RAW (addiction articles summary)
Is Addiction Just a Matter of Choice?
"The United States has elevated addiction to a national icon. It's our symbol, it's our excuse," says Stanton Peele, author of The Diseasing of America.
There are conflicting views about addiction and popular treatments. So, we talked with researchers, psychologists and "addicts" and asked them: Is addiction a choice?
Publicity about addiction suggests it is a disease so powerful that addicts no longer have free will. Lawyers have already used this "addict-is-helpless" argument to win billions from tobacco companies.
Blaming others for our "addictions" is popular today.
In Canada, some lawyers are suing the government, saying it is responsible for getting people addicted to video slot machines.
Jean Brochu says he was unable to resist the slot machines — that he was "sick." He says the government made him sick, and his sickness led him to embezzle $50,000. Now, he's suing the government to restore his dignity and pay his therapy bills.
Psychologist Jeff Schaler, author of Addiction Is a Choice, argues that people have more control over their behavior than they think.
"Addiction is a behavior and all behaviors are choices," Schaler says. "What's next, are we going to blame fast-food restaurants for the foods that they sell based on the marketing, because the person got addicted to hamburgers and french fries?"
Well, yes, actually. Two weeks after he said that some children sued McDonald's, claiming the fast-food chain made them obese. They lost the first round in court, but they're trying again.
Uncontrollable Impulses?
"Impulse control disorder" is the excuse Rosemary Heinen's lawyer used to explain Heinen's shopping. Heinen was a corporate manager at Starbucks who embezzled $3.7 million, which she then used to buy 32 cars, diamonds, gold, Rolex watches, three grand pianos, and hundreds of Barbie dolls.
In court a psychiatrist testified Heinen was unable to obey the law, and shouldn't be given the seven-year prison sentence she was facing. The judge, however, did put Heinen behind bars, sentencing her to 48 months.
The "helplessly addicted" defense seemed to work better for the Canadian gambler. The judge gave Brochu probation and told him to see a psychologist. His mother paid back the $50,000 he stole.
Now Brochu and his lawyer are seeking $700 million on behalf of all addicted gamblers in Quebec, claiming the government is responsible for getting them addicted, too.
Calling Addiction a Disease
Many scientists say addicts have literally lost control, and that they suffer from a disease.
The National Institute on Drug Abuse calls drug addiction a "disease that will waste your brain." This is our government's official policy. And government-funded researchers, like Stephen Dewey of Brookhaven National Labs, tend to agree.
They say their studies of addiction in monkeys and rats show that addiction is a brain disease.
"Addiction is a disease that's characterized by a loss of control," says Dewey.
Dewey takes his message to schools, showing kids brain scans that he says prove his point. He tells students that addiction causes chemical changes that hijack your brain.
Genetic Destiny?
Dewey and other researchers say our genes predispose some of us to addiction and loss of control.
Researchers at Harvard University believe they may have found one of those genes in the zebrafish.
When researcher Tristan Darland put cocaine on a pad and stuck it on one side of a fish tank, fish liked the feeling they got so much that they hung around the area, even after the cocaine was removed.
Then Darland bred a family of fish that had one gene altered. These fish resisted the lure of the cocaine.
Darland says this shows that addiction is largely genetic. "These fish don't know anything about peer pressure. They either respond or they don't respond to the drug," he says.
At the Medical College of Wisconsin, Dr. Robert Risinger scans the brains of human addicts while they watch a video of people getting high on crack. It's what they call a "craving" video. He then shows them a hard-core sex film.
The brain scans show the addicts get more excited by the craving videos. The drugs become more powerful than sex — because addiction's a disease that changes your brain, says Dewey.
I asked Dewey if he was suggesting that drug users don't have free will.
"That's correct," he said. "They actually lose their free will. It becomes so overwhelming."
But if they don't have free will, how come so many people successfully quit?
Is the Disease Message Harmful?
