The paper entitled “The effects of substance abuse on the adolescent brain” provides a thoughtful review of research on how addictive drugs alter brain function. This paper also presents the conventional view that addiction is a chronic and relapsing disorder; however, according to epidemiological research, addiction is the psychiatric disorder with the highest recovery rates and the shortest duration. Experimental and clinical studies show that the factors that influence voluntary behavior, such as economic and social costs, persuade many addicts to quit using drugs. Not mentioned is the fact that the brain mediates the voluntary behavior and the extensive findings on relapse rates and recovery. It has long been acknowledged that changes in brain function alter voluntary behavior, and in the last 20 years or so, laboratory research has revealed many of the details of these relations.
There is one group, however, which stands out quite clearly and can be defined by age. This is the adolescent group. This group is striving to come to terms with sensitivities, mood swings, often with depression, and often seeking panaceas for the problems inherent in adolescence itself. This group requires the opportunity to solve problems by experience, or by counseling, but not by drugs. An addict who takes drugs voluntarily can be persuaded by contingencies or new information to stop using them. To determine whether drug-induced brain changes lead to involuntary drug use, we must turn to the research on relapse rates and recovery. Treatment for addicts can work, and outcome studies indicate that programs are most effective when they are consistent with the ideas that drug use in addicts can be altered by the proper arrangement of costs and benefits, addictive drugs reduce options but do not eliminate choice, and the biology of addiction is the biology of voluntary behavior.
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