I shot heroin and cocaine while attending Columbia in the 1980s, sometimes injecting many times a day and leaving scars that are still visible. I kept using, even after I was suspended from school, after I overdosed and even after I was arrested for dealing, despite knowing that this could reduce my chances of staying out of prison.
My parents were devastated: They couldn’t understand what had happened to their “gifted” child who had always excelled academically. They kept hoping I would just somehow stop, even though every time I tried to quit, I relapsed within months.
There are, speaking broadly, two schools of thought on addiction: The first was that my brain had been chemically “hijacked” by drugs, leaving me no control over a chronic, progressive disease. The second was simply that I was a selfish criminal, with little regard for others, as much of the public still seems to believe. (When it’s our own loved ones who become addicted, we tend to favor the first explanation; when it’s someone else’s, we favour the second.)
We are long overdue for a new perspective — both because our understanding of the neuroscience underlying addiction has changed and because so many existing treatments simply don’t work.
Addiction is indeed a brain problem, but it’s not a degenerative pathology like Alzheimer’s disease or cancer, nor is it evidence of a criminal mind. Instead, it’s a learning disorder, a difference in the wiring of the brain that affects the way we process information about motivation, reward and punishment. And, as with many learning disorders, addictive behaviour is shaped by genetic and environmental influences over the course of development.
Scientists have documented the connection between learning processes and addiction for decades. Now, through both animal research and imaging studies, neuroscientists are starting to recognise which brain regions are involved in addiction and how.
The studies show that addiction alters the interactions between midbrain regions like the ventral tegmentum and the nucleus accumbens, which are involved with motivation and pleasure, and parts of the prefrontal cortex that mediate decisions and help set priorities. Acting in concert, these networks determine what we value in order to ensure that we attain critical biological goals: namely, survival and reproduction.
In essence, addiction occurs when these brain systems are focused on the wrong objects: a drug or self-destructive behaviour like excessive gambling instead of a new sexual partner or a baby. Once that happens, it can cause serious trouble.
If, like me, you grew up with a hyper-reactive nervous system that constantly made you feel overwhelmed, alienated and unlovable, finding a substance that eases social stress becomes a blessed escape. For me, heroin provided a sense of comfort, safety and love that I couldn’t get from other people (the key agent of addiction in these regions is the same for many pleasurable experiences: dopamine). Once I’d experienced the relief heroin gave me, I felt as though I couldn’t survive without it.
Understanding addiction from this neurodevelopmental perspective offers a great deal of hope. First, like other learning disorders, for example, attention-deficit hyperactivity disorder or dyslexia, addiction doesn’t affect overall intelligence. Second, this view suggests that addiction skews choice — but doesn’t completely eliminate free will: after all, no one injects drugs in front of the police. This means that addicts can learn to take actions to improve our health, like using clean syringes, as I did. Research overwhelmingly shows such programs not only reduce H.I.V., but also aid recovery.
The learning perspective also explains why the compulsion for alcohol or drugs can be so strong and why people with addiction continue even when the damage far outweighs the pleasure they receive and why they can appear to be acting irrationally: If you believe that something is essential to your survival, your priorities won’t make sense to others.
Learning that drives urges like love and reproduction is quite different from learning dry facts. Unlike memorising your sevens and nines, deep, emotional learning completely alters the way you determine what matters most, which is why you remember your high school crush better than high school math.
Recognising addiction as a learning disorder can also help end the argument over whether addiction should be treated as a progressive illness, as experts contend, or as a moral problem, a belief that is reflected in our continuing criminalisation of certain drugs. You’ve just learned a maladaptive way of coping.
Moreover, if addiction resides in the parts of the brain involved in love, then recovery is more like getting over a breakup than it is like facing a lifelong illness. Healing a broken heart is difficult and often involves relapses into obsessive behaviour, but it’s not brain damage.
Author: Maia Szalavitz
[The views and opinions of authors expressed herein do not necessarily state or reflect those of SMART Recovery Australia.]