Addiction expert Sally Satel acknowledges drug addiction and withdrawal is "certainly a very intense biological process." But she is one of many experts who say the addiction-as-brain-disease theory is harmful to addicts — and wrong.
She also thinks it's unhelpful to take away the stigma associated with drug abuse. "Why would you want to take the stigma away?" she asks. "I can't think of anything more worthwhile to stigmatize."
"People need to get rid of the idea that addiction is caused by anything other than themselves," says James Frey, author of A Million Little Pieces, a book about his experience as an addict.
Frey says he took just about every drug, from alcohol to crack. Yet Frey says he wasn't powerless. He scoffs at Dewey's claim that addicts' brains compel them to keep taking drugs.
Many doctors agree, saying you can still choose not to take drugs, even if they do cause changes in your brain.
"You can look at brains all day," Satel says. "They can be lit up like Christmas trees. But unless a person behaves in a certain way, we wouldn't call them an addict."
Environment and Choice
In fact, some researchers cite experiments that they say prove that addiction is a matter of choice.
In Canada, researchers gave rats held in two different environments a choice between morphine and water. The rats in cages chose morphine; the rats held in a nicer environment preferred the water.
Whether you get addicted also depends on how you're treated. At Wake Forest University, male monkeys lived together for three months, and established a pecking order.
The monkeys who'd been bullied by the "boss monkeys" banged a lever to get as much cocaine as they could. But the dominant monkeys, just by virtue of being dominant, had less interest in the drug.
"It's just like the human world," says Dr. Michael Nader, who conducted the experiment.
"Individuals that have no control in their job show a greater propensity for substance abuse than those that have control," Nader says.
These comparisons suggest that addiction is a choice — not a disease that takes away free will.
The message from the treatment industry is that drug users need professional help to quit. What they seldom say is that people are quitting bad habits all the time without professional help.
In fact, some studies suggest most addicts who recover do so without professional help.
For example, during the Vietnam War, thousands of soldiers became addicted to heroin.
The government tracked hundreds of soldiers for three years after they returned home. They found 88 percent of those addicted to narcotics in Vietnam no longer were.
Quitting Is the Rule, Not the Exception
Even tobacco companies now admit nicotine is addictive, but does that mean it really denies smokers' freedom?
You seldom hear about those people who just quit … on their own. No one's saying it's easy to quit. But it may surprise you that quitting is not the exception, it's the rule. Most people who've used heroin or cocaine have quit. Since 60 percent of smokers have quit — that's 50 million Americans — it seems obvious that people do have free will.
But the drug research establishment insists most addicts are enslaved, that they don't have free will.
Dewey says just because 50 million people have quit smoking doesn't mean that an addiction to smoking isn't a disease.
Yes, it does, says Schaler. Schaler also says the use of the word "disease" is important, particularly in terms of the money "addicts" are spending to get help. "If you say it's a choice not a disease, well then insurance companies may not reimburse for that. … If you say it's a choice, then the tobacco companies may not be slammed for millions of dollars."
Treatment Trap?
Some experts say the treatment industry is taking advantage of people in desperate situations.
"We're selling nicotine patches, we're selling the Betty Ford Center. We tell people, 'You can never get over an addiction on your own. You have to come to us and buy something to get over an addiction.' It's not true, and it's dangerous to tell them that," says Peele.
Former addict Frey agrees. His parents did pay for him to go to the expensive Hazeldon Treatment Center, but Frey says he didn't buy into the messages the center offered in counseling and therapy.
"I stopped because I have my own 12-step program and the first 11 steps don't mean [expletive] and the 12th is don't do it. And I didn't do it."
Frey and other former addicts say choosing is what it takes, making that decision.
"You can't tell people, 'This is all you're fault and there's nothing you can do about it,' " says Frey. "You have to tell them, 'This is all your fault and you can make it all better if you want to.' "
Frey says he still gets drunk. Now he just does it differently. "I get drunk on walking my dogs, I get drunk on, you know, kissing my wife. I get drunk on a good book. Getting drunk is just doing something that feels good."
