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“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”.

“All illnesses have some heredity contribution. It’s been said that genetics loads the gun and environment pulls the trigger.” – Dr. Francis Collins

“Your genetics load the gun. Your lifestyle pulls the trigger.” – Dr. Mehmet Oz

Welcome to installment 5 of the of the science of addiction, Nature and Nurture Decide. Am I saying that nature (the genes that you inherited) or nurture (the environment in which you grew up) make you an addict? Absolutely not, but heredity and environment do control at what point you will become an addict, if you choose to use. This installment will discuss the roles of heredity and the environment in addiction. I believe that like most things in nature, our tendency toward addiction lies somewhere within a range from “almost can’t become an addict” to “almost can’t avoid it”. As always, I hope that you will see that the things that I present match your own direct observations or experiences.

Blame it on Mom and Dad

I think that everyone can agree that there is a genetic component to addiction, after all, we all know families that have generations of addicts, typically alcoholics.  So obviously to some degree, whether you become an addict or don’t, is just the roulette wheel of genetics. Likewise, we may know people who became addicts and we look at the situation in which they grew up and we say “of course they are an addict, they never had a chance”.  My son had a friend whose father wasn’t around and whose mother was a crack addict. He and his brothers all ended up becoming addicts, what other outcome could you expect?  Mom and Dad gave you your genes and they raised you, so obviously it is their fault. Well, they did contribute but we don’t choose the genes that we pass on, at least not yet, and parents may not have complete control over where you grew up. AND to paraphrase the quotes above, you pulled the trigger when you used.

What Do We Tell Our Adolescents and Young Adults?

I mentioned early in this series that I believe that we must be honest when we try to educate our youth about addiction. When I was in high school, drivers ed consisted of a football coach showing us movies of car accidents and people laying in the road moaning. This was supposed to scare me into being a better driver. It didn’t work and if we try to scare our youth away from drugs with exaggerated, worst case stories, that won’t work either. We might as well be honest with them, they already see more than we want. So:

• Not everyone who uses becomes an addict right away, but many do.
• Some people use for a short time and walk away and never use again while others become addicts.
• Some people start with marijuana or alcohol and move on to harder drugs and some don’t.

The problem is, you don’t know how easily or at what point you will become an addict, until you are one. When you are messing with addictive substances, you are playing Russian roulette. You don’t know which chamber is loaded until the gun goes bang and it’s too late.

If you are my age, you may remember a Three Stooges episode in which a pair of professors argue over which controls a person’s behavior, nature or nurture. They attempt to use the Three Stooges to prove their points and the episode ends in, wait for it, a pie fight. The truth is it is both nurture (our environment) and nature (our genetics). It has been hypothesized that genetics accounts for a little over half of our tendency for addiction and environmental factors account for the rest. I think that this is based on the observation that individuals in seemingly ideal situations still become addicts. There is research being carried out right now that is attempting to identify the genes that increase an individual’s tendency to be an addict. If this gene, or series of genes, or combination of genes can be identified we could possibly cure addiction. As we discussed in Part II, addiction hijacks a system that exists to help us survive. We will need to be very careful messing with such a system, so genetic engineering is unlikely to be the answer any time soon.

Environment

The NIDA (National Institute of Drug Addiction) has also looked at populations and statistics and came up with environmental risk factors and protection factors for addiction. Risk factors are situations that appear to increase the probability that an individual may become an addict. They do not make you an addict, but they make it easier for you to become an addict.  Likewise, protection factors cannot prevent addiction, but they make addiction less likely. Some of the risk factors include:

• Living with parents or siblings that are addicts.
• Living in a community where addiction is common and accepted.
• Access to addictive substances at a young age.
• Being raise by parents that were neglectful or abusive.
• Living in a community where there is a lot of despair or hopelessness, typically due to poverty.

In my observations, some addicts seem to be driven by low self-esteem. Isn’t that what each of those risk factors above would cause? Many addicts speak of pain, be it physical or emotional, as the force that drove them to use drugs or alcohol to try to alleviate that pain. Even though I believe that addicts must accept responsibility for their actions that allowed addiction to take hold of them, we know that some people unintentionally became addicts through the misapplication of opiate pain killers to relieve physical pain.

