Understanding Addiction - What You Need to Know

Addiction causes lasting changes in the brain. It is a disease of the brain – not a disease that has anything to do with will power or weakness.

While to an outside observer it may look like an addicted person makes planned choices to use drugs of alcohol and to engage in the behaviors necessary to frequently use drugs and alcohol – in actual fact, those ‘choices’ occur only after changes to multiple parts of the brain result in disordered thinking and memories and motivations.

Once addicted, what seems like free choice is actually far from it. After 4 years and the work of 80 specialist experts in the field of addiction medicine, the American Society of Addiction Medicine has released a new definition and explanation of addiction.¹

Here are the facts...

They say it’s a disease of the brain and it has nothing to do with will power!

People don’t choose to become addicted but once they are the brain changes can last for a lifetime.

Although negative behaviors often accompany addiction, they are secondary to physical changes in the mind that cause these altered behaviors.

The Brain Changes of Addiction

Addiction is a primary disease of the brain and it causes functional changes in the operation of the brain’s reward, motivation and memory systems and in higher order thinking from the frontal cortex.

1. Motivation and Reward System Changes – Addiction causes physical and functional changes in brain structures involved with reward and motivation, such as the nucleus accumbens, the anterior cingulated cortex, the basal forebrain and the amygdala. These changes in reward structures lead to a skewing of motivation. While most people will prioritize behaviors that result in health and well being, people with addiction-hijacked reward systems inadvertently put a much higher priority on behaviors that stimulate the reward systems, which is why people addicted to certain drugs may behave in hard to understand ways, such as choosing to get high over food, shelter or family.
2. Memory System Changes – Addiction creates altered interactions between memory systems in the hippocampus, reward systems and higher order thinking in the frontal cortex. Once addicted, environmental cues which trigger memories of addictive behaviors result in a biological response and the experience of cravings.  A person without addiction might remember a pleasurable experience such as using cocaine with fondness but experience no cravings to repeat it. A person with addiction would remember that same experience of using cocaine and feel a biological response and experience strong cravings to use again.
3. Frontal Cortex Changes – Addiction causes changes in the frontal cortex that can lead to consequences like a decreased ability to defer gratification or resist impulsive behaviors. Early exposure to substance use and abuse is known to dramatically increase a person’s risk of developing an addiction. This may be because the frontal lobes of the brain are still in development during adolescence and engaging in substance use during this period is likely to result in brain changes that support the development of addiction.

The brain changes of addiction can be long lasting or permanent and because of this addiction is a chronic brain disease that is characterized by periods of remission and relapse and which often requires repeated bouts of treatment over a lifetime for management.

How and Why People Become Addicted

Addiction is a biological disease with a hereditary component. About 50% of your risk for ever developing an addiction is written in your genetic code. Other factors that are known to increase a person’s susceptibility for addiction include:

• Having another condition that affects the brain’s reward systems and which makes a person more likely to enjoy and seek out the rewarding (the highs) aspects of addictive behaviors.
• Changing your brain’s structure and function through the repeated use of substances (or engagement in activities like gambling). Using substances to excess can lead to changes in the brain that make controlling future use more difficult.
  
• Having an emotional or cognitive condition which affects your ability to accurately perceive the world around you or deal with difficult emotions.
  
• Experiencing trauma or abuse – People who survive trauma sometimes use drugs or alcohol as a way to cope, and this can lead to addiction.
  
• Failing to learn resilience strategies during the developmental years (having ineffectual parents, for example) or losing important social support in adulthood (the sudden death of a spouse, for example).
  
• Having any type of mental illness and using drugs or alcohol.
  

So What Are the Consequences of These Significant Brain Changes after Addiction?

So addiction results in changes in the brain – what’s the big deal anyway?!

As a result of the way our brains change in functioning after addiction, we experience a wide array of negative changes in our lives. These changes are behavioral, cognitive and emotional in nature, and when you consider that addiction changes how we act, how we think and how we feel – you realize that there isn’t much left that it doesn’t negatively impact.

