What Happens in the Brain During Addiction

Summary

This discussion explores the concept of addiction through the lens of the disease model, explaining that addiction is influenced by genetic, psychological, and environmental factors ('nature, nurture, and neighborhood'). Vulnerability to addiction can stem from family history, mental health issues, trauma, and easy access to addictive substances or behaviors. Over time, repeated exposure to addictive substances rewires the brain, leading to a dopamine deficit state. This makes individuals use substances not to feel good, but to avoid feeling bad. Recovery requires time for the brain to restore its balance and neurochemical functioning.

Takeaways

• 🧠 Addiction is viewed as a disease, not just an addictive personality, with chronic relapsing and remitting aspects.
• 🔬 Risk for addiction comes from three main factors: nature (genetics), nurture (environment and trauma), and neighborhood (access to addictive substances or behaviors).
• 👨‍👩‍👧 If you have a biological parent or grandparent with addiction, you're at higher risk of developing it yourself.
• 🧑‍⚕️ Mental illnesses and impulsive personality traits can increase the likelihood of addiction.
• 💔 Trauma and environments where drug or alcohol use is modeled as a coping strategy can raise addiction risks.
• 🏘️ Access to drugs and addictive behaviors in your environment increases the likelihood of trying and becoming addicted.
• 💊 Overprescription of drugs like opioids or benzodiazepines also raises addiction risks, as does cultural exposure to addictive behaviors (e.g., video gaming).
• ⚖️ Pleasure and pain are co-located in the brain, meaning the same brain areas process both, and the brain seeks balance, leading to addiction-related dopamine deficits.
• 🐉 The phrase 'chasing the dragon' refers to the attempt to recreate an initial high, but continued use often just avoids withdrawal symptoms instead of providing pleasure.
• 😔 Addiction creates a dopamine deficit state, causing anxiety, irritability, insomnia, and intrusive thoughts of using again, even during recovery, but balance can be restored with time.

Q & A

What is the 'disease model' of addiction, and how is it different from the older term 'addictive personality'?

The 'disease model' of addiction views addiction as a chronic, relapsing, and remitting condition, which contrasts with the older term 'addictive personality' that emphasized certain personality traits. The disease model acknowledges addiction as a brain condition that involves genetic, environmental, and social factors.

What are the three key risk factors for addiction according to the script?

The three key risk factors for addiction are nature, nurture, and neighborhood. 'Nature' refers to biological vulnerability, 'nurture' involves environmental influences such as trauma or exposure to substance use, and 'neighborhood' refers to access to addictive substances or behaviors.

How does having a family history of addiction influence a person's risk of becoming addicted?

A person with a biological parent or grandparent who has struggled with addiction is at a higher risk of becoming addicted compared to the general population, due to genetic predisposition.

How does co-occurring mental illness affect the risk of addiction?

Having a co-occurring mental illness increases the risk of addiction because the person may turn to addictive substances or behaviors as a way to cope with their mental health challenges.

What role does trauma play in increasing the risk of addiction?

Trauma, especially in childhood, increases the risk of addiction by affecting emotional development and coping mechanisms. People who experience trauma are more likely to turn to substances or addictive behaviors as a way to manage emotional pain.

How does repeated drug use alter the brain’s balance between pleasure and pain?

Repeated drug use tips the brain’s balance toward pain, creating a 'dopamine deficit state.' Initially, drugs cause a pleasure response, but over time, the brain compensates by reducing dopamine, leading to feelings of discomfort that drive continued use, not to feel pleasure, but to avoid feeling bad.

Why do people continue to use addictive substances even after the pleasurable effects fade?

People continue to use addictive substances because, over time, their brain shifts into a dopamine deficit state, causing them to use the substance not for pleasure, but to avoid withdrawal symptoms like anxiety, irritability, and discomfort.

What does the term 'chasing the dragon' refer to in the context of addiction?

'Chasing the dragon' refers to the pursuit of the initial high that a person felt when first using a substance, especially heroin. Over time, this initial rush becomes harder to achieve, and the person continues using the drug to avoid withdrawal rather than to feel pleasure.

How does access to addictive substances influence the likelihood of addiction?

Easy access to addictive substances or behaviors increases the likelihood of addiction because exposure makes it more likely that a person will try them. For example, living in a neighborhood where drugs are easily available or being prescribed medications like opioids increases the risk.

What happens to the brain's dopamine system after long-term substance use?

After long-term substance use, the brain's dopamine system becomes downregulated, meaning it produces less dopamine naturally. This leads to a dopamine deficit, where the brain struggles to maintain a balance, and the person experiences withdrawal symptoms until homeostasis is restored, which can take weeks, months, or even years.