The National Institute on Drug Abuse (NIDA), in a far-reaching decision, labeled addiction as a “brain disease” several years ago. Their statement, which carried significant clout, was the result of brain research and also opened the door for further research. Looking for a pharmaceutical cure for addiction, millions of dollars have been poured into the development of antagonist drugs to stem the epidemic of substance abuse in this country.
Is the brain centrally involved in the development of addiction? Absolutely! Addiction can be explained according to brain chemistry and circuitry, especially as addiction affects the production of dopamine, our body’s “feel good” chemical and also the effects on the pre-frontal cortex, our seat of judgment. But addiction is also a personality disease, a motivational disease, a social disease, etc. As we search for better treatment strategies, there is greater value in viewing addiction as a complex behavior that operates on several levels at once – brain function and physiology, psychology, environment, and social relations. All must be addressed in an effective treatment.
So how does a person become addicted? Often, a drug is taken the first time by choice to feel pleasure, relieve stress or depression, or perhaps simply to fit in with peers. There may be multiple motivators for that initial drug use, including such things as boredom or curiosity. Two things are important to understand – no one begins experimentation with substances with the goal of losing control, and addiction is a progressive illness. Often the progression is subtle – a shift in interests, a changing of priorities, a gradual difference in peers, an adjustment in values – all eventually leading to what the Narcotics Anonymous basic text describes – “Our whole life and thinking was centered in drugs in one form or another – the getting and using and finding ways and means to get more.”
Are brain changes responsible for this dramatic shift? Absolutely! But recovery requires more than just a healing of the brain, which science now tells us takes 12-18 months. Science is finally catching up with old AA wisdom that has traditionally taught new members not to make any major decisions and not to get into a romantic relationship in their first year of sobriety. Why? Because their brain needs to heal. But while that is happening, newcomers also need to develop different social circles, discover new pleasurable activities, learn new coping responses to feelings that can be overwhelming.
It is why I tell my clients that it may be a drug or alcohol problem that got them in my door, but that is not their problem, it is their solution. Recovery involves discovering some solutions that don’t also carry with them the horrible negative consequences of addiction.