So, I and My Loved Ones Are Safe Because…

One reason that people may prefer to see addicts as being weak minded or morally bankrupt is because it allows them to take comfort in the knowledge that they and their loved ones are not like that. We will be fine because we are strong, responsible people is greatly preferred to admitting that it can happen to literally anyone. As we said before, environment has a huge impact on the chance that someone will become an addict, but genetics apparently holds just a little bit more control.

Time For My Soapbox, Once Again

At this point I want to talk briefly about my experience but I must start by confessing that when I discuss my son, I frequently say “I and me” when I should be saying “we and us”. My wife and I were a team when it came to raising our sons and talking with them. When I write, I tend to think inwardly, and I forget the team. I hope that you and my wife will both give me a pass on that. My sons had a load of protective factors: two parents at home; parents active in their school and sports; a nice home in a rural area; not a lot of money but never having to do without the things that we needed; parents that praised them when they did well; and parents that held them accountable for the things that they did. We were the perfect parents, at least that’s how I remember it.

Our youngest son was probably an alcoholic before he could drive, though he never drove drunk that I am aware of. We know that he was using heroin by the start of his senior year in high school. How could this be, given the environment in which he grew up? Genetics, probably. Low self-esteem, definitely. But the reason doesn’t matter, the point is it can happen to ANYONE. Contrary our experience, I am sure that there are many situations where there are numerous risk factors, yet the individual did not become an addict.

Genetic Roulette

As we stated earlier, you don’t know at what point you will become an addict until it is too late. I was lucky. I binge drank in college a lot and then I stopped and that was the end of it. In truth, the thought of my wonderful bouncing boy, bouncing on me when I was hung over or just seeing me hung over was not something I ever wanted to experience. Who knows, perhaps another year of drinking like I did in college and I would have become an addict. I GOT LUCKY. If you used addictive substances, no matter how much or how little, and you are not an addict, you got lucky. It is simply our genetics and we don’t get to take credit for that. Many decades ago people believed that certain genetic markers (eye color, hair color, skin color) indicated that one group was superior to another. We abandoned those ideas long ago. Isn’t it time that we abandoned the idea that having genes that make us less likely to be an addict makes us better than someone who was caught in addiction?

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 Science Summary and My Thoughts”.

“Imagine trying to live without air. Now imagine something worse.” — Amy Reed, Author

Welcome to installment 4 of the of the science of addiction, The Limbic System and Stupid Brain Tricks. In the two prior installments we discussed the dopamine response, how it is corrupted by addiction and how it alters the addict’s brain. As I have already said many times, I believe that it is important for an addict to take ownership of their actions/mistakes that allowed the addiction to start but once started, it rapidly spiraled out of control and deprived them or their ability to stop on their own. This installment will discuss another area of the brain that is altered by addiction and what I believe the changes there represent. Finally, in this section I want to discuss tricks that the brain uses to help protect and preserve the addiction. It is this section that I hope will inspire people in recovery to share their ideas and experiences.

The Limbic System, It’s Not the Latest Fad in Aerobic Exercise

In the last installment, I mentioned that the NIDA (National Institute of Drug Addiction) studied brain scans to look for changes that result from drug addiction. One of the things that became apparent is that the changes that occur in the brain are common to all addiction not just drugs (including alcohol). They observed changes in the prefrontal cortex (see Part I) and in the activity of dopamine receptors (see Parts II and III). They also observed changes in brain activity in an area known as the limbic system.

The limbic system is not a single structure but rather a collection of structures. The term has fallen out of favor in scientific literature but is very useful for this discussion. This area of the brain controls more primitive drives such as hunger; thirst; and fight or flight. It also handles emotions; is very active in the dopamine system; and it influences autonomic responses, that is, responses that you do not have conscious control over. Basically, the limbic system handles very import drives and responds to them without you thinking about it. Once again, the amazing design that we are handles things that we don’t want to have to think about like are we hungry or thirsty or terrified and it gives an automatic response.

What Do the Changes in the Limbic System Mean?

I believe that the changes in the limbic system are indicative of the step from desiring a drug to needing a drug. This step is when true addiction sets in and the brain has come to believe that the drug is necessary for survival, just like food or water. This was hammered home to me by my own son when he was trying to explain to me how powerful his cravings were. He told me, “It is like you are absolutely dying of thirst and you can’t get a drink.” Sounds like the limbic system.

