First let me start by clarifying something; I see absolutely NO difference between an alcoholic or a drug addict. Regardless of the name of the drug, they are addicted to being intoxicated. So I will be using the two terms addict and alcoholic interchangeably. While there are differences between a heroin addict and an alcoholic, the two can relate on many levels. Both share shame and guilt, both have crossed lines they said they never would, both struggle with a craving that takes over every fiber of their being, both have families that are angry, baffled, and hurt as a result of their addiction, and both suffer from a disease that is often deeply misunderstood.
A LITTLE HISTORY
For many years now addiction and alcoholism have been referred to as a disease. In the Big Book of Alcoholics Anonymous, Dr. William Silkworth referred to alcoholism as an allergy of the body and obsession of the mind. Narcotics Anonymous coined the term “one is too many, a thousand is never enough,” when referencing how the craving can take over. Addiction has been around for hundreds, if not thousands of years. Once we discovered how to extract the chemicals to give us the optimum effect, drugs started being abused all over the globe. Opium dens were outlawed in San Francisco in 1875, the first of many legal measures against drug abuse. Just as we have had a technology boom over the years we have seen a drug boom as well. Every drug, with an exception to LSD, has become more potent, especially in the last 10 years. For instance, the University of Mississippi has been monitoring the potency of marijuana in an ongoing research project and found marijuana from 1988 was 3.7% THC. In 2008 they recorded an average of 10% with high levels around 15-20%. A relatively new form of hash oil known as “Dabs” and “wax” have about 65-90% THC.
Even though addiction is not new we haven’t fully begun to understand it until about the last 15 to 25 years, and there is still a lot to learn. Another note before I proceed; like addict/ alcoholic I use the term “disease” and “disorder” interchangeably. To me, and many others, addiction is a disease. That disease, lies in a disorder in the brain; so to me there is no difference. Either way it does not take away responsibility. It may not be the addicts fault they have a disease, but it is their responsibility. What we do know about addiction is that it lights up specific regions of the brain and that with continued use over time, the brain of an individual actually changes, as in physically changes. We have scientific evidence that shows addiction is both psychological and biological in nature. This is not a new concept. Dr. Jeffrey Wigand, most commonly known for being the Phillip Morris whistle blower in the 90’s, has been giving lectures on research that found nicotine addiction physically changes the brain, only one of the many reasons it is so addictive. We also know that the brain, the mind, and the body just cannot be separated. They are so interconnected and influence each other they act much like the different parts of a symphony, or a band, or all the components of an engine. They have their own duties and unique characteristics but without one of them the rest don’t work as well; sometimes not at all. The mind influences the body, the body influences the mind, and both affect the brain. Both addicts and non-addicts alike have been baffled and puzzled trying to understand addiction. Why can’t they use self-will? I can control it, why can’t they? Why can’t they just stop? Don’t they see they are hurting themselves and their family? The questions go on and on. I hope to clarify some of them and I am going to start with why some don’t seem to have a problem with addiction and others do.
There is a lot of research out there trying to understand the genetic links to addiction. They have found that genetics can influence addiction but also our environment can influence how our genes are expressed. This field of research is called epigenetics. It has shown that are present environment, and the actions of our ancestors can leave “markers” that might make us more prone to stress, addiction, anxiety, etc…Our environment is also where we learn our coping skills and an internal model of how we view ourselves and the world around us. To date we have not singled out the addiction “gene” or the specific DNA code but they have identified several genes that may predispose one to chasing intoxication. Jaak Panskepp did research with rats and found there are some rats who’s dopamine responses differ than the other rats in a way that makes them more likely to become addicted. More research needs to be done around this with humans. While I believe genetics play a large part it is not genetics alone that accounts for addiction. The treatment of addiction almost always consists of addressing the biological, psychological, and social deficits; and I think that portrays the roots of addiction as well. I think one of the greatest disservices that I experienced was being told my disease is simply genetic, I was born that way, and sobriety is all I need to focus on. More realistically the main predicting factors of addiction are: family history, emotional struggles as a child, and starting at a young age.
