The Neuropsychology of Addiction
What is Addiction?
Addiction is a mental and physical condition that hooks an individual to a drug or behavior that leads to detrimental consequences. It’s a highly complex condition that leads to compulsive consumption of a substance regardless of repercussions, immediate or otherwise. It’s a term normally referred to people that allow substance abuse to control every aspect of their lives as the substance itself becomes the priority in their decision-making process. Addiction is considered a brain disorder that creates an uncontrollable desire to engage in “rewarding” stimuli regardless of the harm associated with these rewards. However, the definition varies slightly. For example, some publications argue that many addicts partake in addictive substances to escape emotional or physical discomfort; others refer to it as a disease.
Essentially, the reason behind taking part in psychoactive experiences is to feel good. The term addiction is thrown into normal conversation every day when referring to someone enjoying a certain food or beverage more than the average consumer, but clinicians take this term seriously as it is a relapsing disorder with eroding consequences when a person relapses and falls deeper into an addiction, often leading to death. Examples of addictive behaviors and substances include gambling, food, sex, shopping, alcohol, opioids, nicotine, heroin, and cocaine; to name a few. The dictionary definition describes it both as a state of being addicted and as a compulsive need. The word’s origin and derivations offer an important distinction, and it is often described as dependence or a habit.
How addiction changes the brain
Addiction gives you unmanageable cravings. This begins by changing the way your brain registers pleasure followed by mutating other brain functions such as motivation, the ability to learn motor skills, and recalling declarative knowledge. The American Psychiatric Association (APA) says, “people with a substance use disorder have distorted thinking, behavior, and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug.” Brain imaging provides evidence of the physical change’s addiction causes on the brain. It demonstrates how it reshapes parts of the brain related to learning, memory, judgment, and behavior control.
The dopamine neurotransmitter is partly responsible for plenty of addictive related behaviors because it has two functions, it allows you to see rewards and propels you to take action towards them. Dopamine is responsible for feelings of pleasure and thus creating a loop between reward and satisfaction. Earlier we mentioned how addiction leads to seeking “rewarding” stimuli, and dopamine is the chief function behind this process. Persons with low dopamine levels are more susceptible to becoming addicted. The neurotransmitter regulates emotions, impulsivity, alertness, etc., and it is possible to possess too little or too much. People with Parkinson’s Disease are found with very little dopamine.
However, those with too much dopamine can experience highly addictive behaviors. Regulating dopamine is treated with antipsychotic medication prescribed by a doctor. Pleasures can originate from psychoactive drugs, delicious food, sex, or monetary rewards; and the brain records them as equals. A powerful blast of dopamine surges from the nucleus accumbens (located in the center of the brain, above the amygdala) after partaking on this “rewarding” activity . The hippocampus remembers this instant gratification leading to the uncontrollable feeling of craving.
Symptoms of Addiction:
The core symptom of addiction is mostly the pattern itself. The pattern is what causes the distress and the spiraling. Symptoms will vary because they relate to the disorder, substance, and behavior at once creating slight differences in separate instances. As we previously discussed, a person exhibiting addictive behavior will continue this pattern regardless of the harm caused by consumption. Regardless of a continuous and expressed desire to quit, the pattern can continue. Another clue is an unquenching craving. Family history, biology, hereditary factors, depression, environment, and a myriad of other circumstances affect a person’s proclivity to exhibit addictive behaviors. The symptoms can be split into three main categories: psychological, social, and physical symptoms.
Unable to stop - when a person cannot stop regardless of continuous commitments, promises, and unsuccessful attempts at stopping.
Seeking the stimuli to “deal” with their problems – when a person feels a need to consume the substance to cope with their living circumstances. Ironically, the deteriorating quality of living created by the addiction leads to more of this, creating a self-fulfilling cycle.
Obsession – when a person becomes obsessed with ways of acquiring and consuming said substance.
Unhealthy risk-taking – an addicted person can engage in risky behaviors such as trading drugs, buying illicit substances, and trade sex for the drug itself.
