For Jimmy, Who Bruised By Ribs and Busted My Nose

I had a bully who pursued me nearly every day during middle school until one day I’d had enough. I round-house punched him in the face, bloodied his crisp white t-shirt. His dad came to the house and threatened to beat up my dad because I beat up his son. “See, this is why I hate fighting,” I said to my dad. The following poem by Brian Fanelli is dedicated to anyone who has ever had a bully.

In our neighborhood, Fat Jimmy descended the mountain,
his chest heaving like a bull,
ready to maul a matador.

He cracked his scarred knuckles, hunted scrawny prey,
curb stomped our basketballs
like heads he wanted to bash,

or ghost rode our bikes
down the garbage trail dump,
until one day I gripped my handlebars

like a soldier clinging to a rifle,
refusing defeat as Jimmy knocked me to my back,
clocked me in the chin.

Numbed, I laughed as he pounded and pounded,
until my nose gushed, my ribs throbbed,
my skin swelled faster than his heated cheeks.

This poem is for the bully who never cried,
who hid belt lashes from us, who ran from the sound
of his father’s battered Ford tracking him down,

the son whose hands tightened to fists like his father’s,
who uncurled his fingers to study my blood,
and then extended a hand to lift me up.

Drug Addiction and our Youth

There’s ample evidence that many youth use drugs to self-medicate for depression, anxiety, and fear, not to mention a host of mental-health disorders. The drugs they take may become the focal point for both kids and their parents, but they may be masking deeper problems. How can a parent know? Parents consult expert after expert, but even the experts don’t necessarily know either. Diagnosis isn’t an exact science, and it’s complicated, particularly for adolescents and young adults, for whom mood changes, including depression, are common. Many symptoms of these disorders appear to be identical to some of the symptoms of drug abuse. Also, by the time experts finally figure out that there’s a problem, drug addiction may have exacerbated the underlying mental health ailment and fused with it. It becomes impossible to know where one leaves off and the other begins. This is frequently referred to by professionals as “double trouble.”

“Considering the level of maturity of young adolescents, the availability of drugs, and the age at which drugs are first used, it is not surprising that a substantial number of them develop serious drug problems,” writes Robert Schwebel, PhD, in Saying No is Not Enough. “Once this happens, the effects are devastating. Drugs shield children from dealing with reality and mastering developmental tasks crucial to their future. The skills they lacked that left them vulnerable to drug abuse in the first place are the very ones that are stunted by drugs. They will have difficulty establishing a clear sense of identity, mastering intellectual skills, and learning self-control. The adolescent period is when individuals are supposed to make the transition from childhood to adulthood. Teenagers with drug problems will not be prepared for adult roles. They will chronologically mature while remaining emotional adolescents.”

My exposure to theories of development while studying psychology at the University of Scranton in the early 1980s, as well as in current psychology courses at Colorado Christian University, tells me that children’s brains are at their most malleable – that is, the greatest change takes place – before they are two years old and then again when they are teenagers. The worst time for a person to be tampering with their brain is when they are a teenager. Drugs radically alter the way teenagers’ brains develop. Experience and behavior help to set up a cycle that may deepen emotional problems. The biological infrastructure that develops as a result may become more acute and more intractable. It enforces and reinforces the psychological problems, which become more firmly established. Treating people whose drug use began when the were teenagers, as did mine, is further complicated because deconstructing or rerouting established pathways have biological as well as emotional and behavioral roots.

To understand the risks associated with psychoactive substances in adolescents, it helps to understand that teenagers are not just less-experienced adults; they are undergoing an important yet challenging developmental stage in which they are prone to errors of judgment, and sensitive to neurological assault by drugs and psychoactive substances. More than any other age group, adolescents are at risk for substance addiction, and, more than any other age group, they risk permanent intellectual and emotional damage due to the effects of drugs.

Obviously, the human brain is sculpted by experience, which is processed primarily by the pre-frontal cortex. This area of the brain executes such skills as setting priorities, formulating strategies, allocating attention, and controlling impulses. The outer mantle of the cortex is involved with processing abstract information and understanding rules, laws and codes of social interaction. Teenagers are notorious for their obsession with social interaction, as well as for making up social rules and breaking them. They are merely testing limits. As teenagers grow into young adults, they often exhibit a fascination with abstract thinking on topics like history, culture, and media, which demonstrates their growing ability to understand the larger world. While the teenage brain is in some ways ill-equipped to make decisions and choices without the help of trusted adults, it is perfectly designed for the types of intellectual and social challenges teenagers most need to master.

