TinyPlantBetweenTwoHands

Nature versus nurture and addiction

The progressive understanding of addiction as a disease rather than a choice has opened the door to better treatment and research, but there are aspects of addiction that make it uniquely difficult to treat.

One exceptional characteristic of addiction is its persistence even in the absence of drug use: during periods of abstinence, symptoms get worse over time, and response to the drug increases.

Link to full article here, originally posted on:

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Don’t Wait For Rock Bottom – The Addiction Series Video

The concept of “rock bottom” can help people describe their experience of recovery from addiction by turning it into a narrative with a clear event that helped turn their life around. But the idea that we should wait for the disease to get worse before seeking treatment is dangerous.

Belief in this “rock bottom” can keep people who are struggling from reaching out for help. It can also keep family, friends, and care providers from addressing the issue when they have been wrongly told that the disease has to “run its course” and that they should practice “tough love” until a person hits bottom—when they will be ready and willing to engage in treatment.

But these ideas aren’t backed by science, and not everyone survives the fall.

You shouldn’t wait for the worst to happen—or a profound moment of awakening—before seeking treatment or helping a loved one, even if they don’t feel “ready.” Decades of research has proven that the earlier someone is treated, the better their outcomes and that treatment works just as well for patients who are compelled to start treatment by outside forces as it does for those who are self-motivated to enter treatment.

Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. If you or a loved one is struggling, don’t wait—reach out for help.

Link to original article here on AddictionPolicy.org.

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Disease or Choice? Insight From a Recovering Heroin Addict

A few years ago, I made a promise to myself that I tend to break every now and again. I challenged myself to never read comments or remarks about articles or creative pieces based on my story of addiction and recovery. Not just my own story, either. Any article written about the state of addiction. I know that there are always going to be people that disagree, and even argue to hold true to their own opinions. I also know that I cannot spend positive energy arguing with each person who has a negative remark. I will accomplish nothing but getting myself fired up and pissed off. That’s part of being a person in recovery. We are awesome like that.

For so many years I was a very violent person. I used intimidation and control to get what I wanted. I would physically fight someone over a parking spot at the grocery store. When I found recovery, that was one of the big things I had to change. Changing from reacting to responding. But the biggest lesson of all was that I don’t have to respond to anything at all if I don’t want to. I don’t have to give my opinion. I don’t have to fight about anything, unless it’s something I’m passionate about. Then I’ll fight the right way.

Amy Parker, Peer Support Recovery Specialist, BrightView

Hello. This is how I fight the right way, today.

Lately, for whatever reason (inspiration maybe?) I’ve been reading comments.

“Addicts are weak and weak minded. They can’t deal with life so they use drugs and we’re supposed to feel sorry for them.”

If I were to respond, it would look something like this: First of all, who is “we” and why are you speaking for anyone else but yourself? Own what you say. Don’t use the excuse of this being a collective opinion to back up your own idea. Why are you judging someone and who gave you the idea that your opinion should have validity about another person’s life? Have you stopped to think about how a person developed the disease of addiction? Have you ever considered what that pathway looked like? No one wakes up one day and says, “I think I’m going to try heroin for the first time today and for the rest of my life struggle with addiction and the aftermath of it, if I even live through any of it.” What if it were your loved one?

I can only speak to how my disease developed. When I was fourteen years old, I had the first of seven knee surgeries in a five-year span. With the first surgery, Vicodin was prescribed to as a routine pain medicine – not for acute pain primarily following a surgical procedure. I received a refill every thirty-days, whether I needed it or not. I was being treated for chronic pain before I was old enough to understand chronic pain. Throughout this time of my life, I was going through some emotional and behavioral issues. I was suffering through several psychiatric medication changes. My brain chemistry was constantly being changed by different medications. It always felt like no one cared about what was happening to my brain and my body. I knew I wasn’t normal. I knew that the medication had changed me. I saw myself go through so many different stages because of all of these medications. At one time, at age 15, I was taking seven different Psychiatric medications along with opiate pain medicine. I gained over 150 lbs in less than six months as a teenager. And I wasn’t learning coping skills on how to change my behaviors or make different choices. It was finally me that stood up and said, No more! I’m not doing this anymore. I’m not taking these medications. They make me empty and numb.

When I stopped taking my medication, I also stopped what very little therapy I was getting for my diagnosis of Borderline Personality Disorder. By age 16, doctors told my mother that her daughter is an addict. At age 16 I had only smoked marijuana and taken my prescription medicine as prescribed. Let that sink in for a moment. How many people do you know that only smoke pot but are not addicts? How many people do you know that take Vicodin as prescribed and you would never consider them to be an addict? They live very productive lives, good parents, are never in any kind of trouble. Your wheels are turning, aren’t they? Good. Now I’ve got your attention.

Amy Parker Being Interviewed

The result of my dropping out of school and continuing behavioral issues lead me to a lifestyle my family had not planned for me. I quickly entered into a life of crime and heavy illicit drug use: cocaine, ecstasy, meth and pain pills. I chose which drugs I was using and when. If I wanted to feel happy and have energy, I would choose cocaine and ecstasy. If I wanted to sleep and relax, I would choose Xanax and ketamine. I was doing what I was taught to do.

