Atrius Health

More than 107,000 Americans died of drug overdoses in 2021, according to the CDC’s National Center for Health Statistics. This marks the first time in history that U.S. drug overdose deaths have surpassed 100,000, and drug overdose is now the leading cause of accidental death in the U.S., with opioids as the most common drug of abuse.

On the front lines of this generational challenge are U.S. employers. In 2020, more than 40 million Americans were living with an addiction—also referred to as a substance use disorder (SUD)—and 70% of those were in the workforce. Even more surprising is the fact that fewer than 10% of these people are being treated.

What is it about addictions that can make them so powerful? People will—sometimes lightheartedly—say they are a coffee addict or “addicted to chocolate.” It’s actually the same mechanisms that come into play, but when talking about tobacco, alcohol, or opioids, we’re dealing with much more powerful, damaging, and potentially fatal chemicals.

The science behind addiction is complex, and in order to talk effectively about addiction, we need to define and understand the term. According to the American Society of Addiction Medicine - addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction ingest substances or engage in behaviors that become compulsive and often continue despite harmful consequences. However, according to Quit Genius Medical Director Justin Yang, M.D., prevention efforts and treatment approaches for addiction can be as successful as those for other chronic diseases.

“It’s important to understand what the latest research is telling us, which is that addiction is actually a chronic disease that should be treated in much the same way that we treat diabetes or high blood pressure. People don’t choose to have an addiction, any more than they choose to have heart disease. These are chronic conditions with deep physiological changes not unlike type II diabetes, cancer, and cardiovascular disease.”

Habit Formation

A recent article in the Journal of Mental Health and Clinical Psychology points out that addiction has exceedingly deep evolutionary roots. The authors suggest that the roots of addiction are found in fundamental biological mechanisms for learning and motivation (i.e., survival) dating back hundreds of millions of years.

It’s only natural to want to keep our bodies alive and reproducing. From an evolutionary perspective, we humans can get a false sense of gain—including increased fitness and viability—from drug addiction, which drives behavior. If we found delicious food or had sex, our brains would produce chemicals (neurotransmitters) that make one feel good. One of those neurotransmitters, dopamine, is released in response to pleasurable experiences, including the “high” from alcohol or opioids—so our brains want to repeat the action, even if the “gain” is only temporary.

Research shows that while the pleasure and reward derived from early drug use can play a substantial part in continued use of the drug, it is only one small part of the neurophysiological cycle of addiction.The intense reward sensation of drug intoxication creates a strong and rapid learning response in the brain. This association leads to ever-increasing drug use in order to experience the pleasure of the reward response more often.

"The science behind addiction is complex, and in order to talk effectively about addiction, we need to define and understand the term"

Addictive substances such as nicotine and opioids act quickly and trick the human brain into thinking the reward was even better than it really was. The measure of a drug’s addictiveness is not only about how much pleasure it produces, but how quickly it reinforces it. Connections related to impulsive behavioral and emotional responses get stronger, while impulses like those used in decision making get weaker. Certain people are more or less susceptible to developing addictions depending on genetics.

Nicotine: Show Me the Way

Nicotine has long been known to play a role as a “gateway” substance because it tends to precede initiation of other drugs. Cigarette use may also act as a “primer” for multiple or polysubstance addictions. Research has shown that nicotine works to prime animals to self-administer cocaine, for example, whereas the reverse is not the case—cocaine does not act as a gateway to self-administering nicotine.

Tobacco shares a number of close associations with the use and misuse of other drugs. The nicotine in any form of tobacco product is quickly absorbed into the bloodstream. Nicotine immediately causes adrenal glands to release the hormone epinephrine (adrenaline), which then stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with drugs such as cocaine and heroin, nicotine activates the brain’s reward center and also increases levels of dopamine, which reinforces rewarding behaviors. Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may also enhance nicotine’s effects on the brain.

In addition to tobacco being the leading cause of death and disability in the United States, the National Institute on Drug Abuse (NIDA) says numerous studies have shown that people who start using tobacco and alcohol products earlier in life are more likely to develop additional issues with substance use, including alcohol, marijuana, cocaine, heroin, and other illicit drugs.

Nicotine and Opioid Addiction

Although people can’t get high on nicotine, the activity is repeated so often with so many other activities that it powerfully enhances the pleasure and motivation associated with nicotine and smoking. Smokers’ brains have learned to smoke, and just like unlearning to ride a bike, it is incredibly hard to unlearn that simple, mildly rewarding behavior of lighting up a cigarette.

Opioids, on the other side of the spectrum, do result in a “high’ that can leave users addicted after just a few interactions, craving the rapid reward of intense pleasure despite its dangers. Even withdrawal can be dangerous, with symptoms including breathing difficulty, irregular heart rate, and seizures.

Addiction and substance use disorders are costly from a societal, personal, and business perspective. For companies, the combined toll of addiction on physical health, pharmacy spend, and behavioral health makes it a top 5 driver of healthcare spend, in line with other traditional high-cost areas such as diabetes, musculoskeletal health, and mental health.

The good news is that getting people to engage in treatment for their SUD’s quickly translates into significant cost savings for companies and health plans. According to the National Safety Council, workers in recovery miss nearly 14 fewer days each year than workers with untreated SUD and almost 4 days less than employees that have never had an SUD.

For more information on how your workplace benefits or health plan team can reduce the impact of SUDs on your business operations through high quality, equitable substance use care, visit our resources page or contact a solutions expert today.