, and doctors freely prescribed cocaine and morphine as treatment for pain. Attempts were made but short lived. One such example of this is the establishment of the U.S. Customs Laboratories that administered the Import Drugs Act of 1848 to enforce drug potency and purity standards of imported drugs (Heath, 2004).
Over the last decade or so there have been more advanced strategies that have focused more on a comprehensive approach but most federal drug control dollars go to law enforcement (Sacco, 2014). Although this is true, there have been attempts to enforce policies around the country. The Controlled Substances Act of 1970 is one of these policies. President Nixon sought greater federal control over drugs and the Comprehensive Drug Abuse Prevention and Control Act of 1970 was passed (Miller, 2018). This allowed federal jurisdiction over specific plants, drugs, and chemical substances. It established the classification or scheduling system for drugs. This act considers a variety of factors when placing drugs in control categories. These categories include:
• The potential for abuse, whether actual or relative,
• Scientific evidence about the drug’s pharmacologic effects,
• All scientific knowledge about the drug,
• The history of the drug and any information about patterns of abuse,
• How widespread the abuse of the drug is,
• Public health risks,
• How likely the drug is to cause either physical or psychological dependence, and
• If the substance is part of the process to make another controlled drug (Miller, 2018).
This act was put into place due to the drug problem on the street which was a major issue at that time. As President Nixon put it at that time, “Those who have a drug habit find it necessary to steal, commit crimes, in order to feed their habit” (Woolley ; Peters, 2018). This goal of this act was to improve the manufacturing, importation and exportation, distribution, and dispensing of controlled substances (Gabay, 2013). This made those who came into contact with these drugs (i.e. manufacturers, distributors, dispensers) register with the Drug Enforcement Administration (DEA). This resulted in a closed system of distribution. Under this act, controlled substances were traced from the initial manufacturing of the drug to the disbursement of the drug to the patient.
This act criminalizes all not only major drug issues but minor ones as well. Although this act is supposed to help with the United States’ supposed war on drugs, there is still a concern with the Fourth Amendment which gives a person the right to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, and shall not be violated, and that no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized (Constitute, 1992). There is always the probability of the government violating this amendment by conducting unreasonable searches and seizures without the proper documentation in place or probable cause. Rights may be violated from performing an unjustified traffic stop, making false statements in order to obtain a warrant, or through the use of illegal wiretapping or eavesdropping (HG.org, 2018).
Future policy decisions can include various areas that will not only help the individual but society as a whole. Such policies should help with decriminalization, depenalization, and regulated access of the drugs. Decriminalization will help with the removal of criminal sanctions for minor drug offenses. In some cases civil sanctions, such as fines, are imposed instead of jail time. Depenalization would deal with the retention of drug offenses as a crime but with flexible administration based on practical considerations and community needs. Regulated access would give government control of illegal drugs in order to experiment with a range of options. This would include, in some cases, a commercial market for substances such as marijuana, or tightly controlled availability for drugs that pose greater risk of harm (Open Society Foundations, 2013).
Drug dependency is a complex behavioral, cognitive, and psychological experience. It progresses under repeated dosing of an abuse substance, through the development of experimentation, recreational or social conditioned use, abstinence, habitual consumption, abuse of the drug, and the addiction to the drug. Organization of services is vital, especially in the five areas of treatment of addiction and abuse. These areas are assessment, referrals, comprehensive service delivery, relapse prevention, and accountability. Treatment can be improved by forming a working communication bridge between treatment programs and the justice system. Communication and collaboration are necessary to achieve a coordinated service delivery.