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What is addiction? Why some can’t give it up, others can walk away


Imagine you’re driving a car. Ahead, you see a little girl playing in the road, but she does not see you. You desperately want to stop, but you can’t — you have no brakes.

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That is how Dr. Nora Volkow, director of the National Institute on Drug Abuse, describes addiction. It’s not that an addict chooses to do drugs despite catastrophic consequences — it’s that the addict cannot stop despite those consequences.

“The person that is addicted does not choose to be addicted,” Volkow said. “It’s not a choice to take the drug.”

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The definition of addiction has morphed as advances in neuro-imaging, technologies that produce images of the brain such as CAT scans, allow researchers to see the inner workings of an addict’s brain. That research is debunking the myth that addicts are weak-willed and undisciplined and that if they really wanted to quit, they could.

That false belief fuels the stigma that prevents addiction from being widely accepted as an illness — even in the medical community. As a result, medical schools in the past provided little training and insurance companies provided little coverage.

“It was never considered a disease; it was considered a lifestyle,” said Thomas McLellan, former deputy director of the White House Office on National Drug Control Policy and founder of the Treatment Research Institute in Philadelphia.

What is addiction?

The simplest answer: Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences. That’s according to the National Institute on Drug Abuse.

To Dr. Barbara Krantz, a researcher and director of Addiction Medicine at Caron Renaissance and Ocean Drive in Boca Raton, it is about understanding how and why that compulsive behavior occurs in an addict’s brain and not in the brain of a non-addict — even though they may be taking the same drugs.

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“There are definite structural and chemical changes in the brain of an addict as opposed to a non-addict,” Krantz said.

Reward for sex, eating

All scientific discussions about addiction begin with dopamine — a chemical messenger that motivates us for doing things we need to do to stay alive.

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It is our brain’s way of rewarding us for doing things that feel good: When you are hungry, dopamine gets you off the couch and to the refrigerator. Cold? Dopamine prompts you to reach for a blanket.

If food and sex were not pleasurable, humans would not eat or procreate.

“You need three things to exist,” said Dr. Corey Waller, an addiction researcher and senior medical director for education and policy at the Camden Coalition of Healthcare Providers in New Jersey. “Food, water and dopamine.”

But in the brains of addicts, drugs damage the dopamine-reward system.

The measure of dopamine in a healthy person’s system is 50 on an average day. “Win the lottery, lay on the beach,” the dopamine may double to 100, Waller said. Eat your favorite food: 94. Sex: 92.

Power of euphoria

But heroin blows the roof off our bodies’ natural dopamine levels. A hit of heroin: 1,000. A shot of alcohol: 875.

“Drugs crank up the reward system above where it is supposed to go,” Waller said.

Overstimulating the system with drugs produces euphoria, a powerful reward that reinforces the behavior, teaching the user to repeat it, without thinking about it.

Also, the brain dials down the amount of dopamine it produces naturally. An abnormally low level of dopamine leaves a person unable to experience any pleasure without the drug. So the addict must shoot up heroin again. But he will not feel the same euphoria with the same amount.

Tolerance increases, meaning the addict needs to take larger amounts. Thus begins the phenomenon of “chasing the high.”

These constant jolts to the dopamine system and the resulting stress response triggered by withdrawal damages the addict’s brain circuitry responsible for judgment, impulse control, decision-making, learning, memory and behavior control.

As the disease advances, so does the damage to the dopamine pathways.

“The disease attacks the part of the brain it needs to get better,” Waller said. “The motivation system is being destroyed by the disease itself.”

Obesity, addiction similar

Volkow likens addiction to obesity — where the brain’s ability to exert self-control is compromised.

In her research, brain scans revealed that obese people had deficiencies in the same part of the brain as addicts.

“Can you imagine food being so pleasurable that you are willing to forego 10 years of your life because of the adverse consequences?” Volkow said.

“The dismissal of addiction and obesity as just a problem of self-control ignores the fact that for us to be able to exert self-control requires proper function of areas in our brain that regulate our behaviors,” Volkow said. “You know, I never ever met an addicted person who wanted to be an addict.”

Is addiction built in?

Researchers are still trying to find out what causes addiction, but it appears that nature and nurture both play a role.

“Not everybody who gets exposed to drugs responds in the same way,” Volkow said. “Not everybody exposed to drugs will become addicts.”

Genetics plays a significant role — responsible for about 50 percent of a person’s likelihood of becoming an addict. Other factors, such as environment and social development, contribute.

“If you are the child of a severe alcoholic and you begin drinking, you are predisposed to react differently to that substance — or any substance,” said Dr. Anthony Campo, medical director at Caron Renaissance and Ocean Drive.

The age a person begins using and how long they abuse drugs is especially important. Drug use at an early age increases the likelihood of abuse later in life.

Kids damage their brain

Also, the area of the brain responsible for decision-making, impulse control and moderating behavior is not fully developed until a person’s mid-20s.

Using drugs at an early age can cause permanent damage to a developing brain, Krantz said. Studies on marijuana use by 14- to 16-year-olds found structural changes in the brain that can be irreversible, she added.

“So, an adolescent who thinks he’s just smoking weed is gravely mistaken,” Krantz said. “It’s having profound effects on the development of neural synapses in the brain and brain structure.”

Tragically, addiction is a family disease. On Aug. 18, Boca Raton police found Amanda Ross’ lifeless body slumped on the floor of her apartment — a syringe next to her and a tourniquet on the bathroom vanity. It was exactly one year after her brother’s death from a heroin overdose, her sister said in a police report.

In her purse, they found a letter she had written to her family.

“What happened was completely the disease. It’s the disease’s fault,” she wrote. “I tried so hard to straighten out my life. I did not do this on purpose. This is not a suicide.”

The medical examiner found heroin and Xanax in her system. He ruled her death a suicide.


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