You can also do a thought exercise to see this. Take a minute and picture in your mind a long-term heavy using addict, someone my son would have called “shot out”. What do you see? Dirty, unkempt, maybe acne, maybe track marks, not looking you in the eye, and skinny. Always skinny. Why, because their brain is prioritizing the drug over food. Remember the rat experiment in Part III, they were directly stimulating the limbic system to create the dopamine-like response and the rats died because they went for the dopamine response and did not eat.

As we have discussed before, what our brain knows is what is real to us regardless of how others see it. If our brain knows that we must have opiates, cocaine, crystal meth, alcohol, etc. to survive, that will control how we act. We will do whatever we must to overcome the obstacles that prevent us from getting what we need. If you were literally starving to death, would you lie, would you steal, would you eat food that might be bad or poisoned? Of course you would, you would die without it.

Time for My Soapbox

Addicts are not bad people or people of poor character. They are people whose mind has been altered by their addiction such that their brain believes the must have their drug of choice. In this stage of addiction, they act like one of poor character, but once they have had sufficient time in recovery they return to the fine people that they were. They may be even better than they were for having gone through the tremendous struggles that they had to endure. I have met some of these people because of my son and there are no finer people in this world. I believe that we owe it to all our fellow man (and woman) to help them stay alive and to help them recover from whatever affliction they may have. This will not be without setbacks and frustrations. This will not be without cost. But we will be rewarded by the presence, knowledge, and understanding of great people who have seen great darkness and with help rose above it.

Stupid Brain Tricks

I have titled this section stupid brain tricks because I want to discuss some of the things that the brain does to maintain addiction because it believes that the addiction is necessary for survival. But first, I must confess that I use the terms “we” and “us” to be inclusive and to denote how small the space is between being an addict and not being an addict. I am not an addict. I am one of the lucky people that drank too much for a time and then was able to walk away from it. More on why I say it was luck in the next installment. I did learn a great deal about addiction through discussions with my son during the way too short time that he was here.

Withdrawal

The first thing that functions to preserve our addiction is not a stupid brain trick. It is physical withdrawal and it is horrible. So horrible that it is terrifying to an addict. I was told by an administrator at a rehab facility that alcohol may kill you during withdrawal (approximately 1% of very heavy long-term drinkers) but opiate withdrawal will make you wish you were dead. We may discuss this further in later blog entries.

Panic Attacks

I am not sure if panic attacks are part of the physical withdrawal or just a very extreme mind trick. My son experienced panic attacks while he was in rehab going through physical withdrawal. He was in an absolute state of panic, like he was about to die. These were some of the most horrible phone calls that I ever experienced. He was insisting that we had to come get him. He thought that he couldn’t stand being confined any longer. We, however, knew that this was the result of his addicted brain realizing that it could not get the drugs that it needed.

Cravings

Cravings probably originate in the limbic system and they are there to make you pursue the drug that you need. Your brain is in effect trying to force you to go get your drug of choice and use. Cravings are relentless! My son explained it this way, “I get up in the morning and I am dying to use. I am driving to work, and I have to fight not to take a detour and go buy. It’s not terrible when I am busy at work but as soon as there is a break I feel that I must use. This goes on all day and is worst when I am laying in bed at night.” This is where groups like AA do tremendous work. They provide meetings to keep you busy. They provide support and understanding at these meetings. They provide someone, your sponsor, whom you can call when the fight is particularly difficult, and they will counsel you and share their experience.

Triggers

Triggers are things that remind you of using and trigger stronger cravings. Triggers are sensory things that you associate with using and they are the result of conditioning, as we discussed in earlier installments. Triggers can be things like: your dealers cologne or cigarettes; the road that you took to go buy; music you listened to when you used; the place that you typically used; food you ate when or after you used (my son ate popcorn a lot, probably when or right before he used); or having cash in your pocket. Triggers are everywhere and while it is best to try to avoid them in the early stages of recovery you must eventually learn to manage them.

Drug Dreams

My son would tell me about the panic that he would feel when he awoke from a particularly real dream that he had used. He said that it was so real that he felt just like he did when he got loaded and he would be panicked that the had just thrown his recovery away. Can you image such a nightmare? It sounded absolutely horrifying to me.

