The Mechanics of Addiction

Addiction Rehab information explains addiction: The American society of alcoholism (1950) was changed to The American Society of Addiction Medicine in 1989 (ASAM) and in 2011 released the latest definition of addiction after a four-year study involving hundreds of scientists and experts.

"Addiction is a brain disease but you don’t have to be a brain surgeon to understand it" 

What is addiction? ASAM

"Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death"

A Chronic disease causing long-term changes in the Brain

They defined addiction as a chronic-progressive-primary and potentially fatal neurological disorder involving many brain functions, most notably, and 'imbalance in the reward circuitry'.

The impaired ability to experience pleasure drives those caught up in addiction to chase the rewards they seem to obtain from alcohol, drugs, and process addictions such as gambling. Willpower is no longer enough once the reward circuitry has been impaired.

Reward centre: Changes in the way addicts experience pleasure

Substance addiction dulls and desensitizes the reward circuitry. Nothing else can compete. Work, family, and friends lose their value until eventually the person isn't even able to get any reward from the substance - by this stage it doesn't matter because the addicted brain drives the person to keep perusing the drug even without the reward.

The Hijacked brain: The human reward system is designed for survival but is hijacked by the payoffs provided by the addiction. The reward circuitry normally bookmarks important things like: food, nurturing children, education, work and friendships, however it is now corrupted.

"The memory of the drug has become more powerful than the drug itself"

Impaired memory, perception and learning - Euphoric recall

The destructive and unhealthy behaviours themselves are all consequences or symptoms of the addiction, not the disease itself. The state of addiction is not the same as the state of intoxication or even physical dependency. Substance abuse is considered a form of self-medicating, allowing their users to escape temporarily from the condition that troubles them.

Instant gratification: In nature, rewards usually come only with effort and after a delay. Addictive drugs provide a shortcut, flooding the reward center with dopamine.

"However, the relief or highs provided by drugs and alcohol are short-lived" 

The term addiction comes from the Latin word ‘addictus’ roughly meaning ‘enslaved by’. Shakespeare was the first recorded writer to use the word addiction in Henry V, meaning he liked activities of no value or importance. Anyone who has struggled to overcome addiction, or tried helping someone, understands why. It could just as well be renamed Reward deficiency syndrome.

The Mechanics of Addiction

"You know you are addicted when you cannot stop doing something that is hurting you. For an addict Using is like going back to the problem for the solution. Addiction’s are repeating repetitive behavior - so don’t be surprised the solution need to be repeated everyday also… Scientists say Addiction could be renamed dopamine deficiency disorder or neurotransmitter disease…Shakespeare used the word Addiction meaning devotion to something unnecessary. The good news is if you can quit for a day, you can quit for a lifetime" 

Common symptoms of Addiction

 

  • Compulsive Reward seeking 
  • Relief seeking
  • Impaired decision-making
  • Anxiety (fear)
  • Obsession
  • Low Stress threshold
  • Low frustration tolerance
  • Denial
  • Dysfunctional emotions
  • Apathy
  • Co-dependency
  • Depression
  • Isolation and agoraphobia
  • Psychiatric problems
  • Low Boredom threshold

 

Primary: not a secondary symptom of an underlying disorder

Treatment specialists see the latest ASAM definition as a validation of what has come to be commonly known as “the disease concept” of addiction since the publication of Alcoholics Anonymous in 1939.

Many people in the population at large see addiction as a moral, social or chosen problem. However understandable this is, it is a dangerous mistake.

The Disease concept is not the medical model as addiction cannot be cured in the traditional medical sense or in a Hospital.

Treatment means addressing psychological, environmental, social and spiritual components (triggers), not just the biological condition. Medication can be helpful, but it needs to be combined with therapy, behaviour and lifestyle change.

Addiction is like cardiovascular disease: recognised as chronic, it must be treated, managed and monitored over a lifetime because there is no pill, which alone can cure addiction. Choosing a recovery lifestyle over unhealthy behaviours is akin to people with heart disease who choose to eat healthier and exercise.    

Hijacks our survival systems  

Disrupting our Hierarchy of needs  

The human reward system is designed to support survival and has been hijacked by the chemical payoff provided by the addiction. The reward circuitry bookmarks things that are important: eating food, nurturing children, having sex, and sustaining intimate friendships. Use of the substance then starts to happen at the expense of what otherwise would promote survival.    

Hardwired: It changes the brains communication pathways

  • I can’t live without it
  • I need it
  • It helps me
  • I don’t have a choice
  • I can’t say no
  • I must have it  

Addict’s belief system  

If we believe we can recover - we can recover  

One analogy that is helpful here involves imagining the brain is like a ski slope after a heavy snowfall. Think about how as skiers make their way down from the slopes, their progress creates groves in the snow - these groves get deeper as they are reused. These paths created by thinking can become so ingrained that it requires a great deal of effort for the thought-skier to traverse onto a new path. However, if the new path is followed enough times, it can eventually replace the old groove.  

A craving is a neurological impulse.  

Neurologically based impulses to use drugs or alcohol sometimes stay hidden unless they are triggered, or opportunity arises. It is as if a threshold has been crossed. Very few people appear able to successfully return to occasional use after having been truly addicted. Addicts usually lose control over their addictions. This is known as powerlessness or compulsive behaviour.  

