The Science of Addiction - Who is to Blame
The engine of addiction is our survival systems
Drug abuse is powered by instinctual and emotional aspects of our natural survival systems. Psychological drug therapies, more often than not, contribute directly to addiction from lack of understanding and/or arrogance.
A good analogy can be made to a vehicle's engine. If you're trying to understand what is wrong with the engine of a vehicle, it doesn't help to know what color the vehicle is, where it has been, or even the drivers intended destination. What really helps is to know the mechanics and design of the engine, and how it operates. What really makes it run and run better. We can kick the wheels and hit the battery terminal with a wrench. We can wiggle wires and check the oil stick and while these efforts appear to help, they seldom do. It is through the science of addiction that we can start to understand the complexities of the engine of abuse.
A lack of fundamental understanding of the mechanisms and systems means, we can't hope to fix the engine or prevent engine failure on other vehicles. Most psychological drug therapies and treatments come from people that don't understand the engine of addiction. Instead they seem to believe that finding out where the car has been, will let them know what is wrong with it. They ask what you think the engine is feeling and then add new synthetic fuel, never considering that the engine is probably already flooded and broken from the last synthetic added. It is not until the general public and especially our doctors understand the science of addiction, that we can expect effective cures and preventions for this illness - yes ILLNESS!!
The reward pathway
The reward system is the "human spirit", that drives us all and is an intrinsic part of our survival strategy. This system is responsible for our environmental and physical well-being and most importantly how we feel about it all. This translates to our success as a person and our species as a whole. People are driven by instinct and neurochemistry to reward themselves with food, sex, work, social interactions and other basics for success and survival. These complex neurochemical hormone systems are connected to the central nervous and the endocrine systems as well. This in turn, allows the pleasures of touch, taste and smell.
Sex gives you very powerful emotional and physical rewards and those rewards for some people lead to abuse. Porn and sex addiction are in essence chemical addiction without the drug. The body comes equipped with it's own delivery systems and emotional responses (natural drugs), so no outside chemistry is needed. These rewards play a key role on our sense of security and well-being and when you fall in love you are flooded with even more, "feel good" chemicals.
Gambling addiction similarly has rewards wired tightly to your success as a person and your survival. When a gambler wins he is gratified by a flood of neurochemicals that makes the whole experience the rush of power and victory that it is, or feels like. The addiction may appear outwardly as "behavioral" but it is the surge of natural chemicals that gets the gambling addict hooked.
In essence the reward pathway is our emotions, ambitions and survival all combined. In many aspects these rewards are beyond conscious thought as they are hard wired into our survival systems. There are several systems that directly or indirectly effect this reward pathway and can include our; dopamine, serotonin, opioid, cannaboid, GABA, endorphin systems and more. Each system supplies emotional and physical effects which are constantly in ebb and flow as your moods change or you go through sleep cycles.
Drugs of abuse stimulate this brain "reward pathway" which is why substance users experience feelings of pleasure or “high” when they use them. When the person starts using the drug the consequences are minimal as compared to the reward that the drug provides. It is not until the abuse as gone on long enough that the impacts of the consequences start to outweigh the perceived rewards. In most cases however by the time you begin to experience the downsides of the addiction you are already too sick to help yourself without hitting the "bottom".
An analogy can be made between drug abuse and viruses of the body. The drug abuse "highjacks" the reward system in a similar way in which the virus "highjacks" the cells of the body. Viruses use our own body cells and systems to thrive and the more they thrive the sicker you get. Just as anti-bodies fight the viruses. Tolerance fights the drugs or poison to it. The longer the drug is abused and the higher the dosage gets, the sicker you become. The longer this sustained high-dose use continues the closer you get to overdose levels several times a day.
Brain structures in reward pathway
The hypothalamus is the control center and serves as a major circuit between the nervous and endocrine (hormone) systems. It is an intrinsic part of the limbic system, and the pituitary. These structures control the reward pathway and influence eating, drinking, sexual activity, aversion, environment, rage, and pleasure. The hypothalamus monitors blood nutrients as well as other body systems to maintain the bodies system balances. This is the command center of the brain and it sends out signals in the form of neurotransmitters (chemical signals) to various parts of the brain and body. This in turn rewards and drives us to find food, water and sex.
Dopaminergic neurons make up the “power lines” of the reward system for structures involved in brain reward. The neurotransmitter they release is called dopamine. One can think of this as the “current”, or energy of the brain reward system. Dopamine is the chemical that most people with addictions are chasing. Too much dopamine appears to cause psychosis and hallucinations.
Homeostasis is equilibrium
All forms of sickness and disease can be defined in some way by an imbalance or dysfunction within a homeostatic relationship. Addiction and substance abuse are not exceptions. We have known for some time that when food or drugs are ingested, they affect the body's natural homeostasis. This process is seen in the endocrine (hormone) system, which has tide like movements, defining the natural homeostatic balance of arousal and rest.