No longer able to practice certain hobbies – a person can progress in a substance such as smoking that he or she is no longer able to perform a hobby (i.e. smoking affecting the lungs of a runner leading to difficulty with breathing while jogging).
Doing it in secret – when the person partakes in secret, slowly edging themselves out of social groups and experiencing an increase desire for solitude.
Keeping stashes hidden – when the person keeps stashes hidden away around the house, vehicle, and other places.
Mounting debt – when using credit cards or selling essential household items so he or she can afford more drugs.
Withdrawal symptoms – when a person experiences an intense craving, seizures, excessive sweating, trembling, or erratic behavior, usually after the addictive substance is reduced or completely removed.
Damage from the substance itself – for example, when a person develops throat cancer from smoking, or infections from needles, to name a few.
Drastic appearance changes – when a person looks worse as time moves on and the addiction progresses. For a more detailed list of these symptoms, consult this post published by the Medical News Today newsletter.
Common myths about addiction
A common misconception about addiction is the ability of the afflicted to “just quit.” They are commonly described as having no willpower. Addiction is a chronic disease, meaning that it’s a persistent visitor. MedicineNet proclaims, “[chronic diseases] generally cannot be prevented by vaccines or cured by medication, nor do they just disappear.” As we’ve discussed earlier, addiction transforms the brain and physically alters the wiring. Another myth about addiction is regarding the stereotype of an “addict.” Traditionally described as lowly, poor, unemployed criminals, an addict can take any form; from a middle-aged housewife to a baby. It affects anyone and everyone at any stage of life. Some manage to become high-functioning addicts with the ability to keep up a social life and other responsibilities, but others don’t fare well and spiral down into potential death.
The third myth is the assumption that every person who uses a drug is addicted to it. Addiction can be a spectrum of sorts where some are deeper into it than others. At a lighter stage, there’s something called “substance dependence.” It’s a substance use disorder not to be taken lightly, as it is a step closer to addiction. The substance-dependent person can feel symptoms of withdrawal when stopping. He or she can also feel a craving for continuous and repetitive use of the drug. The differences are small, but medical journals prefer to acknowledge the distinction. Our fourth myth concerns relapsing and the assumption that a person who has relapsed is a lost cause. Relapse is defined by a recurrence of symptoms. Myth five claims that addiction is not a disease and that you can simply “cure” it by treating it as a behavioral problem. WeFaceItTogether writes the following, “Human behavior begins in the brain.
Advanced brain studies show that different types of treatments, such as psychotherapy and medication, can change brain function. This is true for depression and other illnesses, including addiction. Sometimes behavioral treatments, like counseling, are enough. Sometimes medication may be required as well. But the fact that behavioral treatments can be effective does not mean addiction isn’t a real illness.” Myth number six is concerning the method of cessation and the belief that there’s a one-size-fits-all method of treatment. Smoking offers something called Nicotine Replacement Therapies (NRTs) that allows users to choose between patches, inhalers, pills, hypnosis, among other methods of cessation, each designed to “edge” out the nicotine dependence.
Another myth includes treating addicts as a lost cause or treating them as bad people who deserve to be punished. Harvard Medical School writes, “In the 1930s when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit. The scientific consensus has changed since then. Today we recognize addiction as a chronic disease that changes both brain structure and function.” The myth rabbit hole never ends, but there are common strands with the public that is important to bring into the light.
It is always recommended to seek treatment at any stage of the addiction, preferably during earlier stages. Having a ritual is considered one of the most recognized stages of addiction, starting with the experimentation itself, then ritualizing the partaking of the behavior or substance. The next stage is dependence, and finally, the full addiction. The second stage is the ritualization of the behavior. It is recommended to intervene when we recognize someone ritualizing the consumption of substances. It’s the step before dangerous risk-taking takes place. A ritual is simply a set of actions followed by someone on a regular basis. In the case of addiction, the ritual involves a series of actions followed by the addict that becomes routine.
