Put Away the Guilt: Scientific Advances Offer Even More Explanation Why Addiction Is a Disease of the Brain, Not a Moral Failing

If you are loaded with guilt about your drug or alcohol addiction, please stop. Right this second.

For starters — and most importantly, for an addict looking to recover — guilt and addiction do not mix. Feeling bad about your alcoholism and/or drug addiction usually only fuels it.

Most addicts and alcoholics have been there. Go on a bender, sober up, then feel rotten about whatever you did while drunk or high. At some point along the way, when you begin to realize you are hurting yourself and others, you may end up feeling so bad about what you did that you use again just to numb the pain.

It’s a terrible cycle that for some people doesn’t end until it’s too late.

The truth is that addiction really is a disease. In fact, Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, just published a paper in the prestigious New England Journal of Medicine emphasizing that reality.

As the person who oversees the organization funding most of the world’s research on addiction, Volkow points out step-by-step exactly how the pathology of addiction works in the brain. She also explains why the pharmacological treatments of modern medicine should be used with people who find quitting without help an impossible task.

She explains what happens that causes a person to become addicted through absolutely no moral failing of their own.

Binging and Intoxication

Regardless of which drug is used, addictive substances get a person hooked by flooding the brain with dopamine, which gives the user a sense of well-being. Eventually, the dopamine stops being produced in response to the drug, and instead cells begin to make it in anticipation of the drug. “This process involves the same molecular mechanisms that strengthen synaptic connections during learning and memory formation,” Volkow and her colleagues write in the paper. “In this way, environmental stimuli that are repeatedly paired with drug use – including environments in which a drug has been taken, persons with whom it has been taken, and the mental state of a person before it was taken – may all come to elicit conditioned, fast surges of dopamine release that trigger craving for the drug.”

So, for example, let’s say you’re a cocaine addict who frequently purchases the drug at your favorite watering hole. If you’re there and you see one of your dealers walk in, your brain will say, “I must have cocaine!”

This is why, in sobriety, people with alcoholism and addiction are told they should change the faces and places they see. Saying goodbye to the people and places that you associated with substance use is about more than just hanging out with so-called “good people” instead. It’s not about judging your old friends. But your brain won’t let you get sober if you keep going back into the same situations where you used to get high or drunk.

Withdrawal and Negative Affect

After a while, your brain chemistry changes in ways that make pleasure hard to find, even from things that naturally produce rewards, such food, sex or other activities that you once found pleasurable. That’s why the drug that used to get you so high may not offer the same effects anymore. Often, an addict may think they are just getting “bad stuff.”

With some drugs, such as heroin, the brain changes in ways that causes withdrawal symptoms to be so bad that people use the drug just to avoid withdrawal. It’s not even about getting high anymore. This is why pharmacologic treatment such as naltrexone sometimes is the only hope for breaking free from a severe addiction to opioids.

“In the addicted brain, the anti-reward system becomes overactive, giving rise to the highly dysphoric phase of drug addiction that ensues when the direct effects of the drug wear off or the drug is withdrawn,” the paper explains.

Preoccupation and Anticipation

When addiction becomes particularly severe, the brain begins to focus primarily on seeking the drug. Executive process – which controls things like making rational decisions – becomes impaired.

“These effects explain why persons with addiction can be sincere in their desire and intention to stop using a drug and simultaneously impulsive and unable to follow through on their resolve,” Volkow and colleagues explain. “This altered signaling in prefrontal regulatory circuits, paired with changes in the circuitry involved in reward and emotional response, creates an imbalance that is crucial to both the gradual development of compulsive behavior in the addicted disease state and the associated inability to voluntarily reduce drug-taking behavior, despite the potentially catastrophic consequences.”

Volkow, et al., say more research into how the brain responds to and influences addiction is needed to better inform public policy.

“Despite the scientific evidence and the resulting advances in treatment and changes in policy (such as the Mental Health Parity and Addiction Equity Act of 2008, which requires medical insurance plans to pay for substance abuse and mental health treatment the same as any other illness), the concept of addiction as a disease of the brain is still being questioned,” the authors write.

David W. Newton

David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.

Reviewed by: Kim Chin and Marian Newton