Contemporary Views of Addiction: Psychological and Neurobiological Perspectives
The field of addictions has come a long way in eradicating some of the misconceptions and myths around addiction. Once considered a moral failure, we now know that individuals do not become addicted because they lack integrity. They become addicted as a habitual way to cope with pain and suffering—and to regulate stress. In fact, stress is one of the most important predictors of substance abuse. Some individuals are more susceptible to addiction due to genetic factors, family environment and poor coping skills, as well as other co-occurring forms of emotional distress like bipolar disorder, schizophrenia, post-traumatic stress disorder, depression or anxiety. Advances in the understanding and treatment of addictions make recovery, and healing, possible.
Addictive substances and behaviors activate the human neuronal reward system. Thus, individuals use substances because they serve a rewarding function. This function might include easing anxiety in a social situation, numbing physical pain, ridding boredom, increasing energy, or relieving feelings of emptiness. Achieving the hoped-for result leaves individuals prone to want to use the substance again under similar circumstances, or to repeat the behavior that evoked the desired emotion. With continued use, individuals’ brains and minds start adapting to the substance or behavior, and it becomes habitual. The problem is that uncontrollable desires for a substance or behavior stop rational thought. Individuals are then likely to act in out of control ways—the kinds of ways that often lead to suffering for them, their families, colleagues and friends.
Many individuals enter into treatment after suffering severe relationship problems, depression, anxiety, driving-under-the-influence charges, poor health (e.g., liver damage), or threats to their career. The negative consequences of use have led them or those around them to recognize a need for help. Many resist the need for help, however, believing that willpower or reason alone can prevail. Addictions cannot simply be reasoned through. The power of the addicted brain can quickly overwhelm all rational arguments in favor of stopping the addiction. This can generate profound feelings of helplessness, shame, and failure.
Recovery Occurs Best When Securely Attached to Others
Left to themselves, most are not able to counter the incredible forces of cravings and urges, or escape the ravages of serious depression, alone. The reward system of the human brain reinforces behavior that our brain considers essential for survival—and for the individual with an addiction, using a substance or engaging in an addictive behavior can feel like a life and death matter.
Individuals’ best hope for recovery lies in learning to make use of others. Instead of turning to a substance to cope with pain and suffering, learning to turn to someone who offers an empathic, attuned and supportive response sets in motion a new pattern, and a new reward—but without many of the negative and devastating consequences of substance use. Consequently, the distress will become more bearable, the individual will feel more secure, and an optimal foundation for healing and recovery will be established.
Experimental research strongly supports that individuals regulate stress best when connected to others who provide emotional support. Going it alone when ill is going it the hard way. Psychologist Jim Coan, conducting neuroimaging research at the University of Virginia, found that merely holding a partner’s hand during a stressful laboratory situation significantly diminished brain activity associated with distress as well as brain activity associated with effortful regulation of distress (e.g., deep breathing, or, positive self-talk). Moreover, the mere contact with a partner was especially effective in decreasing the load on the brain when the relationship was felt to be highly supportive and trusting. To begin
reversing the habits of addiction, individuals must gradually replace their deep attachments to a substance or a behavior with a secure attachment to others.
Many Discover Hope of Recovery
Twelve-step recovery groups, like AA and NA, work not only because of the steps of change that are introduced, but because they offer individuals a routine place to feel accepted, known, and understood—even while feeling vulnerable. Peers can relate to the pain of addiction, offer solace, and provide hope, inspiration and encouragement. The experience of responsive emotional support lies at the heart of the relief provided, and a resource for the individual with an addiction to turn to time and time again.
Engaging in recovery helps the brain to begin forming new neural pathways, and recent evidence points to a 90-day period for this process to begin taking hold. In addition to modifying some of the neural networks involving addictions to a substance or a behavior, individuals can change their brains by forming deep attachments to people—instead of to substances or behavior. The possibility of forming secure, healthy attachments, and learning to turn to others for support and help in managing moments of distress, can help individuals stay on the road to recovery.
Many have taken the daring step of allowing their brain to heal from addiction, as well as replacing their attachment to an addictive substance or behavior with caring, responsive human connection. Twelve-step recovery, individual, couples and family counseling, new coping skills, medication, and addictions counseling can all serve to alter individuals’ brains—for good.
Michael Groat, PhD, is the Director of the Division of Adult Services at the Menninger Clinic, and assistant professor of psychiatry and behavioral sciences at the Baylor College of Medicine. He completed his internship in clinical psychology at the Albany Medical Center, a four-year postdoctoral fellowship at the Austen Riggs Center, research training at the Yale Child Study Center, and most recently trained at the Leadership Institute for Non-Profit Executive Management, Rice University. He has written and spoken nationally on attachment, addictions and treatment resistance, and has also published on the relationship between attachment style and recovery among individuals with dual-diagnosis disorders.