The ritual itself is considered pleasant and almost meditative. VeryWellMind writes, “for some, the actions of the ritual are as important as the substance itself. It can fulfill certain urges and the time of day, technique and location can carry significant meaning to the user. Some of the behaviors of rituals actually feed into the addiction; a user may deliberately work themselves into a state of agitation by having a ritual that is easily interrupted, therefore giving them a reason or justification to use the substance more.” A common thread from people living with an addict is always along the lines of, person arrives, walks directly to where the drug paraphernalia is stashed, and thus begins some form of ritualistic preparation of substances before the consumption (like rolling a joint).
Recovery.org sheds a bright light on the routine aspect of this, “using substances is often closely associated with deeply ingrained rituals. Time of day, location and tools are often almost as important as the drug use itself, carrying significant symbolism and meaning. Some ritualized behavior is emotional; a drug or alcohol abuser may purposefully work him or her self into a state of anger or anxiety so that there is a reason to use.” 
Addiction recovery literature repeatedly conveys the idea that recovery doesn’t come simply from cessation, but instead it comes from creating a new lifestyle that makes it difficult to consume the substance in the first place. If this new lifestyle isn’t thoroughly integrated into your life, the old habits, routines, and many other factors will pull you back into the addiction. The acronym HALT stands for Hungry, Angry, Lonely, and Tired. It’s designed as a reminder for addicts to catch themselves from slipping back into old habits.
Simply by asking the questions, (am I hungry, angry, lonely, or tired?) they can prevent backsliding. It is referred as one of the most effective relapse prevention tools. Commonly referred to as “high-risk” situations as well. Nobody can avoid high-risk situations (as defined by the literature) for the rest of their lives, but instead, being equipped with preventive tools is the best defense against relapsing. The awareness helps to prevent small cravings from turning into uncontrollable and unwieldy urges. Making a list of high-risk situations derived from H.A.L.T. with added nuance of emotions and triggers can be even more helpful, as not everybody experiences emotion in a simple shade.
The good news is, people who’ve quit a substance for more than five years, the relapse is unlikely. Addictions & Recovery writes, “after 5 years of abstinence relapse is rare. A study followed 268 Harvard University undergraduates and 456 non-delinquent inner-city adolescents. About 20 percent of the undergraduates and 30 percent of the inner-city adolescents were alcoholics in recovery. The men were followed until the age of 60, every two years by questionnaire, and every 5 years by physical examination. The study concluded that after 5 years of abstinence relapse is rare.”
One solution to quit smoking
Thousands of former smokers share the same conclusion: quitting was the toughest battle they’ve ever taken up. Addiction creates a massive craving that literally rewires the brain. Harvard Health Publishing proclaims, “Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing involvement with it despite adverse consequences. While overcoming addiction is possible, the process is often long, slow, and complicated. It took years for researchers and policymakers to arrive at this understanding.” The SmokeFree website recommends building a quit plan. They’ve created a website where the smoker “sets the table” for the journey to full cessation.
It begins by setting their quit date, followed by jotting down the reasons for quitting (be healthier, save money, smell better, etc.) Afterward, the smoker must describe his or her “smoking triggers” because being mindful of these triggers help to keep your composure when facing a craving. Each smoker has a trigger that causes them to smoke. For example, there are emotional triggers, such as feeling stressed, anxious, down, bored, lonely, cooling off after a fight. Habitual triggers include talking on the phone, watching television, driving, eating (or finishing a meal), drinking coffee or alcohol, after having sex, or taking a break at work. Social triggers include attending social events, bars, clubs, or simply the visual of someone smoking. After being equipped with this information, it’s easier to control the cravings.
