Till the recent past addiction was considered as a bad habit, a lack of will power, a fault in character, lack in morality etc. The addict was morally a bad character and the treatment was punishment.
With the amazing development in psychiatry and neuroscience, ASAM (American Society of Addiction Medicine) has given a new definition of Addiction which is the result of a thorough, four-year process with input from over 80 experts, including top addiction authorities, addiction medicine doctors, and eminent neuroscience scientists from across the USA :
Addiction is a “primary, chronic disease of brain reward, motivation, memory, and related circuitry.”
NIDA (National Institute on Drug Abuse) has also come out with a new definition of addiction:
Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.
With these new definitions from competent authorities, addiction has acquired new meanings:
Let us now try to understand now why addiction has been called a disease and not a consequence of a bad moral character.
THE LIFE HISTORY OF AN ADDICT:
Many studies have found that genes are responsible for a significant part that someone will become addicted to any kind of substance if he or she inherits that gene. However it should be noted that there is no such thing as a gene for alcoholism or a gene for opium addiction. Numerous genes are involved in substance addiction.
Genetic influences are variable depending on the type of substance used. Genetic influences appear to account for about half ( 50%) the risk of becoming an alcoholic, more than half in case of heroin and opium and less than half in case of cannabis.
Some genetic factors may make someone more likely to become addicted to only one specific drug. On the other hand, some genes make people more addicted to many drugs.
Some genes predisposes someone to certain aspects of addiction. For example, certain genes may make some people less likely to get a hangover after drinking large amounts of alcohol. On the other hand, some genes make people release a large amount of dopamine, a neurotransmitter associated with pleasurable feelings, from drinking a small amount of alcohol.
People might have a genetic predisposition to try out novel substances. They might be genetically predisposed to thrill-seeking or risk-taking behaviour. Some people are genetically predisposed to become aggressive after taking alcohol. So on and so forth.
The role of environment in addiction is complicated and multifactorial. In fact environment plays a very important role in developing an individual’s brain, making the individual more or less susceptible to addiction. In humans most of the brain development takes place after birth giving the environment an important role in physically shaping the various neurological systems in the brain.
The effects of genetics and environment can often be hard to separate. Children of addict parents are likely to inherit many of the genes that would make them predisposed to addiction. However, they might grow up in an environment noncondusive to addiction or they might grow up in an environment condusive to addiction. The effect of environmental influence is most appropriately dealt with in the famous Hindi movie “Diwar”, where environmental influence makes one brother a protector of the law and the other brother an abuser of the law.
The best attempt to separate these genetic and environmental factors was done by the study of identical or fraternal twins who were raised in different environments. Since identical twins share all their genes, any differences between them with regard to substance addiction would be the result of differences in their environments and personal experiences. Studies on alcohol addiction using fraternal twins found that roughly the half risk of becoming an addict is due to genetics and the other half can be attributed to environmental factors.
Another important characteristic of addiction is that it Progresses!
On repetitive use of a substance the brain develops tolerance for the substance making him/her need more and more of the substance each time to experience the first high as he did on the first use. Hence, an alcohol addict after a few weeks time may fail to experience a high that he experienced in the first peg as in the start, finding the need to four or five drinks for the same high. At first only evening, then afternoon and evening, and then throughout the day and then throughout life.
As the cells in our brain are constantly splitting and creating newer cells (Mitosis), the new sister/daughter cell that comes out of splitting one cell ends up having more receptor sites for a particular chemical or substance of abuse as the parent cell had been previously bombarded by that chemical. More the empty receptor sites more the craving.
The person will also prefer the drug to other healthy pleasures and may lose interest in normal life activities. In the most chronic form of the disease, addiction can cause a person to stop caring about himself and his own well-being or survival.
These changes in the brain can remain for a long time, even after the person stops using substances. These changes may leave those with addiction vulnerable to cues or triggers that they associate with substance use, which can increase their risk of relapse.
There are four major chemicals in the brain that influence our happiness (DOSE):
Dopamine
Oxytocin
Serotonin
Endorphins.
Each play a different role in happiness.
Dopamine is responsible for causing excitement, vitality, curiosity etc. In particular, it targets the reward centre. Unfortunately, it is also associated with addictions, in which people develop uncontrollable urges to repeatedly engage in pleasurable but harmful behaviours, such as taking drugs, gambling, viewing pornography etc.
Oxytocin is the neurochemical that has allowed us to become social creatures. It makes us feel empathy which helps us feel close and bonded to others when it is released. It has also called as a love chemical.
