Understanding addiction – an open letter to non-addicts

First of all, I apologize for the title. I don’t know if one can properly say “non-addicts.” There must be a better term for it, but unfortunately, I don’t know what it is.

Second, I want to frame this post as a primer for parents, spouses, siblings, friends and all those whose lives have been touched by an addicted loved one. (Geez, I fucking hate the term “loved one,” but again I lack a better turn of phrase.) In short, it is for anyone who has ever asked, “Why?” or “How could they do this to me?” or “Why can’t they just stop?” It is for those who have ever said this to an addict: “You’ve been clean for 17 years, for fuck’s sake! And now you are at it again? Are you crazy?” It’s for parents who have done all they can and hit the end of the rope. It’s for those who tend to stick self-righteous labels on addicts – labels that infer that the addict has some sort of character flaw that makes them “bad” or “criminal” or “weak.” And I’m going to leave out a lot of the big words that scare people away from scientific explanations, because the best articles on the subject are way too intimidating for people who just want answers.

Sooooo – long story summarized in three points:

Fact: The one thing science can’t explain is why some people become addicted and others don’t. People from “good homes” with loving parents who are engaged and involved in their kid’s lives become addicted just as easily as people who have shitty parents. A person is a system – just like nature, just like computers, just like politics, just like academia. They are a combination of environment and genetics, nature and nurture. And it isn’t just the variables. It’s the interaction between them. No living organism, no matter how simple it is, functions in a single-variable lab where you can push button “x” and get result “y” every single time. That only happens in science experiments which are very tightly controlled and do not in any way resemble anything that looks like reality (Neuroscience of Need: Understanding the Addicted Mind, Standford University).

According to the NIH approximately half of a person’s vulnerability to addiction is genetic. Half. The rest comes from the environment and, (dare I say it?), random chance. Wrong place, wrong time, wrong influence. Any other explanation is simply garbage, not based on anything but someone’s own personal opinion. To think otherwise is to believe that if you love someone, you are able to control their every move simply through the influence of  your own stunningly superior will. You can’t. And if your kid or spouse or parent has been lucky enough to avoid this problem, count yourself just that – lucky  – and check your self-righteousness at the door. You passed on good genes and somewhere along the way, unbeknownst to you, your “loved one” narrowly avoided meeting someone who would lead them down the wrong path. One single chance encounter or event – just one – and it all could have turned out differently. One genetic oooops, and your perfect, squeaky clean life becomes unrecognizable.

Fact:  Almost anything is capable of causing addiction, including food. Unsurprisingly, (duh), drugs which influence the brain cause changes in the brain. Refer to the Stanford piece if you want the technical explanation, but to boil it down, studies have shown that brain-influencing drugs cause you to grow all sorts of new shit in your brain and eradicate some of the old shit. The new shit it grows is related to learning and memory. The parts of the brain that deal with survival – the oldest and most primitive parts – are affected the most. In essence, the brain eventually associates the drug of choice with survival and grows more receivers accordingly.

What is more important to an organism than survival? As it turns out, nothing. The substance of choice has basically trumped our much over-rated pre-frontal cortex because the survival instinct is hair-trigger and the pre-frontal cortex is slower. Before the pre-frontal cortex can even say “Hey wait a minute!” the mid-brain has reacted as if it was about to be eaten by a fucking tiger. The mid-brain has all sorts of awesome chemicals it can release in milliseconds to react to life-threatening situations. These chemicals pump up the heart rate and re-direct the blood flow to the parts of the body that are required to escape becoming human tiger chow. Simultaneously, chemicals are released that cut off all the non-essential stuff like digestion, reproductive hormones and deep, introspective thoughts.

Someone who struggles with addiction literally – read that word again slowly…literally – reacts to drug deprivation the same way they would react if they were about to be eaten by a tiger. So I ask you, if you were about to be eaten by a tiger, how much time would you spend dwelling on whether running away would impact the opinions of your friends and family? Would you, in fact, devote a few precious moments to thinking, “Hmmmm. You know my mother might disapprove of this?” Would you ask yourself, “Gosh. If I run now, will it look bad on my resume?” Or, “Good Lord! What will the neighbors think?” Fuck no.

