Addiction——how do we understand it
Addiction = Impulsivity + Compulsivity + Survival Reward
The whole point of the brain is to survive. To do so, the brain uses dopamine to reinforce survival-related behaviors. But addiction hijacked the dopamine system and made itself become survival. If you can’t resist the urge to run away when a high-speed car rushes towards you, it’s the same thing to resist the urge to use.
Therefore, resist addiction is to resist survival instinct. That’s how powerful it is.
Addiction =
Impulsivity (“I impulsively tried it. And I did it again”)
+
Compulsivity (“I can’t stop it. It has to happen now”)
+
Survival Reward (“It’s the best and the most important in the moment”)
Impulsivity Psychopathology
Impulsivity is an inability to stop the initiation of actions. It includes: acting without thinking; lack of reflection on consequences; seeking instant reward instead of delayed reward; choosing risky behavior; lacking willpower and giving in temptations.
The brain circuit (picture next) order is Ventral striatum——to Thalamus——to Ventromedial prefrontal cortex——to Anterior cingulate cortex
Disorders related to impulsivity include:
ADHD
Self-harm
Anger Issues
Impulse control
Conduct Disorder
Bipolar Mania/Hypomania
Borderline Personality Disorder
Compulsivity Psychopathology
Compulsivity is an inability to end ongoing actions regardless of negative feedback. Using habit is a compulsion that the response is conditioned by drug cues leading to using behavior every time, for more dopamine reward and less withdrawal pain.
The brain circuit (picture next) order is dorsal striatum——to Thalamus——to Orbitalfrontal prefrontal cortex——to Anterior cingulate cortex
Disorders related to impulsivity include:
OCD
Hoarding
Skin Picking
Hair pulling
Body Dysmorphia
Tics
Autism
Survival Reward Psychopathology—The Mesolimbic dopamine system (Red pathway down)
The survival reward pathway is how the brain uses a bunch of natural neurotransmitters (the messengers) including dopamine to reinforce survival-related adaptive behaviors (such as eating, drinking, sex) and it produces “natural highs,” such as feelings of joy or accomplishment.
Neurotransmitters involved in the reward system include the brain’s own morphine or heroin (i.e., endorphins such as enkephalin), the brain’s own marijuana (i.e., anandamide), the brain’s own nicotine (i.e., acetylcholine), and the brain’s own cocaine/amphetamine (i.e., dopamine itself), among others.
Drug abuse can bypass the brain’s own neurotransmitters (the messengers) and directly stimulate the brain’s receptors (the message receivers) in the reward system, causing massive dopamine release and a consequent “artificial high.”
Thus alcohol, opioids, stimulants, marijuana, benzodiazepines, sedative hypnotics, hallucinogens, and nicotine all affect this mesolimbic dopaminergic system, which is the ultimate Addiction Cycle.
Once the Addiction Cycle is formed, it can only be treated but cannot be cured. It’s formed from one drug or behavior, but it opens to all addictions, which is called cross-addiction.
Disorders related to Addiction include:
Alcohol/Drug Addiction
Sexual Addiction
Gambling
Internet Addiction
Food Addiction
Paraphilias
Due to the above unique brain changes, the following results of using become the reasons of keep using
Sexual and other behavioral Addictions
Sex addiction is common and it’s true. It essentially shares the same reasons why other addictions happen.
Studies have revealed anatomical and pathological changes in the brains of individuals with sex addiction, similar to those observed in substance addictions. A study utilizing voxel-based morphometry (VBM), a magnetic resonance imaging (MRI)-based technique, demonstrated measurable volume loss in specific brain areas, including the frontal lobes, in individuals with cocaine and methamphetamine addictions. A similar VBM study on obesity, a natural endogenous addiction, also showed volume loss, particularly in the frontal lobes. These findings suggest that addiction, whether related to substances or natural behaviors, can lead to visible damage in the brain.