Food, danger, and bee stings also bring about a change in homeostatic balance affecting our hormonal and neural activity. As do yoga, exercise, processed sugar, sex, fighting, and heights. Any of these produce their own unique potential for physical or psychological addiction or habit.
Negative feedback mechanisms reduce the activity of an organ or body system to keep it within normal operating conditions. Examples of a negative feedback system are body temperature, blood pressure and glucose levels to name just a few. An important example is when the body is deprived of food. The body resets the metabolic (operating) set point to a lower than normal value. This allows the body to continue to function, at a slower rate, even though the body is starving. Consequently, people who diet to lose weight find it easy at first and much harder to lose weight later on in the diet. This is due to the body readjusting itself to a lower metabolic (operating) point to allow for survival with a lower supply of resources. Exercise helps with weight loss by increasing the metabolic (operational) demands.
Positive feedback is often thought to have a destabilizing effect. Positive feedback mechanisms enhance the output created by a stimulus that has already been activated. The positive feedback mechanisms are designed to push levels out of normal ranges. One positive feedback example event in the body is blood platelet accumulation, which, in turn, causes blood clotting in response to a break or tear in the lining of blood vessels. Another example is the release of oxytocin to intensify the contractions that take place during childbirth. While it is not discussed much, in my mind addictive substances seem more closely associated with the destabilizing effects of positive feedback.
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Risk aversion and homeostasis
Risk aversion is an fundamental function for survival, if you are absent risk aversion you can't live long. As such the bodies homeostatic (equalizing) systems compensate by reacting slowly in making adjustments to allow for constantly changing variables. Homeostasis is the main factor that stops people from changing their habits because our bodies view change as dangerous unless it is very slow.
This process can take a long while to find a comfortable level of homeostasis. The longer a person goes without the substance the less the effects of the imbalances are felt. While 30 day treatment is the industry standard 90 days is when the majority feel the shift in emotional stability. Interestingly enough habits are thought to take about 90 days to break as well. Todays modern lifestyle of drugs, instant gratification, temporary relief all increase the demands of our natural equilibrium or homeostatic processes and are counterintuitive to our body and brain balance (homeostasis).
Homeostasis impacts drug tolerance
Effects of these equilibrium processes can be measured and quantified in the human body and as such we can definitively say that environmental controls exist in those systems. We can not measure the neurochemical systems in the same way as the body and even if we could there is no way of understanding the implications. However, we must consider that the environmental control system needs at least as much equilibrium or homeostasis as the organs it is regulating. The brain has to be in balance if it is not then this environmental control system is compromised and can't function properly. This can be most readily seen from the physical effects of withdrawal and the body sicknesses it presents (sweating, overheating, shaking...)
Drugs of abuse attack the control center of the body and our rewards system as well. Drug tolerance is the brains attempts to maintain homeostasis or equilibrium of the neurochemistry. The effected systems try to maintain balance and over time, the more the drug effects the balance. The more the mind must compensate to keep the systems functioning. It views the influence of the drug as poison to it and that is what substances of abuse really are, a long acting poison to our wellness, our brains, our bodies and our life.
You begin to realize you can no longer control your behaviors or emotions. You can only find fault in yourself and others as your realities and the drug are constantly at war for your soul. A new drug or behavior, you think, is the only thing you believe can help the struggle and to avoid the downward spiral. And the new drug may help at least for a little while but tolerance slowly builds and the progression begins anew. This ushers in an even more advanced state of self-desctruction and a faster, and more dangerous cycle of expression.
When the brain is not in balance it sends out a message of distress known commonly as a "craving". That message combines with the effects of drug withdrawal which outwardly appear as "drug seeking" behaviors and these are dependent on the DOC (drug of choice). Long-term sustained abuse of these systems has universal effects on the mind and body. The combination of bad chemistry combines with the ebb and flow of emotions, stresses and environmental changes. Which in turn compromises the entire reward pathway, the command center and your instinctual survival strategy. This survival strategy gets closely linked to the DOC (drug of choice), after all with some drugs, (alcohol and benzos) withdrawal can present life-threatening conditions and as such it becomes a matter of instinct and survival.
Genetic and environmental influences on drug addiction
Experimentation on genetically pure mice indicates that addiction is inherited, which is not a surprise. As addiction tends to run in our families. That does not at all suggest that you will become addicted because of your genetic makeup, only that the risks increase dramatically. It is the variables of addiction that can't be quantified that makes addiction difficult for diagnosis or prevention. The earliest indication of addiction however is tolerance or imbalance cause by the DOC (drug of choice). The higher the tolerance the deeper into addiction you get and the more offset your neurochemistry becomes.
