The Science of Addiction–What We Know About the Illness
For many years, we did not know there was a science of addiction. Historically, addiction was viewed as a moral failing and lack of willpower rather than an illness. And, although the American Medical Association declared alcoholism to be an illness in the 1950’s, many have maintained the view that it is a moral issue instead. However, what we have learned about alcoholism, treating it, and recovering from it, has helped us understand the same about other drug problems. In fact, the program of Alcoholics Anonymous (AA) has been successfully adapted to other issues and substances. While this is a self-help support group and not science or treatment, it does reflect how our understanding of addiction’s science has grown.
For example, we know that addiction to any substance or behavior (such as gambling, sex, or shopping) has roughly the same dynamics and affects the human brain similarly. We also know that an addictive process of any sort will have certain features, characteristics, and symptoms such as denial, compulsion, obsession, tolerance building, cravings and withdrawal.
Despite many achievements in the science of addiction in recent years, there is still a great deal of misinformation, misunderstanding, judgmentalism, stigma, stereotyping and prejudice concerning addiction, the addicted, and even their families. Science, however, keeps pulling us back to the facts: addiction is an illness, and no one is immune. It crosses the borders of race, ethnicity, gender, educational background, socioeconomic status, religion, and geography. As the science of addiction has progressed, we have learned a great deal about ourselves as people, and our brains. The bottom line is that addiction is a human illness, and all people are ‘eligible’.
The Science of Addiction is Brain Science
Any drug use affects the brain, and if it did not, intoxication would not result when we took abusable and addictive drugs. We would have little interest in the misuse or abuse of drugs that did not induce intoxication. Very simply, if brain functioning was not altered, producing desired effects, there would be little interest in repeating those experiences for people who are pursuing euphoria and other intoxicating effects like relaxation, calming and heightened pleasure.
Of course, the science of addiction has revealed more to us than what happens specifically in the brain. However, the brain remains command central and the other things we have learned occur because the brain functioning and even brain structure are altered in addiction. We have learned, for example, a great deal about the behavior of addiction, the biology involving other systems of the body in addiction, and even interpersonal dynamics. We have also learned that there is a strong genetic component to addiction and that many are at greater risk for addiction because of their early traumatic experiences. All of those issues, in some form or fashion, can be traced back to what occurs in the brain when it is exposed to an addictive substance repeatedly.
The Observable Evidence that Addiction is a Brain Illness
We have to rely on the scientists to explain what happens neuro-chemically and neurologically in addiction, and even then, without the proper background, we may have difficulty understanding. However, the signs and symptoms of addiction can be observed and easily identified. They involve loss of control over use and the negative consequences of compulsive use. The diagnostic criteria for an addiction, or a Substance Use Disorder, list 11 symptoms that occur because an addictive substance has altered brain functioning. These symptoms are:
- Taking the substance in larger amounts or for longer than you’re meant to.
- Wanting to cut down or stop using the substance but not managing to.
- Spending a lot of time getting, using, or recovering from use of the substance.
- Cravings and urges to use the substance.
- Not managing to do what you should at work, home, or school because of substance use.
- Continuing to use, even when it causes problems in relationships.
- Giving up important social, occupational, or recreational activities because of substance use.
- Using substances again and again, even when it puts you in danger.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Needing more of the substance to get the effect you want (tolerance).
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
The symptoms above originate in the brain’s response to addictive substances, and as use continues, more of these symptoms will be evident as the brain continues to be exposed to the toxicity of substances. Addiction is a progressive condition, meaning that if use continues, the condition will worsen. This is a direct reflection of the brain’s evolving response to ongoing exposure.
Loss of Control and the Science of Addiction
One of the chief difficulties people have in understanding addiction is that people will continue to use substances even when profoundly adverse effects are occurring. This is often perceived as an unwise choice that could be corrected if one wanted to lead a better life. The science of addiction, however, has shown that one has choice initially when beginning to use addictive drugs, but choice diminishes as an addiction develops and progresses.
The symptoms of a Substance Use Disorder given above reflect this diminishing control and choice as the illness evolves, and lack of self-control is a hallmark characteristic of addiction. Research has documented actual addiction-induced brain structure changes in the areas of the brain that control judgment, decision making, problem-solving, learning, memory, behavior control, and impulse control.
Initial use of substances is typically a pleasurable experience, and this causes people to be more apt to repeat use. In the beginning of any substance use that leads to addiction, people have choice and control. However, after seeking intoxication over a period of time, not only do control and choice become compromised, but the brain comes to rely upon the substance to produce pleasurable effects that are natural functions of the ‘sober brain’. Also, as the brain further adjusts to having substances do this work, people become unable to feel the rewards of usually pleasurable activities without substances.
Neuroscience and the Science of Addiction
The science of addiction has by and large been research into the neurochemical and neurobiological dynamics of addiction. In particular, research into the neurotransmitter dopamine has revealed our core understanding of addiction. Dopamine is a brain chemical that is significantly affected by addictive drugs. The euphoric ‘high’ of substances result from elevated levels of dopamine which activate the pleasure and reward center of the brain. This dopamine surge triggers cravings, obsession, and compulsive use. It eventually overrides all of the judgment, decision-making and self-control mechanisms we have, resulting in the seemingly irrational behavior of an addictive illness. Given the profound brain changes involved, however, one’s behavior in addiction ‘makes sense.
The Risks for and Protective Factors Against Addiction
While no one is immune to addiction, research has shown that there are both risk factors for and protective factors against developing an addiction. However, no research has yet found that any of these guarantee one will develop an addiction, or provide evidence that one will not. Overall, there appears to be a correlation between the number of risk factors and the increased chance of developing an addiction. Similarly, research indicates that the more protective factors in one’s life, the less the risk of developing an addiction.
It is thought that risk factors in the environment and genetic factors are both significant in the development of an addiction and have approximately equal weight. Some of the risk factors documented are childhood experiences such as traumatic events such as physical and sexual abuse and other maltreatment such as lack of parental supervision; home life with adults who abuse substances or lead criminal lifestyles; poverty; availability of substances; peer drug use, and early experimentation. Protective factors against developing an addiction include parental supervision and support, stable in-home environment, school achievement, and supportive relationships inside the family and out.
Addiction is a Treatable Brain Disease
The science of addiction has not only told us how addiction works but has opened our eyes to what is necessary to treat it. Dr. Volkow of the National Institute on Drug Abuse (NIDA) has said, “Addiction is a disease, ”a treatable disease,” and it needs to be understood.” However, some believe that this view relieves people with addictions from responsibility. Nothing could be farther from the truth.
In order to recover from an addiction, the addicted person must be an active participant. The brain alterations that have occurred involve thoughts, feelings, beliefs, perception, worldview, behavior and relationships. In fact, our list could continue to encompass every aspect of how we function if the illness has progressed enough. This means that withdrawal is not enough. We have to help the brain recover normal functioning by actively working on mental, emotional, behavioral and relational issues. Withdrawal is necessary to stop the addictive process, but the changes we make inside ourselves and in our behavior in the world helps the brain re-learn how to function more normally.
If You or a Loved One Need Help
If you or a loved one need help to recover from an addiction, you can give us a call for a free consultation. We can help you identify your clinical needs, and make recommendations that are appropriate for the treatment you need and your current financial situation.
Addiction can be an overwhelming and devastating illness, but it is treatable and you or your loved one can recover. Countless people have done it, and you can, too. Reach out for help. Effective treatment is out there.