Understanding the Addictive Nature of Prescription Drugs

Understanding the Addictive Nature of Prescription Drugs

Given the widespread news and information on the opioid crisis, it is no longer a surprise that prescription drugs can be dangerous, particularly if misused or used for non-medical purposes. But it’s all too easy to write all prescription drugs off as ‘too dangerous to be used’, especially in this climate.

We tend to heavily lean towards one or the other extreme on many issues, and opioid overdoses is one of them. Rather than vilify all opioids, for example, most experts on the crisis would rather than increased public literacy on the matter of prescription drugs will help people and doctors make better choices when faced with a disorder or disease that may warrant prescription medication.

This has become a form of stigma in some cases. While most are aware of the existing stigma against those struggling with mental health issues, a new form of stigma has been slowly rising against the use of medication for the treatment of mental health problem. The misuse of ADHD medication is serious. But treatment is still important. Both children in need of help and adults who feel that ADHD is only a childhood disorder don’t get the help they need to thrive.

Proper discourse surrounding prescription drugs needs to consider how they can be dangerous, addictive, and even lethal, without forgetting that they do play a role in helping millions of Americans lead better lives. Nuance and context are important, particularly in such complex topics.

 

How Medicine Can Be Addictive

For most people, addiction is very poorly understood. It’s not so much that there are Bad Drugs and Good Drugs. Rather, there are addictive drugs and non-addictive drugs. Some addictive drugs serve no real medical purpose, but most do. Many that are still illegal continue to be researched for their potential medical benefits. Some drugs are wrongfully vilified as addictive, but are illegal for other reasons, and may be made legal in certain cases (for example, hallucinogens may prove helpful in treating trauma and anxiety).

Drugs are chemicals and have no moral compass. As such, it’s important not to mistake all good drugs (medication) as being wholly beneficial and much less dangerous to the human body. In the same way, it’s important to recognize that two of the arguably most dangerous drugs in the world (alcohol and tobacco) are completely legal and readily available to most people in the world.

As dangerous as addiction is, there’s more to addiction than the drug itself. While widespread availability is one of the reasons why drugs such as alcohol and tobacco are commonly used, there are countless other much more complex reasons that often feed and further fuel addiction that need to be taken account, such as a lack of education, constant academic or professional pressure, lack of employment, economic woes, family stress, and more. No one case can be blamed entirely on ‘the drink’, as these countless factors all contribute to addiction and make it so much more difficult to treat.

In the case of prescription medication, more must be done to ensure that teens and adults alike understand the dangers of prescription drug misuse, and that just because it comes in an orange vial doesn’t mean it’s any less dangerous than a bag of cocaine or tar heroin. In many cases, parents and communities should focus heavily on catching warning signs of addictive behavior and stopping someone before their habit goes out of control. If a teen or adult is in danger of turning to drugs as a way to cope, they must understand that it’s okay to get professional help instead of self-medicating, with disastrous results.

 

The Effects of Prescription Drugs on the Brain

Addictive prescription drugs are addictive because of the way they manipulate the availability and effectiveness of certain neurotransmitters in the brain. Most psychoactive chemicals affect neurotransmission – even coffee, to a degree – but addictive drugs are deemed such because the effect they have on the brain is so strong, and so specific to certain neurotransmitters, that the brain begins to form an attachment to the drug after a certain number of times.

Prescription drugs are less addictive to those who need them, partially because of the strictly regulated dosage, and partially because their brains respond very differently to the drug versus people who don’t need them.

Over time, what starts as a powerful high can lead to drug dependence, wherein both the body and the mind begin to struggle with staying sober. Withdrawal symptoms kick in, causing cravings and headaches when not high. As time passes, tolerance calls for stronger doses, further feeding the addiction and increasing the risk of overdose. The mechanics differ from drug to drug, and different drugs are addictive for different reasons.

 

Treating Prescription Drug Addiction While in Treatment

In the cases that an individual gets addicted to a drug that is specifically prescribed to them for their condition, alternatives must be thoroughly explored. Prescription medication is often considered a first line treatment for a variety of conditions: opioids for extreme pain, stimulants for ADHD, depressants for severe anxiety disorders, and anti-psychotics for schizophrenia and other disorders. While other treatments may be more effective in certain cases, prescription medication boasts a widespread level of effectiveness, and is often easier to prescribe than a treatment that requires scheduling, complex financing options, or other speedbumps.

However, in some cases, patients misuse or overuse their medication. It’s then that other treatments must be seriously considered. In cases where patients are struggling with a dual diagnosis, a multimodal approach is necessary. That means treating the addiction and the illness/disorder concurrently. Examples include going through rehab while undergoing therapy or visiting an outpatient treatment center and a mental health clinic at the same time.

Prescription drug use is a complex matter, and it’s made much more complex when a patient is abusing their own medication. But through early intervention, the right treatment plan, and proper support from friends and family, both the addiction and the underlying condition can often be treated.

 

Understanding How Drugs Impact Your Health

How Drugs Impact Your Health

To most people, it’s clear that drug use is a bad thing both for society and for individuals. But while many people draw clear connections between drug use and criminality, there’s a lack of knowledge on the physical and psychological effects of drug use, the higher risk for addiction among the mentally ill, and the success of modern-day addiction treatments.

After a person becomes addicted to a drug, breaking the addiction can be a serious challenge. Drugs impact the brain, the heart, the kidneys, the liver, and the mind. It’s the first and last in that list that are hit the hardest, with long-term repercussions and consequences on mental health and cognition.

Depending on how a drug is consumed, long-term drug use can lead to deterioration in other parts of the body as well. It’s clear that drug use, both in the short-term and in the long-term, will impact your health. But while some of these effects will be permanent, many are reversible. The sooner an addict seeks help, the more likely they are to save themselves from the long-term implications of a failing body.

 

Your Brain on Drugs

Decades ago, a TV spot showed a teenager frying an egg, explaining that ‘this is your brain on drugs’. It was meant to be a quick way to catch the attention of millions of young adults in the audience, quite simply showing that drug use fries your brain.

The ad was subject to about as much parody and scrutiny as any other poorly explained analogy. It ended with a rhetorical statement: “any questions?” Yet the truth is that there were many questions, and many felt they weren’t being answered.

