There is growing interest in reshaping the model of addiction that we currently consider to be right. Addiction is considered a disease by the World Health Organisation, but is it really a disease?
“This disease model has been greatly beneficial in providing professional healthcare to those in need”, says UK based Psychotherapist Jason Shiers, “but there may be alternative approaches.” You will not find any physical culprit in the body of someone suffering with addiction. Instead, addiction is characterised by a dysfunction in the brain’s neural pathways. Neurons that fire together, wire together, creating learned pathways in the brain when there is a repeated habitual thought. Addiction to a substance like cocaine, for example, happens as a result of the great impact cocaine and effects of heroin use has on the brain’s reward system, creating an escape from the users current reality.
Dopamine is part of a set of chemicals known as the D.O.S.E chemicals – Dopamine, Oxytocin, Serotonin, and Endorphins. It is known as the feel-good chemical, and is greatly increased in the brain through the use of cocaine. The brain even releases dopamine in anticipation of feeling good, like before seeing someone you love or going to a fun event.
Is addiction really a disease then? Or is it a neural messaging pattern that has been overstimulated and so has fried itself into position? Over use of one neural pathway makes it difficult for the brain to use an alternative route. In order to change the habitual thoughts/behaviours/emotions linked to substance abuse, or any behaviour, new pathways will have to be formed.
The good news is that the brain has a property known as ‘neuroplasticity’, defined by MedicineNet as ‘the brain’s ability to reorganize itself by forming new neural connections throughout life.’ This ability ‘allows the neurons in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.[1]’
The damage that addiction causes is found in the compromised functioning of the prefrontal cortex. Dr. Michael Berier, Assistant Professor at Harvard Medical School, tells us that “An addicted person’s impaired ability to stop using drugs or alcohol has to do with deficits in the function of the prefrontal cortex — the part of the brain involved in executive function. The prefrontal cortex has several important jobs: self-monitoring, delaying reward, and integrating whatever the intellect tells you is important with what the libido is telling you.[2]
When the brain becomes accustomed to a drug, avoidance of that drug will cause within the brain a stress reaction, and conjure up negative emotions, often amplifying them to the point of despair.
Throughout the recovery process, when there is abstinence from the culprit drug, a person suffering needs to be supported through this difficult, emotionally unstable time period by a strong social and therapeutic network which can be easily developed at a structured sober living home.
The neural pathways that have formed throughout the course of substance intake will be the quickest way from despair and need, to relief (as temporary as that relief may be, it doesn’t matter). There will be a straight line from A to B, and the brain will logically perform as it used to when under stress. The challenge for clinicians and therapists then, is to help the addict in shutting down these routes, and building new roads to happiness and joy in the person’s life.
[1] Shiel Jr., W. (2017). Definition of Neuroplasticity. [online] MedicineNet. Available at: https://www.medicinenet.com/script/main/art.asp?articlekey=40362 [Accessed 5 Feb. 2020].
[2] Bierer MD, M. (2016). Is addiction a “brain disease”? – Harvard Health Blog. [online] Harvard Health Blog. Available at: https://www.health.harvard.edu/blog/is-addiction-a-brain-disease-201603119260 [Accessed 5 Feb. 2020].