Addiction
The term "addiction" is a description of compulsive behaviors that lead
sooner or later to harm. Addiction to food, alcohol and numerous drugs are
a prevailing threat to brain function. There is always confusion about the
origin and nature of abnormal behaviors. Most popular “psychological”
ideas are probably wrong since eating and drug use are based on old
programs in the brain and have little or nothing to do with the modern
personality. People who claim that society is to blame or talk about the stress
of modern life are also on the wrong track. You have consider the deep
biological determinants of behaviors in order to understand
addictions and before you can develop effective solutions.
The addiction to chemicals overrides concern for the welfare of others.
Addicts can become unusually destructive humans and the decision to recover from
addiction is an ethical decision to stop harming oneself and others. Those who
argue that alcoholism is a “disease” and excuse the immorality of alcoholic
behavior are making a mistake. Recovery must begin with a mature decision and
must continue with the daily re-affirmation to remain a good person who does no
harm to others. Narcotic drugs have major withdrawal effects. Addicts seeking a
better life often require expert assistance to pass through the withdrawal
ordeal.
We notice similar patterns of addictive behavior with food, alcohol and
street drugs. Alcoholics and drug abusers frequently have atrocious dietary
habits. So many of them grew up dysphoric with bad chemicals in their food and
environment. These addicts often report they first felt well when they had their
first drink or injected the initial dose of heroin. Opiates, like other
molecules, are effective but temporary remedies for dysfunctional body-mind
states. The drive to maintain an opiate level is less to get high and more to
feel normal; mostly to avoid the suffering of withdrawal.
All known addictive drugs activate reward regions in the brain by causing
sharp increases in the release of dopamine. At the receptor level, these
increases elicit a reward signal that triggers associative learning or
conditioning. Repeated experiences of reward become associated with the
environmental stimuli that precede them. With repeated exposure to the same
reward, dopamine cells stop firing in response to the reward itself and instead
fire in an anticipatory response to the conditioned stimuli
that predict the delivery of the reward, a process that involves the same
molecular mechanisms that strengthen synaptic connections during learning and
memory formation. Environmental stimuli are paired with drug use —
including environments in which a drug has been taken, persons with whom it has
been taken, and the mental state before it was taken. Conditioned stimuli
elicit conditioned, fast surges of dopamine release that trigger craving for the
drug.
With repeated use the addictive drug, smaller amounts of dopamine are
secreted. Addicts no longer experience the same degree of euphoria from a drug
as they did when they first started using it. Their brains develop an
antireward system that becomes overactive, producing a dysphoric phase of drug
addiction that peaks when the direct effects of the drug wear off or the drug is
withdrawn.
( Nora D. Volkow
et al. Neurobiologic Advances
from the Brain Disease Model of Addiction. N Engl J Med 2016; 374:363-371
January 28, 2016)
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