Drug don’t cause your brain to cook in a pan, but they do change the way you perceive the world and react to your own natural instincts and thoughts. All drugs are similar in shape and function to many of the chemicals we already produce in our own brain, the chemicals we use to trigger certain reactions, from being hungry to getting excited. When these foreign chemicals bind with our neurons, a reaction occurs wherein the brain is overstimulated with what can be described as a ‘supernormal stimuli’.

We’ve evolved to react to things in certain ways, and an overstimulation of any given natural trigger is going to invoke an exaggerated reaction. This is more apparent in junk food than anything else – we crave sugar and fat because they’re so rare, and that is why foods that consist almost entirely out of these two ingredients are so incredibly delicious to us, despite the fact that they would never exist in the wild.

Drugs elicit something similar in the brain, causing a ‘high’ and prompting a major shift in the way the brain processes other neurochemicals. Over time, the brain begins to get used to the stimulus it receives from drugs, and other pleasures take a backseat. This triggers a process known as ‘drug dependence’, wherein we rely on the drugs we take to feel normal, and simply quitting leads to withdrawal symptoms.

It’s this simple mechanism of ‘training your brain’ to get used to the extreme effects of drug use that kickstarts a long series of serious consequences to a person’s physical and psychological health.

 

Drug Use Side-Effects

Drug toxicity differs from drug to drug, with some being far more toxic than others. Nearly all substances can cause an overdose, with minute exceptions and some unlikely candidates. For example, it is difficult to overdose on benzodiazepines alone, and many individuals simply fall asleep after accidental ingestion of one too many. But in conjunction with other drugs, or taken in extreme quantities, the likelihood of an overdose skyrockets. Meanwhile, drugs like alcohol and tobacco are far more dangerous to the human body, not only due to their acute toxicity, but due to their carcinogenic nature.

Different drugs come with different side effects, owing to their toxicity, the way the brain processes them, as well as how they are consumed. Drugs that are injected are more likely to cause complications with injection sites, ranging from wounds and infections to more dangerous issues, such as necrosis (decaying tissue). Insufflation can cause damage to the nasal cavity as well as a person’s sense of smell and can cause infrequent nose bleeding.

Excess drug use prior to overdose can still cause harm to the organs, particularly the heart, brain, and liver, increasing a person’s likelihood of a stroke, heart attack, or liver cirrhosis. Kidney damage is also frequent among long-term drug users, due the kidneys’ roles in the endocrine system. Because drug use frequently pushes the body to produce dopamine and drive certain hormones and neurotransmitters through the roof, drug users may be more prone to problems with the adrenal gland, as well as being more prone to illnesses related to high levels of stress (due to elevated cortisol levels, both in stimulant users as well as depressant users).

 

Drug Use and Mental Illness

Aside from the damage dealt to the organs, brain, and overall body, drug use can also severely affect a person’s mind. The research tells us that individuals who already struggle with mental health issues are more prone to developing an addiction in the future, for a number of reasons including diminished reasoning, self-medication, lowered inhibition, and more. Individuals struggling with depression and/or anxiety may be more open to suggestion and manipulation or may start using as a way to numb emotional pain. However, there is also an inverse effect wherein drug use exacerbates or even triggers the development of certain mental health problems.

Some drugs are associated with the development of psychosis, or the false perception. This can include visual hallucinations as well as believing certain things to be true despite clear contradictions in thinking (paranoia, and more). Long-term drug use can also lead to extreme fluctuations in mood and motivation, mimicking symptoms of mania and depression, as well as anxiety.

Changes in sleep and diet can further exacerbate existing issues by leaving the body tired and malnourished. This is also expressed through other physical changes, such as sudden weight loss or weight gain, tremors, poor hygiene, and poor skin health, all of which can have a detrimental effect on an addict’s sense of self. The added pressure due to legal problems, loss of friends, and societal stigma can further drive someone into a dark corner, making them less likely to seek help, and more likely to develop more severe depressive symptoms.

 

Inhibition, Addiction, and Risk-Taking

Aside from the direct effects of drug use on the brain and body, there are certain consequences that are related to the side-effects of long-term drug use, most notably the decrease in inhibition and the diminished cognition that follows the long-term use of many popular drugs, including ecstasy, alcohol, and various stimulants.

These drugs often increase sexual desire, decrease critical thinking, and can lead to dangerous situations such as unprotected sex with strangers (massively increasing the likelihood of sexually transmitted diseases and pregnancy), reckless driving, violent behavior, and more.

Some drugs are more likely to lead to certain scenarios than others. For example, alcohol popularly decreases inhibition, but it also increases sexual dysfunction in men. A study of drug use and sexual desire in nightclubs showed that alcohol and cocaine were common, among women and men respectively, with ecstasy being used for general enjoyment rather than sexual activity, and cannabis being avoided due to its relaxing effects.

Drugs are complex, and each drug affects an individual in different ways. Yet nearly all addictive drugs come with their own set of negative consequences, from diminished intelligence among long-term cannabis users to serious cancer risks in alcoholics and heart damage in cocaine users.

Opioids Pose Considerable Risk for Addiction

How Opioids Affect You

To put it simply, an addiction is a condition wherein a pleasant-feeling habit turns into an unavoidable obsession, one you cannot cut ties with or live without. This isn’t like developing a love for a dish and “not getting enough of it”. It is like developing the sense of a need for opioids like you have a need for water and food.

But why do these addictions occur, and why is it that one of the country’s most prescribed drugs also happens to be one of the most potent and addictive? And finally, why is it that opioids have become so ubiquitous, and how did the opioid crisis come to be nearly 30 years ago?

 

Why Opioids Are Addictive

Opioid medication is any medication that is either directly or synthetically derived from opium, an extract of the poppy plant. Historically used as an anesthetic and recreational drug, opium has a long history tracing back to some of the first civilizations in all of human history. Today, most of the opium in the world (both medical and illegal) is produced in Afghanistan, by synthetic opioids are often produced in other countries such as Mexico and China.

However, we don’t use opium in its raw form. Instead, certain chemicals are isolated within opium to produce a variety of compounds, including morphine and codeine. Thebaine extracted from opium is used in the production of synthetic opioids, including hydrocodone (Vicodin), hydromorphone, and the infamous oxycodone (OxyContin). On the illegal side of things, morphine is extracted from opium, then turned into diamorphine (heroin).

While opioids have been known for their addictive potency, opium’s early history is largely medicinal, particularly for pain relief and anesthetics. It wasn’t until the 19th century that morphine and heroin were developed from opium, and since then, other opioids have been designed for pharmaceutical use, ranging from the less potent codeine to the far more potent fentanyl.