I certainly didn’t choose to be a person with a substance use disorder. I did not choose to be an addict. I definitely chose the drugs that I used. I definitely made the choice to put a needle into my veins. I absolutely made the choice to live the lifestyle that I lived for so many years. With every left turn that I made, I had the choice between turning left or right. But I’m not the one that made the choice to develop the disease of addiction. That choice wasn’t given to me. That choice was taken from me at 14 years old when I was being given a dozen pills a day. There was never a discussion of what the Psychiatric drugs were doing to my brain chemistry. There was never, ever a discussion of what addiction is when I was 14, or 16 or 21 or 25. Not until I was 30 years old would a Psychiatrist help me understand what was going on in my brain and why. In March of 2012, I got the real help I needed to break the chains that my illnesses had over me.

Amy Parker Public Speaking

Today I’ve been in recovery from addiction for six years and mental illness for four years. I do not take any medications, except for heartburn (Heartburn is the devil!). I made the choice to end the control that drugs had over my entire life and body. Today, I will choose anything else over taking a medication for anything I’m going through. I have peripheral nerve disease, Crohn’s disease and some terrible arthritis. I meditate, I do yoga and I take care of myself. I no longer suffer with anxiety or depression. I haven’t had an urge to use drugs in more than four years. I’m happy and I’m at peace with myself.  I’m 36 years old. I have a 3 year old, a 15 year old, a healthy marriage and an amazing career as a Peer Recovery Support Specialist for BrightView Health in Cincinnati. I make choices that are healthy for me. Informed choices that I have a say in making. I’m badass. I am a woman who gets shit done.

Instead of debating whether addiction is a disease or choice (By the way, the science shows that addiction is a chronic relapsing brain disease), start trying to understanding how a person develops the disease of addiction. What happened in a person’s life that leads him/her to the darkness and suffering of addiction? People with addiction are sons, daughters, friends, siblings. They’re humans just like you and me. The real debate here should be why are we instantly grouping people into a stigma that is killing folks every single day? Saying that addiction cannot be a disease because of choices made is part of the problem. I want to be part of the solution, don’t you?

Amy Parker is a Peer Recovery Support Specialist and Community Outreach Manager at BrightView.

To read Amy’s entire story about addiction and perseverance click here.

Original article here.

Broken Metal Chain

What You Should Know Before You Say ‘Addiction Is A Choice’

I do not understand the belief held by some that one chooses to become addicted. If addiction is defined as a compulsion to do something or behave a certain way repetitiously regardless of the negative consequences, I find little logic in anyone doing this by choice. Especially if it interferes with the well being of one’s life or hurts the ones we love.

My education and experience tells me addiction doesn’t start out as an act beyond our control. It begins in a slow, progressive notion and we often don’t even recognize its enormous growth until well beyond the awareness of many of those around us. Which, for a time at least, we will adamantly deny.

At first, we try something meant to give us a pleasurable experience and we enjoy the way it makes us feel. We like the giddiness of that first glass of wine after a stress filled day, or that rush of excitement in a winning hand at blackjack. And then we do it again and achieve the same results. And eventually, like it enough to create meaning around it.

We organize birthday barbecues and football parties where consuming large amounts of alcohol is an acceptable way to “celebrate” the occasion. We plan “family” trips to Vegas yet don’t see the outside of those dark walls for days because we are one step away from hitting the jackpot.  Euphoria and fulfillment and the broken promise of happily ever after are just beyond our reach.

We ignore the onlookers who frown at our behaviors and we discount their judgment as simply not knowing how to “have fun” or live on the edge. What we don’t realize is our behaviors have stopped being “fun” long ago, and we are wickedly close to falling off the edge, but we are forever chasing that euphoric feeling that swept us off our feet in the honeymoon phase of our distorted relationship with addiction.

StreetSignsAddiction&Life

What we also fail to recognize in our blindness of addiction is that not only are we continuing to do it because of the the way it makes us feel, we are equally doing it for the way it makes us not feel.  Research is only growing about addictions being a common yet detrimental escape from the unwelcomed experiences of our past. An incomplete mourning for the loss of something or someone meaningful to us that subsequently changes the direction of our life path.

An unexpected death of a close family member or friend, a difficult divorce, an unwanted move or loss of a job can all take considerable chunks of well being out of a previously unscathed being. These adverse experiences can happen in our childhood or as an adult and can weaken our whole existence and life motivation. Especially when those around us are equally effected and unable to help mend our pain because of their own.

It is of no surprise anxiety and depression frequently intertwine in the tumultuous relationship with addiction. And so begins the infinite cycle of turning to our addictions to numb the pain, which further inflames the anxiety of our choices and fuels our depressed state of being. Only causing us to turn toward our addiction all the more.

Soon we learn to escape our fears and insecurities with our addiction because we feel forcefully giddy and excited about what we are doing at that moment that brings us pleasure. And we create misconceptions — that somehow we will achieve ultimate satisfaction and perpetual happiness. Or at least we won’t think about the pain. At least not today.

