The idea that one toke on a crack pipe destroys your life is popular, but it contradicts what we know about brain chemistry.
You know the story. The one that says some drugs are so enjoyable, so insidious, that just one try will get you hooked. And you’d be forgiven for believing this as the media really backs the theory.
- “The Danger In Just One Hit of Cocaine,” reports the Daily Mail.
- “Official: 1-Hit Addiction to Meth No Myth,” announces the Times Daily.
- “It Only Took One Hit to Get Hooked,” writes news.com.
But is it actually true? Can a person become addicted to a drug after using it a single time?
Before we begin to answer this question, it’s important to understand how addictive substances, such as meth and heroin, work on the brain.
Though their mechanisms differ, most addictive drugs act to release the neurotransmitter that makes us feel good: dopamine.
For example, opiates like heroin bind to opiate receptors and block the release of neurotransmitters that counterbalance dopamine release.
When a person takes drugs repeatedly, their reward circuits become desensitized.
Because there is more than enough dopamine around, the body stops making its own and simultaneously down-regulates the number of dopamine receptors.
This means the person needs drugs just to bring their levels of dopamine back to normal.
Without drugs they start feeling flat and lifeless.
That’s odd because, with chronic pain, life can feel pretty flat and lifeless too, though it’s usually interspersed with episodes of extreme distress.
The person may even begin to experience symptoms such as nausea, chills, cramps, and sweating. It is the presence of these withdrawal symptoms that indicates a physical dependence.
Now, back to the question. Dr. John Edwards and Dr. Peter Connor are addiction medicine specialists
They both agree that to be diagnosed as addicted you need physical symptoms of tolerance (you require more of the substance to achieve the desired effect) and withdrawal, alongside
- impaired control,
- social impairment, and
- risky behavior.
No drug will achieve this combination after just one hit.
The above three are also not the behavior of chronic pain patients taking opioids:
- We exercise control by taking our medicine only as prescribed (no binges!)
- We take advantage of opioid effects to get out and socialize, participate, and get more involved in life (not just to sit in a stupor)
- The only risk we take is overdoing activity when we achieve some measure of pain relief (not endangering lives with reckless behavior).
Drugs can’t change brain chemistry fast enough to make someone instantly dependent.
Indeed, a British study of 72 heroin users in 2002 found that it took on average more than a year for people to become hooked to heroin, and none claimed to have been instantly addicted.
However, some research suggests that while a single hit might not make you and addict straight away, it may “prime” the brain for addiction.
According to a study published in Nature in 2001, taking one dose of cocaine may “throw open a window of vulnerability” during which the brain is acutely responsive to further doses.
However, as the lead researcher Dr. Antonello Bonci described to the Australian Broadcasting Corporation, “This is not saying that if you try cocaine once you’ll be hooked.”
“Millions of people have tried it once and never gone back.“
This turns out to be true of most drugs. The user may experience some pleasure and then arrange to get more of the drug to experience more pleasure.
Besides the fact that the means to pleasure happens to be illegal, this is merely normal rational behavior and in no way means the user is addicted.
It is important to state at this point that being physically dependent on a drug doesn’t necessarily make one an addict.
I’m delighted to see this spelled out so clearly.
If more of the media insisted on this kind of accuracy and explanation, the public might be less brainwashed about pain patients being addicted to their pain medicine.
People suffering from chronic pain who take high levels of opiates will experience tolerance and withdrawal,
See my page that explains the differences between Addiction, Dependence, and Tolerance.
but are only considered addicts if their behavior towards the drugs starts to change.
This includes behaviors such as stealing extra prescriptions or spending their time trying to obtain money for drugs.
I’ve always believed that it was plausible that a person could become psychologically dependent after one hit. But Connor and Edwards are of a different opinion, and I have come around to their way for thinking. “You’re still not dependent at that point. You might change your mind the next day,” Connor explains.
“It’s this element of choice and control that exists early on that means a person is not dependent: once you are dependent [I’m almost sure he means “addicted” here -zyp], you lose that ability.”
This is not true of pain patients who have to take opioids all the time.
While our bodies are definitely physically dependent on and tolerant of the medicine, we maintain control over it and do not exhibit the characteristic signs of addiction: impaired control, social impairment, and risky behavior.
I believe Connor means you lose the ability to control your use of a drug when you become addicted, not if you are merely dependent.
So according to the experts, you can’t become addicted to drugs after one hit.
Why then do one hit addiction stories and headlines exist?
Headlines like these play to fears (especially for parents) and therefore make good copy.
And then there’s a general lack of understanding about how these drugs work, which leaves a void for people to believe the headlines.