Drugs, Brains And Behaviors: How Does Addiction Affect The Brain?

Substance addictions are heavily stigmatized — many see addicts as criminals, moral failures, cowards, and drains on society who need punishment rather than help, in turn excluding and further marginalizing them. The picture your average Joe paints in his mind when he thinks "addict" is damaging enough, but research shows that both healthcare providers and addicts themselves stigmatize people with substance use disorders. 

We blame people locked in the mind-prisons substance use disorders put them in for their own problems. While we condemn people with conditions like HIV and hepatitis C in much the same way, would we ever dare to say that patients with asthma, coronary artery disease, hypertension, or kidney failure are themselves responsible for their conditions? Even if those people engaged in behaviors that increased their risk of developing those conditions? 

We don't, not generally — and the fact that so many wrongly believe addiction is a choice has a lot to do with that. Scientists have made major advances in their understanding of how addiction works, and it's time for the rest of the world to catch up.

Anyone who's still wondering if that could possibly be true — and if calling addiction a chronic condition is nothing more than politically-correct nonsense — could do with a closer look at how addiction hijacks brain functioning, stripping its victims of control over their own lives. 

How substance addictions hijack the brain

Perfectly healthy, normal brains get a kind of rush from things like eating, sex, caring for our families, spending time with friends, exercising, or making new discoveries for good reason — all these activities in some way help keep both indviduals and humans as a species alive, and when they make us feel good, we're going to want to do more of them.

The neurotransmitter (chemical messenger) dopamine plays a huge role in this, acting as a motivator that makes us want to get the same rewards again and again. That can be a great thing, but also a dangerous one. Using alcohol and drugs can also be a very pleasurable experience that floods the brain with dopamine, essentially training a person — in a very Pavlovian way — to want to seek the same experience more and more. 

As the brain adjusts to the presence of a substance, it can react by naturally producing fewer feel-good chemicals, which the body then tries to make up for by using substances in higher doses, more frequently, or both. As an addict develops tolerance, the same dose that once made them feel high is now only enough to help them feel normal. 

At the same time, the chemical transmitters responsible for fear and anxiety kick in when an addict isn't using, essentially forcing people with substance problems to seek relief by using again ― even if they very much want to get clean. 

While different substances impact the brain in different ways, they can:

• Damage the prefrontal cortex, a part of the brain essential to the ability to make rational decisions. This can result in increasingly risky and impulsive behaviors.
• Impact an area called the basal ganglia, which helps people feel like they're getting a reward — in this case for incredibly damaging activities. 
• Alter the functioning of the amygdala, an emotional center of the brain, which becomes increasingly sensitive to a substance the longer a person uses it. The processes that go on within this part of the brain go a long way towards explaining why people who were committed to quitting just a while ago go back to the substance they're addicted to once withdrawal sets in. 

Addiction: The diagnostic criteria

Once you see how an addiction messes with brain function, it becomes much easier to understand how addiction results in the kinds of symptoms we're all familiar with:

• Using alcohol or drugs more often and in larger amounts than initiallty planned. 
• Not being able to stop or cut down despite a strong wish to do so. 
• Craving the substance when it's not there.
• Continued use despite a myriad of negative consequences on a person's health, relationships, work, mood, or daily functioning.
• A need to use increased amounts, or more often, to continue to experience the same effects. 
• Going into withdrawal — mental, physical, or both — when the person hasn't used for a while, or continued use simply to prevent withdrawal symptoms. 

Addiction is a mental illness, but also quite literally a brain disease that fundamentally alters the natural reward system. Addicts don't tell themselves they want out only to be back for more a short while later because they're weak-willed low-lives. While people who have fallen victim to an addiction likely chose to experiment with the substance they're now dependent on in the first place, they lost control along the way. Telling an addict to simply stop using isn't all that different to telling someone in who is pain to just stop feeling it.  In many cases, it takes much more than simple willpower to reach remission from the addiction, and an addict needs professional help to get clean and learn to live without the substance.