“The truth is that drug addicts have a disease. It only takes a short time in the streets to realize that out-of-control addiction is a medical problem, not a form of recreational or criminal behavior. And the more society treats drug addiction as a crime, the more money drug dealers will make “relieving” the suffering of the addicts.” – Jay-Z
Welcome to “A Summary of the Science”, the last installment of the of the science of addiction, which will be followed in future posts by discussion about other aspects of addiction. I hope that you will join in the discussion in the future, we all have much to share. If you have read the preceding posts and have arrived here, congrats. You survived my over-explaining and hopefully have a bank of knowledge from which to draw your own conclusions about addiction. You probably have recognized that I am doing just what your freshman English Comp class taught you; tell them what you’re going to tell them, tell them, then tell them what you told them. I hope that this installment helps you solidify what you have learned and stirs up more thoughts.
Maybe you are starting here because you want to know if this blog is worth reading or because you prefer to just read the summary of my summary about addiction. In either case, I hope that you will go back and read the earlier posts as they are important for developing a deep understanding of what addiction does and how. You will formulate your opinions best when they are backed up with facts.
Where Addiction Starts
Not all addicts start in the same manner but the road to addiction, regardless of your ultimate drug of choice (heroin, crystal meth, alcohol, cocaine, gambling, overeating, etc.) is basically the same. First you try it (perhaps out of curiosity, to relieve physical or emotional pain, or peer pressure), then you want more, then you need it. Once you need it you have become an addict and you will be forever changed. Some of the ways that addicts start include:
- Pain relievers were legitimately prescribed to you. Perhaps you didn’t notice, and you became an addict through no fault of your own but be honest you probably felt the high. Maybe you sensed the control that it was gaining but you ignored it because you wanted more. If so, that was your decision, your mistake..one that you pay a terrible price for.
- Perhaps you started as an adolescent or young adult (up to about age 25). The prefrontal cortex of your brain was not developed in the areas needed for what is called executive function (risk evaluation, judgement, self-control, and logic). You were making decisions based on emotion not logic. I like to call this the “What the Hell were you thinking?” phase, for obvious reasons. Perhaps you felt alone, different, not good enough and your emotional brain figured that something to relieve the pain was a good idea. You made the mistake when developmentally your brain didn’t have the resources to assess the risk. It was your decision, your mistake.
- I doubt that many people seek drugs because they want to be a junkie or a drunk, but they may be trying to bury a pain in themselves that they cannot bear. Often addicts have another issue related to their addiction such as, depression, low self-esteem, anxiety disorder, or bipolar disorder. They attempt to self-medicate but they don’t foresee the risk. Again, their decision, their mistake.
Not Every Mistake Results in Addiction
For some people the distance between tried it and need it is very short, while it is much longer for others. Some people try it, want more but are able to stop before they need it. Why is this? Perhaps it is the abusable substance chosen but more likely it is something inherent in the individual. Our son insisted that he had an addictive personality and if not opiates, he would have been addicted to something else.
An individual’s tendency to become an addict is determined by their genetics and the environment in which they grew up. There are risk factors in our environment that make us more likely to be an addict, there are protective factors that make us less likely to become an addict but slightly more influence comes from our genes. The bottom line is that anyone can become an addict. You don’t get to pat yourself on the back because you are not an addict, you just got lucky at genetic roulette. Unfortunately, this also means that you cannot look at your loved ones and know that they are safe.
I Haven’t Spoken of the Way in Which your Brain Changes, Let’s Fix That
Drugs, including alcohol change your brain in ways that make it chase after them more. It is as if the drug wants you to need it, it wants to preserve your addiction. But drugs are just chemicals, the thing that makes you chase the drug, need the drug, is your own brain that has been altered by the addiction. These changes take place without any thought from you. They are built into your brain in the subconscious level, you have no say in it.
Prefrontal Cortex
One of the ways in which your brain changes is the prefrontal cortex is stunted by the addiction. The executive function of your brain that does not develop until your mid-20s gets stunted by addiction. This has been observed in comparative brain scans. This explains why addicts frequently seem to have the judgement of teenagers because part of their brain is still in that developmental phase. In essence, the part of your brain that you need the most is not fully developed at the time that you are most likely to have access to drugs and the addiction stops it from developing.
