Early last century, when researchers first began to explore the concept of addiction, there was a prevalent moralistic view that people who developed addictions were somehow morally or religiously flawed, or they were fatally lacking in resolve, strength or willpower. Beating addiction, they thought, involved socially and criminally punishing users to make them “see the light”. The goal was getting them to change their immoral thoughts and/or, encouraging them to gather the personal will to break a habit, often through “divine intervention”. Those roots are still seen in some views on addiction today.
Luckily though, medical science and Western society itself have progressed a long way from those “dark times”. Modern science has discovered that although addictions certainly involve some element of personal will, they are also very much about the brain and how the brain malfunctions in people who are addicted.
The reward circuit and its malfunction
On a very fundamental level, the brain reacts to “good” pleasurable things like food, sex, alcohol/drugs, and even to things like gambling or physical exercise in a very predictable way scientists call the “Pleasure Principle”.
Pleasure principle. The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex. Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.
All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release. Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.
(Harvard Mental Health Letter, 2011)
But it isn’t just the simple activation of the pleasure principle that creates addiction. The addiction process happens through the brain’s pleasure centre raising dopamine levels and the subsequent interaction with the processes of human learning and human motivation.
Dopamine plays an important and crucial role in our learning and memory systems. At a fundamental level, we learn to become addicted and this learning changes how our brain functions. Most research in addiction points to a process where dopamine interacts with another brain neurotransmitter called glutamate. The interaction of these two neurotransmitter chemicals affects and influences the brain in powerful ways that can result in the patterns, feelings and behaviours of addiction.
This dopamine-glutamate interaction system or “reward circuit” as its commonly called, is deep-rooted in our brain because it has an important role in keeping us alive; as it links the activities needed for human survival like sex, eating and drinking with pleasure and reward. It is also intricately linked with our motivation and memory. When we eat, drink or have sex, our brain realizes these are necessary for our survival and “rewards” us for it. That’s why we have a pleasurable full feeling after a good meal, or experience the warm afterglow after sex.
When we partake in addictive substances and behaviors, they activate this same reward circuit process — and then, for some people, at some point, their reward circuit becomes overloaded and malfunctions (Harvard Mental Health Letter, 2011).
When an addictive substance is used or an addictive behaviour is performed over a period of time, it activates our brain’s reward system over and over and over again, and somewhere along the way the system “short circuits”. When this happens our brain can start to blur the differences between our wants and needs. Our brain confuses what we want with what we need. Our confused brain tells us that we absolutely need the addictive substance or behaviour in our lives. We feel we need it to feel calm, to relax, to feel contented… to feel “normal”. Our brain confuses our wants and needs and then will even encourage and motivate us to find our drug/behaviour of choice, to use it and to continue to use it long term. This also explains why many feel powerless over an addiction; on some level, their own brain is encouraging and motivating them to keep using!
When people continue to use substances or repeat addictive behaviours over time, the reward circuit/dopamine-glutamate interaction for that particular substance or behaviour gets more and more “wired into” their brain and because of this, their tolerance to the substance/behaviour builds – this means it takes more of the drug/behaviour to create the same high or contented feeling. Because of this tolerance, the addicted person will have to use more and more of the drug or use the drug more often to get the same effects. This increased use overloads and short circuits the reward circuit system even further and creates even more perceived “need” for the substance/behaviour.
Making this even more difficult is that over time, the reward circuit in our brain often changes from a “positive reinforcement pattern” where the addictive use or behaviour is motivated by a search for pleasure or good feelings from the substance use — to a “pattern of negative reinforcement” where the user’s goal is now to avoid the often very bad feelings that come from NOT using their substance. These negative feelings are often seen as a part of avoiding withdrawal. These bad withdrawal feelings can be sadness, confusion, fear, loneliness, anxiety, guilt, shame, self-recrimination, stress, anger, irritation, frustration and many others. Using the substance makes these bad feelings feel “better”. Negative reinforcement also explains when an addict uses to escape reality, to self-medicate, or even keeps using to avoid the loss of fun situations or friends who “use”. (Blume, 2001).
