In The Realm of Hungry Ghosts by Gabor Mate

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a langue that tells us about plight that must be understood. 
– Alice Miller

The Keys of Paradise: Addiction as a Flight from Distress 

It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug of the addictive behavior. 

Far more than a quest for pleasure, chorionic substance use is the addict’s attempt to escape distressed. From a medical point of view, addicts are self-medicating conditions like depression, anxiety, post-traumatic stress, or even ADHD (attention deficit hyperactivity disorder). 

Addictions always originate in pain, whether felt open or hidden in the conscious. They are emotional anesthetic. Heroin and cocaine, both powerful physical painkillers, also ease psychological discomfort. Infant animals separated from their mothers can be soothed readily by low doses of narcotics, just as if it was the physical pain they were enduring.  

The pathways in humans are no different. The very same brain centers that interpret and “feel” physical pain also become activated during the experience of emotional rejection: on brain scans they “light up” in response to social ostracism just as they would when triggered by physically harmful stimuli. When people speak of feeling “hurt” or of having emotional “pain,” they are not being abstract or poetic but scientifically quite precise. 

The hard-drug addict’s life has been marked by a surfeit of pain. 

The question is never “why the addiction?” But “why the pain?”

The research literature is unequivocal: most hard-core substance abuses come from abusive homes. The majority of the author’s patients in Skid Row suffered severe neglect and maltreatment early in life. Almost all the addicted women inhabiting the Downtown Eastside were sexually assaulted in childhood, as were many of the men. The autobiographical accounts and case files of Portland residents tell stories of pain upon pain: rape, beatings, humiliation, rejection, abandonment, and relentless character assassination. As children, they were obliged to witness the violent relationships, self-harming life patterns, or suicidal addictions of their parents- and often had to take care of them. Or they had to look after younger siblings and defend them from being abused even as they endured the daily violation of their bodies and souls. 

Not all addictions are rooted in abuse or trauma, but the author believes they can all be traced to painful experiences. A hurt is at the center of all addictive behaviors. It is present in the gambler,m internet addict, compulsive shopper, and workaholic. The wound may not be as deep and the ache not as excruciating, and it may even be entirely hidden – but it’s there. The effects of early stress or adverse experiences directly shape both the psychology and the neurobiology of addiction in the brain. 

A sense of deficient emptiness pervades our entire culture. Drug addiction is more painfully conscious of this void than most people and has limited means of escaping it. The rest of us find other ways of suppressing our fear of emptiness or of distracting ourselves from it. When we have nothing to occupy our minds, bad memories, troubling anxieties, unease, or the nagging mental stupor we call boredom can arise. At all costs, drug add it’s want to escape spending “alone time” with their minds. To a lesser degree, behavioral addictions are also responses to this terror of the void. 

Human beings want not only to survive but also to live. We long to experience life in all its vividness, with full, untrammeled emotion. Adults envy the open-hearted and open-minded explorations of children; seeing their joy and curiosity, we pine for our lost capacity of wide-eyed wonder. Boredom, rooted in a fundamental discomfort with the self, is one of the least tolerable mental states. 

For the addict, the drug provides a route to feeling alive again, if only temporarily. 

The addict’s reliance on the drug to reawaken their dulled feelings is no adolescent caprice. The dullness is itself a consequence of an emotional malfunction no of her making: the internal shutdown of vulnerability. 

From the Latin word vulnerable, “to wound,” vulnerability is our susceptibility to being wounded. This fragility is part of our nature and cannot be escaped. The best the brain can do is to shut down cognitive awareness of it when the pain becomes so vast or unbearable that it threatens to overwhelm our capacity to function. The automatic repression of painful emotion is a helpless child’s prime defense mechanism and can enable the child to endure trauma that would otherwise be catastrophic. The unfortunate consequence is a wholesale dulling of emotional awareness. 

