Up Close With Dr. E

A new perspective on addiction


Today’s column will present a new model of drug addiction. Three terms are presented first, to be followed by details of the new model.

All of us have experienced life events which were so powerful, overwhelming or so emotionally charged that the memory we carry will be forever retained in our mind. Examples of this include the birth of a child, your wedding day or the moment you graduated from school. The key question, about your permanent memory is this: how did your brain decide that these events would qualify for admission into the special place of “memory forever”?

The term used by neuroscientists for those select memories storied in the “forever box,” is “over learning.” Over learning involves a special process where the facts of an event are fused with the emotions you felt at that time. The birth of a child is recorded by over learning because the emotional experience — joy, wonder, awe — fuses with the facts (seeing the child, holding the infant). Over learning is like a coin. One side holds the feelings, the other side holds the facts. When an event occurs, which is of monumental significance, both sides of the coin are simultaneously stamped. This new memory, like a shiny silver dollar, is then deposited into a permanent memory bank.

Let us next look at the term, neuroplasticity. Contrary to old and false beliefs about our brain — your brain is hard-wired, fixed, no new brain cells will be made — the human brain is constantly changing. Throughout your entire life, all the experiences you have, such as new sights, smells or books you’ve read, cause your brain to grow new cells, new connections, and are part of the re-shaping or remodeling all human brains undergo. This process, called neuroplasticity, is like a landscape painting, where the artist applies oil paints upon a canvas surface. But this picture never stays the same: the sky is in motion as puffy white clouds cast shadows upon the river below, whose rushing waters cascade in rainbows of color as they fall over a waterfall. Our brain is like a living painting, constantly shaped and sculpted by the hands of human experience.

The third term is reward center. When you eat your favorite type of chocolate, or when you fall in love, the brain’s reward center releases a specific chemical reward — dopamine — which, in turn, acts like a key to unlock the body’s own supply of euphoric bio-chemicals (endorphins).

Using these three concepts, let’s define drug addiction in a new way: “Addiction is a chronic, relapsing brain disease, characterized by a pathology of learning and memory” (Julien, 2008, pg. 689). Using a 14-year-old boy, Michael, as an example, let’s go through this new model:

1. Michael goes over to his best friend’s house and uses cocaine for the first time. He gets high. Cocaine causes his brain to release dopamine, but in amounts which could never occur under normal conditions.

2. This mega-dose of dopamine causes over learning. Permanent memories are now made — every detail of the room where he used cocaine is indelibly imprinted and fused with his euphoric high. From this point on, all it will take to trigger powerful urges and cravings to use cocaine will be the sound of his friend’s voice or stepping into the room where he first got high.

3. Having been hit by cocaine, the reward center resets itself. This causes all over-learned drug memories to spill out into Michael’s daily thoughts. It’s as if the shiny silver dollars, now pulled out of the bank, flip inside Michael’s head to tease, beg and scream at him, “Find more cocaine.”

4. As Michael uses more cocaine, neuroplasticity alters brain functioning. This, in turn, overrides the restraints he once had to not use drugs — fear about using an illegal drug, guilt about stealing money to buy drugs. His drug altered memory and learning systems now only listen to the loudest voice, “more cocaine.”

This new model of addiction has revolutionized drug treatment: 1. Drug addiction causes neuroplasticity, which means it will take years to re-balance brain functioning. This is why addiction is now viewed as a chronic illness — just like asthma or diabetes, where patients receive life-long treatments. 2. Once all drug use has stopped, withdrawals will occur for years. This means that patients need to learn healthy ways of achieving a dopamine high — exercise, human relationships, hobbies, spiritual connections. 3. A relapse — going back to drug use — is identical to a diabetic patient who sneaks a forbidden food. Therefore, using relapses as a measure of treatment success is inappropriate.

Since drug addiction alters a person’s ability to use learning and memory, the old criticisms hurled at drug addicted patients — unmotivated, morally weak, and inferior — must be seen for what they really are: discrimination against those with a chronic brain disease.

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.

Reference: “A Primer of Drug Action,” R. Julien, 2008


Dr. Richard Elghammer contributes his column to the Journal Review.


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