But just as opium has a legacy of addiction and debauchery tracing back thousands of years, opioids are still very addictive drugs. Despite this, the production and consumption of prescription opioids soared in the 1990s, making the US the largest consumer of opioids in the world bar none. To this day, the sudden and explosive rise in opioid use late in the last century continues to bear a terrible fruit in the form of thousands of opioid-related overdoses per year, many through a growing heroin market capitalizing on the demands of a large number of American prescription opioid addicts.

When you take an opioid, it binds to opioid receptors in the brain and does a number of things, including relieve and numb pain. But it also releases a large amount of dopamine and produces a powerful euphoric effect. Over periods of time, opioid use confuses the brain, and it begins to form a habit of using the drug as a way to feel good. Pushed so far off its equilibrium with each use of an opioid, the brain slowly changes, making regular opioid use the new “normal”. On the other hand, quitting opioids after developing this dependence leads to a series of emotional as well as physical symptoms, and an intense craving for your newfound habit. This kicks other habits and cravings to the curb, as the addiction for opioids overpowers nearly any other form of pleasure.

Opium was a powerful drug, contributing heavily to the temporary downfall of the most dominant economic force on the planet in the mid-19th century. Opioids can be just as dangerous, dealing a massive blow to the US both financially and through loss of life.

 

How the Opioid Crisis Began

Opioid-related deaths rose sharply in 1991 and coincided with the increase in prescription opioids on the market, particularly through pharmaceutical companies like Perdue. A combination of mass marketing for painkillers, the development and sale of OxyContin, campaigns such as “Pain as the Fifth Vital Sign”, and the sheer power and influence of drug lobbying led to an astonishing number of painkillers flooding onto the streets through pressured doctors, far more than were every needed.

While the FDA began cracking down on some of this behavior, it went on for decades. In one particularly astonishing example, a single town of 392 people received a ludicrous 9 million hydrocodone pills over two years. Meanwhile, two pharmacies in Williamson, West Virginia received 21 million opioid painkillers between 2006 and 2016. Opioid deaths rose from over 1 per 100,000 in the late 1990s, to nearly 9 in 100,000 today. That’s an average of about 130 opioid-related overdoses per day.

 

Treating an Opioid Addiction

Opioids are incredibly damaging, but their effects can be mitigated through proper treatment. Sadly, this treatment is not available to all Americans, and even fewer take advantage of it. Opioid addiction is incredibly undertreated in this country and is one of the major reasons why the epidemic continues to be such an issue.

Treatment begins with separation. By separating a patient from the drug, they begin undergoing the process of withdrawal. The withdrawal process takes at most about one month and can be over in as little time as one week. Withdrawal begins anywhere from a few hours to half a day after the last dose. While withdrawal symptoms can be very uncomfortable, they are not lethal. Despite this, it is recommended to undergo withdrawal with the help of a medical professional, within a rehab or detox facility. Certain discomforts can be mitigated through proper management. Furthermore, unlike many other addictions, there are certain medications that can potentially help recovering addicts manage cravings. Opioid antagonists completely block the euphoric and painkilling effects of opioids, rendering them nearly useless. Certain opioid antagonists are used to save an addict’s life during an overdose, by breaking the connection between the opioid and the brain’s cells, and kickstarting respiration.

After withdrawal, the priority is to prepare for a drug-free life. While opioid addiction is potent, long-term management can do a lot to tremendously mitigate the potential of a relapse. Group meetings, support systems, strict schedules, a healthier coping mechanism, and a series of other tools and techniques, such as sober living communities, can be utilized over the course of a recovering addict’s lifetime to continue to commit to sobriety and avoid opioid use.

 

The Dangers of Mixing Drugs

Why Mixing Drugs Is Dangerous

Most people have seen the presentations in school or heard the lectures: your brain on drugs lights up and changes, first producing a high, but with serious long-term consequences. However, do you know what happens when you take more than one drug at a time?

The fact is that anywhere from one-third to over a half of all drug users use more than one drug regularly, depending on area and sample size. Heroin and cocaine users reportedly abused more than one drug more often than other types of drug users, the most commonly concurrent addictions being an addiction to alcohol and heavy use of marijuana.

Studies also show that polydrug use complicates treatment, increases health risk behaviors, leads to greater psychological issues, and makes it harder to treat the addiction, because of the differences between the various drugs the users commonly ingest.

Mixing drugs can lead to volatile effects. The worst-case scenario is death by accidental overdose. Drugs interact with one another, and most have contraindications – reasons and symptoms that tell doctors they should refrain from prescribing a certain treatment. Contraindications can also be syndromes or symptoms suggesting that patients are better off not taking a specific drug. Drug interactions are also something medical professionals watch out for, to prevent unintended side effects. For example, if someone suffers an allergic reaction to baker’s yeast, they shouldn’t take the hepatitis B vaccine. Warfarin is used to treat unwanted blood clotting by preventing coagulation. This interacts negatively with common acetaminophen-containing products and Tylenol. If you’re already taking a drug that acts as an antidepressant, you shouldn’t double up with an antidepressant herbal supplement. The lists go on and on.

Most drug users aren’t trained to know the counterindications for every drug they end up trying. Often, they can’t be sure the drug they’re trying is pure anyway. This makes polydrug use so dangerous, as a person could potentially be ingesting three, four, or five different drugs, all of which interact with the brain and body in very different ways, making the possibility of a severe reaction that much more likely.

 

Drugs and the Body

When a drug enters the bloodstream, it makes its way to the brain, passes the blood-brain barrier, and attaches to receptors in your brain cells. This process causes your central nervous system to send out signals, either reducing pain, or reducing inhibition, or increasing your heartrate, or blocking the decrease of serotonin – and so on and so forth.

One drug alone can prime the brain and body for more drug use, causing a flood of dopamine to slowly but effectively build a dependence on the substance.

But when two different drugs interact with the brain, the effects can be deadly. Here are a few different ways in which polydrug use can damage the brain.

Cocaine and alcohol are commonly combined, especially at parties, either with or without MDMA in the mix in the form of ecstasy. However, while cocaine is sometimes used to maintain the euphoric feeling of alcohol without the drunkenness, cocaine and alcohol combine in the body to produce cocaethylene, a chemical compound of cocaine and ethanol, more dangerous than either drug on its own. Cocaethylene can cause sudden death once enough of it builds up inside the system. It can stay in the body much longer than either drug, and it takes longer for the body to metabolize it.