Intuitively, we all know that it’s better to feel than not to feel. Beyond their energizing subjective charge, Latinos have crucial survival value. They orient us, interpret the world for us and offer us vital information. They tell us what is dangerous and what is benign, what threatens our existence, and what will nurture our growth. Imagine how disabled we would be if we could not see or hear or taste or sense heat or cold or physical pain. Emotional shut-down is similar. Our emotions are an indispensable part of our sensory apparatus and an essential part of who we are. They make life worthwhile, exciting, challenging, beautiful, and meaningful. 

When we flee our vulnerability, we lose our full capacity for feeling emotion. We may even become emotional amnesiacs, not remembering ever having felt truly elated or truly sad. A nagging void opens, and we experience it as alienation, as profound ennui, as the sense of deficient emptiness described above. 

The wondrous power of a drug is to offer the addict protection from pain while at the same time enabling them to engage the world with excitement and meaning. The drug restores to the addict the childhood vivacity they suppressed long ago. 

Emotionally drained people often lack physical energy, as anyone who has experimented with depression knows, and this is a prime cause of bodily weariness that beleaguers many addicts. There are many more: dismal nutrition; a debilitating lifestyle; diseases like HIV, and hepatitis C, and their complications; disturbed sleep patterns that date back, in many cases, to childhood – another consequence of abuse or neglect. 

Another powerful dynamic perpetuates addiction despite the abundance of disastrous consequences: the addict sees no other possible existence for himself. His outlook on the future is restricted by his entrenched self-image as an addict. No matter how much he way acknowledges the costs of his addiction, he fears a loss of self if it were absent from his life. In his mind, he would cease to exist as he knows himself. 

What is Addiction?

Addicts and addictions are part of our cultural landscape and lexicon. We all know who and what they are – or think we do.

In English, langue addiction has two overlapping but distinct meanings. In our day, it most commonly refers to a dysfunctional dependence on drugs or behaviors such as gambling or sex, or eating. Surprisingly, that meaning is only about a hundred years old. For centuries before then, back to Shakespeare, addiction referred simply to an activity that one was passionate about or committed to and gave one’s time to. The pathological sense of the word arose in the early 20th century. 

The term’s original root comes from the Latin advice, “assign to.” That yields the word’s traditional, innocuous meaning: a habitual activity or interest, often with a positive purpose. The victoria-era British politician William Gladstone wrote about “addiction to agricultural pursuits,” implying a perfectly admirable vocation. But the Romans had another, more ominous usage that speaks to our present-day interpretation: an addict us was a person who, having defaulted on a debt, was assigned to his creditor as a lave – hence, addiction’s modern sense as enslavement to habit. 

What, then, is addiction? In the words of a consensus statement by addiction experts in 2001, addiction is a “chronic neurobiological disease characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued used despite harm, and craving.” The key features of substance addiction are the use of drugs or alcohol despite negative consequences and relapse. The issue is not the quantity or even the frequency, but the impact. “An addict continues to use a drug when evidence strongly demonstrates the drug is doing significant harm… if users show the pattern of preoccupation and compulsive use repeatedly over time with relapse, addiction can be identified.” 

Helpful as such deficits are, we have to take a broader view to understand addiction fully. There’s a fundamental addiction process that can express itself in many ways, through many different habits. The use of substances like heroin, cocaine, nicotine, and alcohol are only the most obvious example,s the most laden with the risk of physiological and medical consequences. Many behavioral, no substance addictions can also be highly destructive to physical health, psychological balance, and personal and social relationships. 

Addiction is any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addition involves:

1. Compulsive engagement with behavior, a preoccupation with it; 
2. Impaired control over behavior;
3. Persistence or relapse, despite evidence of harm; and
4. Dissatisfaction, irritability, or intense craving when the object – be it a drug, activity, or another goal – is not immediately available. 

Compulsion, impaired control, persistence, irritability, relapse, and craving – these are all hallmarks of addiction – any addiction. Not all harmful compulsions are addictions, though: an obsessive-compulsive, for example, also has impaired control and persists in a ritualized and psychologically debilitating behavior such as, say, repeated hand washing. The difference is that he has no craving for it, and unlike the addict, he gets no kick out of his compulsion. 