Eventually this relationship with addiction evolves from giving pleasure and avoiding pain to becoming a necessary evil to merely exist. The compulsion sets in and our minds become fixated on our unquenchable urge for that next drink. Oftentimes, our bodies develop a physical dependence we can no longer ignore. So we drink to stop our hands from shaking. We do it to feel “normal” again, at least enough to function in our daily routine. We gamble away that last dollar to suffice the unattainable desire to double our wins. To win back that lost tax return that was meant to pay our mortgage. To get back that feeling of euphoric satisfaction and enjoyment we felt when we first met our addiction.

In the end and without help beyond ourselves, addiction overpowers us with a curse that becomes so strong, nothing and no one in our own innately selfish-driven world can stop us from it. Not our spouses, our children, our parents, our failing health or our careers. Not one thing can stand between our addiction and our mind. We have succumbed to a curse that is larger than us and it becomes stronger than our ability to make any choice to stop. We stand to lose it all and that still might not be enough to stop the insanity. The curse destroys all that was good in our lives and renders us hopeless for a better tomorrow.

Therefore, what they should say…

Addiction is a disease that needs help to recover.

According to multiple health reports published within the National Institute of Drug Abuse and Harvard Health Publications, researchers now recognize addiction as a chronic and reoccurring disease that changes both neurological brain structure and overall cognitive function. This transformation happens as the brain experiences a series of chemical changes, beginning with recognition of pleasure and the lessening of its effect with continued use of that which once gave us enjoyment, and ending with a drive toward compulsive behaviors attempting  to sustain it.

What we once found to be pleasurable in its infancy is altered within our brains to result in a compulsion for utter destruction in the part of our brain we rely on for emotion and pleasure. Our brain is no longer functioning the same way as before we became addicted. So we act on our compulsions because pleasure becomes impossible without intensifying our addictive tendencies.

This alteration in our brain and resulting compulsion is real, and when intermingled with the weakening grip on our addiction and all that once had meaning in our lives, it destroys. And it knows no social, racial or economic barriers.  It can creep into the least expecting community, impact whole cultures and span multiple generations.  Whether it be personally impactful, or through the far reaching ripple effect that results because of it. Ultimately, no one escapes unharmed. Addiction is that strong.

But there can be hope. Hope that there can be change.

To say addiction is a choice and not a disease that needs help is only further perpetuating the stigma that has carried on for decades, and for many, has contributed to loss of time spent having a life worth living. Or worse, of living any life at all.

Recognizing addiction as a potentially life threatening disease that requires continuous effort to recover successfully can allow us to make a much needed paradigm shift in our morally judgmental way of thinking. And to dispel the assumption that all those who suffer continue to do so by their own choosing, can begin to awaken the possibility that recovery exists. But it can not be done without a sincere commitment to end the stigma that at times prevents many from venturing toward the narrow path of healing.

I believe this commitment may include reaching beyond the current treatment models with floundering success rates and incorporating additional unorthodox and holistic methods that are slowly gaining more acceptance in the professional recovery communities. We can begin to focus on tailored recovery modalities because no longer can we assume that the traditional ways will always work for everyone.

My personal and still very raw experience with addiction and recovery has yet to be shared, but there is no doubt in my forever recovering mind the addiction that was in my path was not there by any ounce of my own choosing. My path to destruction came upon me as the horrific and overpowering curse that it was and mentally stole a mother from her children for 18 months of their lives I can never get back. It rendered me helpless for weeks on end and ultimately ended the career I had spent 15 years building for the person I mistakenly thought I wanted to be. It swallowed my joy and buried deep into my unconscious mind all that I once loved. It changed the unscathed child I yearned to be and morphed me into a monstrous entity my conscious mind will never want to know.

Regardless of what society continues to say about addiction, my personal truth will always be I didn’t willingly choose addiction. Rather the disease of addiction chose me. And it was only through the brokenness of my entire being and the insanity of my disastrous mind that I found the miraculous help and saving grace that gave me strength to overcome my addiction that almost became stronger than my will to survive.

Original article here written by Kelly Hubbard or “Kel B”, article also published on TheMighty.com.

WomanComfortingWoman

Why Addicts Need Empathy and Compassion – Not Judgment and Shame

My husband is a physician. Every day at work, he sees devastating illness and death. I don’t know how he does it, to be honest. I’ve always been in awe of the folks who work on the front lines of our health care system. I wonder how they can see the most heartbreaking moments of the human condition, every day, and simply return home to their normal lives.

I was pondering all of this yesterday morning when my spouse walked into the kitchen.

“Honey,” I said. “I have a random question.”

“Okay,” he responded, pouring a cup of coffee.

“What’s the saddest thing you have to see at work?”

He paused for a moment, and his eyes seemed to search.

“Addiction,” he said. “Without a doubt. Addicts break my heart the most, every day.”

To be honest, I had expected him to respond with car accidents, or child sickness, or cancer. But… addiction?

“Why?” I asked.

He shrugged a little.

