Chesterton Tribune

Addiction: Your brain is in a new state of mind

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By KEVIN NEVERS

It’s a bit of common knowledge so common that most grade-schoolers probably know it by heart: many drugs are addictive, both “physically” and “psychologically.”

Physically, in that an addict’s body comes to need a given drug merely to maintain minimal function, and that, deprived of it, the body undergoes a painful and debilitating withdrawal.

Psychologically, in that addicts learn to rely on their drugs of choice, not simply for the dependable pleasure of the high but as a crucial part of their routine: a source of comfort or stimulation to which they return again and again in highly ritualized ways.

To be successful drug rehabilitation programs must treat both forms of addiction, must first lay the groundwork by detoxifying the body and then—a much more difficult process—must break the habit by re-programming the mind. As Robert Downey Jr. has repeatedly demonstrated, though, rehab tends to be a hit-or-miss proposition, relapse rates are frighteningly high, and even the most motivated addicts are statistically likely to fall afoul of their compulsion.

Researchers are only beginning to understand the mechanism by which an addiction establishes itself, and studies now suggest that the addictive potential of some drugs is far greater than anyone would have thought a generation ago. Drugs like methamphetamine are so powerful, in fact, as to make the progression from recreational sampling to obsessive abuse a highly likely one, and only a few experiences with such drugs can set in motion a cascade of events in the brain which profoundly alter its structure.

Dr. Celeste Napier, a neuroscientist at Loyola University in Chicago, compares addiction to the most basic human appetites: those for food, drink, and sex. Addicts, she says, can no more suppress their craving for drugs than the rest of us can suppress the urgings of hunger, thirst, or libido. Indeed, research indicates that this craving actually mimics our appetites by “hijacking a normal process in the brain” and becoming a part of the addict’s fundamental biochemistry.

“That’s why addiction is a disease,” Napier says. “It’s a brain disease.”

The science is not yet complete but neuroscientists do “know a few things.” When ingested, cocaine, heroin, and methamphetamine, for instance, trigger neurotransmitters—“brain chemicals” like dopamine—which initiate a “complex orchestration of events” in the brain, she says. The most obvious effect of that orchestration is euphoria: the high. But at the same time the drug is activating certain genes, common to all humans, whose switches are normally flipped by such on-again/off-again pleasure-producing behaviors as eating, drinking, and sex. Those activated genes in turn produce proteins which accumulate in the brain.

Even after an addict has detoxified—long after the body has flushed itself of any residue of the drug—these proteins persist in the brain and are fully “integrated into the biochemistry of its nerve cells.” The very structure of the brain changes, in a reconfiguration which neuroscientists believe accounts for the cravings of addicts months or even years after they’ve stopped taking drugs. In short, addicts desire the drug as much as the rest of us desire food, their brain wants the drug as much as it wants food, and—deep in its biochemistry—it may always want the drug. As Napier puts it—literally—“Addicts’ brains are in a new state of mind.”

Addicts were not always addicts and their reasons for initially experimenting with drugs vary widely: “seeking thrills, depression, peer pressure.” Yet the “drug will do its biochemical thing” regardless of the addict’s personality. “You may not even like the drug,” she says. “But you must have it. . . . Logically you know better. It’s destructive. It’s ruining your life. But you can’t help it.”

The implications of this research for anti-drug education, drug-treatment therapies, and public-health policy are enormous, she says. “The old adage—‘Once an addict, always an addict’—may be true.”

Rehab

In combination the various components of addiction are wickedly potent. The more addicts use heroin, say, the more they need to use it merely to function on a day-to-day basis. Meanwhile, the genes activated by the heroin are pumping increasing levels of proteins into the brain and their backwash is re-channeling its pleasure center. Simultaneously the addicts are learning to associate certain behaviors and rituals, people and places, even music and fashions, with the euphoria produced by the heroin itself, and these “environmental cues,” as Napier calls them, only serve to fix their addiction in every nook and cranny of their life.

Carmen Arlt, director of chemical dependency and addiction at Porter-Starke Counseling Centers, explains. “All this behavior changes the brain chemistry automatically,” she says, “to where they’re absolutely seeking that type of rush to their brain every time they go out and seek that drug. Everything is brain based, linked in some way to the pleasure center of the brain. So addicts may actually be looking for the whole lifestyle, anything that gives them any type of pleasure. The sexual drive, the rush, the music, anything that’s related to the whole ritual of getting high.”

The only successful rehab program is the comprehensive one which treats each component of the addiction. Notwithstanding the nightmarish depictions in the cinema and on television of withdrawal, detoxification is the easy part. Or—at least—the most quickly achieved. The psychological component is a different matter entirely, Napier says. Addicts must abandon a whole way of life. They must learn—or re-learn—not only how to act but how to think appropriately and productively. They must address the recklessness or loneliness which originally led them to experiment with drugs. And always the chance occurrence of an environmental cue from the bad old days—hearing a song maybe, meeting a drug buddy—will threaten to undo months or years of sobriety.

Nevertheless, the proteins will still remain in the brain and the appetite will still rumble. Soon, Napier says—perhaps within the next few years—a “post-addictive pharmaco-therapy” may be available, analogous to the life-long therapies used to treat diabetes and hypertension. The challenge is to develop medications which can “go downstream and clean up the effects of those proteins.”

“Addiction treatment should not focus on the direct effects of the drug,” Napier says, “but on the person’s compulsion, the obsession, the craving, for the drug.”

 

Posted 6/4/2002