How does the addict know they have impaired control? Because they don’t stop the behavior despite its ill effects. They make promises to themselves or others to quit, but despite pain, peril, and promises, they keep relapsing. There are exemptions, of course. Some addicts never recognized the harm their behavior causes and never form resolutions to end them. They stay in denial and rationalization. Others openly accept the risk, resolving to live and die “my way.” 

On the biochemical level, the purpose of all addictions is to create an alternated physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So addiction is never purely “psychological”; all addictions have a biological dimension. 

Viewing addiction as an illness, either acquired or inherited, narrows it down to a medical issue. It does have some of the features of the illness, and these are most pronounced in hardcore drug addicts. Addiction is “all about” many things. 

Note, too, that neither the textbook definitions of drug addiction nor the broader view we’re taking here includes the concepts of physical dependence or tolérale as criteria for addition. Tolerance is an instance of “give a niche, take a mile.” That is, the addict needs to use more and more of the same substance or engage in more and more of the same behavior, to get the same rewarding effects. Although tolerance is a common effect of many additions, a person does not need to have developed a tolerance to be addicted. And then there’s the physical dependence. As defined in medical timers, physical dependence is manifested when a person stops taking a substance and, due to changes in the brain and the body, experience withdrawal symptoms. Those temporary, drug-included changes form the basis of physical dependence. Although a feature of drug addiction, a person’s physical dependence on a substance does not necessarily imply that he is addicted to it. Withdrawal does not mean you were addicted; for addiction, there also needs to be craving and relapse. 

“Dependence” can also be understood as a powerful attachment to harmful substances or behaviors, and this decision gives us a clearer picture of addiction. The addict comes to dependence on the substance or behavior to make himself feel momentarily calmer or more excited or less dissatisfied with this life. Father Sam Portaro, author and former Episcopalian Chaplain to the University of Chicago, said it admirably well in recent lectures: “The heart of addiction is dependency, excessive dependency, unhealthy dependency – unhealthy in the sense of unwhole, dependency that disintegrates and destroys.” 

From Vietnam to “Rat Park”: Do Drugs Cause Addiction?

In the cloudy swirl of misleading ideas surrounding the public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction – in other words, that the cause of addiction resides in the power of the drug over the human brain. It is one of the bedrock fables sustaining the so-called “War on Drugs.” It also obscures the existence of a basic addiction process in which drugs are only one possible object, among many. 

The notion that addiction is drug-induced is often reinforced. Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods, do not lead to addiction except in a minority of susceptible people. 

We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are. “Addiction is a human problem that reduces in people, not in the drug or in the drug’s capacity to produce physical effects,” writes Lance Dodes, a psychiatrist at the Harvard Medical School Division on addictions. Some people will indeed become hooked on substances after only a few times of use, with potentially tragic consequences, but to understand why we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk. 

For all that, there is a factual basis to the durable notion of certain drugs being inexorably addictive: some people, a relatively small minority, are at grave risk for addiction if exposed to certain substances. For this minority, exposure to drugs really will trigger addiction, and the trajectory of drug dependence, once begun, is extremely difficult to stop. 

In the United States, opiate relapse rates of 80% to more than 90% have been recorded among addicts who try to quit their habit. Even after hospital treatment, the re-addition rates are over 70%. Such dismal results have led to the impression that opiates themselves hold the power of addiction over human beings. Similarly, cocaine has been described in the media as “the most addictive drug on earth,” causing “instant addiction.” More recently, crystal methamphetamine (crystal meth) has gained a reputation as the most instantly powerful addiction-inducing drug – a well-deserved notoriety, so long as we keep in mind that the vast majority of people who use it do not become addicted. Statistics Canada reported in 2005, for example, that 4.6% of Canadians have tried crystal meth, but only 0.5% had used it in the past year. If the drug by itself induced addiction, the two figures would have been nearly identical. 

