The Science of Addiction**
Clients often ask me “why” they drink, use drugs, or behave compulsively with repeated unhealthy coping. There are 6 broad categories that inform the development of a substance use disorder.
While “chemical dependency education” does not transform people or create lasting change, it is a necessary part of the treatment journey and it’s needed for lasting change.
I often say “everything psychological is biological.” Understanding that addiction** has a physical/physiological component is critical. What is going on in the sufferer’s mind and body informs the development, progression, assessment, and treatment of a substance use disorder.
Addiction research has revealed that over-use or misuse of psychoactive substances results from the following 6 broad categories.
Trauma
In the last 25 years, research has been very compelling that there is a correlation between addiction and trauma. Let me explain this from the scientific perspective.
Experiencing trauma changes a person. Often childhood trauma (known as “developmental trauma” because it happened when the brain was still developing) is correlated with the likelihood of developing a substance use disorder. However, the trauma/addiction correlation is not limited to childhood trauma.
When a person witnesses, experiences, or participates in something negative or significant outside the realm of expected and anticipated human experience, it is potentially trauma. In trauma, a person’s brain reacts. When a brain reacts, it does so with a chemical reaction, and that reaction changes the neural pathways of the brain, and those patterns determine mood, perception, and somatic (body) experience.
It changes how the body experiences sensation, psycho-active substances, relationships, pleasure, bio-states such as:
- sleep
- pain
- fear
- hunger
The changes in the brain brought on by trauma shape the brain, which shapes that person, and pre-dispose that person to have a hyper-response to psycho-active substances or compulsive behavior. That hyper-responsiveness is craving.
In summary, trauma changes a person, changes the person’s brain and body, making them more vulnerable to have a craving reaction to drugs, alcohol, and other unhealthy coping.
Interaction with the Substance (or behavior) Itself
Now, before you dismiss this as “well, duh,” read on to understand the nuance of it. To more fully understand this, it might help to think of substances on a continuum of addictiveness. On one side of the spectrum, we have opiates, the crack form of cocaine, and nicotine. On the other, the flower form of weed.
They are all addictive in some bodies, but some substances are, in and of themselves, more chemically addictive in nature. That means that especially in combination with other risk factors (which I am discussing in this post), the chances of developing a substance use disorder are increased.
Surgery or medical trauma can be a precipitant for the development of a substance use disorder. This is the origin of a significant percentage of the opiate crisis. The structure of opiates is such that the substance itself is more likely to create an addictive response in a wider range of brains (even in brains originally less likely to have an addictive response), which is why we see people who have never been observed to have had a problem develop a substance use issue and why persons in long term recovery relapse after a medical event in which opiates were prescribed.
Heritability/Genetics
There is an observed and documented predisposition towards having a hyper-response to substances that “runs in families.” Some researchers and clinicians speculate that the predisposition is dormant until switched on by interaction with a substance, trauma, or co-occurring mental illness.
A discussion about the genetics and heritability and the development of a substance use disorder would be incomplete without discussing the impact of early exposure and age of first use.
Early Exposure and Age of First Use
It’s important to understand the way in which early interactions with substances and behaviors put people at greater risk of developing a substance use disorder. Early interaction with psychoactive substances or behaviors is risky because:
- The more likely the “epigenetic switch” gets flipped and heritable factors may come into play. So, if you are predisposed to having a hyper-response to psycho-active substances (or behaviors) and your first drink (or blunt, or porn or gambling) is early, your brain has less defense against a maladaptive response. It will be more likely to develop into a problem vs. just experiencing the effects of the use or fun and enjoyment of the behavior.
- A brain that experiences porn (or alcohol, gambling, or weed) at 9 is going to have more difficulty managing that experience than if that same person’s first experience is at 19. At 19, while that brain is still not done developing, it has more connections and more neural stability and less vulnerability. A 9-year-old brain is going to react with an exaggerated impact. The chances of a 9-year-old developing into a problem with porn (alcohol, gambling, or weed) is far greater than an older brain.
This reality is the reason I don’t support the parenting decision to allow “supervised drinking at home” to model moderation.
Reward insufficiency/high risk drive
Research suggests that a percentage of persons who regularly misuse substances do so because their brain’s reward system functions differently. This may pre-exist or develop as interaction with alcohol or other drugs changes the structure of the neurocircuitry of the brain. These people do not experience reward at the same level of pleasure and joy as the typical reward response, and the function of psycho-active substances gets hardwired by neurotransmitters (feeling chemicals) as pleasure.
At this point, the brain then stops making “feel good” chemicals organically. When the person’s body has processed the alcohol or other drugs, they do not have sufficient neurotransmitters to feel “normal” and their brain signals a need to elevate mood or bring down anxiety.
What develops is a cycle of “feel bad (or not feel at all), have an exaggerated chemical experience that reduces chemicals that support normal range of feeling, return to a lowered state of sensation, seek sensation” cycle.
Often the term “salience” is used when discussing this theory of substance misuse.
Learned behavior/habit/conditioning
Our brains operate on hard-wired behaviors. For example, you likely put your pants on putting the same leg in first every time and you probably do the same things in the same order when you come home or when you get up. If you have ever tried to start or stop a habit, you have become aware of learned behavior/conditioning. If you come home and immediately make a drink, that is behavior you have taught your brain. “420” became a thing because of habit and conditioning.
Co-occurring mental health issue
When a person has a co-occurring mental health disorder such as depression, anxiety, OCD, process addiction, or bipolar they often find relief from the symptoms of those illnesses when they use psychoactive substances, at least at the beginning. As tolerance to the substance builds and the person needs to use more, more frequently, or more intense substances the relief often becomes elusive. However, as the time has elapsed the substance habit has become established and hard-wired into the neural patterns of the brain. At that point, the person has both the original mental illness AND a substance use disorder.
For Additional Information and Support
I create content, support, and resources for professionals and other high achievers who want to address their substance use issue with positive tools leveraging the science of positive habits.
For more information, content, support, and tools on how to manage executive stress and enjoy life without drugs, alcohol, or over-relying on unhealthy coping, check out my link to a free workbook on managing stress to help stop drinking.
**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.
