Summary: Addiction occurs as a result of the reward system becoming overwhelmed in a way that leads to chronic and permanent alterations in the brain.
Addiction is now understood to be a brain disease. Whether it’s alcohol, prescription pain pills, nicotine, gambling, or something else, overcoming an addiction isn’t as simple as just stopping or exercising greater control over impulses.
That’s because addiction develops when the pleasure circuits in the brain get overwhelmed, in a way that can become chronic and sometimes even permanent. This is what’s at play when you hear about reward “systems” or “pathways” and the role of dopamine when it comes to addiction. But what does any of that really mean?
One of the most primitive parts of the brain, the reward system, developed as a way to reinforce behaviors we need to survive—such as eating. When we eat foods, the reward pathways activate a chemical called dopamine, which, in turn, releases a jolt of satisfaction. This encourages you to eat again in the future.
When a person develops an addiction to a substance, it’s because the brain has started to change. This happens because addictive substances trigger an outsized response when they reach the brain. Instead of a simple, pleasurable surge of dopamine, many drugs of abuse—such as opioids, cocaine, or nicotine—cause dopamine to flood the reward pathway, 10 times more than a natural reward.
The brain remembers this surge and associates it with the addictive substance. However, with chronic use of the substance, over time the brain’s circuits adapt and become less sensitive to dopamine. Achieving that pleasurable sensation becomes increasingly important, but at the same time, you build tolerance and need more and more of that substance to generate the level of high you crave.
Addiction can also cause problems with focus, memory, and learning, not to mention decision-making and judgment. Seeking drugs, therefore, is driven by habit—and not conscious, rational decisions.
One of the most primitive parts of the brain, the reward system, developed as a way to reinforce behaviors we need to survive—such as eating. Image is in the public domain
Unfortunately, the belief that people with addictions are simply making bad choices pervades. Furthermore, the use of stigmatizing language, such as “junkie” and “addict” and getting “clean,” often creates barriers when it comes to accessing treatment. There’s also stigma that surrounds treatment methods, creating additional challenges.
Though treatment modalities differ based on an individual’s history and the particular addiction he or she has developed, medications can make all the difference.
“A lot of people think that the goal of treatment for opioid use disorder, for example, is not taking any medication at all,” says David A. Fiellin, MD, a Yale Medicine primary care and addiction medicine specialist.
“Research shows that medication-based treatments are the most effective treatment. Opioid use disorder is a medical condition just like depression, diabetes or hypertension, and as with those conditions, it is most effectively treated with a combination of medication and counseling.”
Very interesting information.
Dopamine as the reward system is beginning to get a bit outdated. From the newer research (and experience) it would seem to be more accurate to call it the “desire” or “seeking” system. It can’t be satisfied – that next bit that’s just around the corner is what is being looked for!
Although once that bit arrives it doesn’t satisfy either – because you can’t satisfy or satiate desire. You keep on seeking. The dopamine is the signal that the reward is coming, moreso than the actual reward itself.
So when that next dopamine hit comes in, it’s telling you that the reward is just around the corner! One more drink, hit, bite, trigger-of-choice. That will be the one that satiates you and is the perfect thing you are looking for!
It would be much easier if it were a reward. A reward can satiate. Desire… Just keeps on being around the corner.
I forget my sources, but they’re multiple, and they’re out there. I’m pretty sure “desire system” is the right term I’m pulling from memory from a few books and research. There also some very interesting gambling studies based on dopamine signals and when they occur!
If a person living with chronic pain, from a chronic degenerative desease has to take painkillers daily, but still refuses to increase the dosage in order to minimize level of addiction, and sides effects, and fear that one day the little help that there is will be taken away because someone, (activist or polition playing Dr, whatever) decides anyone using painkillers is an addict and turns it into an illigal substance – or one so heavily controlled those who have a legitimate need can no longer get the medicine (or what Dr’s have told this person is a legitimate need)…that’s doesn’t sound like an addiction to me. This person is clearly in increasing pain, but still refuses to increase the dosage, a level that is about half the currently alloud level. So what do you think, is this person addicted just because its pain killers?? (yes, itsclassified as an opiate) Because it’s opiates does that always, automatically mean it’s being “abused?