One thing I’ve always struggled with accepting was labeling Substance abuse as a disease. I live with a user and although I’ve never seen it as a choice, I’ve never fully understood its classification.
My professor tonight related the neurological process of addiction to the evolutionary and neurological process of eating.
In the simplest terms, the act of eating is pleasurable for means of survival. When you eat, your brain rewards you with dopamine, that feel-good neurotransmitter, in the Mesocorticalimbic pathway (MCLP), particularly the Nucleus Accumbens. Because you’re rewarded, you keep going back. That’s what keeps you alive. Your brain and body knows it needs nourishment and it’s not going to count on you to do it right, that’s for sure. So it trains you. Like a dog.
You think you make your body do what you want? Ha. It makes you do what it wants. It’s been conditioning you since birth. That’s why it’s better to work with it than against it.
When you’re dehydrated, you feel better after re-hydrating because of the same process. Your body isn’t going to count on you to drink water, it needs to remind you: “hey dipshit, I’m thirsty over here, come on man, give me some water already!”
Assuming you look at the world through a biological lens, this is what goes on. This is not my opinion, I’m just telling you what researchers have found out thus far. Nothing is ever written in stone.
When a drug has the potential to effect the MCLP, it’s considered to have abuse potential. You know, Benzos, Opiods, Amphetamines, Alcohol.
These facts shifted my mind a bit. If you needed to stop eating because it was harming your body, but you got the feeling of being rewarded each time you did it, would you be able to just stop eating?
We’ve seen that in many examples on shows like My 600 Lb life. The ones who keep off the weight often don’t struggle with as severe of a food addiction as their counterparts. Some have Gastric Bypass and keep eating and eating and eating.
Here’s a scale for you.
Say there’s a baseline dopamine release: than,
Eating increases dopamine by 150%
Sex increases dopamine by 200%
Cocaine increases dopamine by 300%
Meth increases dopamine by 1500%
Stew on that.
Addiction is essentially like a compulsion. That’s how my professor explained it. The user continues regardless of risks of consequences. If you live with OCD, you know what I’m talking about. You know about standing in front of that light switch and having to flip it twenty three and a half times before you can step outside of your room. And as much as you want to stop, you can’t.
If you struggle with substance use and I say something horribly out of line, feel free to tell your story in the comments. I’m just jotting what they’re teaching nurses and community counselors these days, for all of your benefits. Maybe it’ll help someone understand the mindset in the people they work with.
He made it clear that the user may at first choose to try the drug, but because the drug then stimulates a high, the reward pathway is also stimulated and suddenly they can’t stop.
But it’s not as if your body doesn’t try and compensate.
Tolerance is one way. If you’re an alcoholic for example, the main reason why you are sedated and squirming around in a daze on the floor is because alcohol triggers a serious release of GABA (Gamma Aminobutyric Acid), a neurotransmitter that is rather inhibitory. If you lack this neurotransmitter, you’re probably anxious and wired and an insomniac like me. I don’t know if I lack GABA, but whatever, you get my point.
Well your brain really, really values two things: consciousness and Homeostasis. We’ll focus on the homeostasis part.
Homeostasis means balance. Stability. So if you’re overwhelming it with an inhibitory transmitter, it’s going to start spewing an excitory one at you, like Glutamate. It essentially tries to even itself out. That’s why you have to drink more and more the further you dive into alcoholism, just to get a buzz in your brain; there’s so much Glutamate combating the GABA that you need more and more GABA.
What happens when you stop?
I’m sure every alcoholic has had the shakes and mood swings. But when you’re a severe alcoholic (there’s a spectrum), you’re at risk of experiencing Delrium Tremons (DT) which consists of confusion, hallucinations, or the fatal “sympathetic overdrive” which can advance to cardiovascular collapse. You’ve probably had a seizure or two as well.
Withdrawal for severe alcoholics can result in fatality because of DT’s. Other withdrawals cannot.
But Withdrawal from any substance is also your brain’s attempt at homeostasis. When you stop drinking, all that GABA you were once supplying your body with basically crumbles into non-existence. But by now your brain was used to pouring buckets upon buckets of Glutamate on those sedated neurons. Remember, Glutamate is excitory. This imbalance of chemicals is a cause of withdrawal seizures.
You ever hear a doctor explain withdrawal seizures as overactive neurons? Well, that’s what they’re talking about.
I’m not a fan of statistics, they’re about as reliable as my left foot having the ability to spread wings.
Depending on the research, of course, and the researchers.
However, I tend to agree that those of us with a parent who is an alcoholic and those of us that choose to get shit-face drunk raises our risks of developing the disease.
I call it a disease only because I see the biological and genetic development of it much clearer. No one asks for an addiction just as no one asks for heart disease.
Eating Burger king fifty times a month (A CONSCIOUS DECISION) may raise someone’s cholesterol and they may develop heart disease (NOT A CONSCIOUS DECISION).
Having a history of alcoholics in your family and going out to the bars five times a week with your friends (A CONSCIOUS DECISION) and passing out behind the dumpster might switch on that little genetic component and get that reward center flowing and they may develop an addiction (NOT A CONSCIOUS DECISION).
Not everyone gets heart disease from Burger King. Not everyone gets addicted to drugs.
He put on the board HEART DISEASE and asked us what the first words were that came to mind. We said a lot of things like smoking and cholesterol and genetics. He asked us what the people around those with heart disease were usually like. We said supportive, understanding.
He put addiction on the board and asked us what the first words were that came to mind. Someone blurted ANGER. We also copied the physical health we listed under heart disease. Someone else said struggle. Someone said environment. He asked us what the people around those with addictions were usually like. We said angry. Disturbed. Misunderstanding. Unsupportive. And a slew of other negative connotations.
Because we’ve got this crazy notion that people choose to be addicts. No one chooses to be an addict. I didn’t have to take this class to know that. I did have to take this class to see why it’s classified as a disease. But even I’m not stupid enough to think someone chooses to stick a fucking needle in their arm on a street corner.
It’s true, some people refuse help. And if I feel any anger towards that, it’s towards the disease and not the person. A few bad choices damn near doomed their future.
Many suffer comorbid with mental health disorders.
There are reasons for turning to food for comfort and turning to drugs for comfort.
Substance Use might not technically be a “disorder” as much as it is a “disease”, but we’re all in the same boat here.
Little Jimmy didn’t wake up one day and decide to develop schizophrenia and then the next day rolled out of bed and said “eh, I don’t feel like dealing with schizophrenia today, I’ll just stop”.
Little Suzie didn’t wake up one day and say “I want to spend the rest of my time having manic highs and suicidal depressive lows! Yay!”
Middle-sized Kyle didn’t wake up one day and say “I think I want to be a heroin addict on fifth avenue now, mom”.
One bad decision doesn’t mean they chose to be an addict. Everyone makes bad decisions and most of them we don’t have the consequences of developing a disease because of it. For example, I backed into a wall today because I made a lazy decision to not wipe off my back window so I could see. Now there’s a hairline scratch on my car.
But that’s not going to kill me.