If one or both parents have a history of alcohol or drug addiction in their family the likelihood of that child becoming chemically dependent skyrockets. Children of addicts are eight times more likely to develop an addiction. A 1985 study found that sons of alcoholic fathers are four times more likely to become alcoholic themselves. Additionally, the children of parents who have a dismissive view of substance use and addiction are more likely to become addicted. Research has shown that parents who are addicts are three times more likely to overtly abuse their children, and trauma is another common variable in the history of addicts. Research also shows having a parent preoccupied and “absent” (even if physically there) due to their addiction is emotionally damaging and traumatic and doesn’t teach them the skills and tools necessary to deal with emotions without having to numb them. Trauma can be overt, such as physical abuse, emotional abuse, sexual abuse, bullying, a tragic death (near death experience), or witnessing violence. Simply put, any experience that pushes us outside our own emotional capacity and stays unresolved. Another type of trauma is covert trauma. This trauma is more subtle but can be just as harmful; such as relational trauma where the person has grown up feeling out of place, misunderstood, and difficulty fitting in. Especially people who are highly sensitive and “exposed nerves” if you will. These people feel EVERYTHING; which is quite exhausting. This makes it difficult to connect, open up, and learn how to deal with emotions. The weaker our coping skills are the more likely we are to turn to alcohol and drugs to help cope with our emotions. Regardless of covert or overt all these experiences cause stress. I one heard Andrew Chapman define stress as simply when an object lacks the internal resources to meet the external demands. The more overwhelmed we are, the quicker we turn to instant gratification; and the younger we are the less resources we have. Starting to use at a young age is a major factor. The younger we are the more likely we are to become addicted. Our brain doesn’t fully develop until 22-25 and in the younger years it is wired to chase excitement and pleasure and the part of our brain that thinks things through and slows us down and detects danger is not fully online yet. If one continues to use regularly at a young age it primes the brain to chase intoxication, to the point that the brain gets hi-jacked. Also, in the brains ongoing attempt to create balance, if we are overloading it with chemicals it will down-regulate those very chemicals; creating a chemical imbalance and perpetuating using because the person thinks the drug is their “cure.” I hear this all the time: “______ helps me sleep, eat, focus, anxiety, depression, etc…” In the immediate moment they are right but in a lot of instances the drug use is causing a lot of those issues.
THE HI-JACKED BRAIN
Addiction is complex and multilayered. Weekend long medical conferences on addiction are held many times throughout the year. We still have a lot to learn, but it is widely accepted now that addiction is a brain disorder. In fact, it is stemming from a drive we all have; the drive to chase pleasure and avoid pain. Noah Levine wrote in his book Refuge Recovery: “addiction is just the extreme manifestation of the normal human condition.” I believe this fully. To understand this better we have to understand two main parts of the brain; the prefrontal cortex (PFC) and the mid-brain. The PFC helps us think about the future, right from wrong, planning, reasoning, and judgment (the part teens don’t have yet). Basically it is the main “thinking” part of our brain. The Mid-Brain on the other hand, is part of our survival center. It is more about being reactive and impulsive and centered around survival. It is often called our “lizard brain” because it is more concerned with basic survival needs rather than worldly problems such as global warming and determining the laws of gravity. As long as our survival needs (e.g. water, food, and safety) are being met the PFC remains in control of our Mid-Brain, preventing our lizard brain from just drinking all the water, taking everyone’s food, and stopping us from fighting all the time like animals in the wild.
However, when our survival needs are threatened, our mid-brain kicks into action and we are reacting rather than thinking. There is very little thinking about the future or reasoning going on; simply put the brain becomes hi-jacked by the mid-brain. Brain scans have shown the firing in the PFC goes down and the mid-brain firing goes up. For instance, most of us can walk into a store and resist the urge to just start eating all the food we see. This is because our survival need for food is being met and even if we are hungry we can logically think about the consequences or make the decision that we will buy the food or it’s not worth the risk. However, if we had been lost in the woods for days on end and had not eaten anything and stumbled upon that same store most of us would not think twice about just starting to eat the food, whether we get in trouble or not. This is because our mid-brain is in control and telling us we need to eat to survive. The more our brain thinks our survival needs are threatened the greater the drive to satisfy them becomes. So what does this have to do with addiction? Some of you may be reading between the lines already. Another crucial part of the brain that needs to be discussed when it comes to addiction is understanding the Dopamine system. This chemical that our body naturally releases plays a major role in our survival as a species, and addiction.