In one sense certain substances, like narcotics and stimulants, alcohol, nicotine, and marijuana, can be said to be addictive. These are the drugs for which animals and humans will develop cravings and which they seek compulsively. But this is far from saying that the addiction is caused directly by access to the drug. Certain substances have additive potential; the reasons are deeply rooted in the neurobiology and psychology of emotions. 

In 1981 Dr. Bruce Alexander, a psychologist at Simon Fraser University in British Columbia built the most natural environment for rats that they could think of labeled “Rat Park.” It was airy, and spacious, with about 200 times the square footage of a standard labor artsy cage. It was also scenic, comfortable, and sociable. They also administered the rats with fluid from either of the two drop dispersants. One dispenser contained a morphine solution and the other an inert solution. 

It turned out that for the Rat Park animals, morphine held little attraction, even when it was dissolved in a sickeningly sweet liquid usually irresistible to rodents and even after these rats were forced to consume morphine for weeks, to the point that they would develop distressing physical withdrawal symptoms if they didn’t use it. In other words, in this “natural” environment a rat will stay away from the drug if given a choice in the matter – even if it’s already physically dependent on the narcotic. “Nothing that we tried,” reported Bruce Alexander, “instilled a strong appetite for morphogenetics or produced anything that looked like addiction in rats that were housed in a reasonably normal environment.” By contrast, caged rats consumed up to twenty times more morphine than their relatively free-living relatives. 

Dr. Alexander first published these findings in 1981. 1980 it had already been reported that social isolation increased animals’ intake of morphine. Other scientists have confirmed that some environmental conditions are likely to induce animals to use drugs; given different conditions, even captive creatures can resist the lure of addiction. 

The Vietnam veterans study pointed to a similar conclusion: under certain conditions of stress many people can be made susceptible to addiction, but if circumstances change for the better, the addictive drive will abate. About half of all the American soldiers in Vietnam who began to use heroin developed an addiction to the drug. Once the stress of military service in a brutal and dangerous ward ended, so did the addiction. The ones who persisted in heroin addiction back home were, for the most part, those with histories of unstable childhood and previous drug use problems. 

Drugs, in short, do not make anyone into an addict, any more than food makes a person into a compulsive eater. There has to be a pre-existing vulnerability. There also has to be significant stress, as on these Vietnam soldiers – but, like drugs, external stressors by themselves, no matter how severe, are not enough. 

Thus, we might say that three factors need to coincide for substance addiction to occur: a susceptible organism; a drug with addictive potential; and stress. 

A Different State of the Brain 

Addiction is irrational and at times the behavior of addicts seems mystifying even to themselves. But what if we listen to addicts and hear their life histories? And what can we learn if we survey the brilliant and extensive scientific literature that has examined addiction from almost every conceivable angle? 

As we have seen, laboratory animals can be led into drug and alcohol addiction. Hooked up to the appropriate apparatus and allowed unlimited access, many rats will self-administer intravenous cocaine to the point of hunger, exhaustion, and death. Researchers even know how to make some laboratory creatures – rats, mice, monkeys, and apes – more vulnerable to addiction by genetic manipulation or by interference with prenatal and postnatal development.

Animal experiments have allowed for finely-tuned research into the relationships between brain circuitry, behavior, and addiction. Through new imaging methods, we’ve been able to glimpse the human brain in action under the immediate influence of drugs and after long-term drug use. Radioactive techniques and magnetic frequencies enable researchers to measure blood flow to the brain and to gauge the level of energy used by brain centers during various activities or certain emotional states. Electroencephalograms (EGGs) have identified abnormal electrical brainwave patterns in some young people who are at greater-than-normal risk for alcoholism. Scientists have looked at the chemistry of the addicted brain, its neurological connections, and its anatomical structures. They’ve analyzed the workings of molecules, the membranes of cells, and the replication of genetic material. They’ve investigated how stress activates the brain circuitry of addiction. Large-scale contribute to addiction and how early life experiences may shape the brain pathways of addiction. 