There are more stupid brain tricks that we may get into in a later post. These examples are some illustration of the struggles that addicts must endure to gain a foothold in recovery, in order to get to the place where they can begin to use their own willpower to continue to manage their addiction.

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 “Nature and Nurture Decide”.

“Addiction is not something we can simply take care of by applying the proper remedy. For it is in the very nature of addiction to feed on our attempts to master it.” – Gerald May, Author

Welcome to installment 3 of the of the science of addiction, The Dopamine Response and Neuroplasticity. Installment 2 discussed the conditioning aspects of the dopamine response, why it is there, and what happens when addiction takes something that is there to help us and turns it against us. I said that I would rely on hard science and yet much of the prior discussion was about conditioning, the subconscious and the conscious brain. That is getting close to “touchy, feely” psychology stuff but it is there to lay the ground work for the following discussion of how addiction hijacks the dopamine response.

Neuro-what?

You have probably heard the term neuroplasticity in Lumosity.com advertisements and you may have wondered what it meant or maybe you were just too busy with your life to even really listen to the commercial. Well, neuroplasticity is a real thing that has been well documented. Neuro – nervous system specifically the brain and plasticity – the ability to mold and remold. As late as the 1970s, we still believed that once your adult brain was physically formed it did not change until you got very old. I’m not sure why we decided that but since the only brains we could physically study were dead we had no reason to believe otherwise. Now that we have brain scans, specifically PET scans, we can “see” what the brain is doing and how it changes. The NIDA put a good deal of the funding into studying brain scans in differing situations. The scans have been used to define the areas of the brain that fulfill different roles and the changes that take place in the brain as a result of various behaviors and injuries.

Your Brain, Like a Muscle, Gets Bigger Where It Gets Used, Duh!

Danger science! The next paragraph explains how the physical changes to the brain occur. It’s not that you can’t understand this but feel free to skip it and take my word for the fact that it happens.

One of the things that was learned is that the brain is moldable and remoldable and that it physically changes in response to stresses and demands. Neuroplasticity was discovered when it was observed that a demand or stress placed on a certain area of the brain caused, thickening of the brain in that area and construction of new neural pathways and more interconnections between neural pathways. This occurred because in response to the demand, more blood was sent to that area of the brain carrying more oxygen and glucose. The oxygen and glucose spurred on cell generation. Getting back to what a great design we are, it makes sense that if there is a high demand on an area of the brain, it must be doing something important. If it is doing something important for survival, it is advantageous to make it stronger and better at what it does. By the way, the very colorful image at the top of every page illustrates the neural pathways in the brain, like a jumble of wires connecting and interconnecting our brain and allowing signals to pass back and forth.

Drug are Really Smart and Devious

In the previous installment in this series, we discussed that under normal circumstances dopamine is the stimulus that drives conditioning. It is also a sign to the brain that the thing (food, sex, etc.) causing the increase in dopamine is important for survival. When a drug is used, the massive flood of dopamine tells the brain that this is very important. Conditioning causes the brain to focus on the drug and the areas of the brain affected, the addictive areas of the brain. Increased bloodflow causes those areas of the brain that are affected to get thicker, to have more neural pathways and connections, and to get better at what they do. In effect the massive dopamine response caused by addictive substances/behavior causes physical changes in the brain that build a better addict. By build a better addict, I mean that it reinforces addictive behavior and it ignores areas of the brain that would get in the way of the addiction, such as, ethics, relationships, and any outside interests. The longer the individual uses, the more the addiction gets reinforced. The pathways supporting addiction then become highways and the pathways that get in the way become dirt roads.

Wow, drugs are really smart. They know how to take this wonderful system that is built into our brain to help us survive and it uses it to turn our focus to only the drug. Eventually, this drive us to believe that we must have it to survive. Sounds like job security to me. NOPE, I was wrong again, the drug is just a chemical. Drugs don’t think. Drugs aren’t capable of caring if you use them or not. It is in effect, a flaw in an otherwise brilliant system. We managed to accidentally find this particular bug in our programming while we were looking for something to make us feel good. Isn’t that what drives most addicts to start? Trying to feel better, trying to hide from physical or emotional pain, looking for something outside of themselves to fix or hide what they don’t like inside themselves. More on this later.

