An important point which everyone should understand in regard to addiction is that it is, in fact, a chronic relapsing brain disease. The bottom line is that when someone drinks or takes psychoactive substances on a constant basis they will eventually alter the structure of their brain. At what point the brain is altered will depend on both genetic factors as well as the age of onset of the chronic use. Environmental factors also play a role and contribute to the likelihood of someone becoming “chemically dependent” But it is becoming increasingly evident that understanding the neurophysiology of addiction will help people to recover and hopefully help their families and loved ones to have some compassion for the challenge of recovery.
Because the brain is such a complicated topic, I am including a segment of an interview conducted by Bill Moyers with Steven Hyman the director of the National Institute of Mental Health” (http://www.thirteen.org/closetohome/science/html/hyman.html)
Moyers :So there’s solid evidence that alcohol, tobacco, cocaine, and heroin physically change the brain?
Hyman: There is incontrovertible evidence that these drugs physically change the brain. At all levels, beginning with molecular and chemical changes. In many cases we can actually see changes in the structure of synapses and in the shape of cells. Above all, what we’re seeing are the kinds of changes in the way nerve cells communicate with each other that would impact our subjective life and our behavior.
Moyers: You mean drugs change not only the physical size and shape of the cell but the psychological operation of the brain as well?
Hyman: Yes. The psychological operation of the brain — how we feel about ourselves, what we do — reflects the workings of networks of nerve cells. And these drugs change the way that these networks function. And therefore, they can change our behavior.
Moyers: Do these four main drugs all change the brain in the same way?
Hyman: There are some shared properties and some differences. The shared properties have to do with a particular brain pathway — sometimes called the reward circuitry — which is where all drugs of abuse, directly or indirectly, have their effect. This pathway is rather deep in the brain. It extends from a structure called the midbrain and sends projections of nerve cells (they are called axons) to a part of the brain called the nucleus accumbens. In Latin, that means “learning nucleus,” and it’s named because of its shape. The nucleus accumbens is in an area involved in the processing of emotions. This circuit has to do with, among other things, learning what’s good for us. You see, learning that occurs in the presence of strong emotion is very different from trying to remember something that seems dry as dust. Let’s say a child touches a hot stove. Well, that child certainly doesn’t have to study or practice the idea that you don’t touch a hot stove twice. The child will learn in a profound way and carry that for the rest of his or her life. …………………………………………………………………………………………….
Drugs like ….Cocaine and amphetamine put more dopamine in key synapses over a longer period of time in this brain reward pathway than normal. And because they are so rewarding, because they tap right into a circuit that we have in our brains, whose job it is to say something like, “Yes, that was good. Let’s do it again and let’s remember exactly how we did it,” people will take these drugs again and again and again…………………………………..
Here’s this poor synapse which has never seen so much dopamine for so long in its life, what is it going to do? The dopamine on the one hand may be helping the drug user feel euphoria, but at the same time, the receptor cell isn’t very happy. It’s stressed. What happens? First, it’s trying to decrease the efficacy of this dopamine signal so it won’t hit it so hard, and it’s saying “Enough, too much.” It sends signals to other cells to say, “Turn this off.” So adaptation occurs, and we see the clinical realities of this when somebody ends a cocaine binge. At that point, there might be less dopamine in the brain or the dopamine that’s there might be less effective than prior to drug use. So after a cocaine binge, the brain is physically changed — it’s adapted. But that adaptation, less dopamine now, means that the drug user feels bad. The drug user can’t feel pleasure. The drug user might feel depressed and is craving more drugs.
So what this mean is that as a consequence of the brain adapting and changing over time the addict can not control his impulses and stopping is not a choice he/she is able to make without a great deal of support and motivation on his/her part. When someone has heart disease we don’t blame him and we try to get him/her help and offer support. But he or she will need to make some changes in her diet and lifestyle so it is the same in recovery there will need to be changes major changes and the addict is going to need support. This where the 12 step recovery program comes in and the slogan” I can’t but we can”.