The Neuroscience Of Addiction Chapter 1 ‒ Choice
- Brainz Magazine
- Jan 13, 2023
- 5 min read
Updated: Jan 14, 2023
Written by: Dr. Christopher Ashton, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
Puzzling, bewildering and tragic is the experience of people, family and loved ones when seeing, against all rationality, the drinker drinks again or the addict starts consuming. We cheer their efforts as they seem to be doing all the right things and showing sincere effort, and yet another round of disaster ensues. Often people die, although it’s often listed as ‘suicide’ not substance use disorder (SUD). Truth is that the two entities often go hand in hand.
7 to 10 day detox programs are almost a certain recipe for failure, although they’re to be commended for providing humanitarian support for people who can’t carry on with the sickness of substances and allow them a reprieve. 12 Step programs are equally ineffective for the vast majority of persons who participate. Nonetheless, they are to be applauded for offering hope, support and occasional success at no cost to suffering people, most of whom cannot afford the price of private rehabs.
It’s difficult to destigmatize alcoholism and addiction as a ‘disease’ when households are being torn apart, people are being shot or robbed, or precious lives instantly evaporate as a result of drunk drivers
This series will shine light on the ‘whys’ of continued tragedy and offer a rational approach out. People who continue to consume or those who relapse in light of clear evidence that substances are destroying their lives and those around them appear to have no conscience. Rather, in a mammalian sense, they seem to care nothing about getting drunk or high. Despite major attempts, it’s difficult to destigmatize alcoholism and addiction as a ‘disease’ when households are being torn apart, people are being shot or robbed, or precious lives instantly evaporate as a result of drunk drivers.
Where does one even start to make sense of this societal mayhem caused by drugs and alcohol? Definitions of disease and disorder vary so widely across associations and professions that they offer little in terms of description. I just call it ‘the monster’ given what it does to people, often seemingly beyond control. Completely baffling in how people can suddenly relapse often without warning signs, it is little wonder that it’s been framed as a spiritual condition, a matter to be managed by higher powers.
Fortunately, it can be characterized as something real and comprehensible although there are many components to it. This series takes a reductionist approach initially in hopes that the reader will be able to ‘connect the dots’ after reading chapters down the road.
Let’s have another look at the following frightening brain scan (Source: Harvard Medical School, 2021) of someone addicted to cocaine and what it illustrates.
Clearly, the yellow part in the front of the brain above the eyes (orbitofrontal cortex or OFC) shows far less activity in the addicted person than the healthy control. Secondly, the purple section in the interior of the brain (mid-brain or limbic system) is far more expanded in the cocaine person. It even looks a bit like a monster.
From conception to approximately age 25, the yellow and purple areas codevelop together in aim of survival based on ‘healthy’ or ‘neurotypical’ decisions that are good for people over the life course. Very, very briefly, the yellow area (the prefrontal cortex) is considered the rational part of the brain developed to align with societal values and norms and make decisions in response to motivating stimuli from the purple part (the rest of the limbic system). Also simplified, the yellow area is considered more ‘conscious’ (meaning the person is aware and thus may be able to exert influence). The purple area is ‘subconscious’ and provides energy, stimuli and occasionally instructions based on emotions. The monster affects both, drastically.
Motivation for action is through dopamine, a neurotransmitter often confused as imparting reward
In neurotypical persons, the deeper limbic system signals want or need (and occasionally directly creates action) and creates motivation for action (through dopamine, a neurotransmitter often confused as imparting reward) to the prefrontal cortex (PFC) for processing. The two major regions are in continuous communication with each other. The PFC can roughly be described as a traffic light in response to the inputs from the rest of the limbic system. Largely acting on inhibitory signal strength, the PFC may immediately stop an action motivated by the limbic system (red light), determine it needs further consideration and engage other executive brain structures (yellow light) or approve it immediately (green light). In severe SUD, the PFC signal strength is such that it acts as a green light, allowing actions and behaviors to be dictated by the emotional center of the brain.
Overall, decisions and actions are largely based on the relative strength of executive and emotional electrical signals.
Persons are essentially powerless for a certain time period; choice regarding substances can be absent
Returning back to our diagram from HMS, a characteristic phenomenon of SUD is explained, that is the inexplicable continued consumption of addictive substances despite all rational evidence to abstain. In addicted persons and those who have abstained for minimal time periods, there is simply not enough capacity for signal strength in the PFC to inhibit (red) or even consider consequences (yellow) of exaggerated impulses to indulge in substances from the purple area. Persons are essentially powerless for a certain time period. Nonetheless under the correct conditions, the PFC can reactivate as the emotional centers are slowly normalizing.
Estimates are that this neurobiological process isn’t truly in synchrony for at least three months. It is little wonder that detox units are temporizing measures as are the majority of other modalities. Once severe SUD has developed, choice is essentially absent in the early days when the correct cue or stress is presented (often minute in nature). Terrible things happen, usually worse than previous (further chapters in this series will explain why). Nobody or nothing often seems to help.
Efforts focused on re-establishing prefrontal cortex capacity can be life saving
Fundamentally, efforts focused on re-establishing prefrontal cortex capacity can be life saving. Equally ensuring low stress (stress impairs healing) and safe environments minimizing cues are often paramount. ‘Turning the lights back on’ in the PFC is promoted through general healthy lifestyle measures. Additionally, we have found neurofeedback meditation, cognitive challenge and monitoring, as well as high intensity exercise gives far better outcomes than many conventional approaches through focusing directly on prefrontal cortex activity.
The next chapter in this series will discuss the science of altered reward function and the development of a separate anti-reward system as empowering the monster.
Dr. Christopher Ashton, Executive Contributor Brainz Magazine
Christopher Ashton is a thought leader and truth seeker in all matters pertaining to improving health in individuals, organizations and populations. Educated in engineering physics, medicine and business finance, Christopher is able to connect the dots in multidisciplinary, complex scenarios in a manner few other persons can. Driven by the belief that answers always exist, he is currently making sense of previously incomprehensible human decisions from an organic, scientific basis. His personal goal, create something so creative and discover new truths worthy of consideration for a Nobel prize.
