Disease?

If you call it a disease then you have to give it medical treatment.

In a recent and freely downloadable article[i] co-authored by Nora Volkow of the National Institute on Drug Abuse titled Addiction: Pulling at the Neural Threads of Social Behaviors in tomorrow’s Neuron she and her colleagues pull at the heart-strings of the readers. They quote a parent who has had a child steal money from her to but his drugs. Another middle-aged man is quoted in his struggle with alcohol.

From that and other observations such as addicts will take $20 today instead of $40 next week and that addicts getting out of prison have steep challenges to staying sober she concludes “stigma and isolation can further impair the function of neuronal systems necessary for an addicted person’s recovery.” And from that, “addiction as a disease rather than a criminal behavior.”

Wow.

It turns out that the treatment for the sense of isolation and the social stresses referenced isn’t medical at all. It is community and accountability. I take issue with the idea that human beings do not have a choice in the area of addiction. In fact, choice is the very essence of addiction. The addicts are actively choosing the more likely of two rewards from their vantage point.

I will give her the point that the frontal cortex (Orbito-Frontal to be exact) is involved in the measurement and analysis of beneficial choices. It is the likely center of judgment itself. Meditation has been shown to increase the MRI density of this area and the neighboring insula, even if it is done for a few weeks.[ii] The more we practice making good choices the better we become at them. Which is the point I’m trying to make.

Addiction is a co-opting of normal mental processes. All creatures are evolutionarily chiseled to expert precision in pattern recognition and discrimination. Homo Sapiens is so good at pattern recognition that it can spot a pattern when none exists. The more the drug use or short-cut behavior is chosen the more likely a person is to choose a short-term reward. As you know, eventually the choice isn’t for pleasure but merely a reduction in pain.

Drugs in prison

In the 2009 report from Columbia’s CASA[iii] there was a sad statistic. Of the 2.3 million people incarcerated in the US in 2008, just over 2 million of them met criteria for diagnosis of chemical dependency. Half of the inmates were serving time for drug-related charges. Another additional quarter of the inmate population were serving time in the commission of crimes to support their drug habit (burglary and theft).

I spoke with a friend who had spent some time in prison as a result of some mistakes he made in a business he ran. He was sober when he went into prison and during the nearly two years he was there found it very difficult at times not to succumb to the temptations in prison to get high. The drugs were everywhere around him. What pulled him through sober were two things: 1) he made a decision to stay sober no matter what and 2) my friend had the support of close friends and family to rely upon. Nearly all of the family and friend support was mostly imaginary because there was limited contact while he was incarcerated.

He broadened his support network by connecting with similarly minded people in prison. A commitment was made but as importantly nurtured during the most challenging of times. My friend employed the method of approximation that the long-term payoff for remaining sober was greater than the expedient payoff of getting high on any particular day on the inside. His wife even divorced him and he stayed with his sober choice. Talk about commitment.

Neuroplasticity

Our brains are adaptable and changeable. In fact, the only thing you can really count on to stay the same is change. People don’t start out as addicts though most of them report feeling different from other people in starting in their youth. Ironically if you assemble a large group of ex-addicts together that is one thing they will invariably have in common: the sense they are different from everyone else. It usually provokes laughter of recognition when they figure that out by hearing a stranger share precisely how they felt. The facts vary but the feelings are astonishingly consistent.

The brain of the non-addict can be changed into the brain of the addict. The brain of the addict can be changed into the brain of the non-addict. I am not saying that people who formerly drank themselves into pain and misery should pick it up again after a long hiatus. There are many practical reasons why you might want to leave alone the booze or drugs if you have had a problem with them. These subroutines that are created to efficiently seek pleasure (avoid pain) become neural modules and though not used for years are easily refitted into active use. The brain can remember a behavioral dance for one’s whole life. It’s like, well, like riding a bike.

The idea that if we can just get the brain to behave like it normally should then we’ll have conquered addiction is silly. The brain is behaving normally while it is addicted.  It is just naturally using the tools handy to get the feeling and experiences sought in the shortest time possible. This-is-your-brain-on-drugs is old thinking leftover from the 1980s failed war on drugs. Drugs do not have volition. They cannot attack and subdue us.

If we are going to escape from the chemical or behavioral prisons we have fashioned for ourselves then we must use the tools we have. Human beings are pack animals and we are safer when we stick together. Ironically saying that person has a disease causes them to feel inferior and for people to inch away from them.

I imagine a future where the medical profession does not have to compartmentalize a person to help them. Where we can speak freely about dumb choices we made and don’t feel shame around asking for help with tough problems. Where we can just be human beings. Where we can just be free.


[i] Addiction: Pulling at the Neural Threads of Social BehaviorsNora D. Volkow,1,* Ruben D. Baler,1 and Rita Z. Goldstein2 1National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA 2Department of Medical Research, Center for Translational Neuroimaging, Brookhaven National Laboratory, Upton, NY 11973, USA

[ii] http://www.nmr.mgh.harvard.edu/~lazar/

[iii] 2009 report on substance abuse in prisons. New York: The National Center on Addiction and Substance Abuse at Columbia University.

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Category: Current Events, Drugs, History, Neuroscience

About the Author: Dr. Jason Giles is certified by the American Board of Addiction Medicine and the American Board of Anesthesiology. He is a physician specializing in the treatment of drug, alcohol, and behavioral addictions. He is the founder of Haywire.


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