There are controversies, but everyone agrees that on the basic physiological level, addiction represents “a different state of the brain,” in the words of physician and researcher Charles O’Brien. The debate is over just exactly how the abnormal brain state arises. Are the changes in the addicted brain purely the consequences of drug use or is the brain of the habitual user so whose susceptible before drug use beings? Is there a brain state that predisposes a person to become addicted to drugs or behaviors such as compulsive sexual adventuring or overeating? If so, are those predisposing brain states induced mostly by genetic inheritance or by life experiences – or a combination of both? The answers to these questions are crucially important for the treatment of addiction and recovery. 

The drug-addicted brain doesn’t work in the same way as the non-addicted brain and when imaged utilizing PET scans and MRIs, it doesn’t look the same. An MRI study in 2002 looked at the white matter in the brain of dozens of cocaine addicts from youth to middle age, in comparison with the white matter or non-users. The brain’s grey matter contains the cell bodies of never cells; their connecting fibers, covered by fatty white tissue, form the white matter. As we age, we develop more active connections and therefore more white matter. In the brains of cocaine addicts, the age-related expansion of white matter is absent. Functionally, this means a loss of learning capacity – a diminished ability to make new choices, acquire new information, and adapt to new circumstances. 

Other studies have shown that grey matter density, too, is reduced in the cerebral context of cocaine addicts – that is, they have smaller or fewer never cells than normal. A diminished volume of grey matter has also been shown in heroin addicts and alcoholics, and this reduction in brain size is correlated with the years of use: the longer the person has been addicted, the greater the loss of volume. In the part of the cerebral cortex responsible for regulating emotional impulses and for making rational decisions, addicted brains have reduced activity. In special scanning studies, these brain centers have also exhibited diminished energy utilization in chorionic substance users, indicating that the nerve cells and circuits in those locations are doing less work. When tested psychologically, these same addicts showed impaired functioning of their prefrontal cortex, the “executive” part of the human brain. Thus, the impairments of physiological function revealed through imaging were paralleled by a diminished capacity for rational thought. Such changes are sometimes reversible but can last for a long time and may even be lifelong, depending on the duration and intensity of drug use.

To write about the biology of addiction one must write about dopamine, a key brain chemical “messenger” that plays a central role Lin all forms of addiction. An imaging stud of rhesus monkeys published in 2006 confirmed previous findings that the number of receptors for dopamine was reduced in chronic cocaine users. Receptors are the molecule on the surfaces of cells where chemical messengers fit and influence the activity of the cell. Every cell membrane holds many thousands of receptors for many types of messenger molecules. Cells receive input and direction from other parts of the brain and the body and the outside using messenger-receptor interactions. It if wasn’t for their ability to exchange messages with their environment, cells could not function. 

Cocaine and other stimulant-type drugs work because they greatly increase the amount of dopamine available to cells in essential brain centers. That student’s rise in the levels of dopamine, one of the brain’s “feel-good” chemicals, accounts for elation and a sense of infinite potential experience by the stimulant user, at least at the beginning of the drug habit. 

As mentioned, it was already known that the brains of chronic cocaine users had fewer than normal dopamine receptors. The fewer such receptors, the more the brain would “welcome” external substances that could help increase its available dopamine supply. 

Stimulant drugs like cocaine and methamphetamine (crystal meth) exert their effect by making more dopamine available to cells that are activated by this brain chemical. Because dopamine is important for motivation, incentive, and energy, a diminished number of receptors will reduce the addict’s stamina and his incentive and drive for normal activities when not using the drug. It’s a vicious cycle: more cocaine use leads to more loss of dopamine receptors. The fewer receptors, the more addict needs to supply his brain with an artificial chemical to make up for the lack. 

