“Why can’t you just stop?”
A common question that is heard among people regarding dealing with someone who is struggling with addiction is “why can’t you just stop?” The struggling addict can often ask this very question themselves, especially when their day-to-day functioning is impacted to the point of significant dysfunction and chaos. The underlying roots and mechanisms of addiction go beyond the obvious and actual act of using the substance or substances of choice. At its roots, addiction is a complex brain disease in which the substance or substances have impact brain chemistry to the point that the users experience compulsive and sometimes uncontrollable cravings and use despite the potentially devastating consequences that are brought on by use.
Addiction and the Brain
The brain is a complex communications network comprised of billions of cells which govern thoughts, emotions, perceptions, and drives. A central networking hub in our brain that helps regulates drive in regards to rewards is the nucleus accumbens. The nucleus accumbens is a cluster of cells that lies beneath the cerebral hemispheres. When an individual performs a task or action that satisfies a need or fulfills a desire, dopamine is released into the nucleus accumbens and produces pleasure.
The signals coming from the nucleus accumbens indicates to an individual that the action promotes either survival or reproduction. These associations between action and resulting pleasure can either have direct or indirect correlations and these associations form what is called the reward pathway. When we perform a task or action that produces pleasure it gets recorded in our brain. In natural circumstances, the reinforcement of pleasurable experiences comes with effort and a delay.
For people with addiction issues, the effects of drugs provide a shortcut to reward centers and provides a more immediate gratification response. The amount of dopamine flooding the nucleus accumbens during drug use is not serving a base natural function and the amount of dopamine reaching the structure is overwhelming and causes a shutdown. For people with addiction, the natural capacity for the brain to produce dopamine is reduced and the use of the drug eventually becomes the only way that dopamine can be produced in the brain.
As tolerance builds, people with addiction require higher doses of the drug to achieve the same pleasurable effect. The want and need for the drug increase even though the addict may no longer want or desire to use the drug. The use of the drug, therefore, becomes part of the motivational machinery.
Why Can’t People With Addiction Stop?
Why do people with addiction issues cling to the use and abuse of their drug of choice when the consequences of use can be devastating for the user? The use of drugs alter brain chemistry and establish associations between the experience of using the drug and circumstances in which has occurred, such as the set and setting of use. These memories can be recalled when people with addiction encounter places, people and situations which remind the user of those times when drugs were used.
Another factor to consider is both internal and external stresses. Those stressor signals are transmitted to two different brain structures: the amygdala and the hippocampus. The amygdala regulates emotions, emotional behavior, and motivation while the hippocampus is the area where behavioral inhibition is regulated. When stressor signals travel to these two structures it triggers strong emotional responses. Studies have shown that during times of stress a hormone called corticotropin-releasing hormone is released. In people with addiction, levels of this hormone rise and there is an increased risk of relapse.
On an emotional level, people with addictions hold on to their addictive use and patterns of behavior in order to pursue relief. This pursuit of relief can be due to failing health or being haunted by indiscretions towards family, friends and other loved ones. People with addiction use to remove feelings of guilt and emptiness and provides a respite from those feelings, even if they are short-term solutions. People with addiction also use because they feel illusions of power and control. The feelings people with addiction experience is akin to being transported to an ideal place where the addict feels they are in charge.
People with addiction are involved in a cycle in which they use to feel that control and relief. When people with addiction use there can be feelings of shame and guilt which can result in a short period of moral resolve in which promises to cease use are formulated. When that resolve disappears there is disappointment and feelings of despair take over. The only way to remove those feelings of despair is through the use of drugs and the cycle repeats.
Breaking the Cycle
In order to break that cycle people with addiction may often need professional medical treatment and counseling or they may enter a 12 step program. Other times the trigger to change may come with personal or financial ruin in which the addict “loses everything”. Besides treatment and counseling regimens, there are needs to be a spiritual awakening that transcends physical wants and needs.