Discussion of the Causes of Drug Addiction on the Central Coast

Co-Occurring Mental Illness

There are very high rates of substance use disorder among people who suffer from other mental illnesses. According to research compiled by Chambers, Krystal and Self (2001), schizophrenia is the second most co-occurring disorder with substance abuse falling only behind antisocial personality disorder. Many researchers believe that the likeliest explanation is that patients with schizophrenia are self-medicating. This is known colloquially in the field as the self-medicating hypothesis. However, the latest research may suggest a more encompassing explanation called the primary addiction hypothesis. According to Chambers et al. (2001), the “neurodevelopmental alterations in schizophrenia overlay precisely on neural substrates that regulate addictive behavior” (p. 4). The brain’s reward system is comprised of several brain regions collectively called the mesocortical limbic pathway. Some specific brain regions include the ventral tegmental area, the nucleus accumbens, and the medial prefrontal cortex. These areas contain a number of dopamine pathways which are crucial to a person’s perception of reality and experience of pleasure as well as motivation, planning, and rewards. Since this particular system of brain functioning is implicated in schizophrenia and is central to drug addiction, it is argued that this explains the high comorbidity among schizophrenics with substance abuse.

Another common disorder that co-occurs with substance abuse is Attention Deficit Hyperactivity Disorder, better known as ADHD. An international study compiled by Oortmerssen, Glind, Koeter, Allsop, Auriacombe, Barta, Bu, Burren, Carpentier, Carruthers, Casa, Demetrovics, Dom, Faraone, Fatseas, Franck, Johnson, Kapitany-Foveny, Kaye, Konstenius, Levin, Moggi, Moller, Ramos-Quiroga, Schillinger, Skutle, Verspreet, Brink, Schoevers (2013) compared a group of patients who had co-occurring substance use disorder with ADHD and a group of patients who had substance use disorder without ADHD. Oortmerssen et al. (2013) determined that “treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders” (p. 3). It was also noted that patients who had ADHD with co-occurring substance use disorder did not respond as favorably to medication when compared to patients with only ADHD. Like co-occurring schizophrenia patients, these findings may suggest an underlying overlap in the neural circuitry of ADHD patients with substance use disorder.

Genetic Predisposition

In addition to issues with mental health, a person’s genetic makeup can vastly increase the chances that a person will become addicted when using substances. Alcoholism, also known as alcohol dependence, is an addiction that can be inherited genetically. According to Kos, Yan, Dick, Agrawal, Bucholz, Rice, Johnson, Schuckit, Kuperman, Kramer, Goate, Tischfield, Foroud, Nurnberger Jr., Hesselbrock, Porjesz, Bierut, Edenberg and Almasy (2013), alcohol dependence is “a complex, highly heritable disorder characterized by compulsive, excessive consumption of alcohol, resulting in physical, psychological and social impairment” (p. 1). A review article by Niladri Banerjee of the Amity Institute of Biotechnology (2014) illustrates the neurobiology of alcohol addiction. A person who becomes addicted to alcohol experiences neuronal adaptations to alcohol in the brain which result in altered brain chemistry and physical as well as psychological addiction. There are a number of chemicals called neurotransmitters that are implicated in alcoholism. These neurotransmitters are responsible for every aspect of brain functioning. Like all psychoactive substances, alcohol acts on the brain’s dopamine reward system which is central to motivation and pleasure. In addition to altering the behavior of dopaminergic neurons, alcohol addiction has been shown to alter the functioning of serotonergic, GABAergic and glutamatergic neurons. Depletion of serotonin is linked to impulsivity and drinking alcohol in both humans and rats. Drinking alcohol increases levels of GABA in areas of the brain associated with emotions and motivation. Drinking alcohol decreases glutamate signaling which is thought to play a role in craving during alcohol withdrawal.