Okay, Let’s Ramp Down the Science a Little

If you look at the big picture of everything that we just discussed, you can clearly see the typical path of addiction. First, the drug is used to make us feel better in some way. In the case of my son, he never thought that he was smart enough, good looking enough or that anyone really liked him. That combined with some social awkwardness, probably due to his mild ADD (attention deficit disorder), made him uncomfortable in social situations. Later in life, he called alcohol a social lubricant and he first abused alcohol and then moved on to harder drugs. Second, the high from the drug causes us to want to use it again. Third, the changes in our brain that occur from using, convince our brain that we need the drug. As we know, right or wrong, what our brain believes is our reality. We called this time in my son’s life the Dark Times. He changed from someone incredibly honest and ethical to someone who rarely cared about much other than getting the next fix. He worked hard but that was to have money to get the drugs that his brain now told him he NEEDED.

The Skeptic

At this point, you are probably considering that addiction may be a disease that was allowed to start because of a poor decision then rapidly took control. If you think about it, there are other diseases that a person may have done something that allowed it to start (smoking => lung cancer or emphysema; poor diet and no exercise =>heart disease). A skeptic may say, “if you are right about the changes to the brain, then no one would ever get cured.” To this I say, you are right, no one does get cured but they can learn to manage addiction with help. Initially, you cannot overcome addiction by yourself, as I said before, you are fighting your own brain and doing it with one hand tied behind your back. But,

• If you are given support (AA and other 12-step programs) and possibly something to help with cravings such as, suboxone or methadone.
• If you are kept away from any drugs.
• If you work hard to address why you started.
• If you work hard to rebuild your ethics.
• You will SLOWLY begin to recover but the addiction will never leave you.

The neural pathways that were built to support addiction you will turn to dirt roads and the neglected dirt roads of the old you will go back to the highways that they should be. The dirt roads of addiction will never totally go away. Turn down that road of addiction and it will be reconstructed so fast that PennDOT would be impressed.

I have seen this. I have seen my son work hard at his recovery and become a great person. I have met many others like him that did the same. But the journey is so long and so arduous that they will slip sometimes. They may fall sometimes but eventually they will find their footing.
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 “The Limbic System And Stupid Brain Tricks”.

“Telling an addict to just stop is useless. It is like telling someone driving a car with no brakes to just stop. They want to but they don’t have what they need.” – Dr. Nora Volkow, NIDA

Welcome to installment 2 of the of the science of addiction, The Dopamine Response – Addiction Stole My Brain. Installment 1 discussed the adolescent brain, so now we are getting to the meat of how addiction alters the brain. When we understand how the addict’s brain has changed, we have a better chance of finding workable solutions that use our limited resources wisely. Afterall, there are many worthwhile causes, so we must be wise in our approach (that is where you come in). So, let’s discuss what we know about dopamine and some theories that may help round out our understanding.

I Get What Dopamine Is But Why Is It There?

You are probably somewhat familiar with dopamine from discussions about cellphone behavior/addiction but let’s go over the basics so that we are all on the same page. Dopamine is a substance that your brain makes and when it hits a dopamine receptor in your brain, it makes you feel good. This part of the brain is sometimes referred to as the pleasure center of the brain. Generally speaking, you have some baseline level of dopamine floating around your brain that is your general feeling of well-being and certain things cause a release of more dopamine that make you feel even better.

Whether you believe in God, evolution, some combination or nothing at all, I think that we can all agree that humans, and the whole universe, are amazing systems. Nothing is without purpose, so why is this dopamine system even there in our brains? I believe that it is a conditioning system that exists to make us do what is important and since ancient peoples existed much longer than modern “civilized people” it focuses on the needs of our ancestors. The most well-known example of conditioning is “Pavlov’s dog”. Pavlov rang a bell whenever he fed his dog and soon all he had to do was ring the bell and the dog acted like he was fed, he salivated. This was not a conscious choice for the dog, it was an automatic response to the stimulus, the bell. I believe that dopamine is the stimulus that is there in our brain to make us respond automatically, probably somewhat consciously but more so subconsciously, to pursue the thing that caused the release of dopamine.