“I see people suffering every day. Of course, all of it is horrible,” he said. “But most of those people don’t have to suffer alone–except addicts. When an addict comes in, they are almost always by themselves. You ask if there’s anyone to call, they tell you there isn’t. And they are so ashamed, too. It’s like they believe that suffering alone is something they deserve. Nobody has empathy for these people. That’s what makes addiction so heartbreaking.”

I didn’t agree with him, at first. In fact, my husband’s empathy for addicts was making me feel a little bit squirmy. Perhaps a little conflicted, too.

You see, addiction runs rampant in my family. This disease has affected us in horrible ways. My therapist warned me to establish firm boundaries with my addicted loved ones, but to be honest, despising them was just easier. I believed they chose a substance over me, and instead of dealing with the hurt that their disease was causing, I decided to toss them aside.

I’m ashamed to admit this, but I think it’s important to do. Because I know it’s not just me. Society as a whole seems to struggle with how to respond to addiction. And the sad truth is, this horrible disease isn’t going away any time soon. The suffering part is bad enough. But for people to suffer, be stigmatized, abandoned, and loathed? That is a special torment that no human being should abide.

It is time we move toward empathy for addicts, and this is why:

Addiction is a disease, not a choice.

Like diabetes, cancer and heart disease, addiction can be caused by multiple factors: behavioral, environmental, or biological. According to the National Center of Addiction and Substance Abuse, genetics account for half of the likelihood that an individual will develop a severe dependence. Addiction is very much a disease, and addicts deserve to be treated with compassion.

WomanComfortingWoman

Judging is ineffective, and also cruel.

I understand that relationships with addicts can be complicated. I’ve been there. I know firm boundaries are crucial.

However, when we judge someone for symptoms of a disease they cannot control, we are downplaying their struggle instead of acknowledging what it truly is. Addiction is a brain illness that changes the way people behave. People can’t fix their brain chemistry any easier than someone could fix their own broken leg. By shaming an addict, as if their addiction is a personal choice, you are placing a moral expectation on a purely physical ailment. That is not only ineffective, it is cruel.

Shaming has negative impacts on already suffering humans.

Have you ever heard the saying “don’t beat a horse while it’s down”? Think about that for a second. When someone is suffering from addiction, shaming them is not likely to help. In fact, according to a study published in the Journal of Substance Abuse Treatment, fear of stigma is one of the top two barriers deterring addicts from seeking treatment in the first place. Conversely, social support and inclusion were identified as leading contributors to a successful recovery. It turns out, shame is a very poor motivator, and can also deal a deadly blow for someone who is already self-loathing and abusing substances.

Compassion is always the right response.

I think for the longest time, society has avoided compassionate responses to addiction because empathy was viewed as being permissive. However, the truth is quite the opposite. When you show an addict compassion, you are validating their struggle, and letting them know that you see them as the human being they are. Nobody deserves to be defined or stigmatized by their illness.

After all, a person is never the problem. The problem is the problem. 

 

Original article here by 

Four addiction myths busted by national, local, state experts

Living in a heroin epidemic can lead to all kinds of talk about addiction and the answers to it – with a lot of it false.

But on Monday, a national addiction expert joined some local and state experts at the University of Cincinnati’s College of Medicine and met with The Enquirer to bust some common addiction myths.

Link to original article here: Four addiction myths busted by national, local, state experts. Originally posted on Cincinnati.com.

How Science Is Unlocking the Secrets of Addiction

We’re learning more about the craving that fuels self-defeating habits—and how new discoveries can help us kick the habit.

Addiction hijacks the brain’s neural pathways. Scientists are challenging the view that it’s a moral failing and researching treatments that could offer an exit from the cycle of desire, bingeing, and withdrawal that traps tens of millions of people.

Patrick Perotti scoffed when his mother told him about a doctor who uses electromagnetic waves to treat drug addiction. “I thought he was a swindler,” Perotti says.

Perotti, who is 38 and lives in Genoa, Italy, began snorting cocaine at 17, a rich kid who loved to party. His indulgence gradually turned into a daily habit and then an all-consuming compulsion. He fell in love, had a son, and opened a restaurant. Under the weight of his addiction, his family and business eventually collapsed.

He did a three-month stint in rehab and relapsed 36 hours after he left. He spent eight months in another program, but the day he returned home, he saw his dealer and got high. “I began to use cocaine with rage,” he says. “I became paranoid, obsessed, crazy. I could not see any way to stop.”

When his mother pressed him to call the doctor, Perotti gave in. He learned he would just have to sit in a chair like a dentist’s and let the doctor, Luigi Gallimberti, hold a device near the left side of his head, on the theory it would suppress his hunger for cocaine. “It was either the cliff or Dr. Gallimberti,” he recalls.

Patient receives electromagnetic pulses

Gallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says.

 More than 200,000 people worldwide die every year from drug overdoses and drug-related illnesses, such as HIV, according to the United Nations Office on Drugs and Crime, and far more die from smoking and drinking. More than a billion people smoke, and tobacco is implicated in the top five causes of death: heart disease, stroke, respiratory infections, chronic obstructive pulmonary disease, and lung cancer. Nearly one of every 20 adults worldwide is addicted to alcohol. No one has yet counted people hooked on gambling and other compulsive activities gaining recognition as addictions.