So the old ways of learning go out the window and the news ways of learning are all about the drug. Pleasure circuits are hijacked and re-directed. Normal survival instincts that deal with food, water and sex are obliterated and re-formulated to accommodate this new model. Worse yet, the part of the brain that deals with memory is fucked up. (Again, refer to the Stanford piece – although there are many, many other sources, this one summarizes a whole lot of shit in one article). It is so fucked up, in fact, that the memory of the pleasure derived from taking the drug becomes sweeter than the actual experience of getting high.  This should be easily understood by anyone who has ever grown misty-eyed about some childhood memory. Wasn’t Christmas grand back in the day? Conveniently you’ve forgotten the bits about how your sister threw a tantrum and ran your new Christmas tricycle into a retention pond. Conveniently you’ve forgotten staying up all night to put together your daughter’s doll house which came complete with directions that appear to belong to a small nuclear reactor. You forget that Uncle Fred was drunk and that mom was taking Valium and burning the Christmas dinner. You forget that the cat mistook your new sandbox for kitty litter. You forget all that stuff and just remember the warm, fuzzy feeling you had on Christmas morning and the soft glow of the Christmas tree and the pile of unwrapped presents under it.

Yeah. So you understand how a memory can trump a fact, (or even a bunch of facts), yes?

Fact: Relapse happens in any chronic disease, including diseases of the brain. This is not to say that recovery can’t be permanent. It can, but it may take awhile. Don’t expect someone to come out of a 30 day program and just get on with things. The reason it is difficult goes back to the whole Fact #2 bit. And triggers. Triggers are anything that remind a person of an experience they had when they were high. Now recall that the memory of being high is better than the actual experience in the physically altered mind of an addict. And a trigger can be anything at all – a song, a smell, a place, a thing, a person. This is the way the human brain learns – by association.

It works like this. Once when I was about 21 and very stupid, I drank tequila on New Year’s Eve. Quite a bit of it, actually. Around midnight alarm bells started going off in the part of my brain that was still capable of having a coherent thought and that thought was, “Oh my God. I am going to feel like shit tomorrow.” And then I had an idea: “Maybe if I eat something, the room will stop spinning.” It was a really bad idea, but it was followed by an even worse one. My desperate eyes lit upon the one party snack in the room that was a) untouched and b) did not require eating implements. That one thing was fruit cake. To this day, my brain associates fruit cake with spending the rest of a perfectly good evening clutching a dubiously cleaned toilet in the home of a college friend who I fervently hope I will never run into again. To this day, I cannot stand to be in the same room with fruit cake. It’s not rational of course, but this is a perfect example of learning by association. And of course pleasurable memories are similarly learned. If your brain believes that good things happen when you do “x,” you will do “x” as often as you can because you have learned that “x” brings you great pleasure and deep satisfaction. Just the smell of baking bread, which you enjoyed at your grandmother’s house when you were a child, makes you want to return to that place and that time that made you so very, very happy.

In the case of addiction, the trigger works the same way. It fires and your brain reacts. It’s learned. And like the trigger of a real gun, once its been is pulled, you can’t stuff the bullet back in the gun.  This study, for example, showed triggering images to cocaine addicts. The images were tucked in between normal, every day pictures of non-triggering images. The triggering images displayed for 33 milliseconds – long enough for the image to register subconsciously, but not long enough for the brain to process what it had seen. The image was never consciously digested, never reached the executive functions in the brain, never even hit the reasoning circuits. Yet addicts who had viewed the pictures with the embedded trigger images reported stronger cravings for cocaine after the presentation than addicts who had viewed a presentation with no trigger images. The rational, reasoning part of the brain never stood a chance. It’s hard to “just say no” after the part of your brain that houses the survival instinct has already said “yes” without even being aware that it had done so.

This, ladies and gentlemen, is the perfect storm. Genetic predisposition plus random environmental events plus altered brain chemistry plus survival instincts plus altered patterns of learning plus altered memories plus subconscious triggers. If you’ve never struggled with addiction, you got lucky. If you know someone who does struggle with it, you owe it to them (and to yourself, in case you are predisposed to self-flagellation) to understand why it is so intractable and why it keeps coming back.

Can a person recover? Yes. Does it take a really long time? Yes. Do you have the right to judge? No.

Any other questions?

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