When we talk about addictions, we are still in a way burdened by a moral vision, which points out the addicted person as a selfish, liar and prone to committing crimes. We believe that, in a way, he has asked for it and does not deserve compassionate treatment.
Faced with this approach full of prejudices, addiction has been incorporated into the list of mental illnesses that must be treated in a healthcare environment for many years now. It is understood that the addict’s brain has replaced its “natural” mechanisms with external substances or behaviors, which make him totally dependent. And we must “cure” it, so that the individual can reintegrate into society. This second option is much more in line with what we know about the addicted brain.
However, the transition between these two conceptions has not been completed, and in some ways they are sometimes intertwined, as occurs in 12-step programs, which provide religious communities or opportunistic gurus with miraculous herbs. A different conception is increasingly gaining strength, in which the nature of addiction is related to a learning problem..
The consensus reached by the scientific community is that addiction is associated with distorted learning systems in which pleasure is overvalued, risk is undervalued, and learning fails after repeating mistakes. Addiction alters an unconscious brain to anticipate exaggerated levels of pleasure or reduced pain (when dependence is consolidated).
What we know about addiction has changed over time. The way in which a drug user becomes an addict or suffers from a mental pathology is not clear.
In fact, a report by the United Nations Office for Drug and Crime Control (UNODC) states that only 10% of consumers end up having problems with these substances. It is true that it seems somewhat intuitive, since if all the people who report consuming alcohol and drugs ended up being addicts, the number of patients who go to treatment centers would multiply exponentially.
We are forgetting the entire learning process, which causes the individual to progressively replace his interests and affections with his addiction. Along this path, fortunately, many people discover or learn many other experiences that are much more rewarding than substance use. Our interest, from psychology, focuses on those who, despite the existence of other more attractive rewards and despite the harm caused by their addiction, persist in their behavior, reaching dependency.
The neurobiology of addictions
We are talking about a disorder based on the functioning of the brainwhich works abnormally in addicted people. But it is not an irreversible degenerative disease; At least, not in most cases. It is a learning problem that changes the way the brain works, altering its connections through new reward, motivation and punishment mechanisms. Like other learning disorders, it is also influenced by genetics and environment throughout our evolutionary process.
As Maia Szalavitz states in her book Unbroken Brain, “science has studied the connection between learning processes and addiction, managing to recognize which brain regions are related to addiction and in what way. These studies demonstrate how addiction alters the interaction between midbrain regions such as the ventral tegmentum and nucleus accumbens, which are linked to motivation and pleasure, as well as parts of the prefrontal cortex, which help make decisions and set priorities. ”.
One of the functions of these systems, called dopaminergic, is to influence the decisions we make, converting them into rewards, if necessary, increasing their perceived value, provoking expectations about them. Dopamine, the chemical messenger of pleasure in our brain, responds to primary rewards such as food, water or sexual relations. But it also does the same to secondary rewards like money. In the latter case, our expectations play an important role in our brain’s response to stimuli. Addiction makes us learn that, if we continue, for example, gambling, the probability of winning increases. A random negative reinforcement occurs where, despite almost never obtaining the anticipated reward, the behavior (gambling) is consolidated. Despite losing a lot of money.
The brain altered by drugs
In non-addicted people, the dopamine signal is used to update the value assigned to different actions, triggering choice and learning. You learn when something unexpected happens. Nothing focuses us more than surprise. We learn by trial and error.
With addiction, this learning process is altered. The signals surrounding the addictive experience are overvalued, causing dopaminergic systems to assign excessive value to the contexts that surround it. Dopamine continues to be released, through the artificial signal that, for example, psychoactive substances produce.
This causes a disproportionate desire for the drug, a craving for consumption that goes far beyond the pleasure or pain relief it can actually produce. In short, thanks to the distortion in the evaluation system of addicted people, their dependence seems to increase desire without increasing enjoyment of the object of addiction.