Why does chronic self-administration of cocaine reduce the density of dopamine receptors? It’s a simple matter of brain economics. The brain is accustomed to a certain level of dopamine activity. If it’s flooded with artificially high dopamine levels, it seeks to restore equilibrium by reducing the number of receptors where the dopamine can act. This mechanism helps to explain the phenomenon of tolerance, by which the users have to inject, ingest or inhale higher and higher doses of a substance to get the same effect as before. If deprived of the drug, the user goes into withdrawal partly because the diminished number of receptors can no longer generate the required normal dopamine activity: hence the irritability, depressed mood, alienation, and extreme fatigue of the stimulant addict without his drug. 

On a cellular level addition is all about neurotransmitters and their receptors. In different ways, all commonly abuse drugs temporarily enhance the brain’s dopamine functioning. Alcohol, marijuana, opiates heroin and morphogenetics, and stimulants such as nicotine, caffeine, cocaine, and crustal meth all have this effect. 

Like the neurotransmitters, dopamine does its work in the space between cells, known as the synaptic space, or cleft. A synapse is where the branches of two nerve cells converge without touching, and it’s the space between them where messages are chemically transmitted from one cell to the next. That is why the brain needs chemical messengers, or neurotransmitters, to function. Released from a neuron, or nerve cell, a neurotransmitter such as dopamine “floats” across the synaptic space and attaches to receptors on the second neuron. Having carried its message to the target nerve cell, the molecule then falls back into the synaptic felt, and from there it is taken back up into the origination neuron for later reuses; hence, the term reputable. The greater the reputation, the fewer neurotransmitters remain active between the neurons. 

Activities such as eating or sexual contact also promote the presence of dopamine in the synaptic space. Dr. Richard Rawson, associate director of UCLA’s Integrated Substance Abuse Program, reports that food seeking can increase brain dopamine levels in some key brain centers by 50%. Sexual arousal will do so by a factor of 100%, as well as nicotine and alcohol. But none of this can compete with cocaine, which more than triples dopamine levels. Yet cocaine is a miser compared with crystal meth, or “speed,” shoe dopamine-enhancing effect is astounding 1200%. 

In short, drug use temporarily changes the brain’s internal environment: the “high” is procured using a rapid chemical shift. There are also long-term consequences: chording drug use remodels the brain’s chemical structure, anatomy, and physiological functioning. It even alters the way the genes act in the nuclei of brain cells.

Since the brain determines the way we act, these biological changes lead to altered behaviors. It is in this sense that medical languid refer to addiction as a chronic disease.

In any disease, say smoking-induced lung or heart disease, organs and tissues are dam damaged and function in pathological ways. When the brain is diseased, the functions that become pathological are the person’s life, thought processes, and behavior. And this creates addiction’s central dilemma: if recovery is to occur, the brain, the impaired organ of decision-making, needs to initiate its healing process. An altered and dysfunctional brain must decide that it wants to overcome its dysfunction: to revert to normal – or perhaps, become normal for the very first time. The worse the addiction is, the greater the brain abnormality and the greater the biological obstacles to opting for health. 

The scientific literature is nearly unanimous in viewing drug addiction as a chronicle brain condition, and this Ali one ought to discourage anyone from blaming or punishing the suffered. No one, after all, blames a person suffering from rheumatoid arthritis for having a relapse, since relapse is one of the characteristics of chronic illness. The very concept of choice appears less clear-cut if we understand that the addict’s ability to choose, if not absent, is certainly impaired. 

Through a Needle, a Warm Soft Hug

All the substances that are the main drugs of abuse today originate in natural plant products and have been known to human beings for thousands of years. 

Opium, the basis for heroin, is an extract of the Asian poppy Papaver somniferum. Four thousand years ago, the Sumerians and Egyptians were already familiar with its usefulness in treating pain and diarrhea and also with this powers to affect a person’s psychological state. Cocaine is an extract of the leaves of Erythroxyolon coca, a small tree that thrives on the Easter slopes of the Andes in western South America. Amazon Indians chewed coca long before the Conquest, as an antidote to fatigue and to rescue the need to eat on long, arduous mountain journeys. 