Impulse Control: STOP >> GO systems in the brain  

The dopamine pleasure pathway is the Go system, and the pre-frontal cortex is the Stop system.   When the reward centre in the middle of the brain becomes active, it's as if it says Go>Go>Go. When we anticipate and experience something good like food or sex, alcohol or drugs, our brain experiences a surge in the level of the neurotransmitter dopamine.  

Executive function: Distorted thinking - decreased impulse control  

Another part of the brain, the pre-frontal cortex or higher brain is responsible for executive functions. It has evolved over time to help us weigh up the consequences of our decisions. It helps us to put a lid on impulsive behaviour. The "Stop" system is the Brain's brakes. The signals to the pre-frontal cortex, however, tend to be a bit slower.

We need to stop and think things out before forging ahead with an impulsive decision. Putting it in the simplest terms, the "go system" hijacks the "stop system" in the course of this brain disease called addiction.

Changes to Homeostasis caused by Brain chemistry imbalance  

Understanding the role of the neurotransmitter dopamine in addiction is helpful. Low dopamine levels cannot only cause addiction but depression, loss of satisfaction, poor focus and many other symptoms. When we look at our major theories around at the moment, they mostly all agree that addiction changes dopamine metabolism, and it is for this reason we  consider it to be a disease.

People with addictions are low on dopamine.  A low dopamine level causes us to unconsciously seek out dopamine raising drugs and behaviours and get addicted to them. All drugs of addiction and addictive behaviours stimulate dopamine release or increase its activity. This produces the hedonic response: “I like that” and causes motivation, incentive stimulus and goal-directed behaviours.

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Dopamine can be depleted by….

 

  • Addiction
  • Alcoholism
  • Stress
  • Medication
  • Poor nutrition
  • Poor sleep
  • Isolation
  • Depression
  • Neglect
  • Trauma and abuse
  • Genetic predisposition
  • Certain antidepressants
  • Seasonal Effective Disorder
  • Loss  

Understanding the nuts and bolts of addiction helps you plan treatment and target the affected areas.

Factory fault - Addiction could be a basic design fault of the human brain.

Mankind is highly susceptible - all because of a “design quirk” in reward pathways and the fore-brain. Our brain's ability to adapt can turn against us. However, for the same reason we can recover. Neuro-plasticity helps us to adapt to our surroundings. Neurons that frequently fire together form stronger links.  

Your brain is in your head

The brain is constructed of long, skinny cells known as neurons or nerves. Neurotransmitters are chemicals that the brain uses for cell-to-cell communication. It is the inter-neuron communication, after substances cross the blood-brain barrier, that cause the desired effects. Neurotransmitters are like the sparking action of a spark plug or a key that fits into a lock. They can be Excitatory or Inhibitory, regulating our mood. The ones listed below are related to addiction and to experiencing pleasure and satisfaction:

Neurotransmitter - Functions Associated

  • Dopamine - Reward, Pleasure, Motivation, Addiction
  • Serotonin - Mood, Appetite, Sensory Depression
  • Endorphins - Natural opiates, Pain relief
  • Noradrenaline - Arousal, Alertness, Energy Concentration
  • GABA - Arousal, Impulsiveness Cognition
  • Glutamate - Excitatory, Cognition Balance

The brain is a three-pound mass containing some 100 billion nerve cells - neurons - there are some 100 types of neurotransmitters in the brain.

For example, as long as serotonin is flowing between your neurons, your world is 3D instead of grey or flat. Oxytocin is like an invisible cord that creates unity in relationships. It’s released during orgasm and helps couples to create an emotional bond.

Each neurotransmitter is like a puzzle piece, and it flows across the gaps from one neuron to the next where it looks for the correctly shaped hole in which to bond.

Think of a typical neurotransmitter like a letter. It sends information. You keep paper in your house for when you need to write the letter, you send it and it is received by one person.

The neurotransmitter dopamine is released into the nucleus accumbens and produces pleasure. This system is called the reward pathway. When we do something that provides this reward, the brain records the experience and we are likely to do it again.

Damage to the nucleus accumbens or reward center, blocks dopamine release in the region make everything less rewarding.

The natural capacity to produce dopamine in the nucleus accumbens/reward system is reduced. Damage and neuronal degeneration associated with chronic substance abuse. Also cognitive impairments, executive function, mood and movement disorders.

Dopamine is stored in cells like barrels full of chemicals. When something occurs like a good meal or great sex the brain pours out some dopamine from the dopamine barrels into an open space in the brain called a synapse. It floats around there. Think of the synapse like a street, and dopamine is like little cars driving around aimlessly on the street.

Most dopamine-producing neurons are located in areas near the brainstem:  the mesolimbic pathway, which projects into the limbic system, including the hippocampus and amygdala. It is particularly important for motivation, the experience of pleasure, and reward.  

In depression, lack of dopamine, among other things, would account for lack of pleasure. In mania, too much dopamine is viewed as rocket fuel.

The brain’s prefrontal cortex helps to rationalize and check the urge to take the drug when it would be unwise. Motivational drives are also a brain function that is damaged by addiction.