Heroin and cocaine are also commonly combined, usually referred to as a speed ball. Cocaine is used to limit the withdrawal effects of heroin, but at an increased risk of:

  • Renal disease
  • Paranoia and anxiety
  • Depressed breathing/respiratory failure
  • Dizziness
  • Coma

While MDMA in its purest form is not a strong stimulant, MDMA is usually cut and mixed with cocaine and other stimulants when sold as a party drug, and can have serious neurological consequences, including neurotoxicity and other long-term mental consequences.

Any given drug combination can heavily affect your organs, especially the kidneys, liver, and brain. Drugs combine in the liver and create different compounds, with a higher likelihood of long-term damage, including an increased risk of several different cancers.

 

Mixing Like and Like

With two very different drugs can elicit a mixed response in the brain and body, two similar drugs will combine to boost shared effects, massively increasing the risk of an overdose. An influx of illegal fentanyl, a powerful synthetic opioid, has led to a growing number of opioid overdoses in the US through fentanyl-laced heroin. Similarly, taking a mild opioid like codeine and mixing it with alcohol can cause the depressant effects of both drugs to ramp up violently, leading to unconsciousness, respiratory failure, and death through lack of oxygen.

Mixing several different types of stimulants can increase the risk of heart failure, as well as lead to greater long-term risks in the brain, including anhedonia (killing the ability to feel pleasure) and permanent damage to cognitive abilities.

 

Alcohol in the Mix

Alcohol is the most dangerous concurrent drug because it is common, cost-effective, and usually available wherever other drugs exist. Even among drug users used to stronger ‘uppers’ and ‘downers’, alcohol is still a common staple due to its effectiveness and ubiquitous nature. However, it’s also one of the more dangerous drugs to mix other drugs with.

Cocaine and alcohol create a toxic compound that leads to sudden death over time, and an increased risk of liver damage and stroke. Alcohol and depressants (including opioids) can cause an overdose death through respiratory failure. When mixed with hallucinogens, alcohol can cause increased risk taking, fatal accidents, and generally place the user in extremely unsafe situations.

 

Always Consult Your Doctor

Drug use is dangerous one way or another, and most drug users may not feel comfortable openly discussing their drug use with a medical professional unless they’re already seeking treatment.

However, regardless of whether you’re addicted or thinking of using drugs recreationally, don’t take medication without talking to a doctor about it, even if it’s over-the-counter, or simply a herbal alternative. Even the pills you get from a naturopath can negatively interact with regular medication, given the right combination of chemicals. A professional can let you know whether it’s a good idea to take something if you’re presenting certain symptoms, have certain allergies, or are already on a certain drug.

 

Drug Use Isn’t Worth Losing Your Life Over. Seek Help!

Drug Use Isn't worth Your Life

Roughly 72,000 Americans died of a drug overdose in 2017 alone, and that number has been on a steady incline in the past few years. While many drugs have slowly declined in usage, use of prescription opioids like fentanyl and heroin have increased. Meanwhile, alcohol and tobacco continue to claim thousands of lives through alcohol poisoning and related illnesses, from throat and larynx cancer to lung cancer and heart disease.

But drugs don’t typically kill overnight. The road from first contact to last breath can take years and decades, and while thousands of Americans die of drug overdose every year, millions struggle with drug addiction. Rather than being a moral failing or personal choice, addiction is a disease – a disease that can be treated. But it takes a willingness to commit to treatment for it to work.

Today more than ever, drug use is being called into question. After decades of an unsuccessful War on Drugs, many Americans are skeptical of the damage drug use can do. Some teens are misinformed on the dangers of drugs. Others struggle to see the difference between using a drug for performance and using it for medical purposes – leading to the use of Ritalin and Adderall as illegal study aids rather than prescribed medication for ADHD. But it’s important to understand that drug use isn’t black and white. Just because one drug is legal, or because a drug can help someone in a very specific context, doesn’t make it safe or wise to use drugs.

Yes, marijuana is now legal in several states throughout the US. Opioids, benzos and amphetamines are prescribed legally to Americans. THC may be prescribed to cancer patients for pain and inflammation in most states in the US. And alcohol and tobacco can be found in every corner store. But drug use is still dangerous, and often enough, it can lead to disorder and death. Worst of all, you won’t know until it’s too late.

 

How Drugs Change a Life

For some individuals, drugs can be life-changing in a positive way. Thousands of Americans have benefited from cannabis products prescribed for seizures and nausea, and to milden the side-effects of chemotherapy. Children correctly diagnosed with severe ADHD have been able to better manage their disorder through the careful prescription of amphetamines. And cocaine is an excellent topical anesthetic, to this day.

But that’s not always the case. Many Americans have seen their lives spiraled into years of addiction and suffering due to a prescription of OxyContin. Others abused their ADHD medication, or worse yet, abused their relative’s medication, often at a young age. Some whose access to legal prescription medication has ceased have turned to illegal sources, including fentanyl-laced heroin, and have lost their lives as part of the 40,000+ Americans who lost their lives last year to opioids.

Few factors help determine if someone is at risk for an addiction when they come into contact with a drug, but anybody – even the most privileged and happy of individuals – can turn an ‘occasional’ drug habit into a pervasive and deadly addiction.

Drugs capture the minds of their users through a subtle manipulation of the brain’s neurotransmitters: chemicals used in the communication between cells. Dopamine in particular seems to play a primary role in the development of a physical dependence, as the brain changes after persistent drug use. The result can include lowered cognition, memory problems, neurotoxic consequences (causing anhedonia, or the loss of pleasure), reduced problem-solving, trouble assessing risk, and more.

This is accompanied with psychological suffering, as well as the urge to use whenever a high wears off. Partially, people addicted to drugs need more drugs as way to drown out the reality of being addicted to drugs. Partially, it’s because their brain is screaming for more drugs.

As adaptable and intelligent as our brain is, it’s still only a rudimentary computer. It does its best to adapt to drug use, but in a way that backfires tremendously. While many medicines rely on changing the way the brain communicates – such as antidepressants, which increase the amount of serotonin available in the brain – only few affect the reward pathway in the brain in such a way that the only thing you’re effectively motivated by is the drug that elicited the change to begin with.