The hemp plant, from which marijuana is derived, was first free on the Indian subcontinent and was christened Cannabis sativa by the Swedish scientist Carl Linnaeus in 1753. It was also known to ancient Persians, Arabs, and Chinese, and its earliest recorded pharmaceutical use appears in a Chinese compendium of medicine written nearly three thousand years ago. 

Alcohol, produced by fermentation that depends on microscopic fungi, is such an indelible part of human history and joy-making that in many traditions it is honored as a gift from the gods. Contrary to its present reputation, it has also been viewed as a giver of wisdom. 

None of these substances could affect us unless they worked on natural processes in the human brain and made use of the brain’s innate chemical apparatus. Drugs influence and alter how we act and feel because they resemble the brain’s natural chemicals. This likeness allows them to occupy receptor sites on our cells and interact with the brain’s intrinsic messenger systems. 

Why is the human brain so receptive to drugs of abuse? Addiction may not be a natural state, but the brain regions it subverts are part of our central machinery of survival. 

The constellation of behaviors we call addiction is provoked by a complex set of neurological and emotional mechanisms that develop inside a person. These mechanisms have one separate existence and no conscious will of their own, even if the addiction may often experience itself as governed by a powerful controlling force or as suffering from a disease he has no strength to resist. 

So it would be more accurate to say: addiction may not be a natural state, but the brain regions in which its powers arise are central to our survival. 

The constellation of behaviors we call addiction is provoked by a complex set of neurobiological and emotional mechanisms that develop inside a person. These mechanisms have no separate existence and no conscious will of their own, even if the addict may often experience himself as governed by a powerful controlling force or as suffering from a disease he has no strength to resist. 

So it would be more accurate to say: addiction may not be a natural state, but the brain regions in which its powers arise are central to our survival. The force of the addiction precoces stems from that very fact. 

There is no addiction center in the brain, no circuits designated strictly for addictive purposes. The brain systems involved in addiction are among the key organizers and motivators of human emotional life and behavior; hence, addiction’s powerful hold on human beings. Three major networks are involved. 

It was in the 1970s that an innate iPod system was first identified in the mammalian brain. The protein molecules that serve as the chemical messengers in this system were named endorphins by the U.S. researcher Eric Simon because they originate within the organism and because they bear resemblance to morphine. Morphine and its opiate cousins fit into the brain’s endorphin receptors and thus the main endorphin receptor “represents the molecular gate of opioid addiction.” 

Not surprisingly, endorphins do for us exactly what plant-derived opioids can do: they’re powerful soothers of pain, both physical and emotional. For the distracted and soul-suffering person, a hit of endorphins, just like an infusion of optimum products, “composes what has been agitated, concentrates what has been distracted.”

Beyond their soothing properties, endorphins served other functions essential to life. They’re important regulators of the autonomic nervous system – the part that’s not under our conscious control. They affect many organs in the body, from the brain and heart to the intestines. They influence mood changes, physical activity, and sleep and regulate blood pressure, heart rate, breathing, bowel movements, and body temperature. They even help modulate our immune system. 

Endorphins are the chemical catalyst for our experience of key emotions that make human life, or any other mammalian life, possible. Most crucially, they enable the emotional bonding between mother and infant. Endorphins have been well described as “molecules of emotion.” 

On the other hand, positive expectations turn on the endorphin system. Scientists have observed, for example, that when people expected relief from pain, the activity of opioid receptors will increase. Even the administration of inert medications – substances that do not have direct physical activity – will light up opioid receptors, leading to decreased pain perception. This is the so-called “placebo effect.” 

Many other body chemicals serve multiple purposes -and the more evolved the organism, the more functions a particular substance will have. This is true even of genes: in one type of cell a certain gene will serve one function; elsewhere in the body, it will be assigned quite different duty. 