Serotonin is responsible for regulation of mood. If you’re in a good mood, you’ve got serotonin to thank. And if you’re in a bad mood, you’ve got serotonin to blame. It’s a regulator.
Endorphins are responsible for masking pain or discomfort. It also will give you stimulus for achieving goals. For example, in a long distance runner, endorphins will mask pain while running and also will allow you to push farther and harder as you work towards distance goals.
These neurochemicals are released in the synapsis of the nerve fibers and on repeated release create a neurological pathway( called “neuroplasticity”, as explained below). Experiences that release the DOSE neurochemicals make us happy, which makes us want more and more. Together these chemicals create desirable brain states. In a child, these neurological pathways or circuits will only develop in the presence of an environment which is conducive to happiness. In the absence of these, circuits will fail to develop in a child.
Children and people suffering from addiction related problems usually have impairment in one or more of these circuitries and turn to the substance of abuse to fulfil this impairment. These substances then take the place of the deficient natural chemical.
The effects of these identical chemicals are far much stronger than our naturally existing chemicals and the addict’s brain circuit feels “complete” for the first time in life. He/she feel “Normal” for the first time in life!
The term Neuroplasticity is derived from the words Neuron and Plastic. The word neuron means the cell in our brain. Each neuron is made up of an axon and dendritis which are linked to each other by small spaces called synapsis. The word plastic means to mold or to modify. Neuroplasticity means that our brain can modify itself structurally and functionally and create new neural pathways as a result of our repeated actions or behaviour.
Let me explain further by giving an example: Imagine you have a small garden at home with a lawn in centre and flowering plants surrounding the lawn. In one corner you have your favourite rose plant. In order to water the rose plant daily, you have to walk over the lawn. Soon a narrow pathway is formed as a result of walking on the lawn every day. This path gets worn out and more defined every few days. Now then, in another corner you plant a Christmas tree which you badly want to grow to a great height and look tall and attractive. You nurture and water the Christmas tree daily and a new pathway is created by walking on the lawn daily towards the Christmas tree. This path gets worn out and more defined every few days.
Our brain too works in the same way. We all follow the neural pathways that we have created ourselves out of our repeated actions and behaviours.
Our brain is more flexible than we have ever thought before. It was believed until recently that the human brain, which consists of around 100 billion neural cells, could not generate new ones. The old model assumed that each of us was born with a fixed number of neural cells and when a cell died no new cell could grow. This old model of the brain’s inability to regenerate new nerve cells is no longer valid. It has been proven that certain areas in the brain can generate fresh cells( neurogenesis). Another misconception was that the brain had an inability to create new neural pathways (you cannot teach an old dog new tricks, an old saying). New studies have shown through the use PET, and MRI brain scanning technology, that new neural cells as well as new neural pathways are generated throughout life . Even the elderly brains are capable of neurogenesis.
How does this theory of neuroplasty help in the treatment of addiction?
In treatment, we can re-train the brain to develop a new pathway that helps the patient to recover. With intensive psychotherapy and other holistic interventions, we can retrain the brain and we can rebalance the addict’s biochemistry, by doing activities that can rewire their brain. The brain then learns to enjoy recovery, those things that give us pleasure in our sober lives – family, work, interpersonal relations etc.
Can rewiring prevent a relapse?
Essentially in addiction, the pleasure centres of the brain are hijacked by the addiction. Eventually, it is only the addictive behaviour that brings the addict any sense of joy, or freedom from pain – not family, friends, a good meal, or a pleasure trip. We can retrain the brain and we can rebalance the addict’s biochemistry, but the old neuropathways, the old links between addiction and pleasure are still there. For example, if you visit your college after 30 years, you can still find your way to your library or canteen without guidance. And habits die hard. This is why we suggest complete abstinence from drugs to addicts. It doesn’t take much to start the old habit. A single peg and the addict is back to his addiction!
Conclusion: There are many psychiatrists who do not still believe in this new definition of addiction as a disease and put forward their own arguments against it. I will not here state their reasoning– for just one particular reason: with this new definition the whole addict family has come from the cluches of the police and the law to the care of the medical fraternity. Addiction will be gradually decrimalized gradually medicalized!
A glaring example: Fifteen years back, one percent of the whole adult population of Portugal was affected by Heroin. These “criminals” were sentenced to life long imprisonment! Result? Addicts increased and there was no place in jails. A high power meeting between the president, the leader of the opposition and deaddiction specialists from all over the world decided to decrimilize addiction in Portugal. They released the addicts, rehabilated them in the society and gave them medical treatment. Result? Addictions came down by about 50% in 2 years! Please feel free to arrive at your own conclusions!