the addicted brain

3 excerpts from my book TO HELL & BACK on the addicted brain

Our brain cells, the neurons, communicate with each other via neuro-chemicals such as serotonin, dopamine, norepinephrine, and GABA. Alcoholics seem to have unstable levels of these neurotransmitters, resulting in unpleasant states such as anxiety and depression. Recent scientific research considers the existence of an alcoholic gene, which causes a lack of dopamine receptors in the addictive brain. This would mean that addicts are predisposed for abnormal pleasure seeking.

Drugs affect the limbic system in the brain, the site of our survival mechanism, and thus change many functions, such as emotions, memory, learning, and appetite. Lacking dopamine receptors, the alcoholic tends to feel “restless, irritable, and discontent” and seeks “to take the edge off” – with some kind of self-medication like alcohol, heroin (or other opiates), marijuana (or other hallucinogens), cocaine (or other stimulants like crack), anti-anxiety medications (benzodiazepines, such as valium), and so on. In response to these chemicals, our brain chemistry changes beyond the desired effect – more or less permanently. The result is addiction; when the drugs wear off, the neurotransmitter levels drop even lower than before – way too low for comfort. Our brain becomes progressively more unbalanced, and we are compelled to drink or use our drugs of choice even in spite of life-threatening circumstances.

Addicts also seek relief behaviorally by trying to numb emotional pain through endorphin release. Endorphins are natural painkillers, producing a state of well-being. Pain, stress, and/or excitement stimulate the brain to release endorphins in an attempt to re-establish the equilibrium. Addicts try to get that through other forms of addiction as well, such as sex addiction, gambling, fighting, excessive working out – anything that promises tension relief, either instantly or after temporarily increasing the tension. Unfortunately, for the alcoholic/addict no amount of activity along these lines is ever sufficient.

In recent years, non-addictive medications have been available to support sobriety. The most commonly used are antidepressants of the SSRI (selective serotonin reuptake inhibitors – e.g., Prozac) type, which maintain higher levels of serotonin. SNRIs (serotonin-norepinephrine reuptake inhibitors – e.g., Effexor) act upon two neurotransmitters and can help some alcoholics to feel less depressed, anxious, or obsessive-compulsive.

Alcoholics Anonymous (AA) suggests that alcoholism is a spiritual, mental, and physical disease. Spiritual support and guidance through AA, plus psychotherapy, plus medication can be used for treatment. Breathing exercises, prayer, and meditation on a daily basis promote relaxation, which counteracts fear and agitation. It does take some effort, but alcoholics can find permanent relief – as long as they don’t change their mind halfway through the process of recovery…

Brain research sheds some light on self-destructive addictive behavior, which can seem so incomprehensible. Addictive drugs mimic brain chemicals, which provide pleasurable feelings, and our brain adjusts. As we develop a tolerance, we need more and more drugs to feel O.K. When we don’t have our drugs, we feel horrible – and we experience withdrawal. This is addiction.

The brain releases dopamine, the stuff that makes us feel calm and content as a reward for life-sustaining behaviors; for example, when we respond to hunger with eating, or to thirst with drinking, or to sexual desire with sex, or when we try to protect ourselves from a threat with the “fight-or-flight response.” The addictive brain reacts differently to events and drugs. To drugs, our survival system responds with an extreme dopamine surge, which alters our brain chemistry – so we feel the need to get more, and more, and then more. As a result, the “hedonic set point” rises and we experience our needs with life-threatening urgency until all our actions are devoted to an insatiable hunger for pleasure while we may not care that our life is in danger. Avoiding pain and seeking pleasure, which is originally pro-life, becomes essentially pro-drug.

Addicts have an extreme reaction to things. It starts out with “hedonism” – meaning that seeking pleasure and avoiding pain is our most important pursuit. We begin to take drugs because we want to alter the way we feel. On drugs, remember, we evaluate and learn things differently, and so we create a “perceptual bias.” We think we “have to” do things that are socially unacceptable and we’d rather hide that from others, and so we get defensive. When we feel ashamed we attack and blame everybody else, and so we create different experiences and events as we go along. We can’t show up for our responsibilities and so our life becomes frustrating, confusing, and scary. We aren’t able to follow through with our promises, and people tend to be frustrated with us. We can’t deal with it, and we can’t face people anymore. When we run out of drugs, we become flooded and overwhelmed with agitation, anxiety, depression, and despair. Therefore, we feel that we must avoid acute withdrawal at any price, and procuring a steady drug supply becomes our first priority. Being preoccupied with obtaining and using drugs, our view of reality becomes skewed and things get chaotic.

At this point we have a lot of problems and chaos to deal with, so we really need to get high. By the time we become desperate to maintain our drug supply at any price, we are living in constant chaos and despair. That’s when the drugs usually quit working. Now, no amount of drugs provides the needed relief, and the real-life problems become overwhelming. Joy and happiness are a distant memory, as if from another life. There is no more oblivion from despair. For the “hope to die drug addict,” it’s all about survival for no good reason. Some addicts overdose when they can’t stand the relentless daily struggle anymore. Some of us surrender and choose recovery…

No matter how you look at it, addiction is not a smooth ride. We are struggling with something that’s located right in the center of our brain, which makes it impossible to get rid of. However, recovery is an option and that’s really all you need to know. Besides, it is a whole lot easier to live sober than to live with a toxic brain. For one, you can think clearly and so you can take care of things and make decisions that are good for you. You can get a life. That’s good.

In addiction and early recovery, your prefrontal cortex, the brain area of reasoning and decision-making, is somewhat under-active. You can’t think straight and so you may be tempted to do stupid things. As a result, you feel like you don’t know how to “do life” and you get overwhelmed with mundane tasks that healthy people don’t have to think twice about. It takes about ninety days for your brain to reset itself to a more functional level, which is really not so terribly much time, all things considered. This is why you need a lot of guidance, support, and encouragement during this time, so you won’t feel so lost. Alcoholics Anonymous provides all that and you get a chance to change gradually and gain some self-confidence and clarity.

Now to the midbrain, the survival part, the site of the “reward system,” where it’s all about the amount of dopamine available between the neurons in order to feel good. Normally you get a little extra dopamine boost as a “reward for good behavior” – meaning activities that are relevant for survival. Doing the right thing makes us feel good. For addicts, this part is a little fickle, and we don’t get nearly as much dopamine as we like, which is why you have been self-medicating for so long and neglected everything else. In late addiction, nothing matters but catering to the dopamine supply. Unfortunately (and I say this with all my heart), the continued use of addictive substances results in an under-supply of dopamine, and that’s not a good thing – the longer you use drugs, the less they work (as you very well know).

Withdrawal is not a smooth ride, either. Getting clean reduces the available dopamine even more, which feels miserable and there is no way to get around it. However, this stage is time-limited and you will gradually get better, every day. Everybody does, even if it doesn’t feel that way sometimes. Watch out for stress during early recovery, though. You won’t be able to handle it well at all, no matter how cool you think you are. It’s very important to feel safe. That’s why rehabs can be so helpful by giving you some “time out” from the chaos you created. Once you recover, you will find out that you can deal with your problems one step at a time, one day at a time, and with the love and support of other recovering addicts. In sobriety we learn to be kind with ourselves and let others show us how to have a good life.