Facing addiction head-on to break it

Addiction, said American neuroscientists this week, is a disease of the brain, not drugs. Sanchita Sharma elaborates.

Addiction, said American neuroscientists this week, is a disease of the brain, not drugs. And that substance abuse – be it smoking, alcohol or drugs – is about underlying neurology, not what you do. Just think this through. With this new definition of addiction, the American Society of Addiction Medicine (ASAM) has turned the human brain into an unenviable patsy for all our behavioural failings.

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Overdosed on alcohol last night? Blame it on faulty brain circuitry. Can’t quit smoking? You want to, of course, but your uncooperative brain won’t let you. Smoked pot again? You said no, but those bullying brain nuerons forced you to. I still don’t quite see concerned partners and parents buying these arguments, but ASAM has at least made it possible for you to put up a scientific argument in your defence.

Your fate notwithstanding, this new addition to the nature-versus-nurture conflict promises to spice things up. Neuroscientists in the past have blamed both warped genes and bad parenting for making people prone to addictions. While Sigmund Freud’s theories on repression and the subconscious mind made parents the fall guys for everything -- from relationship disasters and insufferable colleagues to power outages and bad menu choices. How we were toilet-trained determined whether we’d be anal-retentive (stubborn perfectionists, like Sherlock Holmes who used cocaine to stimulate his brain) or anal-expulsive (lacking self-control, like Tony “Iron Man” Stark known for his epic addiction to alcohol), while our dormant Oedipus Complex or Electra Conflict – depending on the gender, of course – turn us into manic-depressive addicts looking for crutches navigate life without turning into Norman Bates. In simple words, you can blame everyone but yourself for your failings.

The new definition is not exactly radical as addiction is considered a neurological disorder because of drug-induced changes in brain circuitry. Some of these changes persist for years after a person kicks the addiction, which makes preventing relapse a struggle.

Drugs work by tapping into the brain’s communication system and interfering with the way neurotransmitters send, receive and process information. The chemical structure of some drugs, such as marijuana and cocaine, mimics that of natural brain chemicals and fools the receptors into allowing the drugs to mess up transmission channels by sending out warped messages.

Other drugs, such as amphetamines, cause the nerve cells to release abnormally large amounts of natural neurotransmitters, causing a greatly amplified message before disrupting communication altogether.

Addiction happens because the brain is wired to repeat life-sustaining activities by activating reward circuits when something important happens that needs to be remembered and repeated. Most drugs directly or indirectly target the brain’s reward system by flooding it with two to 10 times the amount of the “pleasure” neurotransmitter dopamine than released by natural behaviours, such as sex and eating.

The brain quickly adjusts to the overwhelming surges by producing less dopamine or by reducing the number of receptors to receive signals. It numbs the natural pleasure sensors, making the addict lifeless and depressed when not using a stimulant. The tolerance to pleasure finally leads to changes in brain circuitry, causing withdrawals and cravings.

Though drug abuse and mental disorders often co-exist, the ASAM definition blurs the fine line between the cause and effect. It implies that faulty circuitry can trigger and exacerbate addictions. That it may, but what you decide to do about it is still up to you.