Addiction

Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences.[8] Despite the involvement of a number of psychosocial factors, a biological process – one which is induced by repeated exposure to an addictive stimulus – is the core pathology that drives the development and maintenance of an addiction.[1][9] The two properties that characterize all addictive stimuli are that they are reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., they are perceived as being inherently positive, desirable, and pleasurable).[1][3][7]

Addiction is a disorder of the brain’s reward system which arises through transcriptional and epigenetic mechanisms and occurs over time from chronically high levels of exposure to an addictive stimulus (e.g., eating food, the use of cocaine, engagement in sexual activity, participation in high-thrill cultural activities such as gambling, etc.).[1][10][11] ΔFosB, a gene transcription factor, is a critical component and common factor in the development of virtually all forms of behavioral and drug addictions.[10][11][12][13] Two decades of research into ΔFosB’s role in addiction have demonstrated that addiction arises, and the associated compulsive behavior intensifies or attenuates, along with the overexpression of ΔFosB in the D1-type medium spiny neurons of the nucleus accumbens.[1][10][11][12] Due to the causal relationship between ΔFosB expression and addictions, it is used preclinically as an addiction biomarker.[1][10][12] ΔFosB expression in these neurons directly and positively regulates drug self-administration and reward sensitization through positive reinforcement, while decreasing sensitivity to aversion.[note 1][1][10]

Addiction exacts an “astoundingly high financial and human toll” on individuals and society as a whole.[14][15][16] In the United States, the total economic cost to society is greater than that of all types of diabetes and all cancers combined.[16] These costs arise from the direct adverse effects of drugs and associated healthcare costs (e.g., emergency medical services and outpatient and inpatient care), long-term complications (e.g., lung cancer from smoking tobacco productsliver cirrhosis and dementia from chronic alcohol consumption, and meth mouth from methamphetamine use), the loss of productivity and associated welfare costs, fatal and non-fatal accidents (e.g., traffic collisions), suicides, homicides, and incarceration, among others.[14][15][16][17] Classic hallmarks of addiction include impaired control over substances or behavior, preoccupation with substance or behavior, and continued use despite consequences.[18] Habits and patterns associated with addiction are typically characterized by immediate gratification (short-term reward), coupled with delayed deleterious effects (long-term costs).[19]

Examples of drug and behavioral addictions include alcoholismamphetamine addictioncocaine addictionnicotine addictionopioid addictionfood addictiongambling addiction, and sexual addiction. The only behavioral addiction recognized by the DSM-5 and the ICD-10 is gambling addiction. The term addiction is misused frequently to refer to other compulsive behaviors or disorders, particularly dependence, in news media.[20] An important distinction between drug addiction and dependence is that drug dependence is a disorder in which cessation of drug use results in an unpleasant state of withdrawal, which can lead to further drug use.[21] Addiction is the compulsive use of a substance or performance of a behavior that is independent of withdrawal. Addiction can occur in the absence of dependence, and dependence can occur in the absence of addiction, although the two often co-occur.

Sioux Falls

Sioux Falls (/ˌs ˈfɔːlz/) (LakotaÍŋyaŋ Okábleča Otȟúŋwahe;[8] “Stone Shatter City”) is the largest city in the U.S. state of South Dakota. It is the county seat of Minnehaha County,[9] and also extends into Lincoln County to the south. It is the 47th fastest-growing city in the United States[10] and the fastest-growing metro area in South Dakota, with a population increase of 22% between 2000 and 2010.[11]

As of 2016, Sioux Falls had an estimated population of 178,500. The metropolitan population of 251,854 accounts for 29% of South Dakota’s population. It is also the primary city of the Sioux Falls-Sioux City Designated Market Area (DMA), a larger media market region that covers parts of four states and has a population of 1,043,450.[12] Chartered in 1856 on the banks of the Big Sioux River, the city is situated in the rolling hills on the western edge of the Midwest at the junction of Interstate 90 and Interstate 29.

The history of Sioux Falls revolves around the cascades of the Big Sioux River. The falls were created about 14,000 years ago during the last ice age. The lure of the falls has been a powerful influence. Ho-Chunk, Ioway, Otoe, Missouri, Omaha (and Ponca at the time), Quapaw, Kansa, Osage, Arikira, Dakota, Nakota and Cheyenne people inhabited and settled the region previous to Europeans and European descendants. Numerousburial mounds still exist on the high bluffs near the river and are spread throughout the general vicinity. Indigenous people maintained an agricultural society with fortified villages, and the later arrivals rebuilt on many of the same sites that were previously settled. Lakotapopulate urban and reservation communities in the contemporary state and many Lakota, Dakota, Nakota, and numerous other Indigenous Americans reside in Sioux Falls today.[13]