Let me give you two common examples to illustrate this belief. What kind of food do you like? Cookies, cakes, steak, chips, bacon, chocolate. All of these foods are high calorie, high fat, high salt foods that cause a little dopamine bump that makes us feel good. That is why we like them. Consider the classic image of a teenage girl who’s first boyfriend broke up with her and she is drowning her sorrows in a ½-gallon of ice cream, which by the way isn’t a ½-gallon anymore. She is getting a dopamine bump (this is a fact, not theory), it is making her feel a little better. Now for us, this is not an advantage, it makes us eat poorly and get fat but food was hard to come by for our ancestors. High fat, high calorie foods got them the most bang for the buck. It helped them survive. Do you have a hard time resisting one of these foods? Of course you do, you like the bump in dopamine. For some people this can rise to the level of addiction.

The second example I would offer to support this belief is sex. Sorry to disappoint all you romantics but one of the main reasons that you like sex is because it causes a bump in the amount of dopamine in your brain. Now consider ancient peoples again. They were busy trying to get their high fat, high calorie foods and trying not to be some other species high fat, high calorie food. They were dirty, they were hairy, they were stinky. Do you think that they would want to be intimate? Well, sex gives you a dopamine bump, probably bigger than chocolate. Ancient peoples got this good feeling and said, “I like this. I’m going to do this again when I get a chance.” And so, they made little ancient people and their offspring made little ancient people and so on, and here we are. The species survived because conditioning, through dopamine, programmed them to do what they needed to survive and reproduce.

I Thought This Was Mostly About Drug Addiction

It turns out that dopamine is the main player driving addiction and in particular driving drug addiction. It makes sense (although I do not know if it is well documented) that the stronger the dopamine response, the stronger and more rapid the conditioning. When someone uses an addictive substance, the brain is flooded with dopamine, something on the order of 10 times the response one gets from sex. This flood of dopamine is what causes the feeling of being high. The conditioning immediately begins, causing the user to fixate on this substance. Furthermore, dopamine is a sign to your brain that this is something important. The biggest, brightest sign that your brain will ever see.

Your brain recognizes, however, that this is an unnaturally good feeling. Something is wrong. Since the brain can’t stop the flood of dopamine it responds by turning off dopamine receptors. This is what causes drug tolerance, the need for an addict to use more and more to get the same high. In fact, you will never again reach that first good high. You will spend your life chasing it but you will have fewer and fewer receptors to respond to the dopamine. Abuse a substance long enough and hard enough and you will turn off so many dopamine receptors that you will no longer have that basic feeling of well-being. You will feel like horrible all the time and when you use, you will no longer get high. You will just get back to normal.

Different drugs cause different kinds of high and it appears that we have a predisposition for a particular type of high. This is known as your drug of choice and this is what really rings your bell.

Addiction Takes Control of Your Brain

As I said in Part 1, it seems like the drug is a living being attempting to preserve itself. It hijacks your dopamine system and uses it to control your behavior. It uses conditioning to turn your subconscious against you so that you are driven to seek the object of your addiction, be it a drug, gambling, alcohol, over-eating or checking your Facebook page. The bell rings and you salivate, not by choice. But wait, the drug is just a chemical, it is not a living thing. Your brain is the living thing and addiction is a part of it. Therefore, if you try to use just will-power, strong character, etc. to overcome addiction, you will fail. All of the will-power at your disposal is also working to preserve the addiction. Remember, the flood of dopamine has told your brain that this (the addiction) is very important.

A study was done in which an electrode was inserted into a rat’s brain so that the dopamine response could be stimulated. The rat was placed in a cage with two levers. One provided a food pellet when pushed, the other stimulated the dopamine response. Without fail, the rats starved to death because they stimulated the dopamine response to the exclusion of the food. I think that we are smarter than rats but this is a very telling result.

I once heard a drug counsellor relate what an addict who was in rehab once again had to say. He said, “It is like the drug knows exactly what I am going to do or trying to do and it is just a little smarter than me.” He hit the nail on the head except it is not the drug. It is his own brain, so of course it knows what he is trying to do. Also, since the addictive part of the brain is functioning in both the conscious and subconscious part of the brain and he is only using the conscious part, it is smarter than him. This does not mean that an addict has completely lost their free will but it does mean that they are attempting to fight the addiction with one-hand tied behind their back.

