American society is finally catching on to something we’ve known for a while now: addiction is a disease of the mind, not a flaw in morality. For some reason, people are quite resistant to believing that- most likely due to the anti-drug propaganda of Richard Nixon’s War on Drugs.
It seems like a pointless debate, doesn’t it? What exact does one hope to gain by “proving” addiction is “a lifestyle choice?” Blocking access to medical services? Dehumanizing a particular sect of people? What is there to gain?
A new paper published by the New England Journal of Medicine is making it harder to deny that addiction is a disease. The authors behind the research paper aimed to explain addiction’s status as a disease through a model explaining how addiction affects a person in three parts: Binging and intoxication, withdrawal and negative effects, and preoccupation and anticipation. The also explain how reactions to stress, impulse control, and decision-making differ between people living with substance abuse disorders and those who do not.
How does that work? Well, it’s simple really.
The researchers explained that addiction begins with the brain associating ingestion of a drug with pleasure and positive rewards. Because addictive drugs typically influence the release of the pleasure hormone, Dopamine, the slope into dependency and addiction can be a steep and slippery one. What’s important to understand about this portion of addiction is exactly what Dopamine is and how it influences your brain:
To explain it simply, Dopamine is essentially your brain’s self-reward. When you perform an act which benefits your body or mind, Dopamine is released, causing you to feel good about that action. It’s a sort of internal Pavlov response mechanism- when your brain rewards and encourages something with Dopamine, we tend to repeat the action in anticipation of the payout (we’ll get back to that in a moment).
Now, when Dopamine is released due to use of an illicit drug, it’s like an explosion of the hormone in your brain; the sudden spike in Dopamine occurs in much larger levels than would naturally be released. This leads to a state of utter euphoria, the intensity of which leads some to actively seek out the experience again and again. At this point, the brain itself begins to seek out these Dopamine spikes obsessively with no cut-off point in which one has had enough.
Your brain builds strong associations with pleasure and the drug which is causing the release of Dopamine, affecting your memories of drug use and your priorities. This is the point at which most people living with addiction begin to experience trouble in other aspects of their lives: they shrug off responsibilities, relationships, and other goals in favor of chasing the high.
But there’s another reason people become addicted to illicit drugs or alcohol: avoidance of withdrawal.
What exactly is withdrawal? We can explore in two ways: physical withdrawal symptoms, and psychological withdrawal.
With physical withdrawal, the body- ever adaptive- has become adjusted to increased levels of Dopamine and other substances associated with drug use. When these levels begin to drop due to no longer maintaining the same level of substance abuse or abstinence, the body goes into full on panic mode. It rings all the bells and blows all the whistles it must to get you to restore the biochemical balances it has becomes accustomed to; sometimes that’s to the detriment of the body itself.
Physical withdrawal varies: it can cause slight irritability, minor flu-like symptoms, or life-threatening reactions including organ failure, seizures, and brain dysfunction. Because your brain has learned to associate use of illicit drugs with feeling good, cravings and urges skyrocket along side with the misery of the withdrawal symptoms. This is where the psychological response to withdrawal meets the physical need, potentially leading to relapse or overdose tragedies.
Psychological ties to a substance can be even more difficult to break than physical dependency. This is mostly due to the mental associations one creates with drug use; when we unintentionally teach ourselves that using is a quick and easy way to feel better, it becomes our go-to response to stress, emotional distress, and the traumas of life. The brain’s connections literally change in such a way that leads to distress and cravings during withdrawal.
Herein lies the greatest struggle of overcoming the mental disease of addiction: breaking the bond between pleasure and using while also conquering the anxiety associated with withdrawal. This final change within the addicted brain is a preoccupation with substance use.
Dr. Nora Volkow, the lead author of this paper and director of the National Institute on Drug Abuse explains that one can identify physical changes in the prefrontal cortex on an addicted brain which is responsible for decision making and self-regulation. This is where the previously mentioned troubles with impulse control and prioritizing stem from; addiction has effectively hijacked one’s brain and placed itself at the top of the list of necessities for survival.
Breaking through these often intermingled levels in the disease of addiction is a challenging feat for a reason- and it has nothing to do with laziness. Substance abuse disorders are complex and difficult to understand, especially because they affect people differently on an individual level. Because of this its impossible to determine a specific substance use “threshold” in which people cross from casual users into people with a serious disorder. There is no absolute way in which to treat this disorder, but understanding what occurs on a scientific level makes it easier to identify the needs of each individual in treatment.
So next time you hear someone ignorantly insisting that “addiction is a choice,” kindly direct them toward this article so they may spread awareness rather than stigmas.