What is Addiction- Choice, Disease or Personality Flaw?

Most people think of “addicts” as people who are addicted to alcohol or drugs, however in reality there are many other types of addictions.  To name a few there are addictions to smoking, shopping, gambling, eating disorders, pornography, sexual addictions, and video gaming addictions (which are impacting high numbers of young adults).  What actually causes these addictions?

The American Psychological Association defines addiction as follows: “Addiction is a condition that results when a person ingests a substance or engages in an activity that can be pleasurable but the continuation of which becomes compulsive and interferes with ordinary responsibilities and concerns, such as work.”  However, this definition leaves out a lot of information.

Humans and all animals are programmed by evolution to seek out things that provide pleasure through a chemical in the brain called dopamine.  Dopamine motivates us to seek food, shelter, companionship, and sex.  It is vitally important for the survival of our species.  People who struggle with depression often have too little dopamine which affects their motivation to play, work, eat, and engage in pleasurable activities.  It sometimes even decreases their will to live. We need the right amount of dopamine released from the mid-brain to our frontal cortex in order to survive and live a healthy life.

The problem with drugs and other addictive behaviors is that they cause a huge amount of dopamine to be released all at once and the thinking part of our brain – the frontal cortex – becomes overwhelmed with pleasure.  Two areas of the frontal cortex that are particularly affected by this surge of dopamine are the parts involved in emotional attachment and decision making.  This leads the addict to give primary importance to the addictive behavior and creates an uncontrollable urge to seek more and more of the activity that creates this intense amount of pleasure – no matter what the cost.  The frontal cortex immediately releases a chemical called glutamate down to the midbrain sending a signal to find more of whatever caused the pleasurable experience.

The amount of pleasure is so intense that the memory centers of the brain are also affected.  Our brains store feelings that are outside the range of normal in a different way – which is what happens with intensely traumatic experiences as well as intensely pleasurable feelings. These memories are much stronger than normal memories and thoughts of them reoccur over and over again.  This is the reason that a person with a gambling addiction can lose monumental amounts of money but will still remember every detail about the time he/she won – not paying any attention to all the losses.

The argument continues to rage about whether addiction is a disease or a choice.  Family members of someone who is addicted often believe the person is choosing the drug over their family – which is true because the emotional attachment centers of the brain have been affected and the main attachment is to the substance or activity that releases large surges of dopamine.  The addict remembers the pleasure associated with that activity above all else.  Therefore, other things fall short – such as love for family, prior commitments they have made to quit, punishments they have incurred, and any other consequences including memories of losses and fears of health consequences.

Is addiction a disorder or a choice?  Actually, it is a “disorder of choice” according to Dr. Kevin McCauley – a medical doctor who struggled with his own addiction and has done extensive research on this question.  Addiction causes a disease of pleasure in both the midbrain and the frontal cortex that makes a person choose the drug or activity over anything else in their life. It can be genetically passed on but certainly not in all cases.

Recovery from addiction is definitely possible with treatment.  However, punishment and anger from family and friends is not helpful.  The person who is addicted has to fight their own brain! They need to learn how their choice system works.  This involves psychotherapy, recovery support groups, and often medication.  Reprogramming your brain is not something that someone can do alone – it takes a huge support network of clinicians and possibly most important support from others in recovery.   Journaling is also an important part of recovery because when a person can read their own notes it does provide them a way to step out of the intensity of the urge by having some insight into their own brain – sort of a memo to the self!

Remember that judgement, decision making, and self-control over actions have all been affected due to the large surges of dopamine the person has experienced.  The result is that ordinary pleasurable social and physical behaviors no longer motivate a person who is early in recovery.  Expectations must be lowered and recovery requires intensive treatment and patience.

The three most important things for family members and loved ones to do are:

1) Get educated on addiction yourself.  See the online video developed bythe Institute for Addiction Study, Pleasure Unwoven.

2) Take care of yourself even if it means setting hard boundaries with your loved one.

3) Talk about it a lot.  Often families are ashamed to talk about someone in their family who is an addict, and if it is a child they may feel a great deal of guilt.  Remember that almost every family is affected by addiction in some form.  Al-Anon is a great support and outlet for families to connect with others and talk openly about their anger and disappointment.  Also, it is very helpful for spouses and parents to get their own counseling to deal with their feelings.

If you or a loved one is suffering from addiction there is help.  Ascendant Behavioral Health Clinics has clinicians specializing in addiction and substance abuse.  For help with addictions to drugs and alcohol call our Comprehensive Treatment Center for Addictions in Taylorsville at (801) 212-9596.

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Susan Mitchell

Susan Mitchell is a licensed clinical social worker and is clinical director at Ascendant Behavioral Health, located in Lehi. She can be reached at smitchell@ascendantclinics.com or 801-502-3913.