Is Addiction A Failure Of Willpower, Or Is It A Physical Disease?

Medicine Is Beginning to Recognize Addiction as a Disease of the Brain

Fifty-two year old Jacques Harvey (a pseudonym) has spent most of the last five years living in a tent in a very grassy field right behind a church in Austin, Texas. While he was once a very successful nuclear power technician located in California, Harvey's world began to completely unravel when, he believed that an alien or robot-like presence levitated straight into his apartment and abducted his wife. Completely terrified of the thought of returning to the site of his "abduction," Harvey decided to begin drifting across the country. He never wanted to spend another night indoors even if there was really bad weather, he dealt with his fear by always sleeping outside and never going indoors.

At first Harvey's friends were more than happy to offer him a place to stay for a while, but he was only able to extinguish his complete terror with alcohol. He started to become ashamed of his behavior when he was drunk. As an atonement and walked all the way from the San Francisco Bay Area to his native state Texas to leave this shame he was suffering—and the extraterrestrials.

When Harvey lives outdoors, he is completely sober. Harvey does not ask for any money, but instead offers to wash other peoples's windows of stopped cars at an intersection near an on-ramp to an interstate highway. After a man in a similar mental state froze to death in 2010, people in his neighborhood were kind and would often stop to bring him food and blankets or even some ice, depending on what the weather was like. Harvey did not receive any institutional services, however. About every month or so, a kindly neighbor offered to take him to the Veterans Administration Hospital for psychiatric help, but Harvey always declined the offer.

Fifty-three year old Randy Jansen (again, a pseudonym) was struck by a car while he was crossing an intersection in late 2009. He was shown to suffer 22 broken bones and had to undergo seven surgeries. Jansen was finally released from an Austin, Texas hospital only to confirm the fact that the reason he had not seen his wife or son recently was that they had left him to find work in New Jersey. Previously diagnosed as an alcoholic and suffering from bipolar disorder, Jansen dealt with his problems by assuming the lifestyle of the classic drunk in the gutter.

Jansen found another street person's stash of Vicodin (hydrocodone), it was enough to keep himself on pain medication. When the Vicodin ran out, Jansen started developing the very common "explosive" diarrhea associated with withdrawal, right in the middle of a very busy street, and was run over yet again a second time.

Though this might seem extremely unlucky, for Jansen, however, getting run over a second time was actually an enormous stroke of luck. After the accident, he was sent to a psychiatric facility and offered a relatively new medication called Suboxone. Also known by its chemical name buprenorphine, this medication acts on the same receptors in the brain that respond to hydrocodone, oxycodone, heroin, and opium-derived drugs. Coming off Suboxone also causes withdrawal symptoms, but they are much less severe than those associated with withdrawal from other drugs like it.

The US government places tight regulation on the use of Suboxone. Only psychiatrists who do group therapy are allowed to prescribe the drug to anyone at all, and only recently have they been allowed to treat up to 100 patients at a time. (The previous limitation on the number of patients any one doctor could treat with the drug was only 10.) Randy Jansen, however, chanced to be examined by a psychiatrist who had room on his roster to treat him, and after  a whole six months of treatment from a half-way house, Jansen overcame his addictions to both alcohol and Vicodin and got a job working for a dry cleaner. You may be wondering , could he not have overcome his addiction just by willpower? Can't we all?
 

Addictions to Alcohol, Heroin, and McDonald's Happy Meals All Involve Same Areas of the Brain

There is a growing body of scientific evidence that tells us that addictions to substances ranging from heroin to Happy Meals all seem to involve cells in the brain that provide opioid receptors. An opioid receptor is a site on a cell that acts like a lock for which pain chemicals are a key. In the case of Randy Jansen, mentioned in the first half of this article, the ongoing pain from 22 broken bones and seven surgeries flooded these receptors with pain signals.

The opioid receptors, however, also respond to similar chemicals such as those found in painkillers. They effectively "jam the lock" so that the brain cell does not transmit a pain signal. But it is not just opium, oxycodone, heroin, and morphine that can stop the sensation of pain.

Former commissioner of the Food and Drug Administration and former medical school dean Dr. David Kessler believes that a combination of sugar, fat, and salt in food locks many of the same receptors that are locked by opium and morphine. But the sugar, fat, and salt we get in fast food and almost any prepared food (at least in the USA) also trigger the release of dopamine that gives the feeling of pleasure. In fact, just seeing a symbol we associate with a sugary, fatty, salty food can give our brains the pleasure we get from eating.

Pills just block pain. Food blocks pain and delivers pleasure. Food can be more addictive than heroin. But can we overcome this addiction with willpower?

Of course, some people can, and most people can't. When it comes to drugs, some people are able to quit their addictions cold turkey. Some people are able to function with ongoing help (such as lifetime attendance of a 12-step group). And some people don't kick their addictions even with the best medicine and their loved ones have to offer them.

When it comes to food, breaking an addiction is even harder. Most of us can't overcome all the multiple layers of experience that keep drawing us back to food. And there are fewer caring professionals who will help.
 

No Single Explanation for Addiction

While there is no single explanation of addiction, a number of studies suggest that the brains of addicts have more receptors for pain chemicals and fewer receptors for pleasure chemicals. Substances that dull pain tend to be addictive. Substances and activities that increase pleasure tend to be addictive.

Moreover, the brain is shaped by experience. Stressful experiences literally rewire the brain. Some pathways will be enhanced. Others will be broken. The effective ratio of pain receptors and pleasure receptors may change, so the brain's responsiveness to pain and pleasure will change, and the addictiveness, or non-addictiveness, of various substances will also change.

Memory also plays a role. For a cocaine addict, just seeing a syringe may trigger desires and a memory of a cocaine high. For a Big Mac addict, just riding past the golden arches of a McDonald's fast food restaurant may start the taste buds watering. Stress may make the idea of a cocaine high less desirable or the idea of downing a Big Mac more desirable, or it might work the other way around.

Scientists don't have a way to quantify willpower to tell people how much willpower they need to overcome addictions without any kind of medical help. Science only knows that most people need some combination of willpower, social support, and brain-based medication to succeed in mastering their desires. Jacques and Randy would tell you that compassion helps, too.