Perspectives on Addictions

Complexity of Addictions

Addictive behaviours represent confusing and complex patterns of human activity. My intention here is to help you gain insight into these confusing, often embarrassing, intemperate behaviours and attitudes you or your partner may have. For many years, concepts of addictive behaviour and motivation were polarised between two theoretical models. One viewed an addiction as moral failure for which addicts are rightly held responsible and judged accordingly. The other saw an addiction as an adapted brain disease that occurred in response to chronic drug or alcohol use, and over which the addict had control. Neither stance considered the partner, family or wider community. This polarisation overlooked and limited investigations regarding behavioural addictions and associated idiosyncratic characteristics many addicts had. The capacity to observe neurobiological phenomena greatly improved, uncovering the consequence of an addiction on brain behaviour. This connected the dominant theoretical models and increased public interest. Furthermore, this neurobiological evidence verified that an addict is NOT a weak-willed person who has a self-inflicted disorder that they don’t want to stop.

As understanding on addiction behaviour deepened, those addicted were no longer vilified and able to seek help for their intemperate, impulsive activities.

The Revolution

The field of addictions was revolutionised, moving beyond the polarized stance. Other behavioural addictions gained recognition. Growing public understanding saw an addiction that comprises a person's ability and a an addicts solution to despondency (not the cause). Therefore, the addiction is a symptom of an underlying problem rather than the problem in itself. However insight into the addictive behaviour must be dealt with first.

Addictions are now usually categorised as either; Substance Use Disorders (alcohol, opiates, barbiturates, cannabinoids, amphetamines etc.) or Process/Natural addictions (Internet pornography, sexual addiction, deviant online behaviour (catfishing), internet relationships, eating disorders, gambling) - replacing Behavioural Addictions. Regardless of the substance or behaviour, there is an associated between "using" and depression, anxiety, loneliness, isolation and paranoia, low self-esteem. The unfamiliar practitioner may; 1) minimize the problematic substance/behaviour; 2) emphasise the associated symptoms; 3) suggest you are going through a midlife crisis, have a Madonna syndrome or just hypersexual.

Brain Reward Circuitry

The American Society of Addiction Medicine (ASAM) distinguished the functioning and brain circuitry of the brain with an addiction (regardless if substance or process) differ from the structure and function of the brain without an addiction. They put the difference to the brain reward circuitry system. This is a survival mechanism in all humans, which make food, sex and social encounters exciting and naturally sought. In a healthy brain, the rewardal mechanism says enough! With an addiction, there is a pathological pursuit of rewards, and the brain circuitry establishes a neurological pathway that says “keep going” and “let’s do this again”.

Simply put, the addictive substance/ behaviour is a motor vehicle to get you from A to B. This vehicle is the “pathological pursuit of a reward” and “brain reward circuitry” is the motorway your vehicle takes. Location A is an anxious, unsafe, lacklustre, boring place, making B's location far more exciting and rewarding!

Overriding Normal Satisfaction

The ancient reward circuitry in the brain compels you to do things that increase survival, create and procreate. These primitive circuits govern emotions, drives, impulses, and subconscious decision-making. The desire and motivation to pursue an act of survival (or procreate) arises from a neurochemical called dopamine.

Dopamine wants pleasure and amps up the centrepiece of the brain known as the reward circuitry. At the top of our human reward list are food, sex, social relationships, and novelty. These are the ‘natural’ reinforcers and most substance reinforcers (addictive chemicals) hijack the same circuitry.

Dopamine is a wanting neurochemical (contrasted with opioids which is a liking neurochemical) that motivates you to do what serves your survival. The greater the release of dopamine the more you want something (e.g. High-calorie chocolate cake and ice cream – a big blast) and no dopamine release and you just ignore it (e.g. Celery, Brussel sprouts – not so much). Dopamine rushes are like a barometer which you determine the value of any experience. They tell you what to approach or avoid, and where to put your attention. Further, dopamine tells you what to remember by helping to rewire your brain.

Sometimes dopamine is referred to as the ‘pleasure molecule’ and this is not strictly true. Dopamine is actually about seeking and searching for pleasure, not pleasure in itself. Thus, dopamine rises with anticipation and your motivation and drive to pursue potential pleasure or long term goals.

The high that comes from substance or process addiction appears to arise from the opioids. Dopamine causes us to want, hunt, desire, seek out, and search, and is stronger than the opioid system. We seek and hunt more than we are satisfied. Seeking is more likely to give that thrill and keep us alive than sitting around in a satisfied stupor. The dopamine system surges for novelty (e.g. a new vehicle, just-released film, the latest phone or gadget). The thrill fades away as dopamine plummets. Recent evidence illustrated methamphetamine and cocaine hijacking the same reward-centre nerve cells that evolved for sexual conditioning. Gorging on sex while on a high from methamphetamine or cocaine is usual and, while in this state, there is the potential to cause sexual harm. Further to this, brain studies on internet addicts reveal the presence of the same core brain changes seen in substance addicts.