As individuals and as a species, It is these brain systems that tell us what matters to us and what we don’t.being associated with food, reproduction and our survival. Addiction distorts these vital objectives, replacing them with the object of addiction, drugs, gambling, sex or even money. It is, in essence, self-destructive behavior. We could compare it to the engine of a car in which we gradually degrade its fuel with, for example, water. The car will run more and more difficult, and no one will understand why we continue to put adulterated gasoline in it.
If to an addicted brain, characterized by focusing on a simple source of satisfaction, we add social pressure to consume drugs, for example, or the use of medications that help us regulate our emotions or our emotional deficiencies, we will understand how Little by little, the person who suffers from an addiction finds himself trapped in it. It is your life, in a way, your comfort zone. No matter how terrible it may seem to us from the outside.
To understand all types of self-destructive behaviors, we need a broader conception than the simple idea that drugs are addictive. Addiction is a way of relating to the environment and those who live in it. It is a response to an experience that people obtain from an activity or an object. It absorbs them because it gives them a series of basic and necessary emotional rewards.even if it damages your life over time.
There are six criteria by which we can define an addiction.
1. It is powerful and absorbs our thoughts and feelings
2. Provides essential sensations and emotions (such as feeling good about yourself, or the absence of worry or pain)
3. It produces these feelings temporarily, while the experience lasts.
4. It degrades other commitments, implications or satisfactions
5. It is predictable and reliable
6. By getting less and less from life without addiction, people are forced, in some ways, to return to the addictive experience as their only form of satisfaction.
It is, as we can see, a full-fledged learning process. AND Understanding addiction from this perspective changes things a lot.in addition to modifying the focus of health intervention quite a bit.
Reversing the learning process
In no case are we considering that, for example, a drug addict cannot become a patient with a dual disorder. It happens, on some occasions. Let’s say that the brain has been hacked so much that it is no longer possible to reinstall the original operating system. But until we get here, The drug addict travels a great path where the learning and consolidation of new routes in his brain can be modified..
Therefore, although the jump from vice to disease represented an important advance in addressing addictions, treating all people who use drugs or are addicted to certain behaviors as patients may be achieving the opposite effect. To treat a learning disorder, such as a phobia, the person’s active participation is essential. Furthermore, it is essential to know in detail how the disorder occurred in order to deactivate it.
The same occurs with the psychological treatment of addictive disorder. We have before us a person who must replace a harmful behavior with another that is not. And for this It is essential that you are involved in it from the beginning.
The classic health approach, by classifying all addicts as sick, does not require their collaboration, at least at the beginning. In the case, for example, of drug addiction, the patient is asked not to fight, to let himself be done, to detoxify him.
We would then move on to psychosocial rehabilitation which, until not long ago, was considered an accessory part of treatment. In a way, we are telling the drug addict’s brain that the solution continues to come from outside and that we are going to provide it with more psychotropic drugs. Fortunately, we have been evolving towards a treatment that addresses addiction as a learning disorder with biopsychosocial components that have at least the same importance.
Conclusion
Trying to understand why a person continues to self-destruct even though a long time has passed since the pleasure their addiction gave them disappears is much better explained as a neuroadaptive learning process than based on the classic disease model.
It is a parallel process of unlearning and relearning that requires the active participation of the person to ensure its success.. If not, in a way, we are reproducing what the addicted brain thinks: that there is a quick, external solution to its discomfort.
The implications of this new approach to treatment are profound. If addiction is like unrequited love, then company and changes in relational dynamics are a more effective approach than punishment. Treatments that emphasize the role of the addicted person in their recovery, such as cognitive therapy, with an important motivational component, or the more recent ones, based on Mindfulness, work much better than traditional rehabilitation in which patients are told patients who have no control over their addiction.
In short, if we have known for a long time that only a few people who gamble, consume alcohol or drugs, become addicts, Isn’t it time that we consider studying why this happens and that we move away from maximalist approaches? It is more important to know what protects these people to the point of distancing them from the easy solutions that addictions provide. This will allow us to design better prevention programs and will help us understand where we should direct the treatment processes.
