Addiction expert Nicole Schramm-Sapyta, PhD, discusses signs of addiction, who is most vulnerable, and the best antidote. Dr. Schramm-Sapyta is an associate professor of the practice in the Duke Institute for Brain Sciences and the Department of Psychiatry and Behavioral Science.
Transcript:
Lindsay Key: Welcome to HeadScratchers, a mini-cast from the Duke University School of Medicine. We ask Duke experts to help us understand the questions in science that have us scratching our heads. Today we're speaking with Dr. Nicole Schramm-Sapyta, an expert in addiction.

Dr. Schramm-Sapyta, I'm curious. Coffee, cigarettes, opioids, alcohol, sugar: these are all substances that people consume and struggle with how much to consume. What is the difference between habit and addiction?

Nicole Schramm-Sapyta: A habit is something we do out of convenience. We do it without thinking, and it makes things easier for us, or else we enjoy it. An addiction is something that we do over and over again, despite causing harm to our lives. And that's easy to see with drugs and alcohol; a little bit harder to see with cigarettes although we know the health risks; even harder to see with caffeine and sugar. But the main definition of addiction is that it's causing harm and yet the person is still doing it.

LK: Is it possible for a person to become addicted to a drug after trying it one time?

NS: The short answer to that question is no. Changes in the brain occur with every use of an addictive substance. And those changes in the brain take time to build up to the point of causing an addiction.

So the things that might happen after the first time someone takes a drug are: they have a great time, they might feel better than they've ever felt before -- might feel what other people would call normal for the first time, and really want to keep taking it. But they have to keep taking it before true addiction emerges -- for those changes in the brain to occur that lead to compulsively take the drug over and over despite negative consequences.

What really causes addiction is the combination of repeated taking of the drug with a brain that is otherwise vulnerable to those changes that form the really bad patterns of taking the drug despite negative consequences. People who have psychopathology, particularly depression and anxiety, are much more vulnerable to what we call self-medication. Another vulnerability comes from socio-economic factors, social factors: abuse, trauma in the home, other negative social circumstances that one might want to escape and use the drug to escape from.

The most hopeful thing that I have learned in all of my years of research and getting to know people in recovery is that recovery is absolutely possible. But since it's a bio-psychosocial problem, we have to bring biological and psychological and sociological solutions to the problem.

What has most inspired me about meeting people who are in recovery is the perspective that they have. They've been to the depths, done things that they absolutely regret, you know, stolen from family members just to buy drugs, lied to their family members, and yet they've managed to recover and figure out what really matters to them in life. The main antidote for addiction is a life filled with meaning and purpose. So if I have wonderful family, wonderful job, good friends, good reasons to get up out of bed and not get high every day, I've got an amazing life. And so people in recovery, they know what gives them meaning, and I find that incredibly inspiring.

LK: Thanks for listening. This podcast was produced by the Duke University School of Medicine. Music by Blue Dot Sessions. Visit us online at headscratcherspodcast.duke.edu. You can also find us on all your favorite podcast players. Don't forget to hit the subscribe button -- and if you like us, leave us a review.

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