THE DOPAMINE SYSTEM
Dopamine is part of our reward and seeking system. Which means anytime we do anything that brings us pleasure our brain releases dopamine and we feel good. It also remembers that reward and the next time the possibility of that reward arises in the future more dopamine is released in anticipation of it, driving us to seek it out, and then released again when we get the reward. Another way to think of dopamine is as a messenger, and the message it is sending is “go get that!” and “do that again!!!” In the prehistoric days this dopamine system helped ensure our survival when we ate food, drank water, had sex, or bonded. Dopamine was released and we knew to do that again. All things that help us survive release dopamine, so over the years our brain has learned to recognize dopamine as instrumental to our survival. However, back then there was not a lot of ways to access dopamine. These days we can access dopamine in so many ways that have nothing to do with our survival: drugs, porn, technology, nicotine, processed foods, etc… At the peak of every intoxication, regardless the name of the drug, the brain releases a flood of dopamine, more than usual, that tells the brain “do that again!” The brain does not care where the dopamine comes from; it only knows there is dopamine and it is hard wired to think dopamine is good; more than good, necessary for survival. Over time and with repeated use the brain starts to think intoxication is needed for survival.
Sometimes this happens quickly, and sometimes slowly. This mid-brain hi-jacking is constantly happening; the addict thinks they need drugs to survive. Coupled with any physical dependency and the addict doesn’t stand a chance. One confusing paradox is addicts do have moments where they are using logic. Every addict has moments where they’d like to be a good son or daughter, a good student, employee, a better husband, or wife. They carry shame and guilt and are baffled by their decisions. Yet the craving, coupled with the hi-jacking that comes once they put in, takes over any rational thought. Especially if they lack the emotional coping skills to tolerate life, let alone a mental obsession. Not only does this addiction create a mental obsession but it comes with a biological drive that when triggered by say, a liquor store, the brain will releases a small amount of dopamine that primes them to get ready to seek that out. The “anticipatory release” I was discussing earlier. In fact this release is so strong addicts will often notice a momentary relief in physical withdrawal once they know they are about to score their drug. So when AA talks about an obsession of the mind and an allergy of the body they were actually correct. Addiction creates a mental and physiological response, they just didn’t have the science in the 1930’s to back it up. Do not be mistaken though, this is not an excuse or justification for addicts to continue doing what they are doing. The excuse “well I’m an addict, this is what I do” does not fly with me. They do make the choice to put drugs in their body. More what I am trying to get across is that once they do they lose control. Additionally addicts usually lack social and emotional skills and are often genetically primed for addiction. A perfect storm if you will. Addicts are not bad people. They can do bad things but any of us would if our brain was in survival mode; ask any combat soldier. More accurately, addicts are usually great people with a bad disorder. That disorder is not personal. It is not due to a lack of will power. Love cannot conquer it. I wish. I would love to be out of a job due to love. In 2014 a large rehab company, Acadia Healthcare, bought out another company, CRC, for a whopping $1.2 billion! If love was strong enough to fight addiction it would not be a billion dollar industry. Addicts are fighting a disorder that lies in their own brain, making it very difficult to treat and understand. It often comes with other mental health issues and underlying traumas. Having the disorder is not their fault but it is their responsibility.
Entire books are written on this subject. Ask anyone whose met me at a party, I could talk forever about this. This is a deeply layered and complex subject; a short article doesn’t really do it justice. Everyday I still talk to addicts, and the loved ones of addicts, who do not fully understand what is plaguing them. That is unacceptable. My hope is to bring a little bit of education and understanding to this topic that touches so many people. Understanding does not always bring about change but it does foster compassion; which is a catalyst to change. If you or someone you know is struggling with an addiction there is hope! I have personally recovered and have seen countless others recover. It is a process and takes time. Sober does not always mean a person is well. Recovery is a lifestyle. Drugs are a symptom; to just stop using does not mean a person now has the ability to regulate their emotions, which is where the real work can begin.
Curtis Buzanski, LMFT, LAADC