This is the basic premise of addiction as a disease. The brain changes to accommodate the effects of a new and foreign substance, by turning the substance and its effects into the new “norm”. It then seeks to maintain that norm by constantly craving more. Without it, you spiral into withdrawal symptoms, accompanied by all the other effects of sobriety – such as a rush of guilt from the stigma attached to abusing drugs. The cycle continues – until it takes your life.

 

How Drugs Take a Life

When a drug is consumed, the body learns to metabolize it. Often, as drug use continues, the body becomes more efficient in metabolizing the drug. Soon, a dose that used to be effective no longer is. This happens with non-addictive medication, especially when someone has to use a drug for years and decades. Sometimes, the process takes a very long time. Sometimes it happens quickly. Sometimes, a certain drug simply isn’t powerful enough to elicit the same old high, and you move onto something more potent and deadlier.

One wrong dose, or one dose mixed badly or laced with an unknown and dangerous ingredient can be enough to trigger an overdose, causing the body to fail in one way or another. With opioids and depressants like alcohol and benzodiazepine, the body fails to properly breathe, and the brain dies of oxygen starvation. In other cases, the heart beats irregularly, before stopping completely. Sometimes, a person may go unconscious and involuntarily vomit, blocking off their airways.

Sometimes, drugs cause deaths indirectly. Drugs injected may be injected through shared syringes, especially in moments when users simply fail to care enough to maintain proper syringe etiquette. This can promote the spread of deadly infections as viruses, including hepatitis and HIV. Drug use can also coincide with deadly accidents, or illnesses and conditions caused by organ damage and death caused by organ failure.

 

Addiction Can Be Treated

This article paints a bleak picture of what drugs can do. The number mentioned at the very beginning of the article only refers to the deaths attributed directly to drug overdoses. Countless others died of drug-related illnesses and accidents, as well as drug-related crimes and violence.

But this isn’t an indictment of anyone using drugs. It’s a wakeup call to identify addiction as a harmful disease – one that can be successfully treated, and must be treated, in order to save the lives of millions of Americans currently struggling with addiction on a day-to-day basis. Most Americans with drug use issues do not seek help – but seeking help works.

What Permanent Damage Can Drugs Do to You?

What Lasting Damage Can Drugs Do

All drugs can leave lasting, permanent damage – if taken often enough. Addictive drugs usually cause the most damage in any given society because, unlike, say, heart medication, taking a drug like heroin compels you to take more of it, until you feel like you can’t live without an ever-increasing dose of the stuff. And as with all drugs, it’s ultimately the dosage that makes the poison.

When given in miniscule amounts, even heroin won’t kill you. The body can process it better than it processes alcohol, and aside from the fact that it’s heavily addictive, there are few dangerous side effects to a low dose of heroin. But the fact that most heroin is illegally-sourced and mixed with other ingredients, injected often through shared needles, and eventually taken at dosages that are likely to kill you, it very quickly becomes a dangerous and unreliable drug. Like heroin, most addictive drugs can hurt us – and some leave lasting, permanent damage.

 

Why Do Drugs Hurt Us?

All drugs are designed and sold to have a certain effect. Some drugs are synthetically put together specifically to mimic naturally-occurring chemicals, with the express purpose of eliciting a specific reaction, for medical or recreational purposes. Other drugs are derived from bacteria and plants, studied, and applied in medicine after decades of rigorous testing and experimentation. But in effect, all drugs leave a lasting mark on an individual – it’s what they’re meant to do.

Most drugs sold today are explicitly on the market because their benefits heavily outweigh their drawbacks. Heart medication may decrease the natural clotting effect in the body’s blood, creating thinner blood that more easily passes through a person’s veins, in order to improve oxygen delivery throughout the body’s tissue despite a weak heart or constricted blood vessels. However, this comes with a series of side effects, most notably the fact that less clotting means longer healing, as the body struggles to fix cuts and bruises.

Some drugs have drawbacks that far outweigh any benefits. When German chemists first discovered an even more potent analgesic by studying and experimenting with morphine, they dubbed it heroin, and sold it as a less addictive, more powerful analgesic and anesthetic under the Bayer brand. Soon, heroin was found to be an even more potently addictive drug than other existing opioids, and in the late 19th and early 20th century, it was banned for medical use in various regions throughout the world.

 

Drugs and the Body

Illegal drugs can generally be split into four categories: stimulants, depressants, opioids, and hallucinogens. Some stimulants and depressants have hallucinogenic properties, but hallucinogens are in a grey area medically. Other than PCP, they’re not strictly-speaking physically addictive, and while they do affect the brain, no evidence shows that their effects are permanent. However, they’re still illegal, and dangerous to use. Stimulants, depressants and opioids on the other hand are generally addictive, with the more potent drugs usually being more addictive.

Taking too much of these drugs or reacting violently to them due to individual differences from person to person or counter indications with other medicines can leave lasting damage in the body, including organ failure, paralysis, blindness, and more.

Drug Spotlight: Opioid-Based Prescription Drugs

Opioid Abuse

The opioid epidemic started back in the 90s, riding in on a wave of painkillers coming in off the streets and from the doctor’s office alike. A surge in heroin production as well as an abundance of unused, stolen and resold prescription opioids led to a nation with thousands of people addicted to and dependent on opioids, both of the prescription drug kind, and the illegally-produced kind. Rather than waning, the crisis has actually grown over the decades, reaching an all-time high of over 42,000 deaths in 2016, and an official declaration by the HHS that the opioid epidemic is a public health emergency.

The US consumes by far most of the world’s opioid supply, with overdose deaths occurring throughout the country, from coast to coast. Combatting this crisis requires a committed and dedicated approach from every angle, including policy, law enforcement, healthcare, and education. Every American can do their part by educating themselves and their loved ones on the dangers of opioid use, what opioids are and how they work, as well as how to recognize opioid abuse and how to treat it.

The majority of opioid consumption in the opioid crisis today is in fact heroin, which is an illegal substance with no real medical value in the US. However, the opioid crisis was first fueled through the over-prescription of opioid-based prescription drugs, which, despite heavy regulation and changes in policy, continue to contribute to nationwide prescription drug abuse.

 

What Are Opioid-Based Prescription Drugs?

Opioid-based drugs are synthetically or naturally derived from opium, the psychotropic extract of the poppy plant. First discovered and cultivated in ancient times, in the civilizations of Mesopotamia, opium is one of the oldest drugs on the planet.

