Is Addiction a Disease? Yes, and it is the only disease that you have to convince someone that they have.The only one. I get this question often. I want to break it down, and explain what exactly happens in the brain once addiction hijacks it.
A normal happy event begins with a stimulus. For example, a visit with your granny gives you a warm experience of joy. Her smile, her eyes, or her calling you by your nickname all set in motion a series of events in your brain that creates a ‘pleasure construct’. We have several of these pleasure constructs, triggered by a fond memory, shopping, food, a favorite sports team, etc. Once triggered, these activities produce a normal release of dopamine in the midbrain. Drugs, however, initiate a massive release of dopamine into the midbrain, way more dopamine than the brain was ever intended to handle.
The midbrain sends signals to the rest of the brain that this drug is great and floods the pleasure circuit with dopamine. This is where those who are genetically predisposed to addiction get set apart. In about 15% of the population, sometimes quickly and sometimes over longer periods of time. something happens: addiction.
What is Dopamine and Glutamate?
Dopamine is the pleasure neurotransmitter. When we experience something that brings us pleasure, the midbrain releases dopamine that tells the brain “this is good, and I like it.” It is also knows as the pleasure circuit.
Glutamate is the memory neurotransmitter. Once the midbrain releases dopamine (“this is good and I like it”), then the prefrontal cortex is responsible for releasing glutamate to say, “don’t forget this, and go get it in the future.”
This is a delicate balance of the magnificent power of our brain, and when this balance functions properly, then we enjoy life appropriately. However, addiction wrecks this delicate balance.
What is the midbrain?
The midbrain is one of the more primal areas of the brain. Think back to our Neanderthal ancestors. It’s reflexive and sub-conscious. It is part of the survival matrix, telling us to eat, fight, flee, and procreate. The process of reward, pleasure, and emotional processing starts here but also involves many other areas. In addiction, the midbrain hyper-prioritizes the drug. In its primal way, with its massive releases of dopamine, the midbrain says to the rest of the brain that the drug is now more important than anything else, including food, health, family, sex, God, etc. The drug becomes the primary focus of the brain.
What is the prefrontal cortex?
The prefrontal cortex is a rather recent development in the brain, appearing in primates about half a million years ago. This is the area of the brain that humanizes us in the highest sense. It is where wisdom originates; it is also responsible for decision making, anticipating consequences, our ability to love others, and even have spiritual experiences.
In a normal functioning brain, the prefrontal cortex executes choices and serves as a governor to more primal drives. Therefore, we do not seek to have sex, eat, or fight all of the time. The midbrain serves its purpose of providing survival drives and indicating when an experience is pleasurable. However, it is the prefrontal cortex that has the final decision-making power as to how these drives are fulfilled.
In addiction, this balance is destroyed. The midbrain takes over and overrides the critical thinking areas of the prefrontal cortex. This disconnect explains the destructive, tragic and often incomprehensible behavior of addicts and alcoholics. Addiction breaks down every area of brain functioning and processing. The ability to think is tragically compromised. Even the addict often struggles to comprehend the chaos.
…so why don’t they just choose to stop? It’s simple.
Well, it’s not so simple, and the answer is disturbing and uncomfortable. They have lost the ability to choose freely. They are at the mercy of a primal brain drive-the midbrain-that is saying the drug is the most important thing in life and it must have it in order to survive.
This explanation is not an excuse. It is simply an explanation of what is happening and is also why the necessity of entering treatment is vital, where freedom to choose can once again be restored because the disease, or illness, is being treated.
At some point in life, almost everyone has taken a drink of alcohol, and experiences a small surge of dopamine. A person genetically predisposed to addiction, however, experiences that same surge, and that pleasurable sensation gets locked in by other areas of the brain in ways that do not occur in someone who isn’t predisposed to addiction.
Their brain has become wired for drugs or alcohol. It has built a pleasure construct around the use of alcohol. The prefrontal cortex, doing what it is supposed to do, has memorized sights, sounds, and smells into this twisted pleasure construct, paving the way for future triggers.
This is a completely unconscious brain drive that takes over the life of the addict.
What began as a disorder of pleasure ends in a catastrophically impaired ability to choose. Note which came first; the tragically bad choices are the result of underlying brain dysfunctions. The brain is broken, diseased, at some very fundamental levels.
Addiction has wrecked the freedom of choice.
What is craving… and what exactly is denial?
Craving is both the physical compulsion to use and the mental obsession about using. The addict’s life revolves around the getting and using of drugs. This obsession may take the form of planning for the next high, or even fighting with the desire not to use. It’s all a form of craving, and its debilitating, overwhelming, and severe.
To paint a picture of what this feels like, imagine not eating for three or four days, and then trying not to think about food. At that point, your midbrain would be screaming for you to eat! The addict has the same obsession with their drug, every day, because the midbrain has declared the drug to be #1.
Denial is often the most maddening part of addiction to the outsider. Everyone around the addict sees the toxic behavior and consequences. The addict often does not see it that way at all, or, if they do, only fleetingly and through a haze. Denial is why the addict is usually the last person to recognize the depth and seriousness of a problem. Essentially, that is what their brains are telling them.
Again, this is all a reflection of what is happening in their brain. The pleasure circuitry of the brain is desperately trying to protect its unobstructed access to the drug.
What is anhedonia?
Anhedonia, or pleasure blindness, is the inability to enjoy formerly pleasurable experiences. Addicts often feel depressed and numb to ordinary and important pleasures such as spending time with family or enjoying favorite hobbies.
This is an outward reflection of the twisted inner chemistry of the addicted brain. In a brain not hijacked by addiction, normal dopamine surges, such as spending time with loved ones, “reach” the pleasure set-point and register as enjoyable events. However, repeated dopamine uptakes from using raise the set-point so impossibly high that only the drug provides any sense of fleeting pleasure. Ironically, in later addiction no amount of drugs bring pleasure. At this point, they will use in a desperate attempt to feel normal, or simply to feel nothing.
Understanding the devastating effects of addiction on the brain should help you understand why “choice” alone is inadequate. In fact, you can take away alcohol from the alcoholic and all you’ll have is an angry, irritable, unhappy alcoholic. They will still crave alcohol, and that is truly a miserable experience. Treatment gets to the underlying brain dysfunctions. It helps the alcoholic manage stress. The normal pleasure circuitry comes back “online.” True freedom of choice can be restored.