Even when faced with horrific consequences-- addicts STILL keep using. Neurology helps us understand why...

It's one of the hardest things for non-addicts to understand. Why does this person keep using drugs even though _____________?

Just fill in the blank with one of the many negative consequences of substance abuse. I've seen clients with failing health- people whose livers are shot, their once-flawless complexion is contaminated with scars and boils, maybe they've had infections in their heart or blood, or have had multiple over-doses that put them in the hospital for weeks with damage to their vital organs. Other consequences like legal problems, jail time, losing friends, betraying family, and financial ruin are also common among clients with substance abuse.

Here's my best shot at explaining the neurology behind addiction and why, frankly, it doesn't make any sense.

Lizard Brain

"Lizard brain" is the somewhat derogatory name for the primitive part of the brain located toward the base of the brain near the spinal cord and includes the brain stem, cerebellum, and limbic system. It is an evolutionary remnant from when our brain's main job was to steer us clear from danger to ensure survival and it's structure is what is commonly seen in reptiles today. Therefore, it makes sense that this more primitive part of the brain heavily influences our fight/flight system, eating, and reproduction (as well as keeping us alive by making sure we breathe and our hearts beat).

Addiction lives in this area of the brain. When someone uses drugs and their brain is flooded with the "do it again! do it again!" chemical dopamine, the pathway is reinforced and becomes more efficient. This is why the longer someone uses drugs, the worse their addiction gets. The addicted brain comes to believe that it needs drugs for survival, no matter how hard the "higher brain" argues logically against it.

Higher Brain

The higher brain is the "newer" and more evolved part of the brain, closer to the outside of the brain. The section that does the most complex conscious processes is the frontal lobe. It is responsible tougher jobs like making decisions, weighing pros and cons, overriding socially unacceptable behaviors, and identifying how current behavior can lead to consequences in the future. This is the center for logic and reason, not for addiction.

Lizard Brain and Higher Brain Battle It Out

One way to look at addiction is to see it as a battle between the thinking part of the brain and the primitive part of the brain. Drowning is used as an example of how this sometimes happens (outside of the context of addiction) and how powerful our primitive brains are. When someone is drowning, their thinking higher brain is sending the message: "Hold your breathe You can't breathe in water! You'll die!" At the same time, the primitive brain is sending the message: "Breathe! You need to breathe! You need air to live and stay conscious!". Eventually the primitive brain wins and the person attempts to breathe and dies instead. The primitive brain isn't sophisticated enough to realize that breathing in this situation would be deadly, and yet, it's strong enough to order the actions that can kill us. Even in a lower-stakes scenario (like having a plate of delicious food placed in front of you when you have already had enough calories for the day), the primitive survival part of the brain wins out and says "Eat it!".

The fact that addiction is linked to this strong and primitive part of the brain, tells us partly why people continually use drugs, even in the face of some pretty ugly consequences.

Problem Solving

It's not all about the survival instinct of the primitive brain, however. Addicts also quickly learn that drug use allows them to avoid their problems (albeit temporarily). It becomes
"the easy button" solution that works and feels good. When an addict goes out and gets high after their best friend has died from drug use, they are just using the only coping skill they have. They are using the easy button, even though it harms them in the long-run.

Recovery

The wonderful news is that even though the brain changes when addiction happens, recovery is also possible! I will share more about early recovery and strategies in my next post. So stay tuned!

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