Stigmas plagued addicts for centuries, as misinformed people viewed addiction as a character or moral flaw. However, in recent decades, researchers identified addiction as a disease of the brain’s reward system and dopaminergic pathways. In other words, modern science and technology have increased our understanding of addiction, recovery and treatment.
One of the essential ways science helped our understanding of addiction is by explaining what makes the condition a disease. Technological breakthroughs in imaging, scanning and other tools helped researchers see how the brain works, including neural changes related to addiction. Developed by the American Society of Addiction Medicine (ASAM) over four years with the help of more than 80 experts, the following long-form definition of addiction highlights the condition’s primary aspects:
- Affected brain areas include the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala
- Altered neurotransmissions between cortical and hippocampal circuits affect memories of previous exposure to drug and alcohol reward
- These alterations change motivational hierarchies and produce memories that, when cued, trigger cravings for the substance of abuse
- Dysfunction in the frontal cortex and underling white matter connections impair impulse control, alter judgment and motivate the unhealthy pursuit of reward
- Addiction-related diseases in the frontal lobes limit the ability to delay drug-reward gratification
- Genetic and biological vulnerabilities account for approximately half of the risk that is involved in addiction development
While the quantity and frequency of substance abuse affects addiction development, ASAM argues that the way someone responds to alcohol, drugs, stressors and environmental cues is a primary characteristic of addiction. In other words, what substance exposure does to individuals is as significant as how much or how often people use, so stronger substance sensitivity can heighten someone’s preoccupation with and pursuit of reward. Other neurobiological effects that stem from addiction include impairments in executive functioning (e.g., judgment and decision making), profound substance cravings, accelerated mental health issues and degenerating social bonds (which means it becomes increasingly more difficult to relate to others).
The latest edition of the Diagnostic and Statistical Manual on Mental Disorders (DSM-V) prefers “substance use disorder” as the term for what most people associate as addiction. As explained by the National Institute on Drug Abuse (NIDA), DSM-V characterizes the disorder by impaired control, social impairment, risky use and pharmacological criteria like tolerance and withdrawal.
Addiction and the Mesolimbic Pathway
A significant scientific finding that involves addiction is the role of the mesolimbic dopamine system, a neural pathway of supreme importance for drug-related reward. Dopamine is a neurotransmitter that sends signals between nerve cells, and drugs trigger reward in the dopaminergic pathway by either spiking dopamine production or by delaying its absorption. While most addictive drugs increase dopamine, others affect other neurotransmitters as well. For example, benzodiazepine sedatives increase the efficiency of gamma-aminobutyric acid, stimulants increase production as they limit the absorption of norepinephrine and opiates (e.g., heroin and painkillers) imitate neurotransmitters like endorphins and bind to their receptors in the central nervous system. Excessive levels of neurotransmitters can shrink and desensitize neural receptors and reduce natural production, which leads to physical dependence on the drugs to perform functions that the body formerly handled itself.
A better understanding of the relationship between addiction and neurotransmissions has helped in the following ways:
- Clinical studies found that Cognitive Behavioral Therapy (CBT) and certain other modalities can help restore healthier neurotransmissions
- Holistic activities like physical fitness increase the production of endorphins and promote healing in the body’s opiate receptors
- Breakthroughs in prescription drugs provide potential options to make the detox process safer and more comfortable
Technology plays a key role in science, but improved clinical testing is equally important, particularly in CBT. Therapists originally used the modality to treat depression, but, in the 1990s, the NIDA and other groups funded studies for addiction recovery. One such study, published by the Archives of General Psychiatry in 2004, outlines that CBT modulates neural functioning in the limbic and cortical regions, while other studies find that it stimulates activation of certain frontal regions while it reduces activation of the amygdalohippocampal subcortical regions. These findings allowed researchers to confirm the viability of CBT in addiction treatment.
The Role of Mental Health in Addiction
Scientific research also increased our understanding of the relationship between addiction and mental health disorders. In a 2005 edition, the American Journal of Psychiatry cites a study that suggests 72 percent of addicts have at least one co-occurring disorder like depression or anxiety. It also highlights the following possible connections between the two conditions:
- Potentially different expressions of related neurobiological abnormalities
- Shared common elements and regions related to abnormal neuro-adaptation
- Stress influences both disorders and may amplify the dopaminergic pathway
If someone has either a substance use or mental health disorder, then her risk level is substantially higher for contracting both conditions. Science has identified the neurobiological connection, risk factors and underlying causes, and treatment professionals utilized the findings to provide the most effective integrated care.
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