Dopamine Response and Conditioning
The human brain has a brilliant system that is designed to make us do things that are important for survival. Certain things that we do, foods that we eat, etc. cause an uptick in the amount of dopamine in our brain and that feels good. That boost in dopamine causes two responses within the brain. First, the brain recognizes the increase in dopamine as meaning that this thing is important, it focusses on this thing. Secondly, it is conditioned to want this thing more because it made you feel good. This caused us to do things that made survival easier.
Drugs cause a massive flood of dopamine within the brain causing both of these responses to be in hyperdrive (nerd reference). This thing, the drug, the addiction, must be very, very important because it dumped a lot of dopamine on our brain. We really want more and soon the brain determines that we need more. The brain, however, recognizes that this response is not natural and so it does the only thing that it can to protect itself, it starts shutting down receptors. This is tolerance, the need for higher doses to try to get the same response. This shutting down of receptors can cause its own set of problems.
Dopamine and Neuroplasticity
The preceding paragraph explains that the brain changes and we can observe this, but how does it happen? Our brain is plastic, malleable, it physically changes in response to need. When a demand is frequently placed on the same area of the brain, more blood is sent to that area. The increased blood flow results in a thickening of the tissue there and the development of more neural pathways and interconnections. This is a good thing. If we are doing something often, it would be good to make that area stronger, better.
The drug has caused a massive dopamine response that focuses on the addictive portion of the brain. More neural pathways and interconnections are made in that area and we build a better addict. Think of neural pathways as roads. The addiction is building roads that support it, highways, while the areas of the brain that would interfere with addiction fall into disrepair..dirt roads.
The Limbic System
The limbic system is a very primitive portion of the brain responsible for things that are too urgent and important for us to think about. It includes things like; fight or flight response, hunger, thirst, and feelings. Brain scans show that this area of the brain is altered by addiction. I believe that this alteration is the brain determining that the source of our addiction, our drug of choice, is necessary for survival.
A Beautiful Mind
All of these systems in the brain, that I discussed, are part of a very elegant design that helped our ancestors survive so that we could be here. When we discovered addictive substances, we found Pandora’s Box, the chemicals that hijack this elegant system and use it against us. Once addiction has taken hold, we are stuck fighting our own brain, but we are at a disadvantage because we are using our conscious brain to fight our conscious and subconscious brain. Our brain “knows” that we need the drug to survive and so it will stop at nothing to drive us to use again. Spend some time talking to addicts and you will eventually hear the comment, “I didn’t even want to use, but next thing I knew there I was..”. It is not that they weren’t aware of what they were doing, it was like they were on autopilot, their brain was driving regardless of what they wanted.
Recovery
Based on what you just read above it seems as if there is no answer to addiction, it is too overwhelming. It is true that addiction cannot be cured but it can be managed. Since addiction causes changes in the brain, the individual cannot take control of it on his/her own. They need help, they need structure and most importantly they need support. There are therapeutic drugs that can help by reducing cravings, but right now it appears to me that 12-step programs are essential to helping an individual take control of their addiction. AA was the first 12-step program and the first to recognize addiction as a disease. AA is not for everyone and it is no guarantee, but it has helped many people. Our son was working hard on his steps and attending meetings, but he didn’t make it. So far there is no silver bullet.
Stop for a minute and take all of this in and process it. To me, this information led me to a few conclusions:
- Most addicts made a poor decision, a bad mistake and because of an inherent tendency for addiction, they rapidly lost control and became addicts.
- Due to changes in their brain, their free will is overwhelmed and they cannot stop on their own. Their brain is sick. They have a disease that they cannot beat on their own. In fact, the best that they will ever do is manage this disease. It cannot be cured.
- Addicts need our help and understanding to get their addiction under control. This is why 12-step programs such as AA are successful for many people.
- While addiction may take hold of an individual’s brain quickly because of the massive dopamine response, it will leave very slowly, kicking and screaming, trying every trick to keep you using the drug.
- Many of the things that an addict’s brain will do keep them pursuing the drug that they “need” do not make sense, they may not be socially acceptable, they may not be morally acceptable. BUT this is not the person, this is the addiction and in recovery they can get back to the amazing, valuable person that they were. I think that they are even better for the agony that they have gone through.
Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.
I hope that you will join me next week for a discussion of “Misconceptions and Stigmas”.