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Addiction also referred as substance dependence is a chronic, relapsing disease affecting the brain’s reward, motivation, and related systems. People struggling with addiction are unable to control their actions or make rational decisions about their behavior, even in the face of negative consequences.
Compounds and experiences with addictive potential activate the brain’s reward circuitry. These triggers are also called reinforcers because the pleasurable feeling we get from them makes us more likely to engage in them again. Both alcohol and illicit drugs are powerful reinforcers, and cause the release of the neurotransmitter dopamine in the brain’s reward system. Repeated activation by these compounds changes the brain’s reward system structurally and chemically, and produces behaviours like bingeing,escalating use, and symptoms of withdrawal when the drugs are taken away.

Addiction is any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addiction involves:

1. Compulsive engagement with the behavior, a preoccupation with it;
2. impaired control over the behavior;
3. Persistence or relapse, despite evidence of harm; and
4. Dissatisfaction, irritability or intense craving when the object be it a drug, activity or other goal—is not immediately available. Compulsion, impaired control, persistence, irritability,
relapse and craving—these are the hallmarks of addiction.
—any addiction. Not all harmful compulsions are addictions, though: an obsessive-compulsive, for example, also has impaired control and persists in a ritualized and psychologically debilitating behavior such as, say, repeated hand washing. The difference is that he has no
craving for it and, unlike the addict, he gets no kick out of his compulsion.
Addiction is a process based in altered functioning of the reward and motivation systems of the brain. It can manifest in many ways, but historically addictions fall under two categories.

Substance-Related Addictions
This includes dependence on any of the following:

Tobacco
Alcohol
Street drugs
Prescription drugs

Behavioral or Process Addictions
Although less well studied, many behaviors appear to have reinforcing properties, and may involve excesses related to:
• Gambling
• Food
• Sex
• The Internet
• Video Games
• Work

Multiple Addictions and Co-morbid Factors
Science shows that substance and behavioral addictions can occur within the same individual and that multiple variants of substance or process addiction can be expressed at the same time. Thus, people can have multiple addictions with each addition being active to differing degrees of severity. Additionally, depression and anxiety frequently accompany addiction as co-morbid factors.


Drug Addiction in Pakistan
Substance dependence is a major problem Worldwide, Pakistan being no exception.
The drugs commonly used in Pakistan are cannabis, opium, alcohol, codeine, heroin and many tranquilizers. United Nations Office for Drug and Crime [UNODC], 2013) data revealed that about 6.7 million substance dependents with age range of 15-64 found in Pakistan. ,one in every 27 persons in Pakistan is using drugs while nearly 25% of the youth population is involved in some form of drug abuse in Pakistan, opiate users are about 1% which is also very high prevalence.

Drug abuse is most prevalent in Khyber-Pakhtunkhwa where 11% of the population uses drugs, followed by Sindh where 6.5 per cent of the population is drug addict. In Baluchistan, almost five per cent population uses drugs while in Punjab, 4.8 % of the population is drug addict.
Cannabis (Charas) is the most commonly used drug in Pakistan; with Almost 5.8 per cent of the adult population is addict of cannabis. Opiates namely opium and heroin are used by almost one per cent of overall drug users. There are 420,000 people who inject drugs in Pakistan, which represents 0.4% population. Non-medical use of tranquilizers and sedatives is higher among women.

Young people are more susceptible to drug use. They often talk about the “highs” but may not be aware of the many “lows”. The widespread availability of drugs in Pakistan is making it easy for them to be addicts. Drug addiction among the youth is killing them morally and socially as well psychologically and even physically.
The reason why the number of drug addicted people especially youth is increasing alarmingly in Pakistan is that the drug cartels in the country are fully backed and supported by the powerful and the wealthy who have got ample influence. Moreover, apparently, police and drug mafia are colluding. Moreover, easy availability of narcotics and psychological effects of violence are also playing part. Children who have suffered violence in their life or who have undergone a traumatic experience turn to drugs to forget about the loss.

WHAT ARE THE CAUSES OF DRUG ADDICTION
Majority of drug addicts usually start with soft drugs like ‘chhaliya’, ‘gutka’ and ‘pan’ and then move to the hard drugs like heroin, opium and cocaine etc. The purchase of drugs or alcohol by young people is usually through dealers or ‘agents’, who are just a phone call away. Their numbers are distributed widely at hostels. In Pakistan, users can get up to 20 Charas cigarettes only for Rs1400.

The drug abuse is often linked to factors such as risk taking behavior’s that may involve experimenting with narcotics, smoking and alcohol, social isolation, stress, anxiety, depression, peer pressure (bad company), modern life style, hippy culture, unemployment, excessive pocket money by parents and lack of supervision and attention, the desire for social acceptance, boredom, curiosity, just to feel good, weak religious belief and lot of free time, easy access to drugs at low prices, existence and presence of drug dens, to heighten sexual pleasure, to overcome frustration and or tragedies, use as pain medication and fashion.

Physical health and sexual health of addicts weaken so rapidly that a young man of thirties looks an old man of over-sixties. “Drug use in general leads to a number of health problems, such as malnutrition, apathy, menstrual irregularities and irregular heart rhythm and premature death.” some of the physical effects of drugs might sound nice but they do not last long. Many people get depressed and start feeling sick. There is economic breakdown of family, loss of self-confidence and will to work, loss of job, indulgence in crimes such as theft, and suicidal thoughts.
Drug addicts are also more prone to accidents and are at higher risk of HIV/AIDS, hepatitis B & C, tuberculosis, suicide, overdose deaths and cardiovascular diseases. Married drug addicts have high probability of having mentally retarded and physically handicapped children. Young people who use cannabis are doubling their risk of psychotic symptoms like schizophrenia, hallucinations, hearing voices etc.

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