Substance Use
Substance use problems are frequent in our community and understanding how to work with patients who have problems with addiction requires skill and practice. Part of our brain and behavior has been shaped over millennia by the need for certain behaviors to be positively reinforced. This is an evolutionary adaptation in all mammals that promotes feeding and reproduction. Addictive drugs act on these systems and provide a supercharged stimulus for which there is no natural analogue. This is the biological basis of addiction but it is also a profoundly human problem. There is no culture in human history that has not used mind altering substances from coca to cannabis, from coffee to alcohol to enhance pleasure, create sacred meaning or dull pain. In other words our problems with addiction are of longstanding. Our understanding of the consequences and ravages of severe substance abuse is more recent and the evidence is compelling that brain chemistry and physiology is profoundly altered, sometimes irreparably by chronic drug taking behaviors. In the past decade we have become much more understanding of the complicated interrelationship between substance abuse and other mental disorders. There are new pharmacologic approaches to addiction that can be helpful in addition to behavioral change.