Understanding the Addicted Brain
A potential client called the other day. We will call her Samantha. She is a prescription pill addict who by chance shares a doctor with Bill, the 22 year old I wrote about recently (“Addiction by Prescription: The Purdue Pharma-OxyContin Saga Continues’).
Samantha was taking Oxycontin — three 80 mg tablets/day plus up to five additional 10 mg tablets. The list of operations she had undergone in a short span of time indicated she might be suffering from Munchausen Syndrome, a psychiatric condition wherein those affected feign disease, illness, or psychological trauma in order to draw attention to themselves (or to get more prescription medication). Her husband, the de facto caretaker of their son was threatening to leave and take their child with him.
Because her insurance was too limited to cover treatment at our facility, I tried to steer her to other rehabs that would take her insurance, but she kept calling. She wanted a “high end” rehab. She and her husband wrote a check to cover detox and she checked in.
Two or three days later, well before Dr. Thom Lobe could get a baseline, still in the throes of detoxing off the synthetic opiates, she suddenly decided to leave. There was no stopping her, no convincing her. Everyone tried. Other clients, who have been in treatment longer, understood. They told me: “That is her disease talking.” And “Her disease is in control.”
They were right. They have been in treatment long enough already to know that their addiction is a disease of the brain, more specifically it is a disorder of the brain’s reward system.
I had been planning for some time to write an article simplifying for myself and others the science surrounding the “addicted brain.” Then when Dr. Roger Waite (a partner of Dr. Kenneth Blum) scored a home run explaining to clients and their families the role of the brain in recovery, I was inspired to stop procrastinating and start writing. It was not easy. I relied on some of Dr. Kenneth Blum’s many writings, Dr. Kevin McCauley’s 2008 “Is Addiction Really a Disease?” presentation at the Conference on Neuroscience and Recovery, and some pretty good information on the web.
Here is what everyone agrees on:
1) The brain is the most complex organ in the body. It is the organ that allows us to think, have emotions, move, and even dream.
2) The brain’s Limbic System (unconscious) develops and matures first. It is this part of the brain that governs our thinking process for the first 15-18 years of life.
3) The Limbic System understands, learns and responds on the most primitive level. Though it cannot exercise rational judgment, weigh options or postpone satisfaction, it is in charge of survival and reward mechanisms.
4) The Frontal Cortex is the most recent addition to the brain. It evolved to evaluate how best to satisfy and cope with our conflicting demands for pleasure and relief. In our late teens and early adulthood it becomes the body’s true center for command and control, responsible for functions such as reasoning, problem solving, judgment, impulse control. It manages higher emotions such as empathy and altruism, causes us to feel love, have morality, decency, responsibility, spirituality. It is where we make “conscious choices.”
5) When the Frontal Cortex fails in its ability to inhibit the drive to seek drugs, the decision-making processes pass to the unconscious Limbic system which associates alcohol and drugs with the principal source of pleasure and relief in life, and with survival itself.
6) The reward center of the brain which resides in the Lymbic System is compromised. Dr. McCauley describes this as “Pleasure Deafness.” He writes: “The patient is no longer able to derive pleasure from those things that have been pleasurable in the past…Addiction is a stress induced hedonic (pleasure) dysregulation.
7) Dr. Blum puts it this way: “If someone was to hold your head under water and prevent you from breathing your natural survival instincts would kick in and you would do almost anything to breathe again. When the Limbic System’s Reward centers are diminished or shut down then the same “breathing” survival instincts activate in order to increase those feelings of Pleasure and Reward.”
8) When the Limbic system (the primitive brain) speaks the rest of the brain listens. It is much easier to understand someone’s irrational “Drug Seeking” behaviors when you understand the origins of that motivation. The key to treatment for these individuals is to normalize these Limbic regions of the Brain so that the Frontal Cortex (Logic & Reasoning) can predominate.
Samantha’s irrational determination to “survive” by leaving treatment in the middle of a difficult detox from powerful prescription pills was made by the Limbic (“survival”) part of her brain. The drugs had shut down the ability of her Frontal Cortex to think rationally and be rewarded by dopamine surges which come from normal pleasures. Her behavior was that of someone with low dopamine levels, either because she was genetically predisposed to addiction, or had depleted her dopamine levels with drugs, poor nutrition, and lack of appropriate exercise.
|Frontal Cortex Does the Thinking||Limbic System In Control|
|Free Will Exists||No Free Will|
|Can stop||Can’t Stop|
|Punishment & Coercion DO work||Punishment & Coercion DON’T work|