Opiate Addiction and the Brain


Drug addiction has plagued humanity for thousands of years, but it’s only in the past few decades that scientists have begun to discover the real reasons for addiction: Rather than being a moral or spiritual failure, addiction is a physical illness. It causes deep, long-lasting changes to the brain that can be extremely difficult to reverse.

But this knowledge is only a first step, and there is no simple solution to treating an addiction to drugs such as opiates. With the number of prescription opiate addicts growing every year, addiction treatment professionals have their work cut out for them.

Hijacking the Reward Response

Most forms of addiction are roughly the same. Whether it’s opiates, nicotine, alcohol or any other addictive substance, addiction is closely tied to the chemical dopamine. When these addictive substances are ingested, dopamine floods the area of the brain that makes one feel a strong sense of reward. This is the same part of the brain that makes us feel good when we accomplish something, eat a large meal, earn money or win a competition. It’s part of an evolutionarily developed survival mechanism that keeps us focused on getting the things we need to live.

Drugs like opiates take advantage of this system. With habitual use, the brain becomes reliant on this foreign substance to produce dopamine, and the natural reward system becomes increasingly incapacitated. Addicts require higher and higher doses to achieve the same effect, while their ability to enjoy other aspects of life is diminished. That’s why opiate addicts are often unmotivated and incapable of taking pleasure in anything else. The drug becomes the sole stimulant of their internal reward system.

Automatic Emotional Associations

But the dopamine response isn’t the only thing that keeps people addicted to opiates. Through long-term drug use, addicts also begin to associate the drug with positive emotions, and these associations eventually permeate all aspects of life surrounding the drug.

For example, if a heroin addict always injects the drug in a certain room, he or she will forever associate that room with being high, even years later. This is why relapses can be so unexpected and irresistible. The recovering addict may, for example, see a hypodermic needle, and suddenly feel an overpowering compulsion to go out and do heroin. The associations are not always so obvious. They may also be related to things such as music, seasons or even certain indescribable moods.

This happens as a result of the brain’s natural tendency to make habitual associations even when they’re not logical. These associations are made deep within the subconscious mind, which makes them almost impossible to reverse. In this sense, addiction is very similar to any type of learning. As children, we learn that certain things are safe, dangerous or pleasurable, and these associations eventually become so deeply buried in the subconscious mind that they’re practically a part of us. It takes real mental heavy lifting to reverse a learned response, and most former addicts never quite get past their associations.

Genetic Predisposition to Opiate Addiction

Addiction is also very much determined by our genes. While life factors do play a role, studies have shown that susceptibility to addiction is at least 50 percent hereditary. Individuals vary in their ability to release dopamine, and there are also vast differences in individuals’ abilities to learn new behaviors and to push back against powerful internal impulses.

In other words, some people are born with the natural ability to resist their urges and to use substances in moderation. Others are born without those internal safeguards against excess and repetitive behaviors.

It’s also been determined that mental illnesses such as anxiety, depression and schizophrenia are genetic. As any treatment professional will tell you, a substance abuse addiction often goes hand in hand with such illnesses.

Thus, when it comes to addiction, there are varying levels of seriousness. Less serious addicts may not have a natural predisposition to addiction, which makes their treatment relatively easy. On the other hand, people who are predisposed to both addiction and mental illness tend to have a very rough time beating an addiction, especially when their problems go untreated for years.

Why Is Treatment so Hard?

Since we know so much about how addiction works in the brain, why can’t doctors come up with drugs to counter these natural reactions? The problem is that addiction tends to be a complex problem, and it must be treated on multiple fronts.

In order to counter the effects of opiate addiction, these hypothetical drugs would have to profoundly tamper with the brain’s natural reward circuits in much the same way that opiates already do. Understandably, doctors don’t want to go down that path. That is why addiction treatment professionals often tend to advocate traditional treatments methods.

In other words, knowing about how addiction happens doesn’t make things like support groups and drug treatment therapy obsolete. If anything, this knowledge just makes these aspects of treatment work better. In the past, when addiction was thought of as a personal flaw, recovering addicts were made to feel guilt and shame over their weaknesses, and they were encouraged to help themselves through things like religion. Today, in contrast, addiction treatment programs can approach addiction as what it really is — an incurable problem that one must always live with.

There will be no simple cures for opiate addiction anytime soon. For the foreseeable future, addicts will have to rely on personal strength, the support of friends and loved ones, and competent doctors and treatment professionals to help them stay sober in the long term.

The perpetual danger of relapse is part of life for a recovering addict. Fortunately, we do have drugs like methadone and Suboxone, which, when used under careful doctor supervision, can allow recovering addicts to live normal lives without intense cravings for illicit drugs. These drugs may not get rid of one’s emotional opiate associations, but they can take care of the physical side of addiction, which is a good start.

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