Your Brain on Drugs: Dopamine and Addiction
"You can turn your back on a person, but never turn your back on a drug, especially when it's waving a razor sharp hunting knife in your eye," wrote gonzo journalist Hunter S. Thompson, no stranger himself to the compelling nature of addiction.
As has been demonstrated many, many, many times over, drug addiction is a powerful force that can take control of the lives of users. In the past, addiction was thought to be a weakness of character, but in recent decades research has increasingly found that addiction to drugs like cocaine, heroin and methamphetamine is a matter of brain chemistry.
Dr. Nora Volkow, the director of the National Institute on Drug Abuse, says that the way a brain becomes addicted to a drug is related to how a drug increases levels of the naturally-occurring neurotransmitter dopamine, which modulates the brain's ability to perceive reward reinforcement. The pleasure sensation that the brain gets when dopamine levels are elevated creates the motivation for us to proactively perform actions that are indispensable to our survival (like eating or procreation). Dopamine is what conditions us to do the things we need to do.
Using addictive drugs floods the limbic brain with dopamine—taking it up to as much as five or 10 times the normal level. With these levels elevated, the user's brain begins to associate the drug with an outsize neurochemical reward. Over time, by artificially raising the amount of dopamine our brains think is "normal," the drugs create a need that only they can meet.
"If a drug produces increases in dopamine in these limbic areas of the brain, then your brain is going to understand that signal as something that is very reinforcing, and will learn it very rapidly," says Volkow. "And so that the next time you get exposed to that stimuli, your brain already has learned that that's reinforcing, and you immediately—what we call a type of memory that's conditioning—will desire that particular drug." Over time, the consistently high levels of dopamine create plastic changes to the brain, desensitizing neurons so that they are less affected by it, and decreasing the number of receptors. That leads to the process of addiction, wherein a person loses control and is left with an intense drive to compulsively take the drug.
According to Volkow, the reason that dopamine-producing drugs are so addictive is that they have the ability to constantly fill a need for more dopamine. "So a person may take a hit of cocaine, snort it, it increases dopamine, takes a second, it increases dopamine, third, fourth, fifth, sixth. So there's never that decrease that ultimately leads to the satiety," she says.
Adam Kepecs, a neuroscientist at Cold Spring Harbor Laboratory says that addiction has to do with the brain's expectations. An emerging idea, he says, is that drugs basically "hijack" the brain's normal computational enjoyment and reward mechanisms.
"Let’s say you’re happy about a great chocolate ice cream," says Kepecs, as an example."Over time you learn to expect that the chocolate ice cream is really great and you have no more dopamine released in expectation of that when you receive it. Whereas, if you take an addictive drug, you can never learn to expect it because the drug itself will release an extra kick of dopamine. And when that happens, the value of that drug keeps increasing because now you’re learning that 'Wow my expectations were violated, therefore this must be much more valuable than what I thought before.' So basically what ends up happening: the dopamine system gets hijacked by these drugs."
Volkow notes that there are other components to addiction—like genetics and age of exposure—which is why not everyone who takes drugs becomes an addict. She says approximately 50% of the vulnerability of a person to become addicted is genetically determined, and research indicates that if a person is exposed to drugs in early adolescence they are much more likely to become addicted than if they were exposed to the same drugs as an adult.
Takeaway
One of the key functions of the neurotransmitter dopamine is to create feelings of pleasure that our brains associate with necessary physiological actions like eating and procreating. We are driven to perform these vital functions because our brains are conditioned to expect the dopamine rush that accompanies them.
Addictive drugs flood the brain with dopamine and condition us to expect artificially high levels of the neurotransmitter. Over time, the user's brain requires more dopamine than it can naturally produce, and it becomes dependent on the drug, which never actually satisfies the need it has created.
REFERENCES:
http://abcnews.go.com/US/story?id=90688
http://bigthink.com/going-mental/your-brain-on-drugs-dopamine-and-addiction
