Understanding Addictions Part 2

Addictions can invade every facet of our lives.  Whether we are the addict, in close relationship with an addict, or deal with it at work or in friendships our hope is this series will help with understanding and seeking help to work through and come out the other side healthy and whole.   So please stick with us and post comments or email us and ask us questions.... we are here to help!

For as prevalent as addiction is, the amount of misinformation and misunderstanding that surrounds the issue is truly disheartening. The word itself is used in a variety of different contexts, anywhere from offhand comments to deadly serious medical conversations.

In this three-part series on addiction, our goals are to first define what addiction is, then to understand why and how addictions happen, and finally to look and see what we can do about addiction.

In Part 1 of our series, in exploring what addiction is, we came to understand that it’s vitally important to keep addiction in the proper perspective: The established prevalence rates are undoubtedly alarming, and higher than you might think. And yet, at the same time, it’s important to keep in mind the rigorous scientific criteria for addiction, so that we don’t mistake an innocuous habit for a deadly disease.
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In this second in-depth look at addiction, we’ll try to understand why addiction happens, and how this works in the brain.​

Etiology of Addiction

When medical professionals consider the causes of things, they will often times use the word “etiology.” Also spelled “aetiology,” the word comes from the Greek words “aití,” meaning cause, and “logos,” meaning discourse or study.

So when we discuss the etiology of addiction, what we are talking about is simply the study of or discourse about the causes of addiction.

And as with any ongoing study, there are a variety of models by which we can explain addiction, each with its own degree of truth. These theories are generally divided into three major subgroups: Social theories of addiction, psychological theories of addiction, and biological theories of addiction.

Of course this wealth of information provided by the different theories and ideas about the causes of addiction are very difficult to sum up in brief. Nonetheless, here is a short list of factors that have been identified by scientists as potential contributors to the development of an addiction:
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• Insecure attachment in childhood leading to an addictive personality as a coping mechanism
• Emotional pain or emptiness from the family of origin; lack of supervision or family structure
• Modeling of addictive behavior from a primary caregiver or important childhood figure
• Peer pressure, particularly in young adulthood; behavior as part of an effort to form identity
• Conforming to the norms of a group that had a negative influence; being teased or coerced
• Perceived individual deficiencies in personality being met or filled by the addictive behavior
• Hereditary factors, or, more importantly, the perception that an addiction is hereditary
• Gateway effects, in which lighter substances or behaviors end up resulting in heavier use
• Community structure fostering use of addictive substances; enabling rather than discouraging

It’s important to note here that this is not an exhaustive list, nor is it a conclusive diagnosis. This is simply an informal assemblage of some of the different factors that, when combined together, can potentially lead to addiction.​

Brain Mechanism of Addiction

None of the factors listed above is a conclusive diagnosis for an addiction. And all of the factors above contribute to the development of an addiction in different ways, according to different models. Some factors contribute to social development of an addiction; others contribute to psychological need.

But in one very important sense, all of these various different understandings of addiction ultimately come down to the brain.

Every predisposition, every personality feature, every behavior, every memory, every fixed action pattern, every temperamental factor – ultimately, each of these bears a physical legacy in the brain of the individual. And regardless of whether treatments for addiction include talk or behavioral therapy, social support groups, medications, or any combination of these, it is the brain that is treated.

In this way, understanding how addiction manifests from the microscopic perspective of the brain is just as important as understanding how addiction manifests from the macroscopic perspective of etiology.

In brief, understanding how addiction happens in the brain is tantamount to understanding long-term memory. Basically, when something positive or pleasurable happens to us, it is advantageous for us to remember this feeling, and to know how to recreate it. For prehistoric man, the ability to remember a lush watering hole could have been the difference between health and starvation.

And mostly, the things that make us happy (or, more to the point, the things that activate the reward pathway of the brain) are also the things that provide us adaptive advantages, such as loving relationships, wholesome foods, exercise, etc.

However, in addiction this adaptive learning process becomes twisted, and we “learn” that the rush of neurochemical release that accompanies a reward will only come if we continue using a substance or performing a behavior that has been demonstrably damaging to our body or our relationships.​

Why This Matters

Without going into too much detail, the important thing to understand about the neurobiology of the reward pathway mentioned above is that the effects of the addiction can have very widespread effects.

The connections involved in the reward pathway are located in the part of the brain known as the medial forebrain bundle, which is important to understand because this bundle has nerve connections throughout a big portion of the brain, including areas that are involved with emotion, pleasure, memory, and decision-making ability.

So when an addiction to a substance or behavior ends up changing or altering the neural machinery for an entire class of molecule – such as the way the pleasure neurotransmitter dopamine is taken up and used by brain cells – this global change can’t help but impact a huge variety of different areas. When the brain’s pleasure system becomes rewired due to addiction, it can affect everything.

Just in the same way that a bodily disease like cancer can metastasize and spread throughout a number of different organ systems, so too can the brain disease of addiction spread throughout a number of different mental and emotional systems, wreaking havoc in just the same way.

Fortunately, unlike cancer, the effects of recovery efforts and rehabilitation programs can form a positive spiral, making the chronic brain disease of addiction something that is eminently treatable.
Stay tuned: In Part 3 of our series we will discuss the responses necessary to lead to wholeness and healing from the horror of addiction.​

References
Erickson, C. K., & Wilcox, R. E. (2001). Neurobiological causes of addiction. Journal of Social Work Practice in the Addictions, 1(3), 7-22.

Hyman, S. E., Malenka, R. C., & Nestler, E. J. (2006). Neural mechanisms of addiction: The role of reward-related learning and memory. Annual Reviews of Neuroscience, 29, 565-598.
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Jadidi, N., & Nakhaee, N. (2014). Etiology of drug abuse: A narrative analysis. Journal of Addiction.

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