What causes addiction, and why is it so hard to treat? - Judy Grisel

Prevodilac: Jovana Babic Lektor: Milenka Okuka

As of 2021, more than 36 million people worldwide

Smatra se da je 2021. godine više od 36 miliona ljudi u svetu

were estimated to be experiencing substance abuse disorder.

patilo od poremećaja zloupotrebe supstanci.

This condition spans a spectrum of patterned drug use

Ovo stanje obuhvata spektar obrazaca ponašanja upotrebe supstanci

that causes issues in a person’s life.

koji dovode do problema u životu te osobe.

At the more severe end of the spectrum is substance addiction.

Na ozbiljnijem kraju spektra je bolest zavisnosti.

To understand why some people are more susceptible to addiction

Da bismo razumeli zašto su neki ljudi podložniji zavisnosti

and why it can be so difficult to treat,

i zašto može biti tako teško lečiti je,

let’s take a look at how addictive drugs affect the body.

pogledajmo kako droge utiču na telo.

When someone repeatedly uses an addictive substance,

Kada neko kontinuirano koristi adiktivnu supstancu

their brain may adjust to account for its regular presence.

njihov mozak može da se prilagodi na njeno redovno prisustvo.

This is called tolerance; it diminishes the drug’s effect

Ova pojava se naziva tolerancija; ona smanjuje uticaj droge

and means more is required to produce the same experience.

i dovodi do potrebe da se poveća doza da bi se održao isti efekat.

Alcohol, for instance, increases the transmission of chemical messengers

Alkohol, na primer, povećava prenos hemijskih glasnika

like endorphin and GABA,

poput endorfina i GABA-e,

which promote sensations of pleasure and calmness.

koji podstiču osećaj zadovoljstva i smirenosti.

When someone uses alcohol frequently, their brain will adapt to its presence.

Kada neko često konzumira alkohol, mozak mu se navikne na njegovo prisustvo.

So when they don’t use it, their brain receives fewer signals

Dakle, kada ga ne piju, mozak prima manje signala

from those pleasure- and calm-inducing neurotransmitters,

od neurotransmitera za zadovoljstvo i smirenost

which impacts their energy and mood.

što utiče na njihovu energiju i raspoloženje.

In addition to the unique effects each addictive substance has,

Pored jedinstvenih efekata koje svaka adiktivna supstanca ima,

all of them alter the release of dopamine

sve one menjaju oslobađanje dopamina

in a brain region called the nucleus accumbens.

u delu mozga koji se zove nukleus akumbens.

This area is part of the brain’s reward pathway,

Ovaj region je deo mozga koji se naziva “sistem nagrađivanja”,

which is sensitive to experiences that give us pleasure

osetljiv je na iskustva koja nam donose zadovoljstvo

and drives us to repeatedly seek them out.

i pokreće nas da ih tražimo iznova.

The reward pathway is essential to our well-being—

Sistem nagrađivanja je ključan za naše blagostanje,

but addictive substances also exploit it.

ali ga adiktivne supstance takođe iskorišćavaju.

When someone is repeatedly using a substance

Kada neko ponavljano koristi supstancu

and their body has adapted to its presence,

i njihovo telo se prilagodi njenom prisustvu,

they may develop dependence

može se razviti zavisnost

where the drug is necessary for them to function comfortably.

gde je supstanca neophodna za normalno funkcionisanje.

Meanwhile, repeated use can decrease the influence of the brain’s cortex,

U međuvremenu, ponovljena upotreba može smanjiti uticaj moždane kore,

which is responsible for driving deliberate decision-making

koja je odgovorna za donošenje promišljenih odluka

and limiting impulsive behaviors.

i ograničavanje impulsivnog ponašanja.

And it can increase the influence of the brain’s subcortex,

Takođe, može povećati uticaj subkorteksa mozga,

which is crucial in habit-learning and impulsivity.

koji je ključan za učenje navika i impulsivnost

Together, these changes can make someone feel a lack of control

ove promene zajedno mogu učiniti da neko oseća da gubi kontrolu

over how they’re using a substance.

nad načinom na koji koristi supstancu.

This can mean suffering in other facets of their life

Ovo može proizvesti patnju i u drugim aspektima njihovog života,

and taking risks to continue using it.

dok nastavak korišćenja nosi sa sobom veliki rizik.

If the substance leaves their system, their body's equilibrium is disrupted,

Ako supstanca napusti njihov sistem, ravnoteža u njihovom telu je poremećena

so they may experience cravings that motivate thoughts and behaviors

pa mogu osećati žudnju koja izaziva misli i ponašanja koja dovode

of seeking and using the drug.

do traženja i upotrebe droge.

And if they continue without the substance,

I ako nastave život bez te supstance,

they may experience withdrawal.

mogu doživeti apstinencijalne simptome.