Duncan (2012) states that although no single gene has been identified that predisposes an individual to become addicted, a combination of mutations in several genes within a person’s genetic makeup can vastly increase the likelihood that they will become addicted. The research indicates that addiction is highly correlated with but not necessarily predicted by a person’s genetic information. Furthermore, an individual’s environment interacts with their genes and can activate or deactivate the expression of those genes. The study of this phenomenon is a modern field known as epigenetics. This mechanism may explain the difference observed in identical twins who possess the exact same genetic predisposition toward heart disease, for example, but only one develops it. According to Duncan’s research (2012), a current hypothesis is that “exposure to drugs of abuse results in stable epigenetic modifications that alter gene expression and neuroadaptive changes seen during the transition to, and maintenance of, an addicted state” (p. 9). Kos et al. (2013) compiled a study that looked at the genetic architecture of both European-Americans as well as African-Americans. The study found that although both European-Americans and African-Americans are at risk for alcoholism, there may be differences in the genetic causes of each group. This study illustrates the fact that addiction is highly correlated to genetic makeup but specific genes cannot be isolated. Furthermore, genes may even vary among individuals with different ethnicities.

Prescription Pain Medication

Addiction knows no racial or socioeconomic boundaries. This reality is illustrated by the problem that both Monterey and Santa Cruz counties have experienced in the last several years with prescription painkiller abuse among its poor and wealthy residents. Many heroin users began their addictions with prescription drug abuse. Heroin is one of many opiate painkillers which also include prescription drugs such as Vicodin, hydrocodone, OxyContin®, morphine, methadone and hydromorphone. These drugs can be very expensive on the street. For example, one pill of OxyContin® can cost as high as $80. Since this is the case, many addicts who use prescription painkillers turn to heroin for a cheaper high. A study by Cicero, Ellis, Surratt and Kurtz (2014) looked at an analysis of heroin use in the United States over the past 50 years in 48 states. The study used a sample of 2,797 treatment-seeking heroin addicts who had been diagnosed primarily with substance use disorder. Cicero et al. (2014) showed that the majority of heroin users have shifted from inner-city minority groups to suburban white men and women. It has been well documented that the influence of prescription painkillers has been a big reason for such a shift. This shift is evident in both Monterey and Santa Cruz counties.

In 2012, Virginia Hennessey wrote an article for the Monterey County Herald newspaper documents that two specific cases of local young men addicted to opiates. One such case involves a young man pseudonymously called “Brandon” who began using OxyContin® legitimately to relieve pain following a car crash. He was soon abusing OxyContin® and was placed in the Clint Eastwood Youth Program at Community Hospital of the Monterey Peninsula. The day following the completion ceremony of the program, Brandon and a friend were arrested while intoxicated on heroin. Brandon had been passing urinalysis with urine purchased from a local store. The other case involves a young man pseudonymously called “Dylan” who had also been using OxyContin® legitimately following an accident. In a relatively short amount of time, Dylan had also transitioned from OxyContin® to heroin. Following their initial experiences, both Monterey County residents rendezvoused in the same Arizona Drug Rehabilitation Center. The transition from prescription opiates to heroin is not an uncommon scenario. In the aforementioned study by Cicero et al. (2014), a 54-person subset of participants completed an additional interview further elaborating on their heroin use. Of the additional interviewees, 94 percent said they chose heroin because “prescription opioids were far more expensive and harder to obtain” (p. 5).

A 2014 news article written by KION reporter Marissa Schwarz illustrates the same problem in Santa Cruz County. The report came the week after the highly publicized heroin overdose and death of Actor Phillip Seymour Hoffman. A local drug and alcohol treatment facility called Janus of Santa Cruz reports that a majority of its clientele are seeking treatment for heroin addiction. Program manager Les Washburn attributes the high numbers of heroin addicts in his program to the prescription painkiller epidemic. In addition to the reports from local rehabilitation clinics, an organization known as Take Back Santa Cruz has been involved in cleaning beaches and parks. Phil Gomez of KSBW news wrote an article about the organization. As of Memorial Day Weekend 2015, the organization had picked up 7,681 needles over the previous 29 months. This highlights the heroin epidemic that exists not only in America at large but particularly in Monterey and Santa Cruz counties.