Behavioral Consequences Include:

Losing control over how much or how often you use drugs or alcohol or engage in an addictive behavior (like gambling). Repeatedly trying and failing to control how you use, drink or otherwise engage in a harmful behavior.

• Experiencing significant consequences from your addictive behaviors, such as experiencing negative consequences on the job or in important social relationships.
• Spending a lot of time using, getting money to use or recovering from your use.
• Continuing to use drugs or alcohol or engage in another behavioral addiction despite knowing the harms it does to your physical or psychological health or well being
• Rarely taking part in social activities that aren’t associated with your addiction of choice (If you like to drink and you can’t drink with a certain group of people – you are unlikely to want to spend much time with them.)
• Knowing you have an addiction problem but being unable or unwilling to make any substantive changes.

Cognitive Changes Include

• Becoming obsessed with the focus of our addiction - Be it alcohol, drugs or gambling, once addicted we focus most of our attention in any given day on making sure we get what we need.
  
• Losing the ability to accurately assess the costs and benefits of our addictive behaviors – Most actions have both rewarding and negative consequences. When using alcohol, examples of rewarding consequences include feelings of relaxation and pleasure and examples of negative consequences include health problems, hangovers, DUI’s, poor performance at work, etc. Once we are addicted, our thinking becomes very focused on the positive consequences and we pay much less attention to the negative consequences. This is one reason why a person can continue to drink or use drugs or gamble, even as the costs of those actions become very obvious to concerned friends and family members.
• Believing that the problems faced in life are caused by factors other than addictive behaviors. For example, after being fired for poor performance, an alcoholic might blame her boss for unfairness and be unable to accurately assess how her drinking and daily hangovers contributed to her poor performance and job loss.

Emotional Changes Include:

• Experiencing greater feelings of anxiety, unhappiness and general emotional pain
• Becoming more sensitive to stressors – Once addicted your behaviors likely cause stressful situations (getting a DUI, owing money to a bookie, etc.) and you also experienced a reduced capacity to manage normal everyday life stress. As a result of your addiction, then, life becomes far more stressful than it was prior to addiction.
• Losing your ability to accurately gauge your feelings
• Experiencing persistent emotional lows that can only be reversed by engaging in your addictive behavior of choice (drinking, drugging, gambling etc.). Once addicted, you may develop a tolerance to the highs but you never develop a tolerance to the lows that come after using. As a result, you spend a lot of energy trying and failing to get as high as you’d like to and experiencing ever greater rebound lows as you come down into states of withdrawal. Once addicted, people chase the high, but also use everyday just to get rid of the deep low... using just to feel emotionally normal.

Addiction Treatment – What You Need to Know

When considering addiction and addiction treatment, three facts worth keeping in mind are:

1. Addiction is a chronic disease that typically features periods of remission (abstinence or non harmful use) and periods of relapse (addictive behaviors and harmful use).
2. Addiction treatment works well. Relapsing after remission is not inevitable and addiction treatment helps some people avoid relapse for good. Addiction treatment helps most people achieve longer periods of remission between relapses and also reduces the severity of relapses that do occur. Additionally, people in addiction treatment learn skills that improve functioning and well being during periods of remission.
3. When addiction is left untreated or insufficiently treated it can lead to disability or early death

Addiction treatment should not be evaluated as an all or nothing - success or failure - type of endeavor.  Addiction treatment helps some people to abstain for a lifetime, but even those people who do go back to using at some point benefit from longer periods of remission and from learning to reduce the harms of use and the severity of relapses that do occur. Like many chronic disease (diabetes, heart disease, etc.) treatment is rarely a one-shot success but rather something for a lifetime and ideally something that evolves and changes as the needs and circumstances of the client change.

More truths about addiction treatment include:

• Some types of addiction respond well to medication management (opiate addiction with methadone or Suboxone, for example). Medication management, when available, tends to improve treatment outcomes.
• The best results are achieved when appropriate medications are combined with evidence based psychosocial therapies (like group therapy, for example).
• Addiction treatment needs to be chronic and ongoing in nature
• Anyone can achieve recovery, even people who think they are beyond help
• Peer support, such as that found in groups like AA and others can be a beneficial part of the ongoing treatment process