Daily Archives: 04/08/2014

Addiction Is a Learning Disorder

There was an excellent article on Substance.com recently by Maia Szalavitz  titled ‘Most of Us Still Don’t Get It: Addiction is a Learning Disorder’.

It tackles the thorny subject of addiction as a learned pattern of behaviour.  These are the bits that interested me the most although the whole article is definitely worth reading.

In fact, despite hundreds of millions of dollars spent on neuroimaging research, we still don’t have a scan that can reliably separate addicted people from casual drug users or accurately predict relapse. Some studies have suggested that this may be possible but none have found a replicable diagnostic scan, even though some clinicians market the use of scanners in treatment.

Moreover, recent sex and food addiction research showing similar alterations to those seen in drug addictions strikes at the heart of arguments made about the uniquely addictive nature of psychoactive chemicals. For example, on the website of the National Institute on Drug Abuse, a section on the “science of addiction” explains that “addiction is considered a brain disease because drugs change the brain.” But this idea—first promoted heavily by the former head of NIDA, Alan Leshner—isn’t the whole story.

All experience changes the brain—it has to, in order to leave a mark on memory. If experience didn’t alter us, we couldn’t perceive, recall or react to it. So, simply changing the brain doesn’t make addiction a disease because not all changes are pathological. In order to use brain scans to prove addiction is a disease, you’d have to show changes that are only seen in addicted people, that occur in all cases of addiction and that predict relapse and recovery. No one has yet done this.

Secondly, if you can be addicted to activities like sex, gambling and the Internet—which do not directly chemically alter the brain—how can they be addictive, if addiction is caused by drug-related brain changes?

Researchers long argued that the pharmacology of particular drugs is what makes them addictive—that, say, cocaine’s alterations in the dopamine system cause a worse addiction than sex or food do because the drug directly affects the way the brain handles that chemical. But since sex and food only affect these chemicals naturally—and can create compulsive behavior that’s just as hard for some people to quit—why should we see cocaine differently?

Of course, none of this is to say that addiction isn’t a medical disorder or that addicted people shouldn’t be treated with compassion. What it does show, I believe, is that addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry. While this theory is implicitly accepted or stated outright in much of today’s neuroscience research on addiction—and it runs through specific theories of addiction, including theories as varied as those of Stanton Peele, George Koob, current NIDA head Nora Volkow and Kent Berridge—its implications are not well understood by many treatment providers and the public. Instead, addiction is a seen as a “chronic, progressive disease,” which can only remit or worsen and which pretty much affects all addicted people in the same way.

What this means is that addiction isn’t simply a response to a drug or an experience—it is a learned pattern of behavior that involves the use of soothing or pleasant activities for a purpose like coping with stress. This is why simple exposure to a drug cannot cause addiction: The exposure must occur in a context where the person finds the experience pleasant and/or useful and must be deliberately repeated until the brain shifts its processing of the experience from deliberate and intentional to automatic and habitual.

This is also why pain patients cannot be “made addicted” by their doctors. In order to develop an addiction, you have to repeatedly take the drug for emotional relief to the point where it feels as though you can’t live without it. That doesn’t happen when you take a drug as prescribed in a regular pattern—it can only happen when you start taking doses early or take extra when you feel a need to deal with issues other than pain. Until your brain learns that the drug is critical to your emotional stability, addiction cannot be established and this learning starts with voluntary choices.

This above paragraph resonates with my own experience of nursing patients where opiates are used for post operative acute pain management and the conclusion is the part that I wholehearted agree with:

The real issue is what purpose does addictive behavior serve and how can it be replaced with more productive and healthy pursuits.

Speaking from personal experience giving up drinking has been made immeasurably easier by finding other positive things to do with my time and energy rather than lamenting what was and how I used to spend my time.  Would you agree?

48 days to go