Aside from being highly addictive, opium was also known for its analgesic and anesthetic properties, and when modern medicine was in its infancy, more concentrated derivatives of opium – including morphine and heroin – were marketed as anesthetics and analgesic drugs, both pre- and post-surgery. It didn’t take long for morphine overuse to be recognized as dangerous, and both morphine and heroin became highly-regulated drugs in the post-WWII era, with heroin being banned in most nations since the early to mid-20th century.

Today, opioid-based drugs continue to contribute in modern healthcare, usually for analgesic purposes as we’ve since discovered more effective anesthetics. Commonly-prescribed opioid-based prescription medication includes codeine, hydrocodone (Vicodin), and the extremely potent drug fentanyl, which is reserved for terminal pain, and severe cancer pain. Morphine is still used in post-operative care.

Other less common opioid-based drugs still exist, including carfentanil, a derivative of fentanyl that is roughly 100 times as potent, used typically only in veterinary medicine due to its extreme potency. Described as a “nerve gas” due to how easily it can be inhaled, carfentanil has also been mixed into batches of illegal heroin sold throughout the United States, leading to a number of overdoses due to poorly-mixed batches.

When people talk about opioid-based prescription drugs, they typically mean one of the following drugs:

Morphine is also sold under the brand name Kadian, as well as MS Contin.

 

How Do Opioids Kill Pain?

Opioids are primarily used as analgesic medication, which means that they’re specifically prescribed to kill pain. Morphine, hydromorphone, and oxycodone are all very powerful painkillers capable of numbing a wide variety of pain – but how?

All neurons possess a number of different receptors, which intercept neurotransmitters and other chemicals in order to communicate and facilitate the various functions for which they’re used. Opioid receptors, named such because of the effects that opioids have on them, exist on neurons throughout the brain and nervous system, and these receptors accept the opioids and begin blocking out pain signals throughout the body.

It’s as simple as that, really. The opioids attach to the cells in the brain, gut, spinal cord, and other areas throughout the body, and send out a message stopping the spread of pain signals. Opioids do this more effectively than any other drug known to man, but at a cost. While they’re very effective at stopping pain, there are several reasons why these drugs are also considered dangerous.

 

Why Are Opioids Dangerous?

The two major reasons why opioids are considered dangerous is that they can cause serious side effects (including death), and they are highly addictive. More so than many other drugs, opioids are among the most addictive drugs on the planet. Rather than simply block out pain the way over-the-counter medication like NSAIDs and paracetamol do, opioids also induce a reaction in the brain by increasing the release of dopamine, heavily changing your mood. Their effect on the brain also seems to convince your mind that you need more of the drug than you actually do, causing you to seek opioids out even when you aren’t in pain, or when it’s been prescribed that you should be taking less.

Most people who struggle with an opioid addiction never took the drug for pain to begin with. Since people who are prescribed medication usually only take the dosage prescribed to them, they are at a lesser risk of developing an addiction. On the other hand, people who start taking prescription drugs illegally and are more liberal with their consumption of opioids, or people who started on heroin, are much more likely to struggle with addiction as their drug use continues.

This leads to serious issues over time, including drug tolerance, wherein a previous dosage is no longer enough to elicit the same level of high it used to elicit. This can quickly take a turn for the worse by causing you to take more of the drug than before, eventually reaching levels that cause you to shut down physically.

Opioids affect the nervous system in a similar fashion to an anesthetic or a sedative, causing sleepiness, shallow breathing, and a slow heartrate. An overdose on opioids can cause unconsciousness, followed by respiratory arrest and death. Naloxone and other opioid inhibitors can block the effects of opioids on the brain and stop an overdose, but if applied too late, the overdose can still cause brain damage and paralysis due to oxygen deprivation.

 

How Is Opioid Addiction Treated?

Opioid addiction is treated at times through a combination of medication, therapy, and residential treatment. Rehab facilities and sober living homes specialize in helping opioid addicts find a place to fully recover from their addiction by giving them programs and schedules to help keep themselves occupied, learn to deal with a number of physical and emotional problems without the use of opioids, and slowly wean off their addiction through the use of methadone, naloxone, or buprenorphine.

Legal Drugs Are Just as Bad as Illegal Ones

Legal Drugs Are Bad Too

Drugs are drugs, and some of the most dangerous drugs are legal – and are partially as dangerous as they are because they’re legal. While drugs like cocaine and heroin can quickly lead to serious neurological side-effects, hygiene issues, and heart problems, cigarettes and alcohol are two of the world’s leading causes of cancer, while the current opioid crisis was fueled and arguably started through prescription opioids, and alcohol-related deaths continue to out-perform almost every other drug in terms of fatality. Which drug kills even more people than alcohol does? Tobacco.

An estimated 88,000 people die every year from alcohol-related deaths, and an estimated 480,000 people die annually due to tobacco, including over 41,000 deaths through second-hand smoke. For every death, another 30 people are left alive struggling with smoking-related illnesses, including smoking-induced cancer, heart disease, lung disease, obstructive pulmonary disease, and more.

In comparison, the great opioid crisis that has gripped the country’s attention and has been claiming headlines throughout 2018 has killed roughly 33,000 people in 2015, while steadily increasing since the 90s.

Indeed, drugs are drugs. To understand the full impact that drug use and addiction have on humans, we need to explicitly eliminate misleading double standards and see beyond the veil to realize that all drugs have the potential for dangerous misuse and fatal consequence, and that all addicts ultimately need medical help and the attention of professionals to get through this part of their life.

 

Why Legal Drugs Are Legal, and Illegal Drugs Aren’t

Tobacco is ostensibly legal due to the fact that cigarette lobbies are incredibly powerful, and cigarette companies are some of the most powerful in the world. There is no other explanation. Or is there? Indeed, while cigarette companies do hold a vast amount of power, they are probably not the reason why many governments have not reinforced a serious plan to completely curb or even eliminate cigarette smoking – there are millions and millions of smokers in the US. Outlawing tobacco would likely lead to an epic backlash and civil unrest.

Nevertheless, banned it should be. Cigarettes offer no health benefits, nicotine is a highly addictive drug that has often been cited as being one of the hardest habits to kick, and tobacco kills more people than fast food and alcohol.

Cigarettes should be, by all means, completely illegal – and in some shape or form they are, as not all tobacco products are totally kosher in various parts of the world, and in certain countries, harsher measures have been taken to prohibit the proliferation of cigarettes, such as by banning outdoor public smoking.