I read an article about a woman in recovery and she was discussing her attempts to break free from addiction. She said that when she had just gotten loaded, she was certain that she could stop but when she sobered up she was certain that she could not live without the drug. When loaded, the conditioned drive to use is satisfied but as one becomes sober, the addicted part of the brain comes roaring back to protect what is important, using. Free will is not gone, just completely overwhelmed. Worst of all, this is not the end of the discussion of changes to the brain. The next installment will discuss the physical alteration to the brain.

An addict is someone who repeatedly does something that is detrimental to their well-being, even when they don’t want to. “Even when they don’t want to”, this is key to understanding addictive behavior. No one ever truly thinks, “I want to be a junkie”, “I want to be ruled by a chemical or food or gambling”.

Is Addiction Really a Disease?

The individual made a poor choice and used, then dopamine caused conditioning that drove the individual into addictive use. The conditioning operates in both the subconscious and conscious mind and therefore, has tremendous control over our behavior. Free will is not gone but mightily overwhelmed. Understanding this is what caused me to see addiction as a disease, but more on this in posts after we get through the basic science. Do you have ideas 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 “The Dopamine Response and Neuroplasticity”. Continue reading “Part II – The Dopamine Response”

“What the Hades were you thinking?  Why would you do that?”

 – Plato to 17-year old Aristotle, translation approximate

Welcome to installment 1 of the discussion of the science of addiction.  As I explained in the introductory entry, the first several installments of this blog provide an accessible explanation of the current understanding of addiction to act as a starting point and reference for future discussions.  We must know our enemy if we are to have any chance to succeed in addressing this threat to society.  So, let us begin with the typical beginning, the adolescent brain.

Teenagers Don’t Use Their Brains, That’s Not News

Research into brain development has revealed something that is both profound and common knowledge at the same time.  I heard a neuro-scientist describe the brain as developing from back to front.  For this reason, the prefrontal cortex of the human brain develops last and is not fully developed until the age 25, plus or minus.  Women develop a little sooner than men.  Sorry guys but I told you that this would be fact based.  The prefrontal cortex is responsible for higher (sometimes called executive) thought processes, such as, logic, self-control, risk evaluation, decision-making, judgement, and more complex emotions like empathy.  This means that your teenager is not insensitive, stupid or lazy.  Well he/she might be, I don’t know them but there is a developmental reason for some of their behavior.  Just like you didn’t have armpit hair when you were in elementary school but you certainly did in high school, this development is not controlled by the individual’s actions.  This was a somewhat profound idea to many of us.

We all know that teenagers have poor judgement, that is common knowledge.  Our parents knew this.  The founding fathers knew it.  The ancient Greeks knew it.  What we didn’t realize is that when we yelled at them “What the Hell were you thinking?” and they replied with a shrug and a mumbled “I don’t know.”, they were telling the truth.  They really don’t know what they were thinking.  In short, they were not thinking.  They were acting on emotion, not logic because that part of their brain was not fully developed.

Adolescents and Drugs – A Recipe for Disaster

This stage of development, when the prefrontal cortex lags behind the rest of the brain, occurs not only during adolescence but into early adulthood.  Early adulthood is the college years or the years that an individual enters the working world in earnest.   Adolescence and early adulthood is the time when individuals have the most freedom and are searching for their identity.  This is also the time they are most likely to have access to abusable substances, drugs.  In short, the time when they are least able to comprehend the risks involved, is the same time that they are most likely to encounter drugs and have money to purchase them. Keep in mind, alcohol is a drug, an illegal drug if you are younger than the legal drinking age.  One illustration that I read proposed this thought exercise:

Suppose you were talking to someone in their mid-20s who did not have a lot of experience with substance abuse and you told them; “I will give you this powder and a straw so that you can snort it.  When you do, it will give you the best feeling you have ever had and ever will have.  It will last about 15 or 20 minutes, followed by a couple of hours of feeling very relaxed and peaceful.  There is just one catch, if you do this you may become addicted to this substance.  If that happens, obtaining more will become the only thing that matters in your life. You will lose interest in everything else. You will destroy your relationships. You will destroy your health. You will destroy your career.  Even if you manage to free yourself from the hold of this substance, you will never be completely free, the addiction will lie in wait for you to make a mistake. Do you want to try it?”.

The answer you will most likely get will be something like; “Why would I throw away everything that I have achieved and everything that I might achieve for this temporary feeling.  Get the Hell away from me.”