The addicted brain creates the so-called “addicts dilemma”, where the user knows that the substance use or addictive behaviour may be very emotionally, socially or physically bad for them… but if they don’t use, they begin to feel very badly emotionally (and even bad physically if they are addicted to a physically addictive substance). They begin to need the substance to feel “normal” even if that normal is a high or numb feeling. Quite a dilemma indeed.
Changes in the brain.
Continued use of a substance or repeating an addictive behavior has at its very center the continued and repeated activation of the reward circuit. This activation of the reward circuit and its interplay with our motivation and learning systems can create a pattern or habit that becomes like a “well-worn road in a farmer’s field” etched into the circuitry of our brain. This continued, repeated interaction pattern of the reward circuit’s dopamine and glutamate, creates a process that even changes how our brain works at a fundamental level. In fact, this process even changes the way the brain physically functions.
Research has shown that long-term drug abuse results in changes in the brain that persist long after a person stops using drugs. These drug-induced changes in brain function can have many behavioral consequences, including an inability to exert control over the impulse to use drugs despite adverse consequences—the defining characteristic of addiction
(National Institute on Drug Abuse, 2009, p. 7)
Addiction becomes a vicious circle where the use of the substance alters brain functioning in a way that keeps people from being able to think clearly and logically about their addiction; they begin to believe and feel that they need to use a substance or perform a certain activity to feel “normal” and their altered brain function then motivates, encourages and supports this way of thinking. A pattern occurs where an individual’s ability to make good choices is fatally affected by the repeated substance use, which in turn further alters their brain every time they use… and around and around they go. An addiction is almost like a symbiotic organism that insidiously adapts itself inside the host’s brain and changes the host’s thinking in order to keep the host addicted.
The word “addiction” is derived from the Latin term Addīcō, which can be translated to mean “enslaved by” or “bound to”. For many with addictions, that is probably a very apt description. Why else would someone hurt their health, damage their closest relationships, spend all their money, or even commit crimes to support their addiction? Simply put, because brain function is altered, addiction isn’t logical or sensible to someone looking at it from the outside.
This great difficulty in beating most addictions is evidenced in the relapse rates. About 40-60% of people who make the effort to get formal treatment for a drug addiction will relapse at some point. In addition, people who are addicted often relapse numerous times before the treatment finally “takes”.
But really these numbers are not different from other lifestyle related diseases. For instance:
- 30 to 50 percent of people with type 1 diabetes fail to stick with their treatment plan
- 50 to 70 percent of people who suffer from asthma fail to take their meds or make recommended lifestyle changes
- 50 to 70 percent of people with chronic high blood pressure don’t take their hypertension medication as directed (National Institute on Drug Abuse, 2009)
Given these statistics, we can see why it’s so very important to have patience, persistence, empathy and flexibility in dealing with colleagues, friends, and family who struggle with addictions.
So given the functional brain changes that addiction creates and the relapse statistics…
Ending an addiction is not just a simple question of willpower.
What can you do for someone or yourself to help with an addiction?
Here are some resources to start with:
Alternative Recovery Programs
Blume, A. W. (2001) Negative reinforcement and substance abuse: Using a behavioral conceptualization to enhance treatment.The Behavior Analyst Today, Vol 2(2), 2001, 86-90.
How Addiction Hijacks the Brian. (2011) Harvard Mental Health Letterhttp://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain
National Institute on Drug Abuse. (2009). Principles of Drug Addiction Treatment: A Research-Based Guide (2nd ed.). Bethesda, MD: United States. Health and Human Services. National Institute on Drug Abuse.
About the writer:
Robert Hammel is a licensed Psychologist in private practice in Calgary, Alberta, Canada. He loves to help people with anxiety, depression, and addictions. He also works with couples to improve their relationships. He lives with his patient wife and two overly energetic herding dogs.
Another article from Robert: SMART Recovery: A thoughtful alternative to Alcoholics Anonymous