Updated: Jan 10
A simple discussion on what happens in the brain during addiction
Our brains are complex universes with massive simultaneous communications happening in milliseconds. In addiction, the communication process between a few areas of the brain are different that that of those who do not have the disease. Understanding these differences can help us have more compassion for those with addiction (also called Substance Use Disorder [SUD]).
Dopamine is the neurochemical produced in the brain that is the common problem in those with SUD. Dopamine is produced in many places but mostly in the midbrain (ventral tegemental [VTA], nucleu accumbens, amygdala, hippocampus). The midbrain and the dopamine produced in the midbrain link pleasure and survival so that it feels good to do things that keep us alive. For example, it feels good to eat, get hydrated, go to the bathroom, breathe... you get the idea. The midbrain helps us to do these things and it also communicates with the frontal lobes, the area of executive functioning, also called the prefrontal cortex. When we are using our frontal lobes, we apply reason, make decisions, have personality and values, and are rational. Using our frontal lobes we might decide to have sushi for dinner instead of a cheeseburger. While the midbrain says, "I'm hungry, let's eat." The frontal lobes say, "What should I have to eat?"
Communication between the midbrain and frontal lobes changes for people with addiction. While many people are predisposed to becoming substance dependent, many are not, and what we know is that either way, if you do enough of an addicting drug (including alcohol) often enough, you will become addicted to it (aka substance dependent). Because addiction involves massive amounts of dopamine dumping out and creating euphoria for the user, the brain becomes depleted of its endogenous dopamine. An easy way to think about this is that the person using a substance takes it into their system, the brain dumps out dopamine, and the person experiences a high. After use and high, the dopamine is gone, the brain cannot produce enough on its own any longer because of the frequency and the extent of use, and the person becomes dependent on the substance. The brain says, "I need more of that to feel good. Get me more of that."
Not only is the communication process in the midbrain changed in a person with SUD dependence, the drug the person is using becomes number one in midbrain functioning (see diagram above). Remember, the midbrain links pleasure and survival. So now, the person with SUD has a brain that is saying, "You need this drug to feel good. AND you need this drug to survive."
Meanwhile, back in the frontal lobes, they have a diminished capacity (aka the lights are on but no one is home), and logic is tossed out the window. The rational people who have known the now-addicted person for years will start to say things like, "I didn't raise you with these values," "Who are you now? I don't even recognize your personality," "Why would make a decision like that?", "You used to be so great and now you don't even care about anything but your drug."
The result of these malfunctions in the brain is a person who no longer acts logically, rationally, or with the same personality, and a person who unconsciously stops caring about things that actually help them survive and instead has the primary charge of getting the drug to "survive". Thus, a person with SUD begins slowly killing themselves through a misfiring and poorly communicating brain. Survival from this process becomes one that requires medical interventions as well as psychological/behavioral interventions. Because the process affects so many areas of the person's life, modifications to nearly every area of life are required.
...And this has been your two-and-a-half minute run down on what's up with that brain of the addicted person you know and love...
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