Opioids, for example, relieve pain and induce sedation.

Opioidi, na primer, ublažavaju bol i izazivaju sedaciju.

Withdrawal from them causes heightened pain, anxiety, and insomnia.

Odvikavanje od njih izaziva pojačanu bol, anksioznost i nesanicu.

The faster a drug reaches the brain and stimulates the reward pathway,

Što brže droga stigne do mozga i stimuliše put nagrađivanja,

the more addictive it is.

to je ona više adiktivna.

For example, heroin and morphine have similar effects,

Na primer, heroin i morfin imaju slične efekte,

but heroin’s chemical structure enhances its ability

ali hemijska struktura heroina pojačava njegovu sposobnost

to penetrate the blood-brain barrier and bind to specific receptors.

da prodre kroz krvno-moždanu barijeru i veže se za specifične receptore.

This makes it faster acting and more addictive than morphine.

To ga čini brže delujućim i adiktivnijim od morfina.

Meanwhile, compared to nicotine patches and gum,

Osim toga, u odnosu na nikotinske flastere i žvake

regular and electronic cigarettes are more addictive

obične i elektronske cigarete su adiktivnije

because smoking and vaping deliver nicotine to the brain fastest.

jer pušenje i vejping brže dovode nikotin do mozga.

Depending on their chemical structure and mode of delivery,

Zavisno o njihovoj hemijskoj strukturi i načinu dostave,

drugs vary in how addictive they are—

droge se razlikuju po stepenu adiktivnosti,

but people also vary in how susceptible they are to substance use disorder.

ali se i ljudi razlikuju po tome koliko su podložni bolestima zavisnosti.

Scientists think this is due to a mix of life experiences

Naučnici smatraju da je to rezultat kombinacije životnih iskustava

and genetically inherited traits,

i genetski nasleđenih karakteristika,

though neither predetermines addiction.

iako ni jedno ni drugo ne predodređuje zavisnost.

Trauma and mental health conditions appear to make people more susceptible.

Traume i mentalni zdravstveni problemi čine ljude podložnijim.

And, overall, using addictive substances before 18

Sve u svemu, korišćenje adiktivnih supstanci pre 18. godine

is considered a strong risk factor.

smatra se snažnim faktorom rizika.

This is in part because the reward pathways of younger brains

Deo razloga za ovo je što su putevi nagrađivanja u mladom mozgu

are especially sensitive.

veoma osetljivi.

Many of the genetic factors at play remain unknown,

Mnogi genetički faktori koji su u igri ostaju nepoznati,

but some genes do seem to track with certain substance use disorders.

ali izgleda da su neki geni povezani sa određenim bolestima zavisnosti.

For example, specific genes increase the risk for nicotine addiction

Na primer, specifični geni povećavaju rizik od nikotinske zavisnosti

by making certain receptors more sensitive to nicotine

tako što čine određene receptore osetljivijim

and withdrawal from it more difficult.

i odvikavanje od njega težim.

At the same time,

Istovremeno,

some genes actually make people more resistant to substance use disorders,

Neki geni zapravo čine ljude otpornijim na poremećaje zloupotrebe supstanci,

such as genes that slow the breakdown of alcohol,

poput gena koji usporavaju razgradnju alkohola,

leading to unpleasant side effects that make people less interested in drinking.

što dovodi do neželjenih efekata koji ljude odvraćaju od alkohola.

In fact, one drug that treats alcohol use disorder

Zapravo, jedan lek koji leči poremećaje upotrebe alkohola

operates with this very mechanism.

upravlja upravo ovim mehanizmom.

Detoxing from a substance the body has become dependent on

Detoksikacija od supstance na koju je telo postalo zavisno

can be extremely difficult.

može biti izuzetno teška.

And in some cases, abruptly quitting can also be physically risky,

A u nekim slučajevima, nagli prestanak može biti fizički rizičan,

so it isn’t always advised.

pa se ne preporučuje uvek.

Beyond detoxing, quitting is often a long-term process.

Osim detoksikacije, odvikavanje često predstavlja dugotrajan proces.

It’s aided by treatment plans that prioritize

Ono se olakšava planovima lečenja koji prioritet daju

addressing underlying conditions;

lečenju osnovne bolesti,

developing new associations with experiences

razvijanju novih asocijacija sa iskustvima

previously linked with drug use;

koja su bila povezana sa upotrebom droge

and creating safe, supportive environments.

i stvaranju osećaja sigurnosti i podrške.

Ultimately, both addiction and recovery are the results of a brain

Na kraju krajeva, i zavisnost i odvikavanje su rezultat

with an incredible ability to adapt from experience.

neverovatne sposobnosti mozga da se adaptira na osnovu iskustva.