Brain & Drugs 

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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