When drastic events occur in your life your neurochemistry makes adjustments to remain in balance. The greater the impact of the tragedy or success the more the mind adjusts accordingly. Through habits, food, sex and our social interactions our neurochemistry changes and so does the ebb and flow of our chemical moods. We are the sum of our rewards in the end, that is how we all view our lives after all. Our human spirit is driven by those rewards and so it drives our life.
Success and failure contribute equally to drug addiction. There is no demographic, survey or data that can say why one member of the family contracts addiction while others are impervious to it. Drastic life events (good or bad), genetics, personality types, co-occurring conditions and early exposure to the drugs. All play a role in addiction. While it may (or may not) be your fault to start use of the drug to begin with. The progression of the illness overtakes and changes mental function and survivability. So the sicker you get the less responsible your are due to the illness, as time goes by. However, recovery is possible and in the end it is on you if you never try to get the help. Sick or not you must at some point understand that your life will be lost and if you don't you realize this you will die. The "moment of clarity" is the realization that the addict knows they are going to die and die horribly and self-preservation is the last option. Tragically for far to many addicts the "moment of clarity" is something they never get to see.
Common misconceptions about the addict
Mice experiments illustrate best that our reward pathway is key to survival. The tested mice would starve to death by pushing the "reward" button repeatedly and disregard the "food" button. To say the mouse is making a conscious choice to die or that the mouse is at fault, is a stretch. Maybe we can argue that the mouse should not have pushed the button in the first place but that does little for the mouse. As long as the mouse is able the mouse will push the "reward" button and in the end it will die. This is most easily translatable by the lung cancer patient begging for a cigarette when they can't breathe enough to smoke it.
Twelve step programs learned 60 years ago what governmental, social, and religious institutions still refuse to accept. Most addicts will not stop pushing the button (taking the drug) until they hit bottom or die. Along with the descent to the bottom and beyond you get inner turmoil, rage, bitterness and resentment for yourself and the world around you. At or near the bottom the drug is as much about withdrawal as it is forgetting your life. As the pain that you see all around, you looks impossible to endure without the drug. This has the outward appearance that you have made a conscious choice for the drug over everything else in your life. When the reality is that you have given up on life and yourself. Finding the chemical at some point becomes as much about forgetting yourself and withdrawal than anything else.
Addiction is an illness and society aggravates addiction at best
Addiction quite obviously is an illness and it is the only illness that society still shuns and criminalizes. Just as the lepers in the past, our illness is so unnerving to people that we are cast away into the streets. Addiction is seen as a behavioral issue and or a criminal act and why not we look like we are crazy and it is illegal to be a drug addict, at least that is what we are told.
How strange that prescription medication has not been included in our "war on drugs" until very recently, and only then from fallen stars like Whitney Houston. The real truth is that addictive prescription medications are a cash cow for many industries and political suicide for our lawmakers. There is big potential liability for many of our most trusted members of society and includes; our medical, our health insurance, our pharmaceutical, our government, our charities and our churches.
Our foster, welfare and elderly-care systems actively promote use of benzodiazepines to tranquilize people to more easily manage care. What they don't understand is that the "management" gets worse over the long-term due to addiction, adverse effects and increases the overall level of anxiety. Our doctors prescribe pain medications liberally and almost anytime you complain of pain. The reality is they are prescribing opiates, which is the same as heroin and if taken long enough, will cause much more pain in the end. Our ADD/ADHD children and our college students are liberally prescribed amphetamines, which are the same class as cocaine and has similar effects. When you consider that most of the people with addictions have been diagnosed with ADD/ADHD you have to seriously wonder about the logic and motives.
In fact, substance abuse addiction is the only mental disorder that we can definitively say has a measurable cause and effect relationship in the human brain. There is no way to measure the imbalances of neurochemistry for any mental illness. When you use psychiatric medications you are effecting homeostasis in the brain and body, that is the point after all, and when you are abusing chemicals you are adversely effecting these systems. The "chemical imbalance" diagnosis has had far reaching impacts on millions of people that mistakingly believe they are medicating for balance when in fact the medications are causing the "chemical imbalance" from abuse, misuse and bad prescriptions.
If we are to stem the tide of addiction we must first start with the fabric of our society. We must start by controlling addictive prescription medication to have any hope at all. Doctors MUST become aware of the implications on every prescription they write. One wrong prescription can take a person that has never abused drugs and destroy their life. The reward pathway is our human spirit and our survival systems. Drugging that system has implications that are never seen right a way, as addiction takes years to play out. If the reward button is pushed by the wrong mouse, it will in the end lead to illness and early death. Until society understands that it is an illness and treats it as such, we will only see more casualties in this chronic disease.
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