This is a question friends and families often ask those who are addicted.
It’s hard to explain how drug addiction develops. It can seem like a constant search for pleasure, but the pleasure from drugs fades with repeated use. Some addictive drugs have no noticeable effect on regular users.
As an addiction researcher, I have spent 15 years studying the brain to understand how recreational drug use becomes compulsive, prompting people to make bad choices.
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Myths about addiction
Many believe taking drugs is a bad habit addicts just need to “kick.” But, to the brain, a habit is just our ability to perform a repetitive task – like tying our shoelaces – more efficiently. People don’t typically get addicted to tying their shoelaces.
Another theory claims that overcoming withdrawal is too difficult. The feeling when a drug leaves your body can be highly unpleasant; with drugs like alcohol, withdrawal can be dangerous if not properly managed.
People often say the pain of withdrawal symptoms is the reason addiction seems inescapable. However, even for heroin, most symptoms subside after two weeks. Plus, many addictive drugs produce varying and sometimes only mild withdrawal symptoms.
Pleasure, habits, and withdrawal are all part of addiction. But are they necessary components of it – and would addiction even exist without them?
Pleasure versus desire
In the 1980s, researchers claimed food, sex, and drugs all cause dopamine to be released in areas of the brain. This suggested that these areas were the brain’s pleasure centers, and that dopamine was the body’s pleasure transmitter. This idea has since been debunked; the brain does have pleasure centers, but they are not controlled by dopamine.
“Liking” and “wanting” are actually separate processes in the brain. “Liking” is the spontaneous delight you might experience eating a cookie. “Wanting” is what happens when you eye the plate of cookies on the table.
Dopamine is responsible for “wanting,” not “liking.” In one study, researchers studied rats that couldn’t produce dopamine in their brains. They lost the urge to eat, but still showed pleasure when food was placed in their mouths.
All drugs of abuse trigger a surge of dopamine – a rush of “wanting” – in the brain. This makes us crave more. With repeated use, the “wanting” grows, while our “liking” of the drug appears to stop or even decrease, a phenomenon known as tolerance.
In my research, we looked at a small part of the brain that influences fear and emotion. We found that activating this area makes rats more likely to show addictive-like behaviors. This part of the brain may also be involved in excessive “wanting” in humans, influencing us to make risky choices.
The recent opioid epidemic has produced what we might call “involuntary” addicts. Opioids (e.g., fentanyl) are effective at managing severe pain. Yet they also produce surges in dopamine release.
Most people begin taking prescription opioids to manage pain. Any pleasure they may experience comes from pain relief.
However, over time, users can develop a tolerance; the drug becomes less effective, and they need larger doses to control the pain. This exposes people to large surges of dopamine in the brain. As the pain fades, they find themselves inexplicably hooked on a drug and compelled to take more.
Regularly taking a drug in large quantities causes a hyperreactive “wanting” system, which makes people crave the drug whenever they are around it or exposed to drug cues, whether drug paraphernalia, negative emotions such as stress, or specific people or places. Drug cues are one of an addict’s biggest challenges.
These changes in the brain can be long-term. Genetic factors may make some people more likely to undergo these changes, explaining why a family history of addiction leads to increased risk. Early life stressors, such as childhood adversity or physical abuse, also seem to be factors.
Addiction and choice
Many of us regularly indulge in drugs of abuse, such as alcohol or nicotine. We may even occasionally overindulge. But, in most cases, this doesn’t qualify as addiction, partly because we manage to regain balance and choose alternative rewards like spending time with family or enjoyable, drug-free hobbies.
However, for those susceptible to excessive “wanting,” it may be difficult to maintain that balance. Researchers need to understand what makes people susceptible to developing a hyperreactive “wanting” system, to help doctors better manage the risk of exposing a patient to potentially addictive drugs.
We need to rethink addiction, because we still don’t understand where the risk of addiction comes from. In many cases, the addict doesn’t lack the willpower to quit; they recognize the pain and suffering their addiction causes around them, but their craving is often too strong for them to overcome alone.
That’s why people battling addiction deserve our support and compassion, not the distrust and exclusion that our society too often provides.
Assistant Professor of Psychology, Wesleyan University