Previously we mentioned that the pleasure center is a portion of the brain over which we have no conscious control, and that it can be stimulated by a variety of chemicals — some of them produced inside our bodies and some that we introduce from outside. We said that the pleasure center rewards us for activities that it interprets as contributing in some way to our survival, whether they be social interactions, exercising, or more prosaic things such as eating. We also stated that these pleasurable feelings, when pursued too far or for too long can create problems. Now we need to examine how that happens.
While the actual mechanism of addiction is terrifically complicated, the underlying principles are reasonably simple.
- When we use drugs or are involved in pleasurable activities, they stimulate (or cause the stimulation of) receptor sites in the pleasure center and other areas of the brain. This causes us to feel good.
- With constant stimulation, the brain begins to adjust to the higher levels of brain chemicals by making physical changes that involve, among others, the growth of additional receptor sites to accommodate the excess neurotransmitters. This leads to tolerance: needing more stimulation in order to achieve the same effects. Tolerance is one of the first signs of developing addiction.
- As tolerance develops, we reach a point where our brain needs the presence of the stimulation in order for us to feel normal. If we cease whatever is causing the stimulation, whether it be alcohol, other drugs or stimulating activity, for very long we begin to feel uncomfortable because all those extra receptors are telling us they need to be filled up.
- Eventually, we reach a point where any pleasure is short-lived, and we simply need the stimulation to keep going. When we don’t have it, we experience withdrawal, feelings that, as a general rule, are the opposite of whatever good feelings the stimulation caused. If we were using cocaine or other central nervous system stimulants, we feel depressed; if using downers, agitated; if we are a thrill junkie, bored and/or depressed, etc. Because of the changes in other parts of the body there are often other symptoms. For example, opiate withdrawal is like the worst case of flu you can imagine, doubled, combined with overpowering anxiety, nervousness and generally feeling terrible both physically and emotionally.
- At the point of marked, prolonged withdrawal in the absence of the drug or activity, we are definitely addicted.
But why can’t we quit? We know using is causing us life problems, and we know withdrawal doesn’t last forever. There are even medications to help. What’s with the constant failures to stop using?
Remember that we said the pleasure center is a part of the brain over which we have no conscious control. This part of the brain, because it is survival-oriented, interprets failure to meet its needs as survival issues. We have created an artificial situation in which the brain needs extra stimulation to feel normal. Therefore, when it does not get the extra stimulation, it sends messages to our subconscious that our very survival is threatened. Addicts continue to use because their subconscious, over which they have no control, tells them that if they don’t they’re liable to die.
Those messages alone are enough to make it extremely difficult to stop using. When reinforced with physical withdrawal, they are sometimes impossible to overcome with conscious effort because — again — we have no control over the feelings or the symptoms except for the use of more drugs.
Of course there is more to it. The stresses created in our lives by addiction-related problems (and perhaps problems that preceded the addiction) make it even more difficult for us to allow ourselves to return to reality. We must first detox from the drug, and then we need a lot of support and help while normalizing our social, emotional and health issues during the first months and years of sobriety. We also need help getting through the “post acute withdrawal syndrome” (PAWS) that occurs while the brain and rest of the body are rebuilding and getting back to something like normal. This can take a long time, and the issues associated with PAWS are a frequent (if not the most frequent) cause of relapse.
That, however, is a subject for another article of its own. For now, understanding that addicts are subject to powerful emotional and physical experiences over which there can be no direct control will clarify a lot about addiction and the problems of getting clean.