In the United States an epidemic of opioid addiction continues to get worse. The Centers for Disease Control and Prevention reported a record 33,091 overdose deaths in 2015 from opioids, including prescription painkillers and heroin—16 percent more than the previous record, set just the year before. In response to the crisis, the first ever U.S. surgeon general’s report on addiction was released in November 2016. It concluded that 21 million Americans have a drug or alcohol addiction, making the disorder more common than cancer.

After spending decades probing the brains of drug-loving lab animals and scanning the brains of human volunteers, scientists have developed a detailed picture of how addiction disrupts pathways and processes that underlie desire, habit formation, pleasure, learning, emotional regulation, and cognition. Addiction causes hundreds of changes in brain anatomy, chemistry, and cell-to-cell signaling, including in the gaps between neurons called synapses, which are the molecular machinery for learning. By taking advantage of the brain’s marvelous plasticity, addiction remolds neural circuits to assign supreme value to cocaine or heroin or gin, at the expense of other interests such as health, work, family, or life itself.

“In a sense, addiction is a pathological form of learning,” says Antonello Bonci, a neurologist at the National Institute on Drug Abuse.

Rat Simulated Slot Machine

Gallimberti was fascinated when he read a newspaper article about experiments by Bonci and his colleagues at NIDA and the University of California, San Francisco. They had measured electrical activity in neurons in cocaine-seeking rats and discovered that a region of the brain involved in inhibiting behavior was abnormally quiet. Using optogenetics, which combines fiber optics and genetic engineering to manipulate animal brains with once unimaginable speed and precision, the researchers activated these listless cells in the rats. “Their interest in cocaine basically vanished,” Bonci says. The researchers suggested that stimulating the region of the human brain responsible for inhibiting behavior, in the prefrontal cortex, might quell an addict’s insatiable urge to get high.

Gallimberti thought TMS might offer a practical way to do that. Our brains run on electrical impulses that zip among neurons with every thought and movement. Brain stimulation, which has been used for years to treat depression and migraines, taps that circuitry. The device is nothing but a coiled wire inside a wand. When electric current runs through it, the wand creates a magnetic pulse that alters electrical activity in the brain. Gallimberti thought repeated pulses might activate drug-damaged neural pathways, like a reboot on a frozen computer.

He and his partner, neurocognitive psychologist Alberto Terraneo, teamed up with Bonci to test the technique. They recruited a group of cocaine addicts: Sixteen underwent one month of brain stimulation while 13 received standard care, including medication for anxiety and depression. By the end of the trial, 11 people in the stimulation group, but only three in the other group, were drug free.

The investigators published their findings in the January 2016 issue of the journal European Neuropsychopharmacology. That prompted a flurry of publicity, which drew hundreds of cocaine users to the clinic. Perotti came in edgy and agitated. After his first session, he says, he felt calm. Soon he lost the desire for cocaine. It was still gone six months later. “It has been a complete change,” he says. “I feel a vitality and desire to live that I had not felt for a long time.”

It will take large, placebo-controlled trials to prove that the treatment works and the benefits last. The team plans to conduct further studies, and researchers around the world are testing brain stimulation to help people stop smoking, drinking, gambling, binge eating, and misusing opioids. “It’s so promising,” Bonci says. “Patients tell me, ‘Cocaine used to be part of who I am. Now it’s a distant thing that no longer controls me.’”

Not long ago the idea of repairing the brain’s wiring to fight addiction would have seemed far-fetched. But advances in neuroscience have upended conventional notions about addiction—what it is, what can trigger it, and why quitting is so tough. If you’d opened a medical textbook 30 years ago, you would have read that addiction means dependence on a substance with increasing tolerance, requiring more and more to feel the effects and producing a nasty withdrawal when use stops. That explained alcohol, nicotine, and heroin reasonably well. But it did not account for marijuana and cocaine, which typically don’t cause the shakes, nausea, and vomiting of heroin withdrawal.

The old model also didn’t explain perhaps the most insidious aspect of addiction: relapse. Why do people long for the burn of whiskey in the throat or the warm bliss of heroin after the body is no longer physically dependent?

The surgeon general’s report reaffirms what the scientific establishment has been saying for years: Addiction is a disease, not a moral failing. It’s characterized not necessarily by physical dependence or withdrawal but by compulsive repetition of an activity despite life-damaging consequences. This view has led many scientists to accept the once heretical idea that addiction is possible without drugs.

The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders, the handbook of American psychiatry, for the first time recognizes a behavioral addiction: gambling. Some scientists believe that many allures of modern life—junk food, shopping, smartphones—are potentially addictive because of their powerful effects on the brain’s reward system, the circuitry underlying craving.

“We are all exquisite reward detectors,” says Anna Rose Childress, a clinical neuroscientist at the University of Pennsylvania’s Center for Studies of Addiction. “It’s our evolutionary legacy.”

