Why an Addicted Brain Makes Such Poor Decisions By Olasimbo Olanusi, MD, FASAM The human brain holds the mystery of controlling most of your day to day activities. It serves as the mirror through which we view the world around us. When our mirror the [brain] is askew, then our view of ourselves and the world around us is out of balance with the rest of the community we live in. Addicts view things differently from the rest of the society and society, in turn, views them differently. Scientific advances over the past decade clearly demonstrate that addiction is a brain disease that leads to compulsive, uncontrollable drug-seeking use with irrational behavior.  Q: In which part of the brain does addiction take place?
A: There is an area of the brain called the cerebrum that regulates the executive functions, such as planning, organizing, making good judgments and solving problems. This is the thinking part of the brain. There is also another part of the brain known as the limbic system, which modulates bodily functions that occur without thinking such as breathing, coughing, smelling, motivation and a series of complex emotional reactions. This is the automatic area of the brain. The disease of addiction takes place in the automatic segment of the brain and overrides the thinking part of the brain that regulates executive functions. The net effect of the "hijacked" brain is the production of unhealthy thoughts that generate poor decisions and the compulsive behavior that typifies the life of substance abusers.
Q: What effect do drugs have on the brain?
A: Mood-altering substances, including alcoholic beverages, are carried through the bloodstream into the brain. In the brain, these substances through complex reactions produce an altered sense of reality described as intoxication, euphoria or getting "high."
Q: How do mood-altering drugs change the brain?
A: Most addicting substances modulate the wiring of the brain, which is accomplished by interaction with the powerful neurotransmitters in the brain called dopamine, serotonin and endorphins, which are the "feel-good" chemicals required for maintaining a balanced mood state in an individual. Addicting substances produce changes in the pleasure/reward part of the automatic brain. Research has shown that the greater the increase of these neurotransmitters produced by the drugs in the brain, especially dopamine, the greater the "high" phenomenon that occurs.
Q: Why are some people more prone to using drugs than others?
A: The euphoric "high" feeling produced by drugs is highly pleasurable and worth repeating to some people while other people do not find it so pleasant. The individual differences that dictate the response of an individual to drugs is determined by multiple factors which include the following: - Some genes make individuals more vulnerable to drug and alcohol use, which helps to explain why the disease of addiction runs in some families.
- The environment where drugs and alcohol are easily available and accessible makes it easier for some people to use drugs. This is why drug use is more rampant in certain geographical locations within or community.
- People who are insecure or have poor self-esteem are more likely to use drugs in an attempt to alter their feelings about themselves.
- Research has shown that a good family background and a sound spiritual support system are very good protective resources against drug and alcohol use.
Q: Why is it that people who take drugs to make them feel good over a period of time end up becoming depressed?
A: Initially taking drugs increases the level of the neurotransmitters in the brain, which are the feel-good chemicals. After a prolonged period of time, these drugs actually produce the opposite effect, which is to lower the level of the neurotransmitters. At that point, people no longer take the drugs to get "high," but instead use the drugs to avoid feeling depressed. In an attempt to pump up their neurotransmitter level, they escalate their drug use trying to chase the initial "high" feeling, but it no longer happens.
Q: Can we increase the feel-good chemicals [neurotransmitters] in our brain by other means without using drugs?
A: There are some ways of producing natural "highs" in the brain that are not harmful to the body. This includes engaging in pleasurable activities such as exercise, watching movies, dancing, eating a delicious and well balanced diet, being involved in good intimate relationships and having sound and restful sleep. The goal is not to increase or decrease the levels of neurotransmitters in the brain, but instead to maintain them in a balanced state.
Q: Why do people who use drugs have such irrational behavioral patterns?
A: Drugs change our brain and hijack our motivation to do the things that enhance our survival, such as sleep, sex, food and shelter. Addiction then becomes the main motivating factor or essence of living, which helps to explain why people will abandon their family or career for drugs. Some people forfeit safe shelter to pursue drugs and some prefer drugs to a healthy intimate relationship. Drugs hijack our motivation to survive, unlike, the natural motivation system which works to promote the survival of humanity.
Q: Could addicts be described as morally decadent or have poor willpower because the initial act of drug use begins with a voluntary act?
A: Even though the condition initially comes about because of voluntary behavior, drugs induce some changes in the brain that, over a period of time, cause the substance abuser to lose control over initial voluntary behavior. A similar concept is the act of overeating or of not eating well, which also started with a voluntary behavior. Overeating can lead to diabetes, obesity and hypertension. However, people who develop this disease are not usually described as morally decadent or weaklings in our society.
Q: Why is it difficult for people to admit they have the disease of addiction and seek treatment?
A: Because of the stigma that goes with the disease of addiction. Family values, cultural beliefs and mass media tend to portray a negative image for people who suffer from the disease of addiction [e.g., they are losers, failures, weaklings, etc.].
Q: Why do some people who stop using drugs for a period of time quickly end up back where they left off?
A: Addiction is a chronic, progressive, recurring disease. Even though the person has not used drugs over a period of time or several years, the concept remains that the foundation of addiction wiring has been laid and connected in the brain. All that is required is a flicker or switch to turn on the addiction process again after an interval of time. The progressive nature of the disease makes it dangerous, and sometimes fatal.
Q: Are the brain changes induced by drugs reversible or not?
A: Some drugs literally destroy the brain cells over time. The damage may not be reversible, but there are many skills that one can acquire over time to compensate for changes in the brain. These acquired skills help get the person back to normal functioning. Other damaging effects of drugs on the brain may be reversible; however, the effects may not be to their full potential.
Q: What are triggers and what role do they play in relapse?
A: Triggers are automatic recollection of memories and feelings of a drug-use experience. Our bodies react to these triggers by anticipating the euphoric high feelings associated with drug use, which generates tremendous drug craving and potential relapse.
Q: How can we cope with our triggers and cravings for drugs without relapse?
A: The most important thing is to identify your triggers and have mapped out strategies in advance to help you deal with exposure to them. When you experience cravings, become engaged in activities that will divert your energy and attention away from them. As you do this on a repeated basis, the intensity of the cravings will dissipate over time.
Q: If addiction is a brain disease, then is it treatable?
A: Addiction is a treatable disease that requires approaching the different components of the disease - whether it is through medications, behavioral therapies or social, family and occupational rehabilitation in treatment programs available in the community. Treating the disease of addiction is highly cost effective financially. Society and humanity also benefit because of reduction in crime and family violence, as well as in making addicts feel like productive members of society.
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