How We Develop An Addiction and How To Use It To Your Advantage
Addiction has been redefined. No longer strictly a behavioral issue, the American Society of Addiction Medicine has recently published a new definition. This definition has undergone a four year long intensive consideration by more than 80 addiction experts:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.
Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
If addiction is a chronic disease of brain reward, motivation, memory, and related circuitry, and not some Freudian manifestation of an unsuccessful resolution of the oral stage of development, then perhaps we should consider neurocognitive solutions to rewire and manage those addictive impulses.
Turning An Addiction To An Advantage
Perhaps we can even reformat that pathology in a meaningful, healthy way.
First, let’s consider why we may become addicted in the first place. The NIDA’s or National Institute on Drug Abuse’s director, Dr. Nora Volkow, explains that our brains exhibit specific reactions to stimuli that have special relevance.
Relevance, or salience, can vary. The higher the salience, the higher the reactivity of the brain centers.
Food, for example, is a stimulus that is highly salient, particularly when we are hungry. Machine vendors capitalize on this by putting vending machines in easy sight to trigger brain reactivity. If you are hungry, it is almost impossible to not be drawn in by these highly salient beacons of drive reduction.
If you do manage to ignore the initial impulse to peruse the goodies that lay waiting to satisfy your craving, you may find your hunger taking over more of your brain centers, interrupting concentration and diverting attention from the task at hand.
Volkow explains that when addictions are present, higher functioning cognitive centers including memory systems, reward circuits, decision-making skills and conditioning all succumb to the over-salience input to create uncontrollable craving.
The salience, or importance, of the behavior attached to the resultant neurological and nervous system changes becomes overpowering and all consuming.
One of the difficult aspects of overcoming addiction is the double whammy an addict from both physical and psychological responses.
Whether the behavior involves ingestion of food or alcohol, sensory inputs tied to basic drives (e.g. surfing pornography), alteration of states of consciousness through drugs, or risk related behaviors such as gambling, what begins as a casual or controlled activity may quickly move into a highly salient behavior with a direct link to the pleasure centers of the brain.
It is the activation of these pleasure centers that becomes the motivator for our behaviors. When we sit down to peruse our email, we are unable to set aside the urge to light up those pleasure centers through a quick dip into our “World of Warcraft” persona.
Sure, we understand that the term paper due at the end of the week should be our predominant concern, but that drive to stimulate those basic pleasure centers has hijacked our frontal lobe and Warcraft it is. Put simply, for the pleasure centers, Warcraft has more salience than our term paper.
One of the difficult aspects of overcoming addiction is the double whammy an addict from both physical and psychological responses. In the past, the physically addictive processes have been considered in terms of the presence of withdrawal symptoms when deprived of the substance.
Yes, the fact that an alcoholic can develop terrible hallucinations, tremors, seizures or convulsions, even heart attack or strokes during a detoxification process is an obvious indication of physical addiction.
But never before has an individual addicted to gambling been considered a physical addict.
Addiction As a Disease
The new definition insinuates that due to the neurochemical changes undergone in the brain of a gambling addict, he or she also is in the throws of a disease process. As such, medical attention is required in order to overcome the addiction.
For some of us, this is hard to swallow. After all, we all know people who through sheer determination, were able to set aside a long standing vice in order to accomplish some goal, beat an illness, or change a lifestyle. Take into consideration, however, that it is often within the parameters of some joyous occurrence that we beat these addictions.
A woman may be able to quit smoking in order to ensure she provides the best prenatal environment during a pregnancy. A couple may decide to give up highly caloric foods and alcohol in order to slim down before a wedding. In effect, the salience of the addiction becomes overpowered by something even more salient in the individual’s life.
If we can not stop our brain from responding to salient environmental cues, perhaps we can retrain it to respond to something healthier.
Is there a method by which we can recover control of our pleasure centers from an addictive hold? Ongoing treatment processes can increase recovery from 20% to 40%. This may be due to the increase in salience of the recovery process through continual reminders and the heightened sense of accountability brought on by groups such as AA.
Current research on the reactions of dopamine receptors to addictive processes is also shedding light on possible solutions. According to Frank Vocci, director of pharmacotherapies at NIDA, one group, D3 receptors, seem to multiply in the presence of stimulants, increasing salience.
Dopamine is implicated in reward systems in numerous studies, and the decrease in dopamine in Parkinson’s patients is responsible for the generalized dampening of emotion pleasure centers. Pharmacotherapies targeting faulty Dopaminergic systems may be one solution to addictive holds.
In the mean time, good old fashioned classical conditioning may be worth a try for the addict wanting a change. If we can not stop our brain from responding to salient environmental cues, perhaps we can retrain it to respond to something healthier.
If we continually follow up a cigarette with a carrot stick or celery stalk, perhaps we can effectively train the pleasure centers to let loose those Dopaminergic neurotransmitters to give us that boost we seek. True, there is no carrot that will be able to provide the nicotine of a cigarette.
But there is gum that can give us the nicotine without the risk of lung cancer. If we can transfer the salience of the cigarette to a carrot through classical conditioning, over time we may be able to eliminate the need for the cigarette.
Wouldn’t it be great if we could get light up those pleasure centers and get the same jolt out of a piece of nicotine gum and a healthy dose of veggies!
Image by Lampeduza