Strike A Chord: Addiction #2 - Emergence

America is experiencing a huge spike in the number of drug overdose deaths.  Over 71 thousand in 2016.  In our Strike A Chord series this week, we're be looking at the addictions that underpin these deaths.

Ask ten addiction experts what addiction is, you have to be prepared for 20 different answers. Or maybe even no answer at all. That's according to Dr. Samuel Kelton Roberts, Director of Columbia University’s Institute for Research in African American Studies and is writing a book about the history of drug addiction policy and politics. He says addiction isn’t that easy to explain.

"We'd like to know if there’s one thing or at least a constellation of a small number of things which predictably will cause said health condition. That as far as I understand is not the case with this thing called addiction."

Daliah Heller, an investigator at the CUNY institute of implementation Science on population health and formerly Assistant Commissioner for New York City’s Department of Health and Mental Hygiene, agrees that addiction is a tough phenomenon to define. She points to a popular book and theory by Norman Zinberg known as Drug, Set and Setting.

The Drug is just that. The drug makes us feel a certain way... and even thinking about using the drug sends our brain’s reward center into action.  Called the high before the high, this is a well documented phenomenon that users report a rush of good feeling in anticipation of getting high, Then comes the Set. The Mindset. Dr. Heller describes it like this:

"Where you at? You know I could use an opioid and I'm feeling really good today, dadada it's kind of fun. Whatever little up that I can use tomorrow and I'm feeling really down and whoa tha opioid It makes me feel kinda, happy and warm again and the like I feel safe in in a way that I felt really lonely and sad before I took it and it's sort of so it's counteracting something that I am are already feeling or it's, addressing something that I'm already feeling so what is that set them and that's really key."

The third element is the Setting. Are you at a party? With a friend? Are you all alone? Feeling isolated? Dr. Heller says those associations and how those associations come together shape your relationship to the drug use.

The interplay of Drug, Set, and Setting can turn casual and social use of substances into addictions.