Welcome to Hope Rehabs ‘what is addiction’ page, on here you will find a detailed and compressive explanation of the latest and most helpful theory of addiction. It can come as a surprise for many addicts and non-addicts that Addiction is regarded as a disease and therefore treated as a disease. Please cast any suspicions aside and open your mind to allow this very helpful and revealing information in. For many addicts, it comes as a relief that we are not bad people, we just require the right treatment for our illness. At Hope we have created the optimal program to address all the various elements of this destructive condition, giving you the best chance for recovery.

The brain is constructed of long, skinny cells known as neurons or nerves. Neurotransmitters are chemicals that the brain uses for cell-to-cell communication. It is the inter-neuron communication after substances cross the blood-brain barrier, that causes the desired effects. Neurotransmitters are like the sparking action of a spark plug or a key that fits into a lock. They can be Excitatory or Inhibitory, regulating our mood. The ones listed below are related to addiction and to experiencing pleasure and satisfaction:

The brain is a three-pound mass containing some 100 billion nerve cells – neurons – there are some 100 types of neurotransmitters in the brain. For example, as long as serotonin is flowing between your neurons, your world is 3D instead of grey or flat. Oxytocin is like an invisible cord that creates unity in relationships. It’s released during orgasm and helps couples to create an emotional bond. Each neurotransmitter is like a puzzle piece, and it flows across the gaps from one neuron to the next where it looks for the correctly shaped hole in which to bond. Think of a typical neurotransmitter like a letter. It sends information. You keep paper in your house for when you need to write the letter, you send it and it is received by one person. The neurotransmitter dopamine is released into the nucleus accumbens and produces pleasure. This system is called the reward pathway. When we do something that provides this reward, the brain records the experience and we are likely to do it again.

Damage to the nucleus accumbens or reward center blocks dopamine release in the region and makes everything less rewarding. The natural capacity to produce dopamine in the nucleus accumbens/reward system is reduced. Damage and neuronal degeneration are associated with chronic substance abuse. Also cognitive impairments, executive function, mood and movement disorders.

Dopamine is stored in cells like barrels full of chemicals. When something occurs like a good meal or great sex the brain pours out some dopamine from the dopamine barrels into an open space in the brain called a synapse. It floats around there. Think of the synapse like a street, and dopamine is like little cars driving around aimlessly on the street. Most dopamine-producing neurons are located in areas near the brainstem:  the mesolimbic pathway, which projects into the limbic system, including the hippocampus and amygdala. It is particularly important for motivation, the experience of pleasure, and reward.

In depression, lack of dopamine, among other things, would account for the lack of pleasure. In mania, too much dopamine is viewed as rocket fuel. The brain’s prefrontal cortex helps to rationalise and check the urge to take the drug when it would be unwise. Motivational drives are also a brain function that is damaged by addiction.

Treatment specialists see the latest ASAM definition as a validation of what has come to be commonly known as “the disease concept” of addiction since the publication of Alcoholics Anonymous in 1939. Many people in the population at large see addiction as a moral, social or chosen problem. However understandable this is, it is a dangerous mistake. The Disease Concept is not the medical model as addiction cannot be cured in the traditional medical sense or in a hospital.

Treatment means addressing psychological, environmental, social and spiritual components (triggers), not just the biological condition. Medication can be helpful, but it needs to be combined with therapy, behaviour and lifestyle change.

Addiction is like a cardiovascular disease: recognised as chronic, it must be treated, managed and monitored over a lifetime because there is no pill, which alone can cure addiction. Choosing a recovery lifestyle over unhealthy behaviours is akin to people with heart disease who choose to eat healthier and exercise.

Addiction is disrupting our hierarchy of needs: The human reward system is designed to support survival and has been hijacked by the chemical payoff provided by the addiction. The reward circuitry bookmarks things that are important: eating food, nurturing children, having sex, and sustaining intimate friendships. Use of the substance then starts to happen at the expense of what otherwise would promote survival.

One analogy that is helpful here involves imagining the brain is like a ski slope after a heavy snowfall. Think about how as skiers make their way down from the slopes, their progress creates grooves in the snow – these grooves get deeper as they are reused. These paths created by thinking can become so ingrained that it requires a great deal of effort for the thought-skier to traverse onto a new path. However, if the new path is followed enough times, it can eventually replace the old groove.

Neurologically based impulses to use drugs or alcohol sometimes stay hidden unless they are triggered, or opportunity arises. It is as if a threshold has been crossed. Very few people appear able to successfully return to occasional use after having been truly addicted. Addicts usually lose control over their addictions. This is known as powerlessness or compulsive behaviour.

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Substance addiction dulls and desensitises the reward circuitry. Nothing else can compete. Work, family, and friends lose their value until eventually, the person isn’t even able to get any reward from the substance – by this stage, it doesn’t matter because the addicted brain drives the person to keep perusing the drug even without the reward.

The Hijacked Brain: The human reward system is designed for survival but is hijacked by the payoffs provided by the addiction. The reward circuitry normally bookmarks important things like food, nurturing children, education, work and friendships, however, it is now corrupted.

The destructive and unhealthy behaviours themselves are all consequences or symptoms of the addiction, not the disease itself. The state of addiction is not the same as the state of intoxication or even physical dependency. Substance abuse is considered a form of self-medicating, allowing their users to escape temporarily from the condition that troubles them.

Instant gratification: In nature, rewards usually come only with effort and after a delay. Addictive drugs provide a shortcut, flooding the reward center with dopamine.

The dopamine pleasure pathway is the Go system, and the pre-frontal cortex is the Stop system.   When the reward centre in the middle of the brain becomes active, it’s as if it says Go>Go>Go. When we anticipate and experience something good like food or sex, alcohol or drugs, our brain experiences a surge in the level of the neurotransmitter dopamine. The term addiction comes from the Latin word ‘addictus’ roughly meaning ‘enslaved by’. Shakespeare was the first recorded writer to use the word addiction in Henry V, meaning he liked activities of no value or importance. Anyone who has struggled to overcome addiction, or tried helping someone, understands why. It could just as well be renamed Reward Deficiency Syndrome.

Another part of the brain, the pre-frontal cortex or higher brain is responsible for executive functions. It has evolved over time to help us weigh up the consequences of our decisions. It helps us to put a lid on impulsive behaviour. The “Stop” system is the Brain’s brakes. The signals to the prefrontal cortex, however, tend to be a bit slower.

We need to stop and think things out before forging ahead with an impulsive decision. Putting it in the simplest terms, the “go system” hijacks the “stop system” in the course of this brain disease called addiction.