The Diseased Brain, Choice and Addiction

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The death of Phillip Seymour Hoffman shocked the entire country. So sad and so incredibly senseless – it was a genuine tragedy. But, possibly even more tragic is that his death is not all that unique. Every single year thousands of people in the U.S. die from a drug overdose. Unlike Phillip Seymour Hoffman, the majority of people who die from addiction are not celebrities. They are everyday people, men and women, boys and girls who share a disease – one that they simply cannot overcome on their own.

And yet, the world at large continues to beg the questions: Why? Why didn’t he know better? Didn’t she realize if she did this long enough, it would kill her?

It’s time to stop asking these questions and start understanding what happens to the brain when a person is addicted. In a nutshell, the brain’s ability to function correctly is altered. The alterations happen in a few important places. One is in the brain’s reward center, which gets very active when the person’s drug of choice is ingested. This activity is associated with the release of dopamine in the reward area, which produces a feeling of wellbeing, euphoria, and decreased negative emotions.

Another change takes place in the prefrontal cortex, the part of the brain responsible for self-control, decision making and exercising judgment. When the reward center goes crazy after a person uses a drug he or she is addicted to, the prefrontal cortex essentially goes off line, and the individual is unable to use this area of the brain to make good long-term decisions. Brain imaging studies from drug-addicted individuals show actual physical changes and decreased activity in the prefrontal areas.

Once these changes occur in the brain of an addicted person, their ability to exert free will is limited. This is one of the physical aspects of the disease that a person with addiction is powerless over. Thankfully, there are other powerful parts to us as human beings than the brain alone. The most important when it comes to recovering from addiction is the spirit. You can’t use a broken brain to heal a broken brain. Although people with substance use disorders can’t change the way their brains respond to drugs or alcohol, they do have choice in one area: how much help are they willing to get to understand what needs to happen and what they need to do on a daily basis to stay in remission.

The power of 12 step support groups and good addiction professionals are key because they act as an external prefrontal decision making support for people whose brains need time to heal. The frontal lobes will heal over time, but the reward center changes are more permanent.

This distinction is critical to understand. A doctor who prescribes to a heroin addict, albeit one who has been sober for 20 years, needs to understand the risks and necessary precautions that must be put in place for that person to safely use the medication. A doctor who does not do this is negligent. And a person with addiction, despite many years of sobriety, needs to understand this as well. We all benefit from an extra set or two of high functioning prefrontal cortices looking over our decisions.
The first time a person takes drugs, a choice is involved; those who develop addictions usually could never imagine where that first choice would eventually lead them. Once addiction takes hold, choice is limited—not to whether or not to continue using, or whether or not to relapse, but limited to how much help and for how long that person is willing to be connected to this help. Until this truth is understood, friends, families, doctors, and the media will keep asking the same question – “Why?” Followed by the same remark – “tragic.”

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