Still, development of fully mature complex thinking takes a long time. MRI studies show that the development of the pre-frontal cortex and outer mantle of the brain continues into the early 20s, and may not be completed until the mid 20s. There are many ways that psychoactive substances can alter or damage the development of the adolescent brain. Psychoactive substances often target and alter the function of neurotransmitters, which are chemical messengers that allow nerves to communicate with each other. Interference with neurotransmitters can directly damage fragile developing neural connections. More importantly, drug and alcohol use alters perception, and may interfere with developing perceptual skills. Habits and choices associated with the use of drugs and alcohol slowly become ingrained into the wiring of the brain. Repeated action becomes habit, and the habits of thought, perception, and reasoning developed in childhood and adolescence can stay with a person throughout his or her lifetime. My addiction began at the vulnerable young age of 18. I continued to abuse drugs and alcohol throughout nearly forty years of my life.

As many mental health professionals are quick to point out, if you do something for long enough it becomes automatic. Nowhere does this wisdom more hold true than in teens and young adults. Though teens may change clothes, ideas, friends and hobbies with maddening frequency, they are busily developing ideas about themselves, their world, and their place in it that will follow them for the rest of their lives. Adults may spend years trying to create or break even the simplest habit, yet most adults find that their most profound ideas about themselves and the world were developed in high school or college. This is because, by age 25 or so, the brain is fully developed, and building new neural connections is a much slower process.

Early detection and treatment is essential to heading off the development of substance addiction in adolescents. Given their brain development, teenagers cannot be expected to understand the full range of consequences in their choices regarding drugs and alcohol. The disease must be prevented, and where it cannot be prevented it must be arrested while there is still time for a full recovery.

O God, that men should put an enemy in their mouths to steal away their brains! That we should, with joy, pleasance, revel, and applause, transform ourselves into beasts. – Wm. Shakespeare.

Drugs, Brains and Behavior

Many people do not understand why or how other people become addicted to drugs. It is often mistakenly assumed that drug abusers lack moral principles or willpower, and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions or a strong will. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so. Through scientific advances, we know more about how drugs work in the brain than ever, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.

What is Drug Addiction?

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs. Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, and are preventable and treatable, but if left untreated, can last a lifetime.

Why Do People Take Drugs?

In general, people begin taking drugs for a number of reasons.

To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates, such as oxycodone or heroin, is followed by feelings of relaxation and satisfaction.

To feel better. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction.

To do better. Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids.

Curiosity and “Because others are doing it.” In this respect, adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules.

If Taking Drugs Makes People Feel Good or Better, What’s the Problem?

When they first use a drug, people may perceive what seem to be positive effects; they also may believe that they can control their use. However, drugs can quickly take over a person’s life. Over time, if drug use continues, other pleasurable activities become less pleasurable, and taking the drug becomes necessary for the user just to feel “normal.” They may then compulsively seek and take drugs even though it causes tremendous problems for themselves and their loved ones. Some people may start to feel the need to take higher or more frequent doses, even in the early stages of their drug use. These are the telltale signs of an addiction.

Is Continued Drug Abuse a Voluntary Behavior?

The initial decision to take drugs is typically voluntary. However, with continued use, a person’s ability to exert self-control can become seriously impaired; this impairment in self-control is the hallmark of addiction. Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction. No single factor determines whether a person will become addicted to drugs.

Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems. This may reflect the harmful effect that drugs can have on the developing brain; it also may result from a mix of early social and biological vulnerability factors, including unstable family relationships, exposure to physical or sexual abuse, genetic susceptibility, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.

Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense “high” can fade within a few minutes, taking the abuser down to lower, more normal levels. Scientists believe this starkly felt contrast drives some people to repeated drug taking in an attempt to recapture the fleeting pleasurable state.

The Brain Continues to Develop Into Adulthood and Undergoes Dramatic Changes During Adolescence.

One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that enables us to assess situations, make sound decisions, and keep our emotions and desires under control. The fact that this critical part of an adolescent’s brain is still a work in progress puts them at increased risk for making poor decisions (such as trying drugs or continuing to take them). Also, introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences.

How Science Has Revolutionized the Understanding of Drug Addiction

For much of the past century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When scientists began to study addictive behavior in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society’s responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punishment rather than prevention and treatment. Today, thanks to science, our views and our responses to addiction and other substance use disorders have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of compulsive drug use, enabling us to respond effectively to the problem.

As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior. We have identified many of the biological and environmental factors, and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities.

Despite these advances, many people today do not understand why people become addicted to drugs or how drugs change the brain to foster compulsive drug use. The National Institute on Drug Abuse (NIDA) aims to fill that knowledge gap by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse, and the basic approaches that have been developed to prevent and treat substance use disorders. At NIDA, they believe increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation’s well-being.


National Institute of Drug Abuse
The Science of Drug Abuse and Addiction
July 2014