Gang Activity

Illicit drugs like heroin and methamphetamine are being consumed by local residents. The consumption of those substances is being supplied by local street gangs who sell the drugs in order to fund more clandestine activities. The central coast of California is infested with rival gangs whose origins are from inside the California prison system. According to the Federal Bureau of Investigation (FBI), the Nuestra Familia is a highly organized gang that formed in prison and subsequently spread to the streets. The members of street gangs whose allegiance is to the Nuestra Familia are known as norteños. Salinas, California is a city known for being heavily concentrated by norteño gang members. Among other illicit operations, norteños are known for the sale of narcotics such as methamphetamine and heroin. Salinas’ Chinatown is an area where these activities frequently occur. In 2013, Operation Snake Eyes got underway which sought to take down the local Nuestra Familia and norteño structure in the Salinas Valley. According to a 2015 KSBW article chronicling the operation, authorities found evidence that money from the illegal activities of local norteño street gangs were being sent up to Vincent “Chente” Garcia who was receiving the funds while incarcerated. At the time of his arrest, Garcia was the highest ranking member of Nuestra Familia who was living outside of the prison system. On February 12, 2015, authorities ended a six month long investigation of gang activity and narcotics sales in the Chinatown area of Salinas. The entire block of Chinatown was raided and searched resulting in a total of 12 arrests by a coalition that includes the Salinas Police, the FBI, Marina Police, Monterey County Sheriff, California Highway Patrol and the California Department of Justice. Felix Cortez of KSBW published a news report the following day stating that the authorities were searching for “gangsters, drug dealers, heroin, and methamphetamine.”

In Santa Cruz, on the other hand, the sureños have a higher concentration than their norteño rivals and are controlling narcotics trafficking in that area. Sureño gangs hold their allegiance to the Mexican Mafia also known as “la eme”. According to the FBI, the Mexican Mafia is made up of mostly Mexican-American convicts or ex-convicts from poorer neighborhoods in Los Angeles and is “felt to be the most powerful of the prison groups.” However, members of street-level gangs in areas outside of L.A. are also affiliated with the Mexican Mafia which can be observed in both Monterey and Santa Cruz counties. These sureño gangs pay homage to the Mexican Mafia by placing the number 13 at the end of the names of their gang because the letter “M” is the thirteenth letter in the alphabet. A 2012 San Jose Mercury News article written by Cathy Kelly highlights an arrest of 3 Santa Cruz sureño gang members. The three suspects were arrested for the sale of heroin and methamphetamine with gang enhancements. These arrests illustrate the fact that gangs are responsible for selling narcotics that supply the demand of residents throughout both Santa Cruz and Monterey counties.

Social Factors

These clandestine organizations are made up of individuals who were born into them as well as young children and teenagers who have been recruited from the streets. Many times these children who join are attracted to a community and acceptance that they feel the gangs provide. There are also a number of social factors that contribute to the ongoing epidemic of drug addiction. A study by Boshears, Boeri and Harbry (2011) looked at the sociality of drug addiction with an emphasis on methamphetamine users. Although the study was done in the suburbs of Atlanta, Georgia, the social framework that the article discusses applies across humankind. Upon interviewing 50 current methamphetamine users and 50 former methamphetamine users, Boshears et al. (2011) report more social reasons given for drug use than physical or psychological. This suggests that a person’s social environment plays a larger role in drug addiction than is currently emphasized in the body of literature on the subject. According to the qualitative data obtained during the study, social relationships “influenced continued use of methamphetamine” and the “cessation of use typically involved a new social relationship or change in social setting” (p. 5).

It is well known that adolescents can be easily influenced by their peers. A study by Allen, Chango, Szwedo, Schad and Marston (2012) looked at a number of factors including substance use, observed autonomy difficulties with mothers, maternal support, close friend social acceptance and social skill handling deviance. The study found that teens who lacked in social skills and autonomy came to match their drug use with the level of substance use of their closest friend. In addition to peers, an adolescent’s early experiences with their parents are associated with substance abuse. According to an article published in 2009 by the Society for Research in Child Development, data compiled from various studies indicate that adolescent substance abuse is linked to parental stress from factors such as family medical conditions, unemployment, and a high ratio of adults to children in the house, as well as parental disorganization and emotional instability. These conditions are the same ones that far too many children grow up in who later join street gangs throughout Monterey and Santa Cruz counties. Often times, the stated reasons for joining are to satisfy the desire to feel a sense of love and community that are not being perceived at home. Unfortunately, along with the street gangs comes criminal activity from dealers and users alike.