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How Addiction Hijacks the Brain

Addiction involves craving for something intensely, loss of control over its use, and continuing involvement with it despite adverse consequences. Addiction changes the brain, first by subverting the way it registers pleasure and then by corrupting other normal drives such as learning and motivation. Although breaking an addiction is tough, it can be done.

What causes addiction?

The word “addiction” is derived from a Latin term for “enslaved by” or “bound to.” Anyone who has struggled to overcome an addiction—or has tried to help someone else to do so—understands why.

Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing involvement with it despite adverse consequences.

For many years, experts believed that only alcohol and powerful drugs could cause addiction. Neuroimaging technologies and more recent research, however, have shown that certain pleasurable activities, such as gambling, shopping, and sex, can also co-opt the brain.

Although a standard U.S. diagnostic manual (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or DSM-IV) describes multiple addictions, each tied to a specific substance or activity, consensus is emerging that these may represent multiple expressions of a common underlying brain process.

New insights into a common problem

Nobody starts out intending to develop an addiction, but many people get caught in its snare. Consider the latest government statistics:

  • Nearly 23 million Americans—almost one in 10—are addicted to alcohol or other drugs.
  • More than two-thirds of people with addiction abuse alcohol.
  • The top three drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine.

In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit.

The scientific consensus has changed since then. Today we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.

Pleasure principle

The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex (see illustration). Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.

All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.

Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.

Brain’s Reward Center

Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine. The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli.

Learning process

Scientists once believed that the experience of pleasure alone was enough to prompt people to continue seeking an addictive substance or activity. But more recent research suggests that the situation is more complicated. Dopamine not only contributes to the experience of pleasure, but also plays a role in learning and memory—two key elements in the transition from liking something to becoming addicted to it.

According to the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to take over the brain’s system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival (such as eating and sex) with pleasure and reward.

The reward circuit in the brain includes areas involved with motivation and memory as well as with pleasure. Addictive substances and behaviors stimulate the same circuit—and then overload it.

Repeated exposure to an addictive substance or behavior causes nerve cells in the nucleus accumbens and the prefrontal cortex (the area of the brain involved in planning and executing tasks) to communicate in a way that couples liking something with wanting it, in turn driving us to go after it. That is, this process motivates us to take action to seek out the source of pleasure.

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Dealing with Drug or Alcohol Addiction and Co-Occurring Mental Health Problems

When you have both a substance abuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems. But there is hope. There are plenty of treatments and steps you can take to help you on the road to recovery. With the right support, self-help, and treatment, you can overcome a co-occurring disorder, reclaim your sense of self, and get your life back on track.

What is the link between substance abuse and mental health?

In co-occurring disorders, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function at work or school, maintain a stable home life, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other. When a mental health problem goes untreated, the substance abuse problem usually gets worse. And when alcohol or drug abuse increases, mental health problems usually increase too. But you’re not alone. Co-occurring substance abuse problems and mental health issues are more common than many people realize. According to reports published in the Journal of the American Medical Association:

  • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
  • 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

While substance abuse problems and mental health issues don’t get better when they’re ignored—in fact, they are likely to get much worse—it’s important to know that you don’t have to feel this way. There are things you can do to conquer your demons, repair your relationships, and start enjoying life again.

What comes first: Substance abuse or the mental health problem?

Substance abuse and mental health disorders such as depression and anxiety are closely linked, and while some substance abuse can cause prolonged psychotic reactions, one does not directly cause the other. However:

Alcohol and drugs are often used to self-medicate the symptoms of mental health problems. People often abuse alcohol or drugs to ease the symptoms of an undiagnosed mental disorder, to cope with difficult emotions, or to temporarily change their mood. Unfortunately, abusing substances causes side effects and in the long run often worsens the symptoms they initially helped to relieve.

Alcohol and drug abuse can increase the underlying risk for mental disorders. Mental disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental disorder, abusing alcohol or illegal or prescription drugs may push you over the edge. There is some evidence, for example, that certain abusers of marijuana have an increased risk of psychosis while those who abuse opioid painkillers are at greater risk for depression.

Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or even trigger new symptoms. Abuse of alcohol or drugs can also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective at managing symptoms.

Do I have a substance abuse and co-occurring mental health problem?

It can be difficult to diagnose a substance abuse problem and a co-occurring mental health disorder. It takes time to tease out what might be a mental disorder and what might be a drug or alcohol problem. The signs and symptoms also vary depending upon both the mental health problem and the type of drug being abused. For example, the signs of depression and marijuana abuse could look very different from the signs of schizophrenia and alcohol abuse. However, there are some general warning signs that you may have a co-occurring disorder:

  • Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?
  • Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink?
  • Has someone in your family grappled with either a mental disorder or alcohol or drug abuse?
  • Do you feel depressed or anxious even when you’re sober?
  • Do you have unresolved trauma or a history of abuse?
  • Have you previously been treated for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?
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How to Stop Abusing Drugs, Find Treatment, and Begin Recovery

Developing a drug addiction isn’t a character flaw or a sign of weakness, and it takes more than willpower to overcome the problem. Abusing illegal or certain prescription drugs can create changes in the brain, causing powerful cravings and a compulsion to use that makes sobriety seem like an impossible goal. But recovery is never out of reach, no matter how hopeless your situation seems. With the right treatment and support, change is possible. Don’t give up—even if you’ve tried and failed before. The road to recovery often involves bumps, pitfalls, and setbacks. But by examining the problem and thinking about change, you’re already well on your way.

Overcoming drug addiction: Decide to make a change

For many people struggling with addiction, the toughest step toward recovery is the very first one: recognizing that you have a problem and deciding to make a change. It’s normal to feel uncertain about whether you’re ready to make a change, or if you have what it takes to quit. If you’re addicted to a prescription drug, you may be concerned about how you’re going to find an alternate way to treat a medical condition. It’s okay to feel torn. Committing to sobriety involves changing many things, including:

  • the way you deal with stress
  • who you allow in your life
  • what you do in your free time
  • how you think about yourself
  • the prescription and over-the-counter medications you take

It’s also normal to feel conflicted about giving up your drug of choice, even when you know it’s causing problems in your life. Recovery requires time, motivation, and support, but by making a commitment to change, you can overcome your addiction and regain control of your life.

Think about change

  • Keep track of your drug use, including when and how much you use. This will give you a better sense of the role the addiction is playing in your life.
  • List the pros and cons of quitting, as well as the costs and benefits of continuing your drug use.
  • Consider the things that are important to you, such as your partner, your kids, your pets, your career, or your health. How does your drug use affect those things?
  • Ask someone you trust about their feelings on your drug use.
  • Ask yourself if there’s anything preventing you from changing. What could help you make the change?
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