Understanding Addiction

By Lindsey Boman, MA, LPC

“Why can’t I stop?” is often the first question people struggling with addiction will ask me when they come into treatment. They will name all the reasons that they have to maintain sobriety, (family, friends, finances, freedom, health, career etc.) but will confess that they keep choosing their drug of choice over the other people and things that they care about. As such, I thought it would be a good time to begin (this is a big topic with much more involved) to shed light on why individuals in recovery may feel they can’t stop using. Additionally, I would like to give a few suggestions for how to begin the road to recovery.

The Science of Addiction

In the past, people believed in a “moral model” of addiction [1, 2]. They thought that those who suffered from this illness were “weak” or just lacked the “will power” needed to break free from addiction. We are now aware that this belief is not true, as the research indicates that addiction has the ability to take anyone prisoner [3,4]. This is largely because repeated use of a drug can literally rewire your brain so that it places the “drug of choice” above all other needs [1, 2, 5]. Essentially, it hijacks your sense of what is important. We know that many neurotransmitters have an integral part in this process, but for our purposes, I would like to discuss one in particular. Dopamine is a neurotransmitter that is believed to play an important role in addiction [6, 7, 10]. When we do things that are pleasurable (sex, eating, laughing, favorite activity etc.) this neurotransmitter is released and tells our brain that whatever we are doing is good, and we should keep doing it. This same process occurs in addiction, except the amount of dopamine released in the brain is far greater when using drugs and alcohol then is released for any of the other needs listed above. Therefore, the “want” to use is more intense and pervasive [7].

Additionally, after a person begins the process of using, a set of conditioned responses occur that facilitate and maintain continued use [5, 7]. The hijacked brain begins to make associations (people, places, and things that they have been around when they used) to determine when and how it can more rapidly get its needs met (release more dopamine). These associations often become triggers for intense urges/cravings. Therefore, when an addicted person happens upon a trigger, their drive to use increases. If the person decides that they no longer want to use, they are often assaulted by withdrawal symptoms (stomachaches, headaches, extreme cravings, sweats etc.) as their body and brain try to re-adjust to the lack of chemical consumption. 

Where to Start

Given this information about brain chemistry and associations, it’s easy to see why it requires herculean effort to stay committed to recovery. My hope is that after reading this, those of you who suffer from this ailment will understand that like many other diseases, addiction can inflict anyone, and that recovery takes time and effort to overcome. Additionally, since sobriety can feel like a daunting task, I would like to offer a few suggestions for where to begin.

Firstly, you are going through a lot, so give yourself a break! It is important to be compassionate towards yourself as you walk this journey. To learn about how to be more self-compassionate, I encourage you to listen to the guided exercises and explore the plethora of information on self-compassion.org. Additionally, relapse rates for addiction remain as high as 60% [12]. If you find yourself concentrating on the times you have fallen short, begin to think of those as moments as an opportunity for growth (what did you learn from that experience and what can you do differently?).

Most importantly, you do not have to do this alone! There is a strong positive correlation between connection with others in recovery and accomplishing long-term sobriety [9]. Therefore, reaching out for help and finding support will increase your chance of maintaining long-term sobriety. There are several places you can go to find help. Narcotic anonymous (NA), Alcoholic anonymous (AA), and Celebrate Recovery ^® are always a great place to begin [12]. It is also beneficial to seek-out professional help so that you can explore new coping skills, increase mindfulness, deal with past trauma, and address boundaries that may be contributing to continued use [11, 12].

References

[1] Marino, N. (2008). A treatment approach for drug and alcohol addiction that integrates holistic principles and the 12-Step Model.

[2] Alexander, B. (1987). The disease and adaptive models of addiction: A framework evaluation. Journal of Drug Issues. 17(1):47-66. DOI:10.1177/002204268701700104

[3] Volkow, N., & Li, T. (2005). Drugs and alcohol: Treating and preventing abuse, addiction         and their medical consequences. Pharmacology & Therapeutics, 108, 3-17.

[4] Leshner, A. (1997). Addiction is a brain disease, and it matters. Science, 278:45-47.

[5] Parnell, L. (2018). Rewiring the addicted brain. Green Tara Books, 15-52

[6] Chen., W. Nong, Z., Li, Y., Huang, J., Chen C, & Huang, L. (2017). Role of dopamine signaling in drug addiction. Current Topics in Medicinal Chemistry, 21, 2440-2455. DOI: 10.2174/1568026617666170504100642. PMID: 28474551.

[7] Gluck, M., Mercado, E.., & Myers, C. (2014). Learning and Memory: From brain to behavior. New York: Worth Publishers, 2, 118-165 & 191-207.

[8] Neff, K. et al. (2021). Website: Self-Compassion (self-compassion.org)

[9] Harandi, T., Taghinasab, M., & Nayeri, T. (2017). The correlation of social support with mental health: A meta-analysis. Electron Physician, 9, 5212-5222. DOI: 10.19082/5212.

[10] Solinas M, Belujon P, Fernagut PO, Jaber M, & Thiriet N. (2019). Dopamine and addiction: what have we learned from 40 years of research. Journal of Neural Transmission, 126, 4, 481-516. DOI: 10.1007/s00702-018-1957-2.

[11] Tipps, M., Raybuck, J., & Lattal, M. (2014). Substance abuse, memory and post-traumatic stress disorder. Neurobiology of Learning and Memory, 112, 87-100.

[12] Chiesa, A. & Serretti, A. (2014). Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use and  Misuse, 49, 492-512. [13] Kelly, M., O’Grady, K., Schwartz, R,. Peterson, J., Wilson, M., & Brown, B. (2010). The relationship of social support to treatment entry and engagement: the Community Assessment Inventory. Substance Abuse, 31, 43-52. DOI: 10.1080/08897070903442640.