Alcohol is equally useless for one’s health, but at least we have some precedent that explains why outlawing that a bad idea is as well. In theory, both cigarettes and alcohol shouldn’t be allowed. In practice, banning these drugs would only make matters worse, creating entire criminal enterprises, illegal importation, and inviting the dangers of several varieties of illegally produced and potentially fatal alcohol making their way onto the black market.

The only exception by which legal drugs are potentially helpful is the category of the prescription drug. As much flak as prescription painkillers have received in the last few years – with good reason – opioids are still useful for the treatment of massive acute pain and terminal pain. It still makes you feel numb and happy like nothing else, which certainly helps after a physically traumatic event rips through your insides.

Other addictive prescription drugs include anti-anxiety medication and ADHD medication, or depressants and stimulants respectively. Depressants help calm down someone with anxiety, helping them catch a well-deserved breather and lowering their inhibition, so they’re less likely to worry about any given number of things. Stimulants, on the other hand, are very different a drive up a person’s heart rate, making them feel focused and motivated, much like an extremely powerful cup of coffee.

These drugs are typically not prescribed at quantities that allow for addiction and wholesale distribution, but due to teens stealing pills from their family or buying them illegally to study/party, they’ve become popular as an illegally-acquired albeit technically legal high, separate from the usual drugs found at parties, such as MDMA (ecstasy) and cannabis.

 

A Depressant is A Depressant

Drugs like alcohol and Xanax are extremely similar, which is why they should never mix. Taking these two together is potentially fatal, if not very potent, because they both do a similar thing in the brain thus leading to an additive effect.

This is why alcohol is most people’s drug of choice when they’re worried, because it can help you forget about your fears and inhibitions and instead do whatever first comes to mind. Both alcohol and Xanax are similar but weaker in comparison to older, stronger depressives, include tranquilizers and illegal barbiturates.

 

A Stimulant is a Stimulant

Cocaine, methamphetamine, and amphetamine work in a similar fashion as well, although cocaine is sourced from the coca plant, while amphetamine and methamphetamine are entirely synthetic, produced both in high-tech super labs as well as in an addict’s kitchen somewhere, albeit with highly varying levels of quality.

Stimulants pose great risk to the heart and brain, increasing the risk of a heart attack and stroke. Adderall, as addictive as it is, is also a major issue especially in academic circles as a way to compete for better grades by staying up and focusing.

 

An Addiction Is an Addiction

At the end of the day, an addiction is an addiction is an addiction – regardless of whether it is an opioid dependence or an alcohol use disorder, a physical dependence to a dopaminergic substance is a very dangerous thing that is very hard to treat, and often takes years to overcome.

Addictions take lives, and they don’t discriminate, killing people from all walks of life, leading them to their deaths in any age group, skin color, or socioeconomic class.

But addictions are also treatable. By getting help and getting into a sober living home or residential treatment facility, you’re securing a better future for yourself.

 

Why Do Cities Seem to Have Larger Drug Problems?

City Drug Use

Drug use is prevalent throughout the world, in all populations, but most research is focused on urban drug use. And in a way, cities do have larger drug problems. Why? The answer is actually quite simple, but the question itself reveals a lot about addiction as a societal issue and can bring to light a number of other issues that should be discussed.

To put it as simply as possible, drug use is common in cities because cities tend to have larger populations than rural areas. There are more people within an urban city than there are within a rural town – but even more importantly, living together in such close proximity often causes other problems that increase the risk of drug use, not the least of which is that a greater population simply means a larger group of potential drug users.

This, in turn, reveals other problems. Urban communities share unique struggles, especially with crime and poverty, both of which often involve drugs either by way of culture, trauma, or otherwise. However, in addition to poverty being more prevalent in rural areas, addiction is not exclusive to the poor. Far from it, drug use is prevalent across the country, across all demographics, but at different rates. Exploring these issues says a lot about how risk factors determine a person’s likelihood of using and potentially abusing drugs, but also reveal how drug use and addiction is pervasive in all levels of society, like many other mental health issues, and why.

 

More People, More Drug Use

More people mean more drug users, as any given population on average is bound to have people who struggle with addiction, if drugs are at all available. However, a greater concentration of people often means more potential drug use because of other factors that commonly go hand-in-hand with a large concentration of people in a small patch of land.

High-density urban areas tend to be communities and neighborhoods with low incomes, where families live under harsher conditions in land they can afford. Poverty is inexplicably linked with higher rates of addiction because of the stress and desperation that comes from lacking any form of financial security, and a positive outlook for a hopeful future.

This desperation can also be linked to crime. Crime and drugs are linked for obvious reasons, as the illegal trade of drugs is one of the more lucrative ways to make fast cash despite high stakes, the kind of stress that might promote and perpetuate a culture within gangs that lack any assurance for their members that they would survive past the inebriated short term.

Poverty, drugs, and crime are linked by a long history of poor social mobility in low income neighborhoods, especially in cities where gentrification is pushing families out of their homes and boxing them further into smaller and smaller areas. Drug use is also more prevalent among people who are scared of their neighborhoods. Without the money to leave, they’re forced to stay and seek out any possible opportunities to find work, or at least manage to live while unemployed and in the company of family and friends. Of course, this applies to rural areas as well.

 

Rural Areas Are Just as Susceptible

Urban areas have more people per square mile, but rural areas are just as likely to struggle with drug use. While traditionally, the city and country dichotomy might have implied a large difference in the rates at which people use drugs in both environments, the numbers say that people in rural areas are just as likely to use drugs – but they use different drugs.

Those in rural areas are more likely to abuse alcohol and prescription medication, while cocaine and heroin are more common in cities than out in the country. While addicts seeking treatment in cities are usually ethnically diverse, most addicts entering in treatment in rural locations are white, as well as younger, although this also has to do with the fact that urban areas tend to be more ethnically diverse and the fact that rural addicts tend to start drug use earlier than people in the city. Education and employment rates among addicts were also higher in rural areas than in urban ones.

 

Drug Use in Affluence

While poverty is linked with addiction, so is affluence. Stress is stress, and severe stress is severe stress. Someone who grew up being poor is often quite capable of coping with the reality of poverty but will also face greater struggles than someone with better opportunities and easier circumstances.

But teens in affluent families grow up facing different kinds of struggles, usually revolving around the pressure to succeed, live up to a certain legacy, or simply engage in risky behavior as way to act out or experience something new – all of which leads to higher drug use than is the norm. Having deep pockets also helps finance a greater volume of drug use, only compounding the issue.

