Understanding Addiction or,

Things are not Always What They Appear to Be

Addiction is nothing if not a contemporary of humans since the dawn of recorded history. During this time, there have been many attempts to explain addiction with most having relied on the behavior exhibited by those identified as addicted in order to explain addiction. This is something like explaining the common cold as congestion, runny-nose, sneezing, and a scratchy throat. Although some or all of these realities may be indicative of the common cold and even descriptive of one who has that condition, they are not, individually or collectively, “the common cold.” If we introduce the construct of viruses—and the rhinovirus in particular—we come closer to operationally defining the common cold. However, even then, the “cold” itself is but a condition where the virus is an organism with the ability to affect its host in a particular way, the result of which is to bring about a condition we call the common cold…and then it is but one of dozens of viruses that result in conditions with “cold-like symptoms.”

Such is the case with addiction. Historically we have looked at the actions and choices of individuals who behave in a particular way and have labeled them as “addicted.” Most frequently, the interpretation of these behaviors has had a decidedly moral bent resulting in describing those “with addiction” as being morally bankrupt or of weak personal character if not the personification of moral turpitude. All of this, based upon the behaviors of an individual whose comportment falls outside the constraints of socially constructed boundaries.

With the advent of contemporary science—and more to the point, the technology that has enabled these scientific advancements—we now know that addiction is more than the behavioral indicators that suggest its presence. In fact, not only is addiction not the result from moral turpitude or a defect of personality, it is more than likely the result of distinct functions of the human brain that make some individuals particularly susceptible to this disorder. Although this susceptibility to addiction is beyond the scope of this brief essay, it is, nonetheless, a “scientific nut” that remains to “be cracked,” and likely sooner on a technological timeline than later.

Explaining addiction requires more than the simple blaming of one’s moral shortcomings and/or personality defects for the continued use of a substance or pursuit of a maladaptive behavior. Recognizing that the characteristic euphoria or “rush” associated with use and the craving that eventually follows both result from normal functions of the brain more than suggests that we revisit our understanding of addictive disorders and our historic approaches to their treatment. That particular regions of the brain associated with the “rush” and “craving” associated with the advent of this disorder suggest its etiology may be more elegant than pejorative.

We know that particular drugs like alcohol and cocaine activate what is referred to as the “reward pathway” in the brain, specifically, the ventral tegmental area (VTA) – nucleus acumbens – prefrontal cortex. Were it not for this unique function of the brain that has evolved so as to ensure that securing food, water, and the desire to continue the species are rewarded, we would literally “not be here.” That drugs like alcohol, cocaine, and behaviors like gambling can activate this pathway by mimicking or compromising the naturally occurring neurotransmitters designed to ensure survival begins to explain the “high” that occurs when engaging in these behaviors; the more one consumes, the greater the high and the greater the desire to repeat the experience. The intensity of the “high” or “rush” is what, in turn, sets the stage for the craving. As one recalls the intense pleasure associated with the addicted behavior, the rush to repeat the experience can preoccupy the individual’s mind to a point that consumption becomes an irresistible urge.

Historically, addiction, or more specifically, the repeated use noted in those with addictions, was thought to be motivated by the negative reinforcement realized when one would seek to assuage the withdrawal symptoms associated by separation from the object of one’s addiction. New research, however, suggests that it is the desire to re-experience the high that is hinge on which the door of addiction swings. The irony is, the very physical system that creates this cascade of events that results in addiction seeks to correct the imbalance created by the flood of neurotransmitters associated with the pleasure pathway by reducing the production of endogenous neurotransmitters. This reduction in neurotransmitters results in a tolerance to an established quantity of use thereby necessitating an increase in drug used or behavior required to ensure satiation. The entire cycle of behavior we have come to refer to as “addiction,” is essentially one’s attempt to recapture the euphoria associated with intoxication. One is not so much addicted to “cocaine” or “alcohol” or “gambling” as he or she is addicted to being intoxicated.

Simply stated, drugs like cocaine and alcohol block the ability to reabsorb the neurotransmitters naturally produced in the brain. As new neurotransmitters are produced to ensure the normal functioning of the brain, a flood of neurotransmitters, for example dopamine, results in continued and over stimulation of the reward pathways. As the body detects this malfunction in the normal flow of neurotransmitters, it reduces the amount of dopamine naturally created. This results in a reduced “high,” which we know as tolerance. Tolerance is met by the consumption of greater quantities of the addictive substance resulting in a spiral so frequently observed in addicted individuals.

If individuals who have an addiction do not have a crisis of character or a dysfunctional personality then to judge them as individuals based on behavior resulting from a discernable physiologic process ceases to make sense. To be blunt, people with an addiction are not bad people who need to learn how to become good; they are individuals with a behavioral health problem who need to get well. Just as there are treatments for individuals with “physical” health problems, so are there treatments for individuals with “behavioral” health problems and in both cases, those treatments work.

What do you think?

Dr. Robert

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