If, however, you made the same offer to an adolescent, there is a good chance that you would get an answer something like: “Best feeling ever? Hell yeah, bring it on. I won’t get addicted. That happens to other people, not to me.”

That is the response of a prefrontal cortex that is retarded in its development relative to the rest of the brain. It is not thinking logically, it is thinking emotionally.  It is the typical thought process of an invincible teenager, just as Bob Seger so eloquently describes in his song “Like a Rock” (forever ruined by Chevrolet commercials).  Remember, teenagers don’t do this to frustrate us, it is simply a result of a brain not completely developed.

But Wait, There’s More

Studies have also shown that adolescents are more susceptible to peer pressure then they will be later in life.  This may have a hormonal component or a developmental component but it may also be that in searching for who they are, adolescents are more impressionable.  As their peers are very important at this time, adolescents are more likely to yield to the will of their peers and their peers are operating with the same partially-developed prefrontal cortex.

As if all of this information does not create enough of a perfect storm, there is something else that occurs in the pre-frontal cortex.  Brain scans performed by the NIDA on addicts and non-addicts have revealed that there is much less activity in the prefrontal cortex of an addict’s brain. In other words, the brain becomes even less capable of understanding the risks of addictive behavior as a result of the addiction.  It is almost as if the addiction is a living organism trying to preserve itself. My son described it as being like a parasite. The drug is just a chemical. It is our own brain that is the living organism and it is the physical alteration of the brain that works to preserve and enhance the addiction.  Spend some time with addicts in the early stages of recovery and you will see the same behavior and attitudes that you see in adolescents and young adults.  This is because the prefrontal cortex is functioning or not functioning on about the same level.  As their brain heals, addicts prefrontal cortex will catch up but while they are using, it is stunted.

In future installments, we will see that addiction physically alters the brain.  I would argue that addicts must accept responsibility for initiating their addiction but once the addiction starts it rapidly alters their brain and they are incapable of stopping on their own (more on this in later installments).  This initiating step, choosing to try/use drugs, most likely was made with a not-fully developed brain.  This is not an excuse because I believe that recovery relies on acknowledgement of your actions, but it is a reason why it happens so frequently in that age group.  Furthermore, stunting of the prefrontal cortex as a result of addiction further supports the continuation of addictive behavior.

Stop Addiction Before It Starts

Obviously, the first step in addressing the crisis that we are now facing is to stop the creation of new addicts, which means convincing adolescents and young adults not to use addictive substances. As I said in my introduction, I don’t have the answers but I do have a suggestion to address this manner by which addictions starts. Adolescents, perhaps even younger children, need to be presented the facts about addiction, as we now know them. Does this mean the answer to your question “What were you thinking?” may become “It was the fault of my retarded prefrontal cortex.” Maybe, but if we know that we are not running on all cylinders, we (they) have a responsibility to attempt to correct for this deficiency. I suggest that we teach our young people the following:

When you are about to do something that causes you to say “this will look awesome on YouTube/Snapchat” or whatever, slow down, stop and think for a moment. When that voice in the back of you head that is very quiet in adolescence and even quieter when your friends are around says, “I don’t think this is a good idea.” Stop and think about this phrase “Risk and Reward”. Ask yourself these four questions.

1. What is the best possible thing that could happen if I do this?
2. What is the most likely good outcome?
3. What is the most likely bad outcome? And
4. What is the worst possible thing that could happen if I do this?

Compare the answers to these questions.  Is the risk (worst outcome) really worth the potential reward (best outcome)?

The decision-making part of their brain is still not fully developed but if we can get them to slow down and think, perhaps we can build a better, safer adolescent/young adult. If we teach our children what happens to an addict’s brain, what the real risk of substance abuse is, perhaps we can begin to stem the tide of the addiction crisis. Do you have another, maybe better suggestion? Please comment, let’s get to work solving this problem.

If you wish to read more detailed information regarding adolescence and addiction, this link will take you to the National Institute on Drug Addiction’s webpage where there is a wealth of information.  https://www.drugabuse.gov/related-topics/adolescent-brain

I have written a more recent post as a follow-up to this discussion that includes new information that I have learned about the adolescent brain.  If you would like to continue reading about the adolescent brain, please click on this link to The Adolescent Brain Followup to Part I.  I hope that you will join me next week for “The Dopamine Response – Addiction Stole My Brain”.