 

Everybody Can Recover

It can be difficult to find hope and strength when faced with some of the facts on addiction in America. But there is a bright side – more than one, in fact.

The numbers show that only a fraction of people who start using illicit drugs ever develop a problem – about one in five, by some estimates. Of these, many simply stop using after a certain number of years without professional intervention, although professional help would have probably saved the lives of those who pass away before they quit. Others who do keep struggling decades after use can still get clean and stay clean through a myriad of different addiction treatment programs, or through sober living homes and rehab centers.

Maybe the most reassuring fact is that most people with drug dependence issues can recover. Even if they struggle to do so at first, and even after many “failures” in the form of relapses, they still have the potential to quit for good. All it takes is time and support. However, many lack the support. Not everyone has a healthy coping or support system, and others lack the healthcare coverage to get the treatment they need.

Addiction needs to be fought like a disease, rather than a crime. By focusing on funding treatments and programs to help encourage people to get help rather than perpetuating their addiction through criminal punishment, a lot of progress could be made in lowering the rate at which people use and get hooked on drugs. Of course, it’s important to limit usage as well – but criminalizing drug use rather than treating it has not been doing much to stop the problem.

Your Addiction Can Threaten Your Job

Addiction threatens your job

We see it on the news all the time – addiction can be life-threatening, leading thousands of people down a desperate path and eventually culminating in a tragic fate. But while thousands of Americans lose their lives to addiction overdoses and accidents every year, over 24 million Americans currently struggle with a substance abuse problem.

For the overwhelming majority of them, addiction is not an immediately life-threatening situation, but a day-to-day. Some, often early on in their addiction, believe that they can control their habit and manage to keep things “normal” while relying on a daily supply of substances. But the reality is vastly different.

No matter how strong-willed you may think you are, a substance use disorder – a compulsive need to take drugs, coupled with the inability to stop – will eat into your life and deal damage to your day-to-day long before things become lethal.

Your addiction will threaten your job. And it’s not a matter of keeping your tracks covered well enough – rather, it’s simply a matter of time. To keep your life’s work (and your life) safe, you’ll need to learn to give up your addiction, or even recognize that you’re struggling with one to begin with.

 

Why Addiction Strips Your Reputation

The primary feature of an addiction is that it often renders an individual unaccountable and incapable of making rational decisions outside of the context of serving their brain’s new supreme priority – getting more drugs. Drug use becomes compulsive and dangerous when both your body and mind decide in unison that they need drugs in order to function. It’s the that addiction or dependence kicks in, and you’re finding yourself falling into a downward spiral wherein your choices are dictated by the need to find access to your next high, lest the emotional and physical pain of withdrawal and sobriety kicks into full gear.

It’s not you – at least, mostly. Yes, all addictions begin with bad choices, but every human being makes mistakes and bad choices. Some have worse consequences than others, and when we’re emotionally blinded, those consequences are not immediately obvious. In cases of stress and trauma, or coercion, drug use becomes the only easy way out, or perhaps even the only way out. While we forgive most people for the mistakes they make, many can’t help but not forgive those who made the mistake of becoming addicted, because what looks like willful misdirection and elaborate lies is a disease in the brain, that cannot be seen on the surface level.

It starts with a few highs, but eventually it becomes a habit, and one you can’t function without. Even if your company doesn’t test for drugs, eventually you will begin to lose track of time, struggle to concentrate and perform your duties, and you’ll let your responsibilities slip. Promises will be broken, trust will be destroyed, and your reputation as a once-accountable person slips away under the haze of drug use.

You promise to change, and you really want to, but you can’t on your own. The drugs keep pulling you back, and every time they do, others around you look on in disappointment thinking you’ve betrayed them and their trust once again. You sink further and further into despair, and it becomes harder and harder to look at the prospect of tomorrow with even a shred of hope.

 

How Addiction Affects Your Thinking

To understand how addiction can strip you of your career – and many other things – it’s important to understand how and why drug use affects your thinking drastically.

Firstly: chemical and emotional dependence. When addictive drugs enter the body and make their way to the brain, they take effect by binding to the brain’s cells and manipulating the way the brain processes dopamine, either by producing more, or by heavily blocking dopamine’s reuptake, causing a massive surge.

Other pharmacological drugs do similar things – antidepressants, for example, block the reuptake of serotonin – but dopamine is so intrinsically tied to our reward system that researchers believe it’s specifically the interaction between drugs and dopamine that causes the brain to begin getting addicted.

After the initial high, the aftermath often causes the brain to want a little more. This feeling goes away with time and is easily inhibited. This is how millions and millions of Americans experiment with drugs without ever getting hooked on them.

However, if a person decides to use drugs more and more, the brain starts to get used to the presence of drugs in the brain. Two things happen.

The brain develops a chemical dependence. The constant stream of highs causes the brain to adapt to its new dopamine-filled environment, and it begins to struggle to function properly when not high. Even when high, “functioning” is a strong word. Dependence is signified by the presence of harsh withdrawal symptoms that occur upon sobriety – from headaches and nausea to extreme cravings and seizures, depending on the drug.

The other thing that often occurs is tolerance. As the brain gets used to drugs, it begins to metabolize the foreign substance much faster, causing the effects of a certain dosage to diminish. This leads to people using more and more drugs, further increasing their risk of overdose – because while the high may slowly wear off and grow weaker, a drug’s lethality or toxicity doesn’t change as drastically.

Through these two mechanisms, addictive drugs enslave a person. It’s not completely known why they do this, but there are no naturally-occurring drugs that are anywhere near as addictive as synthesized or isolated substances, meaning that addictive drugs on the scale of heroin, cocaine and methamphetamine are entirely man-made in design and effectiveness. Perhaps it’s sheer coincidence that these chemicals happen to interact with the portion of the mind dedicated to rewards and habit-forming.

 

Getting Back on Track

Getting professional help for your addiction as soon as possible is the most important part of recovery – the sooner you start, the sooner you’ll function again.

Drug recovery treatment involves keeping a person mentally and physically healthy until they’re ready to stay sober on their own, utilizing various different therapeutic methods to help them adjust to a sober lifestyle, work against their inner cravings and temptations, and resist the urge to use again. Time is the primary element in a good recovery plan, and it takes a long time to feel comfortable with sobriety after a stint of addiction. But by persevering and working hard to focus on what matters most to you, you can keep yourself clean against all odds.