Once the person’s triggers have been identified and understood, the next step is to prepare to fight the inevitable cravings. For example, if one of your reasons for smoking is so you can keep your mouth and hands busy, the website recommends holding a straw in your hand and breathing through it. If the addict smokes to improve mood or relieve stress, they recommend talking to friends, family, or practice deep breathing to ease said stress. By understanding triggers and equipping the person with ways to combat cravings, half the battle is won. The following step is to rid of smoking reminders such as the smell in your clothes, car, or areas of your house; and ashtrays, matches, and cigarette butts. In order to break the pattern, it is also recommended to place “craving fighting” items such as straws, fake cigarettes, nicotine gum, e-cigarettes, etc., [x] in places where the person kept the real ciga rettes. In other words, ridding of all items that remind you of smoking.
Nicotine Replacement Therapy
Not all methods of cessation work for everyone. There are other ways, too, such as NRTs (nicotine replacement therapies). An NRT can help you by giving you smaller doses of nicotine, over time decreasing the amount until fully edging the dependence out. It is also meant to relieve the painful withdrawal symptoms that come with quitting smoking. Using an NRT can almost double the chances of quitting smoking. It is recommended to try a nicotine replacement therapy if the person smokes more than one pack of cigarettes per day, or if they smoke within five minutes of awakening. Other reasons include waking up at night to smoke and smoking while sick.  The more of these a person does, the deeper the addiction and dependence exist in his or her brain.
NRT isn’t necessary for quitting, but as alluded in the previous section, not all addictions are created equal. Exploring one method can, by contrast, accentuate better compatibility with another option. NRTs are created to help with the physical dependence of quitting. There are other factors at play such as emotional and mental. Studies show that attending some sort of support system increases your chances of quitting. Full cessation is tricky, and smoking is one of the most common addictions out there. Cancer.org writes the following, “Many people can quit tobacco without using NRT, but most of those who attempt quitting do not succeed on the first try. In fact, smokers usually need many tries – sometimes as many as 10 or more – before they’re able to quit for good.
Most people who try to quit on their own go back to smoking within the first month of quitting – often because of the withdrawal symptoms.” The failure rate is high and the withdrawal symptoms extremely unpleasant. Examples of nicotine replacement products include nicotine patches, nicotine gums, lozenges, inhalers, nasal spray, and e-cigarettes. The US Food and Drug Administration has only approved of the first five. There are other methods of cessation such as smokeless cigarettes designed to fight the specific craving for those with the trigger of holding something with their hands and placing it between their lips.
Quitting an addictive substance can be painfully difficult. Lives can spiral out of control because of it and lead to extremely dire consequences. An awareness of addiction combined with the right tools to fight it can lead to a successful transition to a healthier life. This includes lifestyle changes, emotional support, meditation, replacement therapies, counseling, etc. If you’re someone who is struggling with addiction, there are many ways to seek help. Here are a few helplines to help you take the first step:
SAMHSA – Substance Abuse and Mental Health Services Administration
National Helpline – 1-800-662-HELP (4357)
NDH – National Drug Helpline
24/7 Helpline – 1-844-289-0879 / FREE PRIVATE CALL (844) 289-0879
Addiction and Alcohol Hotline
24/7 Toll-Free Confidential – 1-844-244-3171
DrugRehab.com Alcoholism Treatment Hotline
24/7 Toll-Free – 1-855-789-9197
- (2019, August 19). How Addiction Hijacks the Brain. Retrieved from https://www.helpguide.org/harvard/how-addiction-hijacks-the-brain.htm
- Felman, A. (n.d.). Addiction: Symptoms, effects, and what to look for. Retrieved from https://www.medicalnewstoday.com/articles/323459
- Hartney, E. (2019, April 29). What Is the Ritual Stage of Addiction? It Matters. Retrieved from https://www.verywellmind.com/what-is-a-ritual-22450
- (2018, May 8). Do You Understand Your Addiction Rituals? Retrieved from https://www.recovery.org/pro/articles/how-to-understand-your-addiction-rituals-with-mindfulness/
- (n.d.). Nicotine Replacement Therapy for Quitting Tobacco. Retrieved from https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/nicotine-replacement-therapy.html