by Mark P.
I have been following the literature on chemical dependency for 17years and always like to get my $.02 in. Especially since this has been a topic of discussion here of late.
The nature of chemical dependency is, to me, one of nature’s really fascinating stories. Why is there such a thing as addiction at all? What even makes such an odd thing possible? If you step back from it, it sure is a goofy-ass thing to have happen to anybody.
“Once upon a time”…. roughly 500 million years ago, evolution came up with one of its most elegant inventions. It happened in some fish-like critter since the land wasn’t populated yet. It was the evolutionary invention of the self rewarding neuron. Imagine it. A “feel good” neuron. A way to manipulate behavior (in evolutionary terms) by having the organism reward itself!! This is, to me, one of the most interesting moments in all of evolution, because it is what makes complex behaviors possible. So here we are 500 million, or so, years later at the end of an intricate evolutionary shaping process.
What makes you feel good? Sex, obviously. If it weren’t for these reward neurons, sometimes called reward centers, there wouldn’t be 5 billion or so sapiens sapiens running around the planet. But these reward systems are much more ubiquitous and subtle. They reward us for all kinds of things from eating a good meal to doing a good job to making a friend. They regulate our social behavior in public. They make possible intricate forms of social learning. There are probably thousands of behaviors that are rewarded by our own little brains, and hundreds of reward systems to deal with them.
Remember, this has been going on for 500 million years, enough time to create some pretty evolutionarily crafty stuff. So there you are, your wife has just given birth to your first child and you see it for the first time and are overwhelmed with good feelings. Reward system in action, big time.
So how about addiction? As I mentioned there are probably hundreds of these reward centers in the brain. Certainly trillions of reward neurons coursing throughout most of the brain. When one ingests what we call addictive chemicals what happens to the brain is that most or all of the these reward centers are set off at once. In a way that was never intended by Mother Nature. The addictive chemicals bind to the receptors on these reward neurons and, if you’re on this email list, you know what happens. Especially in the early stages of addiction: Euphoria. An overwhelming sense of wellbeing. No problems. All is well with me and the world. I look in the mirror and I am 2 inches taller and I can talk to girls at the dance…etc. The effect of all this is BAM!…new brain! The use of the addictive substances reconfigures the whole reward system of the brain. In little pieces these reward systems motivate evolutionarily productive behaviors and, as I mentioned, the success is in the pudding. 5 billion or so.
But, now all of Mr. Brain’s reward neurons have been set off at once and focused on the substance that did it! Holy shit, Mary. The use of the substance, because of its effects on the reward neurons, takes on all the characteristics of the strongest biological drive possible. It surpasses even the drive for self-preservation. Why? Because the brain’s reward systems have been reconfigured to support the use of the substance that sets them off, in the same way that they were originally configured to reward certain behaviors, only now they have become overwhelmed, focused on supporting the use of the addictive substance. We all know what happens from that point on.
At this level of organization an addiction is a relatively simple thing to understand. At the neurochemical level it gets a little more complicated. All brains are not the same. All receptor sites are not created equal. Thus, because some molecule in a person’s dopamine receptor hooks a little left instead of right, cocaine is not addictive to that person but might be to the other 80% of the population. Alcohol we know becomes addictive to those whose neurochemistry manufactures a synthetic opiate out of alcohol. We’ve known this for at least 26 years. Hence the reason alcoholism is hereditary. The possible neurochemistry is coded for in the DNA. It only becomes a problem when it meets alcohol.
So, is this a disease? Certain things are irrefutable. It is organic. It is biologically based. It is a functional disorder of the reward system of the brain. It alters the behavior of trillions of neurons. It causes irreversible damage. You, obviously, can’t have the condition without the addictive chemical but then you can’t have an allergy without the allergic substance.
I will say that, in my humble opinion, the understanding of the nature of addictions represents the finest of what science can do. Parenthetically, the most significant research wasn’t done by people in the alcohol/drug field. As is often the case, old paradigms do not change from within but only change when confronted with new evidence from without.
What is not so nice is what happens in the socio/political world. It has always been difficult for Western culture, particularly American culture, to accept any behavior that is not volitional. We are, after all, captains of our destiny are we not? There is this thing called consciousness and it is the arbiter of all behavior. That’s the way it is for me, by God, and that’s the way it is for you. If you’re “addicted” to a substance it’s your own damn fault, etc.
Most people in A.A. have no real understanding of the biology of addiction. When they talk about the disease (dis- ease [give me a break!]) they are usually referring to some kind of characterological disorder (addictive personality or somesuch) as the disease entity. It is all very strange and, of course, interspersed with mysticism.
For some reason many individual resent the idea of being “diseased.” I have never really understood why. Personally I don’t give a tinker’s damn that it might be a “disease.” What matters to me is that there are behavioral techniques and therapies that can be used to put this thing in remission. I think I am grateful that so many people have spent so much time in trying to understand this thing and uncover its nature. It perhaps, someday, will change the attitudes of the general public toward chemical dependency. But, I’m beginning to ramble. I hope the above gives people a context in which discussion can take place about this crazy, deadly thing called addiction.
(Posted April 14, 1997)