For years Childress and other scientists have tried to unravel the mysteries of addiction by studying the reward system. Much of Childress’s research involves sliding people addicted to drugs into the tube of a magnetic resonance imaging (MRI) machine, which tracks blood flow in the brain as a way to analyze neural activity. Through complex algorithms and color-coding, brain scans are converted into images that pinpoint the circuits that kick into high gear when the brain lusts.

Childress, who has flaming red hair and a big laugh, sits at her computer, scrolling through a picture gallery of brains—gray ovals with bursts of color as vivid as a Disney movie. “It sounds nerdy, but I could look at these images for hours, and I do,” she says. “They are little gifts. To think you can actually visualize a brain state that’s so powerful and at the same time so dangerous. It’s like reading tea leaves. All we see is spots that the computer turns into fuchsia and purple and green. But what are they trying to tell us?”

The reward system, a primitive part of the brain that isn’t much different in rats, exists to ensure we seek what we need, and it alerts us to the sights, sounds, and scents that point us there. It operates in the realm of instinct and reflex, built for when survival depended on the ability to obtain food and sex before the competition got to them. But the system can trip us up in a world with 24/7 opportunities to fulfill our desires.

Desire depends on a complex cascade of brain actions, but scientists believe that the trigger for this is likely to be a spike in the neurotransmitter dopamine. A chemical messenger that carries signals across synapses, dopamine plays wide-ranging roles in the brain. Most relevant to addiction, the flow of dopamine heightens what scientists call salience, or the motivational pull of a stimulus—cocaine, for instance, or reminders of it, such as a glimpse of white powder. Each drug that’s abused affects brain chemistry in a distinct way, but they all send dopamine levels soaring far beyond the natural range. Wolfram Schultz, a University of Cambridge neuroscientist, calls the cells that make dopamine “the little devils in our brain,” so powerfully does the chemical drive desire.

How powerfully? Consider the strange side effect of medications that mimic natural dopamine and are used to treat Parkinson’s. The disease destroys dopamine-producing cells, primarily affecting movement. Dopamine-replacement drugs relieve the symptoms, but about 14 percent of Parkinson’s patients who take these medications develop addictions to gambling, shopping, pornography, eating, or the medication itself. A report in the journal Movement Disorders describes three patients who became consumed by “reckless generosity,” hooked on giving cash to strangers and friends they thought needed it.

Through learning, the signals or reminder cues for rewards come to provoke surges of dopamine. That’s why the aroma of snickerdoodles baking in the oven, the ping of a text alert, or chatter spilling out the open door of a bar can yank a person’s attention and trigger craving. Childress has shown that people who are addicted don’t have to consciously register a cue for it to arouse their reward system. In a study published in PLoS One she scanned the brains of 22 recovering cocaine addicts while photos of crack pipes and other drug paraphernalia flashed before their eyes for 33 milliseconds, one-tenth the time it takes to blink. The men didn’t consciously “see” anything, but the images activated the same parts of the reward circuitry that visible drug cues excite.

In Childress’s view the findings support stories she has heard from cocaine patients who relapsed yet couldn’t explain what prompted it. “They were walking around in environments where most of the time one thing or another had been signals for cocaine,” she says. “They were basically getting primed, having that ancient reward system tingled. By the time they became conscious of it, it was like a snowball rolling downhill.”

The brain, of course, is more than an organ of reward. It houses evolution’s most sophisticated machinery for thinking, considering risks, and controlling runaway desire. Why do craving and habits overpower reason, good intentions, and awareness of the toll of addiction?

“There’s a strong-ass demon that messes you up,” says a burly man with a booming voice who smokes crack regularly.

He sits in a black swivel chair in a small windowless room at the Icahn School of Medicine at Mount Sinai in Manhattan, waiting for his MRI. He’s taking part in a study in the lab of Rita Z. Goldstein, a professor of psychiatry and neuroscience, about the role of the brain’s executive control center, the prefrontal cortex. While the scanner records his brain activity, he’ll view pictures of cocaine with instructions to imagine either the pleasures or the perils that each image evokes. Goldstein and her team are testing whether neurofeedback, which allows people to observe their brains in action, can help addicts take more control over compulsive habits.

“I keep thinking, I can’t believe I’ve wasted all that damn money on the drug,” the man says as he’s led to the MRI machine. “It never balances out, what you gain versus what you lose.”

Goldstein’s neuroimaging studies helped expand understanding of the brain’s reward system by exploring how addiction is associated with the prefrontal cortex and other cortical regions. Changes in this part of the brain affect judgment, self-control, and other cognitive functions tied to addiction. “Reward is important in the beginning of the addiction cycle, but the response to reward is reduced as the disorder continues,” she says. People with addiction often persist in using drugs to relieve the misery they feel when they stop.

In 2002, working with Nora Volkow, now the director of NIDA, Goldstein published what has become an influential model of addiction, called iRISA, or impaired response inhibition and salience attribution. That’s a mouthful of a name for a fairly simple idea. As drug cues gain prominence, the field of attention narrows, like a camera zooming in on one object and pushing everything else out of view. Meanwhile the brain’s ability to control behavior in the face of those cues diminishes.

