Addiction is a difficult conundrum that scientists have been trying to solve for years.
When research began in the 1930s, the majority of scientists believed that addiction was a sign of weak moral character and criminal tendencies treated by better discipline. Addicts who tried their best to simply stop drinking or taking drugs were baffled and demoralized when they couldn’t stop. Repeat offenders were punished and received very little, if any treatment. Most died in jails or mental institutions, never able to recover.
Since then, much research has been done on addiction, specifically on how it affects the brain. Years of research and advances in technology has revealed that addiction is actually a chronic disease that changes the structure and functioning of the brain. Addicts don’t lack discipline or willpower, their brains have literally been rewired to need their drug of choice.
The choice to ingest drugs or alcohol for the first time is usually a voluntary choice, but after that the choice to do drugs or consume alcohol again becomes complicated by changes in the brain. When a drug is consumed in the right quantities, the brain gets flooded with dopamine, a feel-good chemical. Dopamine is produced when we do anything pleasurable: eat good food, have sex, listen to a song we love, watch a show we like, etc. These activities produce a normal amount of dopamine. The brain then records that these activities felt good and we remember that they gave us pleasure.
But when a drug is taken, the brain gets completely overloaded with dopamine. The chemical is produced in much larger quantities than when we engage in normal activities. The brain doesn’t know how to handle the overload, so it ends up turning off some of the dopamine receptors in the brain. The problem is that these receptors don’t always gets turned back on. So, the brain thinks that there is a deficiency of dopamine, which makes the person feel flat or sad or depressed.
The pleasurable experience created by using drugs also creates a pleasurable memory in the brain, so when the person doesn’t feel good anymore, they immediately think about how good they felt when they were under the influence of drugs. Many addicts and alcoholics can remember exactly how they felt the first time they used the drug and often describe chasing that feeling for their entire addiction.
When the person uses drugs again, the brain gets flooded with dopamine all over again and has the same reaction: to turn off dopamine receptors. In effect, the use of the drugs makes the brain believe that there is a constant dopamine deficiency. The brain also believes that the solution to this dopamine deficiency is to use drugs because of the memory that drugs provide so much pleasure.
So, addicts are not using drugs because they want to, they are using them because their brains have been rewired to believe they need to. Full blown addiction takes place when the brain becomes so rewired to crave the drug that the addict continues to use drugs even when they are aware that it is causing them harm. The addict is often not aware of this need at all. They may believe that they can control their drug use, even when it’s clear they cannot.
Some people are more susceptible to addiction that others. Scientists have not been able to pin down exactly what makes someone likely to be an addict, but there is a consensus that both environment and genetics play a role. Scientists estimate between 40 and 60% of susceptibility is determined by genetics. This means that a person’s biological makeup may be a factor in determining whether they will be an addict. Some studies have found that alcoholics actually metabolize alcohol differently than non-alcoholics, which leads them to crave more alcohol. Other studies have found that people who are born with dopamine deficiencies or who develop trouble producing dopamine are more likely to develop addictions. Environmental aspects such as growing up with addicted parents, childhood abuse, or experiencing trauma also increase risk for addiction.
Treatment for addiction requires treating the whole person, physically and psychologically. Medication is often required to safely wean people off drugs and alcohol or to prevent withdrawls. Therapy and 12 step programs are also very helpful. Many people also find that spirituality is important to their recovery, not necessarily religion, but a belief in a Higher Power. Letting spiritual principles guide their life helps to change behaviors that caused their addiction and stemmed from their addictions.
Treatment options are widely varied. The most important thing to understand is that recovery is a lifelong process.
Understanding addiction as a chronic disease of the brain is essential in tackling the drug abuse crisis that is currently overwhelming the United States. Alcoholics and addicts are not criminals, they are sick people who need treatment. We shouldn’t be focused on locking them up, we should be focused on changing our healthcare system so they can get the help they need. And we should be working on our own understanding of addiction so we can approach addicts with compassion instead of judgement. Doing this will change the state of addiction in this country and prevent thousands of deaths.