It has been discussed that dopamine sets off the neurochemical events that cause addiction-related brain changes. The protein DeltaFosB [ΔFosB] is the actual molecular switch that initiates many of the lasting brain changes.

The dopamine surges trigger ΔFosB production.
ΔFosB accumulates slowly in the reward circuitry in proportion to the amount of dopamine released when we indulge in natural rewards (e.g. sex, sugar, high fat, and aerobic exercise) or virtually any substance abuse.
It turns on a very specific set of genes that physically and chemically alter the reward centre.
ΔFosB accumulating in the reward centre of the brain is now considered a sustained molecular switch for both behavioural and chemical addictions.
ΔFosB takes a month or two to dissipate, but the changes it causes can remain.

Simply, think of dopamine as the supervisor on a construction site barking the orders and ΔFosB as the construction workers actually pouring the cement. Dopamine is yelling, ‘this activity is really, really, important, and you should do it again and again.’ ΔFosB’s job, as the construction worker, is to remember and repeat the activity. It does this by rewiring your brain to want ‘it’ - ‘it’ being whatever you have been bingeing on (food, sex, gambling, porn, chemical substances). A spiral ensues leading to wanting then to doing, doing triggers more surges of dopamine, dopamine causes DeltaFosB to accumulate – and the urge to repeat the behaviour gets stronger with each loop. ‘Nerve cells that fire together wire together’ and create neuronal pathways or reinforce existing rewardal circuits. These specially constructed pathways that cause cravings are known as sensitisation. Conversely as ΔFosB continues to build up it can also bring about desensitisation, that is, a diminished emotional response to the stimuli’s. Thus, the need for more of whatever has been binged on to get that “high” sensation again. Desensitisation also brings a numbed response to everyday pleasures, in particular, sex with your everyday partner.

The discovery of ΔFosB has dismantled the claim that porn/sex addictions do not exist (discussed further on the online pornography page) and illustrated that we are all vulnerable to an addiction - where you experience cravings and pleasure, is the potential to get addicted. Often I am asked how much/long do I need to be doing this before I’m addicted and that’s like asking a gambler whether is blackjack or slot machines that caused the addiction. The dopamine and ΔFosB mechanisms in the brain do not actually recognise the dependent substance or process. These mechanisms register a spike, therefore have a job to do. Similar to turning on a lamp. The lamp doesn’t know whether a finger activated a switch, or someone joined an extension cord together, the lamp only registers it has to light up.

Simultaneously, activating these primitive rewardal pathways, triggers a chain reaction and other circuits in the brain spark into action. The area I wish to discuss here is hypofrontality. Hypofrontality is the feeling that two parts of your brain are engaged in a tug-of-war. Often addicts feel they are two incongruent people and hypofrontality is the brain's way of managing the out-of-control primitive rewardal pathways. The sensitised addiction pathways are screaming ‘Yes!’ while your ‘higher brain’ is saying, ‘No, not again!’ While the executive/frontal part of your brain are in a weakened state, the addiction circuitry always wins. This creates dysfunctional stress circuits which cause minor stress, lead to cravings and relapsing.

To sum up, if your addicted brain could speak: Desensitisation would be moaning, ‘I can't get no satisfaction’. At the same time, sensitisation would be poking you in the ribs saying, ‘hey, I’ve got just what you need’ (which happened to be the very thing that caused the desensitisation). Hypofrontality would be shrugging and sighing, ‘bad idea, but I can't stop you’. Dysfunctional stress circuits would be screaming, ‘I NEED something NOW to take the edge off!’

In Essence...

An addiction arise in the parts of our brains that govern our basic and life-sustaining needs and functions, such as, incentives and motivations, physical and emotional pain relief, stress regulation, and the capacity to feel and receive love

Sexual Addiction Specialist counselling available

Brain circuits and crucial neurological systems develop under, the influence of the nurturing environment in early life, and a large body of evidence supports; an addiction replaces a failure of these crucial systems to mature in the way nature intended.

An addictive brain, with treatment, continues to develop new circuitry throughout the lifespan, including well into adulthood, giving new hope for people mired in addictive patterns.

The "Addict"

The origins of addict derive from the Latin addictus . Addictus referred to the relationship a slave had with his/her master, that is, an enslavement or erosion of free will. I ask myself “How much free-will does a person with an addiction have?” Which invites a discussion about the degree of enslavement, suffering and helplessness, pivotal to any addiction. This view breaks the rigid, erroneous view that an addict is a moral failure for which “should be” held responsible and judged accordingly. An addiction sabotages brain processes, diminishes a person’s ability to consciously plan and guide rational thought; injures intimate relationships and conflicts with beliefs, values and life goals