Goldstein has shown that as a group, cocaine addicts have reduced gray matter volume in the prefrontal cortex, a structural deficiency associated with poorer executive function, and they perform differently from people who aren’t addicted on psychological tests of memory, attention, decision-making, and the processing of nondrug rewards such as money. They generally perform worse, but not always. It depends on the context.

For example, on a standard task that measures fluency—how many farm animals can you name in a minute?—people with addiction may lag. But when Goldstein asks them to list words related to drugs, they tend to outperform everyone else. Chronic drug users are often great at planning and executing tasks that involve using drugs, but this bias may compromise other cognitive processes, including knowing how and when to stop. The behavioral and brain impairments are sometimes more subtle than in other brain disorders, and they’re more heavily influenced by the situation.

“We think that is one of the reasons why addiction has been and still is one of the last disorders to be recognized as a disorder of the brain,” she says.

Goldstein’s studies don’t answer the chicken-and-egg question: Does addiction cause these impairments, or do brain vulnerabilities due to genetics, trauma, stress, or other factors increase the risk of becoming addicted? But Goldstein’s lab has discovered tantalizing evidence that frontal brain regions begin to heal when people stop using drugs. A 2016 study tracked 19 cocaine addicts who had abstained or severely cut back for six months. They showed significant increases in gray matter volume in two regions involved in inhibiting behavior and evaluating rewards.

Marc Potenza strides through the cavernous Venetian casino in Las Vegas. Electronic games—slot machines, roulette, blackjack, poker—beep and clang and trill. Potenza, an affable and energetic psychiatrist at Yale University and director of the school’s Program for Research on Impulsivity and Impulse Control Disorders, hardly seems to notice. “I’m not a gambler,” he says with a slight shrug and a grin. Out of the pleasure palazzo, he heads down an escalator and through a long concourse to a sedate meeting room in the Sands Expo Convention Center, where he will present his research on gambling addiction to about a hundred scientists and clinicians.

The meeting is organized by the National Center for Responsible Gaming, an industry-supported group that has funded gambling research by Potenza and others. It takes place on the eve of the industry’s mega convention, the Global Gaming Expo. Potenza stands at the podium, talking about white matter integrity and cortical blood flow in gamblers. Just beyond the room, expo exhibitors are setting up displays touting innovations engineered to get dopamine flowing in millennials. E-sports betting. Casino games modeled on Xbox. More than 27,000 game manufacturers, designers, and casino operators will attend.

Potenza and other scientists pushed the psychiatric establishment to accept the idea of behavioral addiction. In 2013 the American Psychiatric Association moved problem gambling out of a chapter called “Impulse Control Disorder Not Elsewhere Classified” in the Diagnostic and Statistical Manual and into the chapter called “Substance-Related and Addictive Disorders.” This was no mere technicality. “It breaks the dam for considering other behaviors as addiction,” says Judson Brewer, director of research at the Center for Mindfulness at the University of Massachusetts Medical School.

The association considered the matter for more than a decade while research accumulated on how gambling resembles drug addiction. Insatiable desire, preoccupation, and uncontrollable urges. The fast thrill and the need to keep upping the ante to feel the fireworks. An inability to stop, despite promises and resolve. Potenza did some of the first brain-imaging studies of gamblers and discovered that they looked similar to scans of drug addicts, with sluggish activity in the parts of the brain responsible for impulse control.

Older Couple Drinking Beer In A Royal Room with Chandelier

Now that the psychiatric establishment accepts the idea that addiction is possible without drugs, researchers are trying to determine what types of behaviors qualify as addictions. Are all pleasurable activities potentially addictive? Or are we medicalizing every habit, from the minute-to-minute glance at email to the late-afternoon candy break?

In the United States the Diagnostic and Statistical Manual now lists Internet gaming disorder as a condition worthy of more study, along with chronic, debilitating grief and caffeine-use disorder. Internet addiction didn’t make it.

But it makes psychiatrist Jon Grant’s list of addictions. So do compulsive shopping and sex, food addiction, and kleptomania. “Anything that’s overly rewarding, anything that induces euphoria or is calming, can be addictive,” says Grant, who runs the Addictive, Compulsive and Impulsive Disorders Clinic at the University of Chicago. Whether it will be addictive depends on a person’s vulnerability, which is affected by genetics, trauma, and depression, among other factors. “We don’t all get addicted,” he says.

Perhaps the most controversial of the “new” addictions are food and sex. Can a primal desire be addictive? The World Health Organization has recommended including compulsive sex as an impulse control disorder in its next edition of the International Classification of Diseases, due out by 2018. But the American Psychiatric Association rejected compulsive sex for its latest diagnostic manual, after serious debate about whether the problem is real. The association didn’t consider food addiction.

