Most of Us Still Don’t Get It: Addiction Is a Learning Disorder
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Published: 07-24-2014 08:01 am
Updated: 07-24-2014 09:13 am
Sex, food, shopping, the Internet, video games—all of these activities are being studied by neuroscientists, which frequently leads to headlines like “Oreos May Be As Addictive As Cocaine” and “Brain Activity of Sex Addicts Similar to That of Drug Addicts.”These stories carry the very strange implication that our brains have areas “for” drug addiction that can be “hijacked” by experiences like sex, junk food and MILF porn. Shockingly, kids today with their Tinder and Grindr andnomophobia are misusing the regions nature gave us to allow us to get hooked on wholesome pleasures like heroin, cocaine and methamphetamine.Of course, put that way, these claims sound completely absurd. Evolution didn’t provide us with brain circuitry dedicated to alcoholism and other drug addictions—it gave us brain networks that motivate us to seek pleasure and avoid pain in ways that promote survival and reproduction. To understand addiction, we’ve got to stop falling for arguments that obscure this truth and make unsound claims about brain changes that cannot tell us anything about its real nature.This means that any study that says it shows that something is addictive because the stuff “lights up” the same brain areas seen in addiction is tautological. Anything that provides pleasure or certain types of stress relief will activate these regions. If it doesn’t activate these areas, it can’t be perceived as pleasant, desirable or comforting.If you image the brain of a musician hitting the perfect note, a coder getting sudden insight on a complex problem, a father watching his child take her first step, you will see some of these areas go wild. That means these folks are experiencing joy: It doesn’t tell us that F sharp, a particular line of code or baby steps are “addictive.” Simply seeing activation in the brain’s pleasure and desire circuitry doesn’t reveal addiction.In fact, despite hundreds of millions of dollars spent on neuroimaging research, we still don’t have a scan that can reliably separate addicted people from casual drug users or accurately predict relapse. Some studies have suggested that this may be possible but none have found a replicable diagnostic scan, even though some clinicians market the use of scanners in treatment.
[quote]Despite hundreds of millions of dollars spent on neuroimaging research, we still don’t have a scan that can reliably separate addicted people from casual drug users.[/quote]
Moreover, recent sex and food addiction research showing similar alterations to those seen in drug addictions strikes at the heart of arguments made about the uniquely addictive nature of psychoactive chemicals. For example, on the website of the National Institute on Drug Abuse, a section on the “science of addiction” explains that “addiction is considered a brain disease because drugs change the brain.” But this idea—first promoted heavily by the former head of NIDA, Alan Leshner—isn’t the whole story.All experience changes the brain—it has to, in order to leave a mark on memory. If experience didn’t alter us, we couldn’t perceive, recall or react to it. So, simply changing the brain doesn’t make addiction a disease because not all changes are pathological. In order to use brain scans to prove addiction is a disease, you’d have to show changes that are only seen in addicted people, that occur in all cases of addiction and that predict relapse and recovery. No one has yet done this.Secondly, if you can be addicted to activities like sex, gambling and the Internet—which do not directly chemically alter the brain—how can they be addictive, if addiction is caused by drug-related brain changes?Researchers long argued that the pharmacology of particular drugs is what makes them addictive—that, say, cocaine’s alterations in the dopamine system cause a worse addiction than sex or food do because the drug directly affects the way the brain handles that chemical. But since sex and food only affect these chemicals naturally—and can create compulsive behavior that’s just as hard for some people to quit—why should we see cocaine differently?Of course, none of this is to say that addiction isn’t a medical disorder or that addicted people shouldn’t be treated with compassion. What it does show, I believe, is that addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry. While this theory is implicitly accepted or stated outright in much of today’s neuroscience research on addiction—and it runs through specific theories of addiction, including theories as varied as those of Stanton Peele, George Koob, current NIDA head Nora Volkow and Kent Berridge—its implications are not well understood by many treatment providers and the public. Instead, addiction is a seen as a “chronic, progressive disease,” which can only remit or worsen and which pretty much affects all addicted people in the same way.
[quote]Addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry.[/quote]
But the system that goes wrong in addiction is designed to make us persist despite negative consequences: If we didn’t have such a mechanism, we’d never push through the difficulties that characterize both love and parenting. Unfortunately when this motivational network gets channeled toward an activity that is destructive to our life’s prospects, it becomes dangerous.Neuroscience can help us better understand this circuitry. However, the fact that non-drug addictions exist shows that drugs are neither necessary nor sufficient to “hijack” it.What this means is that addiction isn’t simply a response to a drug or an experience—it is a learned pattern of behavior that involves the use of soothing or pleasant activities for a purpose like coping with stress. This is why simple exposure to a drug cannot cause addiction: The exposure must occur in a context where the person finds the experience pleasant and/or useful and must be deliberately repeated until the brain shifts its processing of the experience from deliberate and intentional to automatic and habitual.This is also why pain patients cannot be “made addicted” by their doctors. In order to develop an addiction, you have to repeatedly take the drug for emotional relief to the point where it feels as though you can’t live without it. That doesn’t happen when you take a drug as prescribed in a regular pattern—it can only happen when you start taking doses early or take extra when you feel a need to deal with issues other than pain. Until your brain learns that the drug is critical to your emotional stability, addiction cannot be established and this learning starts with voluntary choices. To put it bluntly, if I kidnap you, tie you down and shoot you up with heroin for two months, I can create physical dependence and withdrawal symptoms—but only if you go out and cop after I free you will you actually become an addict.Again, this doesn’t mean that people who voluntarily make those choices don’t have biological, genetic or environmental reasons that make them more vulnerable and perhaps less culpable—but it does mean that addiction can’t happen without your own will becoming involved. It also means that babies can’t be “born addicted.” Even if they suffer withdrawal after being exposed in utero, they haven’t engaged in the crucial learning pattern that shows them that the drug equals relief and they can hardly go out and seek more despite negative consequences.Addiction—whether to sex, drugs or rock & roll—is a disorder of learning. It’s not a disorder of hedonism or selfishness and it’s not a sign of “character defects.” This learning, of course, involves the brain—but because learning is involved, cultural, social and environmental factors are critical in shaping it.If we want to get beyond “Is Sex Addictive?” and “Crack vs. Junk Food: Which Is Worse?” we’ve got to recognize that we’ve been asking the wrong questions. The real issue is what purpose does addictive behavior serve and how can it be replaced with more productive and healthy pursuits—not how can we stop the demon drug or activity of the month. We’ve been doing the equivalent of trying to treat obsessive-compulsive disorder by banning hand sanitizer when what we really need to understand is why and how obsessions and compulsions develop in particular people.Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, The New York Times, Scientific American Mind, The Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about the 10 ways that addiction in America is different from the rest of the world.