WHAT IS ADDICTION?
Our knowledge of the causes of addiction has dramatically improved in the last decade. Yet despite advances in our understanding the brain and genetic underpinnings of addiction, the myth that it is a moral failing persists. If dependence on drugs and alcohol is not the result of poor ethics, then what is it?
The American Society of Addiction Medicine (ASAM) defines addiction:
“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are as successful as those for other chronic diseases.”
Let’s unpack that and more closely look at what the definition means. Nowhere in this widely accepted definition is the concept of a moral failure. Rather, addiction is defined as an illness that can improve with proper treatment.
Diseases come in two basic categories. Acute illnesses, like the flu or an infection, are sudden, sometimes severe, and end. A chronic disease has a more gradual onset, can last a lifetime, and is managed but not cured. Diabetes, arthritis, and heart disease are excellent examples of chronic illnesses.
Diabetes is the perfect disease to compare to addiction because of the course of both illnesses. Addiction and diabetes both occur in people with a genetic susceptibility for them. A person is far more likely to develop these disorders if they have a biological family member who also suffers from it. While many people are at risk because of their genes, not all of them develop lifelong illness. For that, certain lifestyle choices come into play. For diabetes, years of a sedentary lifestyle coupled with poor food choices ends in disease. For addiction, repeated use of addictive chemicals creates a compulsion to use. Not everyone who sits on the couch eating ice cream becomes diabetic, just like not everyone who uses drugs loses control over their use. In both substance dependence and Type 2 Diabetes, the combination of life experience and genetic underpinning interact in the development of sickness.
Part of the above definition discusses the compulsive nature of an addiction that drives people to continue to use despite mounting consequences like loss of family, job, and health. To understand how a generally good individual falls to this state, we need to examine what traits the genetic susceptibility creates and how those traits interact with environmental stress.
Certain structures in the brain circuits driving addiction vary depending on genetics. Dopamine is the brain chemical driving almost all addictive behavior. Whenever you get a reward you were really looking forward to like a sweet treat, your paycheck, or a drug high; the chemical floods a part of the brain called the reward circuit. Think of it like the release of thousands of tiny keys. When those keys find a lock on the brain cells, called a receptor, that’s when the magic happens. It feels great! And the reward drives people to repeat the behavior. The Lay’s company understands this perfectly in their potato chip marketing. No one can eat just one.
Neuroscientists have discovered that people susceptible to addiction are born with fewer dopamine receptors than the average person. This means they experience less pleasure from day-to-day things and would be more likely to try drugs. This is why a 3 month prescription for opioids can send some people down the road to addiction.
The situation gets more complicated when stress gets added to the mix. The rates of addiction in veterans and people who suffered other traumas are dramatically higher than in the general public. Turns out experiencing high levels of emotional pain reduces the number of dopamine receptors, often driving a person to seek comfort in more extreme substances like opioids which flood the receptors to a degree where relief is possible.
The addictive cycle of compulsion begins when an individual's use repeats. The more frequently someone uses opioids in response to stress, the fewer receptors they have. Stressors come from more than trauma. Financial instability, job stress, or the death of a loved one are all the kinds of things that trigger a vicious cycle where each use of opioids reduces the number of receptors and intensifies the craving for relief in increasing amounts. Essentially the reward circuit goes on runaway. Once the brain makes this adjustment to substances, the structural changes become permanent.
None of the people coping with these issues suddenly lost their moral compass and decided to ruin their lives. The good news is that with proper treatment, addicted people can and do recover. Just like with diabetes, there are setbacks and relapses along the way. Interestingly, the relapse rates for addicted people are within the same range as the rates for other chronic illnesses like diabetes or heart disease. Between forty and sixty percent of people suffering from one of these diseases have relapses and for the same reason. Lifestyle change is extremely difficult.
More about addiction.
How drugs affect the brain.
The disease model of addiction.
Kiwi bird video shows the progression of addiction.
The Rat Park shows a possible cause of addiction.