Nicole Avena, a neuroscientist at Mount Sinai St. Luke’s Hospital in New York, has shown that rats will keep gobbling sugar if you let them, and they develop tolerance, craving, and withdrawal, just as they do when they get hooked on cocaine. She says high-fat foods and highly processed foods such as refined flour may be as problematic as sugar. Avena and researchers at the University of Michigan recently surveyed 384 adults: Ninety-two percent reported a persistent desire to eat certain foods and repeated unsuccessful attempts to stop, two hallmarks of addiction. The respondents ranked pizza—typically made with a white-flour crust and topped with sugar-laden tomato sauce—as the most addictive food, with chips and chocolate tied for second place. Avena has no doubt food addiction is real. “That’s a major reason why people struggle with obesity.”

Two sheriffs patting down a citizen next to a bicycle

Science has been more successful in charting what goes awry in the addicted brain than in devising ways to fix it. A few medications can help people overcome certain addictions. For example, naltrexone was developed to treat opioid misuse, but it’s also prescribed to help cut down or stop drinking, binge eating, and gambling.

Buprenorphine activates opioid receptors in the brain but to a much lesser degree than heroin does. The medication suppresses the awful symptoms of craving and withdrawal so people can break addictive patterns. “It’s a miracle,” says Justin Nathanson, a filmmaker and gallery owner in Charleston, South Carolina. He used heroin for years and tried rehab twice but relapsed. Then a doctor prescribed buprenorphine. “In five minutes I felt completely normal,” he says. He hasn’t used heroin for 13 years.

Most medications used to treat addiction have been around for years. The latest advances in neuroscience have yet to produce a breakthrough cure. Researchers have tested dozens of compounds, but while many show promise in the lab, results in clinical trials have been mixed at best. Brain stimulation for addiction treatment, an outgrowth of recent neuroscience discoveries, is still experimental.

Although 12-step programs, cognitive therapy, and other psychotherapeutic approaches are transformative for many people, they don’t work for everyone, and relapse rates are high.

In the world of addiction treatment, there are two camps. One believes that a cure lies in fixing the faulty chemistry or wiring of the addicted brain through medication or techniques like TMS, with psychosocial support as an adjunct. The other sees medication as the adjunct, a way to reduce craving and the agony of withdrawal while allowing people to do the psychological work essential to addiction recovery. Both camps agree on one thing: Current treatment falls short. “Meanwhile my patients are suffering,” says Brewer, the mindfulness researcher in Massachusetts.

Brewer is a student of Buddhist psychology. He’s also a psychiatrist who specializes in addiction. He believes the best hope for treating addiction lies in melding modern science and ancient contemplative practice. He’s an evangelist for mindfulness, which uses meditation and other techniques to bring awareness to what we’re doing and feeling, especially to habits that drive self-defeating behavior.

In Buddhist philosophy, craving is viewed as the root of all suffering. The Buddha wasn’t talking about heroin or ice cream or some of the other compulsions that bring people to Brewer’s groups. But there’s growing evidence that mindfulness can counter the dopamine flood of contemporary life. Researchers at the University of Washington showed that a program based on mindfulness was more effective in preventing drug-addiction relapse than 12-step programs. In a head-to-head comparison, Brewer showed that mindfulness training was twice as effective as the gold-standard behavioral antismoking program.

Mindfulness trains people to pay attention to cravings without reacting to them. The idea is to ride out the wave of intense desire. Mindfulness also encourages people to notice why they feel pulled to indulge. Brewer and others have shown that meditation quiets the posterior cingulate cortex, the neural space involved in the kind of rumination that can lead to a loop of obsession.

Brewer speaks in the soothing tones you’d want in your therapist. His sentences toggle between scientific terms—hippocampus, insula—and Pali, a language of Buddhist texts. On a recent evening he stands in front of 23 stress eaters, who sit in a semicircle in beige molded plastic chairs, red round cushions nestling their stockinged feet.

Donnamarie Larievy, a marketing consultant and executive coach, joined the weekly mindfulness group to break her ice cream and chocolate habit. Four months in, she eats healthier food and enjoys an occasional scoop of double fudge but rarely yearns for it. “It has been a life changer,” she says. “Bottom line, my cravings have decreased.”

Nathan Abels has decided to stop drinking—several times. In July 2016 he ended up in the emergency room at the Medical University of South Carolina in Charleston, hallucinating after a three-day, gin-fueled bender. While undergoing treatment, he volunteered for a TMS study by neuroscientist Colleen A. Hanlon.

For Abels, 28, a craftsman and lighting design technician who understands how circuitry works, the insights of neuroscience provide a sense of relief. He doesn’t feel trapped by biology or stripped of responsibility for his drinking. Instead he feels less shame. “I forever thought of drinking as a weakness,” he says. “There’s so much power in understanding it’s a disease.”

He’s throwing everything that the medical center offers at his recovery—medication, psychotherapy, support groups, and electromagnetic zaps to the head. “The brain can rebuild itself,” he says. “That’s the most amazing thing.”

About the author: Fran Smith is a writer and editor. This is her first article for National Geographic. Max Aguilera-­Hellweg is a photographer who also trained as a medical doctor. His last assignment for the magazine was “Beyond Reasonable Doubt,” in the July 2016 issue.

Link to article here: How Science is Unlocking the Secrets of Addiction