by Hope Rehab Team
What is addiction?
This question has finally been answered comprehensively by The American Society of Addiction Medicine (ASAM). In 2011, they released the latest definition of addiction after a four year process involving more than 80 experts, defining addiction as a disorder involving many brain functions, mainly an imbalance in the reward circuitry. This imbalance creates a problem experiencing pleasure and compels people to seek ways to boost their pleasure related brain chemistry by using substances.
The American society of alcoholism (1950) was changed to The American Society of Addiction Medicine (ASAM) in 1989 and in 2011 released the latest definition of addiction:
Addiction is a Chronic Causing Long-Term Changes to 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.
Our Inner Reward System
The human reward system is designed to support survival however over time it is hijacked by the chemical payoffs provided by substances and addictive behaviours. The reward circuit bookmarks things that are important: e.g. food, nurturing children, earning money, sexual intimacy, achieving goals etc. However the substance use or particular behaviour starts taking priority over what really promotes survival.
Addiction is a condition that permanently changes the way our brain works and requires intensive work to reverse its hold over a sufferer. Consequences of this condition range from loss of Jobs or relationships to life threatening situations, and are described as Biological, Psychological, Physical and more recently accepted as spiritual also.
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.
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.
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.
Common symptoms of Addiction
Compulsive Reward seeking.
Low Stress threshold.
Low frustration tolerance.
Isolation and agoraphobia.
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.
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.
The Importance of Understanding Addiction
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
More about the Addicted Brain
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.
Is There a Cure of Addiction?
Don’t be confused about addiction, it cannot be cured in a traditional medical sense, it is best viewed as chronic condition like diabetes. Treatment means addressing psychological, environmental and social aspects (triggers) of the problem, not just its biological condition.
Medical treatment in this field is known as “medication-assisted therapy” not “therapy-assisted medication.” Medication alone fails in the long-term. An analogy is with depression, if you ask people what depression is, they’ll say it’s a serotonin deficiency and that the solution is to prescribe antidepressant medication. This is a simplistic and short-term way of managing depression. Medication can be helpful however it needs to be combined with talk therapy and lifestyle change. Also humans become tolerant to all drugs and medication so a sustainable long-term solution is needed. There is no pill, which can cure addiction, so choosing a recovery lifestyle over unhealthy behaviours is the same as people with heart disease who choose to eat healthier or begin an exercise program.
The term dependence and the term addiction have been interchangeable in recent times, however the latest medical thinking is that Substance dependence can be a symptom of addiction, not the addiction itself, the cause is the brain chemistry deficit that pre-exists it, low dopamine levels. And the same goes for substance-abusers who binge occasionally for example. The reason for making this distinction is not to exclude people who do not form a physical-dependency and to include those users of non-physically-addicting substances like stimulants, as they are equally compulsive and problematic.
If you are concerned that you (or someone you care about) has developed an addiction problem, please contact our team by phone or email for advice and support.