The Addict Brain

Recently I was doing my usual rapid scrolling through my Facebook news feed, catching quick glimpses of updates as I continued moving along, when a comment caught my eye and compelled me to pause and read more.  The comment: “There’s a cure for addiction, it’s called just stopping.”  The comment gutted me, because it highlighted the very prejudice of addiction that experts in the field are constantly battling.  The replies were even worse, echoing similar beliefs that addiction is a choice, a moral deficit, a flaw in one’s character, etc.   These comments perfectly captured the disturbing misconceptions that exist about addiction (misconceptions that result in criminalization of addiction rather than treatment, and denials from insurance companies for treatment coverage).

There are many pathways that lead to addiction.  More and more people recognize that trauma, emotional disturbance/mental illness, and inability to cope with challenging life events can lead one to turn to substances.  I conceptualize this as turning towards alcohol or drugs to experience pleasurable emotions not accessible when sober, or using them as an escape from painful emotions.  There is also a growing group of individuals who have become addicted to medications prescribed by their doctor (such as Oxy, Xanax, Codeine, Adderall, etc.) and transition to illicit drugs (such as heroin) that are cheaper and more accessible.

Regardless of how someone becomes addicted to a substance, the process of addiction in the brain looks the same.  Addiction changes the brain.  Built into our brains is this fantastic little area that ensures the survival of the species, called the reward center.  The reward center is responsible for pleasure and involves the release of the neurotransmitter dopamine.  Dopamine is not only responsible for producing pleasure, but also plays a large role in motivation, learning, and memory.

When someone uses heroin, for example, there is an immediate release of dopamine in the brain (at a much higher level than what can be reached by natural means- although over time dopamine production and re-uptake is negatively affected leaving people desperate to try to achieve the same initial high).  The instant gratification becomes reinforcing, so much so that the brain becomes hijacked by the addiction and all motivation is shifted towards continued use.  The brain starts to develop associations with the reward center activation produced by the drug, leading to the development of emotional (i.e. depression, anxiety, despair) and sensory (sights, sounds, smells, places, people) triggers that prompt intense cravings.  Remember Pavlov’s dog?  Pavlov would ring the bell before serving the dog a delicious steak, and eventually through learning/association the dog would start to salivate just by hearing the bell, even when no steak was in sight?  Same concept.

Dr. Paul Earley (consultant for RiverMend Health, the parent company of Malibu Beach Recovery Center) coined the term “addict brain” to describe how addiction rewires the brain and changes one’s thinking, motivation, learning, and behaviors to support ongoing use.  Neural circuits that produce compulsion (wanting/craving) are activated, repetitive automatic behaviors are established, and the conscious interpretation of reality is hijacked.  Once addiction is established, the brain runs on autopilot to support the addiction.  What this looks like to outsiders: continued use despite significant negative consequences, denial, minimization of problems related to the addiction, romanticizing the substance, cravings, manipulation, lying, and automatic behaviors directed towards using (aka the “moral deficits” or “character flaws” we see).  Addict brain impairs higher executive brain functions like judgment, decision-making, and impulse control.  At this point, the brain is functioning in a manner that takes choice out of the equation.  “Just stopping” is not an option given the rewiring of the brain. You’re asking someone to do something they are simply not capable of doing on their own.

This is where treatment comes into play.

I could go on and on about the different treatment approaches for addiction, but the core components of treatment involve:

  1. Containment- The individual needs to be in a setting where he/she can get sober and stay sober.  This is best accomplished when access to the substance is denied.
  2. Developing recovery skills- This involves understanding triggers and learning how to manage cravings.  Relapse prevention plans are a large part of this.  FYI- relapses do happen, its a normal part of the recovery process, and does not doom someone from achieving long-lasting sobriety.
  3. Accessing emotions and addressing core emotional issues- this is where the relational work comes into play.  Addiction does not occur in a vacuum.
  4. Developing healthy body, healthy mind, and healthy spirit (we use nutrition, exercise, yoga, and psychotherapy)
  5. Developing a support system
  6. Maintaining ongoing treatment and/or support

There is a nationwide epidemic of addiction that is stealing our family members, our lovers, and our best friends.  The only hope in taking down this epidemic is to change the discourse on the topic, and to make sure that people have accurate information removed of prejudice and judgment.


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