The Head Center

I work as an addiction treatment specialist. The information in this post is material from a lecture I often give to my patients on the disease concept of addiction.

Why can't I quit? Cocaine, alcohol, and as it turns out, gambling, have a similar effect on the dopamine system in the brain. I'm going to explain, in terms anyone can understand, why an addict is addicted and why that is such a powerful and inexplicable thing.

Dopamine is a neurotransmitter which is active in certain key parts of the brain. To understand addiction, you have to understand something about how the brain developed and look at the part of the brain where this dopamine does it thing. When I say developed I mean how the human brain evolved. At the base of your brain, the part just above the spinal cord at the center of your head, is an ancient part of the brain, sometimes referred to as the neomammalian brain. (It is also referred to as the meso-limbic system, for you techies.) The word neomammalian comes from the roots new + mammal. All mammals, even mice and chipmunks have some form of this brain region. While dopamine exists in various places in the brain, this is where the dopamine which we are interested in lives. This area of the brain is also called the pleasure center and the dopamine itself is active in the process of feeling pleasure.

Bookmark that while we look at another part of the brain. The frontal cortex is the part of the brain that is just behind your forehead, above your eyes. This part of the brain, evolutionarily speaking, is much younger. It almost certainly developed along with the ability or phenomenon we call consciousness which exists in the higher mammals such as the so-called great apes of which humans are one species. It is where the part of us we call "I" or "me" resides. This is the manager. The executive. When we think, plan, make decisions, or play the piano, the frontal cortex is involved.

Now, back in the ancient part of the brain we were talking about earlier -- that part has responsibilities too. The neomammalian part of the brain contains the hypothalamus and other areas where we know that functions such as sleep, hunger, thirst, and the sex drive are located. The neomammalian brain also contains a structure called the amygdala, which is a key area where processing emotions are involved.

Now, you can use your frontal cortex, your executive function, to decide to stay up late tonight and watch a movie. You could probably even stay up all night. But could you stay up for two days? How about 5? Eventually, no matter how grand your plan (planning is a frontal cortex function) you will succumb to the commands of the ancient part of the brain which asserts itself when you need sleep in order to survive.

Likewise, we can control our appetites. We can control them to the point where we almost starve ourselves. We do this by using our management part, the decision making part of our brains, again, the frontal cortex. But eventually, you'll be so hungry you'd eat anything, if you starved yourself long enough. The part of the brain that makes you ravenous and unable to overcome the desire to not eat is that ancient part.

In addicts, the ancient part of the brain is the part that is addicted.

When you abuse alcohol, or cocaine, or gamble to excess, the addictive substance or addictive behavior causes an abnormal increase in the amount of dopamine present in the pleasure center of your brain. This has two nasty side effects. One side effect is that the brain decides to produce less dompamine. The second side effect is that the brain, over time, becomes less responsive to dopamine. This phenomenon is why we become addicted and why addiction is a disease process.

Just like in the examples with eating and sleeping, you can decide not to use drugs or drink or gamble. The question is how long can you go without? That ancient part of the brain, modified by historical abuse, needs for you to do drugs, or drink, or gamble. That ancient part of the brain asserts itself behaviorally. It makes you crave. Sometimes subtly, but it asserts itself because there is an imbalance of dopamine. A shortage. Of course, addiction is not exactly like sleep and hunger. While the mechanisms of assertion are different in hunger, sleep and craving phenomena, the routes between the meso-limbic system and the frontal cortex are the same for all of them and dopamine is active in those regions of the meso-limbic system where the signals originate.

I like to say that ... We can't choose not to use.

Before I leave this topic, I want to address the issue of the nasty side effects I mentioned. The result of the brain being out of balance with dopamine means that the pleasure center is not working properly. So if before you got loaded a bazillion times you enjoyed going to concerts and watching you child in a school play and having a milkshake, now your booze-addled brain doesn't respond to those things the same way. They don't give you as much pleasure. Abstinence is the only thing that makes this go back to normal. These processes are reversible. A long period of abstinence will in most cases restore the majority of dopamine system functioning.

Long-term abuse creates an addicted brain. Sustained abstinence slowly reverses some of the damage."

Abstinence heals. That's why we call it recovery. Since recovery can take a long time, we are quite likely to relapse before our brains are sufficiently restored. So what do we do? We can't choose not to use, but we can choose to recover. We can choose meetings, and service, and sponsorship, and the steps.