Please visit my blog to see more evidence: Understanding Sexual Addiction in the brain
DSM-5 Core Symptoms for Addiction (alcohol/substance/addictive-behavior use)
1. Alcohol/substance/addictive-behavior is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol/substance/addictive-behavior use.
3. A great deal of time is spent in activities necessary to obtain, use alcohol/substance/addictive-behavior, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol/substance/addictive-behavior.
5. Recurrent alcohol/substance/addictive-behavior use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol/substance/addictive-behavior use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol/substance/addictive-behavior.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol/substance/addictive-behavior use.
8. Recurrent alcohol/substance/addictive-behavior use in situations in which it is physically hazardous.
9. alcohol/substance/addictive-behavior use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol/substance/addictive-behavior.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol/substance/addictive-behavior to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol/substance/addictive-behavior.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol/substance/addictive-behavior
Local Resources for Addiction Healing (Cleveland, Cleveland Heights, Columbus and Cincinnati)
Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County: https://adamhscc.org/ The ADAMHS Board of Cuyahoga County provides a wide range of addiction and mental health services, including prevention, treatment, and recovery services, to individuals and families in Cleveland and the surrounding areas.
Cleveland Recovery Center: https://clevelandrecoverycenter.org/ The Cleveland Recovery Center offers addiction treatment services, including detoxification, counseling, and support groups, for individuals struggling with addiction in Cleveland and the surrounding areas.
The MetroHealth System Addiction Medicine Center: https://www.metrohealth.org/addiction-medicine-center The MetroHealth System Addiction Medicine Center provides addiction treatment services, including medication-assisted treatment and counseling, for individuals struggling with addiction in Cleveland and the surrounding areas.
Ohio State University Wexner Medical Center: https://wexnermedical.osu.edu/mental-behavioral/addiction-treatment/sexual-addiction The Ohio State University Wexner Medical Center offers specialized addiction treatment services, including treatment for sexual addiction, for individuals in Columbus and the surrounding areas. Their program includes individual and group therapy, as well as medication management if needed.
Narcotics Anonymous (Cleveland Area): https://www.nacleveland.org/ Narcotics Anonymous is a mutual help group that provides support and fellowship for individuals in recovery from drug addiction in the Cleveland area.
Alcoholics Anonymous (Cleveland Area): https://www.aacle.org/ Alcoholics Anonymous is a mutual help group that provides support and fellowship for individuals in recovery from alcohol addiction in the Cleveland area.
Alcoholics Anonymous (Columbus): https://www.aacentralohio.org/ Alcoholics Anonymous (AA) is a mutual help group for individuals struggling with alcohol addiction. The Columbus chapter of AA offers meetings throughout the city, including both in-person and virtual meetings.
SMART Recovery (Cleveland Area): https://www.smartrecoverytest.org/local/meetings/?search=cleveland%2C+ohio SMART Recovery is a mutual help group that offers a science-based approach to addiction recovery and provides support and fellowship for individuals struggling with addiction in the Cleveland area.
SAA Cleveland (Sex Addicts Anonymous): https://saa-recovery.org/meetings/?type=1&state=OH&city=Cleveland Sex Addicts Anonymous (SAA) is a mutual help group that provides support and fellowship for individuals in recovery from sexual addiction in the Cleveland area. They follow a 12-step program and offer meetings and support for individuals and their loved ones.
Sex Addicts Anonymous Columbus: https://saa-recovery.org/meetings/?type=1&state=OH&city=Columbus Sex Addicts Anonymous (SAA) also has a presence in Columbus, with regular meetings held throughout the city. These meetings offer a safe and supportive environment for individuals in recovery from sexual addiction to share their experiences and receive support from others.
Book an appointment with our addiction specialist right now!
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References:
Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., ... & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature reviews Disease primers, 1(1), 1-23.
Stahl, S. M. (2021). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://en.wikipedia.org/wiki/Default_mode_network#cite_note-5