Oxytocin also interacts with opioids. It is not an endorphin,m but it increases the sensitivity of the brain’s opioid systems to endorphins – nature’s way of making sure that we don’t develop a tolerance to our opiates. 

Why is it essential to prevent tolerance to our natural reward chemicals? Because opioids are necessary for parental love. The infant’s well-being would be jeopardized if the mother became insensitive to the effects of her opioids. Nurturing mothers experience major endorphins surges as they interact lovingly with their babies – endorphins “highs” can be one of the natural rewards of motherhood.

Given that many thankless tasks are required in fact and child care, nature took care to give us something to enjoy about parenting. Tolerance would more than rob of us those pleasures; it would threaten the infant’s very existence. By making our brain cells more sensitive to opioids, oxytocin allows us to remain “hooked” on our babies. 

Opiates, in other words, are the chemical linchpins of the emotional apparatus in the brain that is responsible for the protection and nurturing of an infant’s life. This addition to opiates like morphine and heroin arises in a brain system that governs the most powerful emotional dynamic in human existence: the attachment instinct. Love. 

Attachment is the drive for physical and emotional closeness with other people. It ensures survival by bonding infants to others and mothers to infants. Throughout life, the attachment drive impels us to seek relationships and companionship, maintains family connections, and helps build community. When endorphins lockout opiate receptors, they trigger the chemistry of love and connection, helping us to be the social creatures we are. 

Opiates do not “take away” pain. Instead, they reduce our consciousness of it as an unpleasant stimulus. Pain begins as a physical phenomenon, registered in the brain, but we may or may not consciously notice it at any given moment. What we call “being in pain” is our subjective experience of that stimulus and our emotional reaction to the experience.

Opiates help make some pain bearable. It has been suggested, for example, that high levels of endorphins help toddlers endure the many bumps and minor bruises they sustain on their rambunctious advert urges. It’s not that a toddler’s injuries don’t cause pain; they do. But partly because of endorphins, the pain isn’t enough to discourage him. 

Anatomically, physical pain is registered in one part of the brain, the thalamus, but its subjective impact is experienced in another part, the anterior circulate cortex or ACC. The brain gets the pain message in the thalamus, but “feels” it in the ACC. The latter are “lights up,” or is activated when we are reacting to the pain stimulus. And it’s in the cortex – the ACC and elsewhere – that opiates help us endure pain by reading not its physical but its emotional impact. 

 Why did nature make the mammalian opioid system responsible for our reactions to both physical and emotional pain? For a very good reason: the complete helplessness of the young mammal and its absolute dependence on nurturing adults. Physical pain is a danger alarm: if a child wakes up with a tummy ache, her ACC goes into overdrive and she’ll give every possible signal to call her caregivers promptly to her side. For the infant mammal, emotional pain is an equally essential warning: it alerts us to the danger of separation from those we depend on for our very lives. Feeling this emotional pain triggers infant behaviors – ultrasound vocalization in rat pups, and pitiful crying in human babies – designed to bring the parent back. The attentive presence of the nurturing adult will trigger endorphin release in the infant’s brain, helping to soothe her. 

In keeping with Nature’s efficient, multipurpose “recycling” of chemical substances, endorphins are also responsible for the experience of pleasure and joyful excitement. One stud found that endorphin levels tripled in the blood of bungee jumpers for the half-hour following the leap and were correlated with the degree of reported euphoria: the higher the endorphin levels, the greater the euphoric feelings. 

While the brain’s opiate receptors are the natural template for the feelings of rewards, soothing, and connectedness, they are also triggered by narcotic drugs, and they play a role in other addictions, too. In a study of alcoholics, opioid receptor activity was diminished in several brain regions, and this was associated with increased alcohol cravings. The activation of opioid pathways and resulting increased endorphin activity also enhances cocaine’s effects. As with alcohol, less endorphin activity means a greater desire for cocaine. Activation of opiate receptors contributes to the pleasure of marijuana use as well. 

In short, the life-foundational opioid love/pleasure/pain relief apparatus provides the entry point for narcotic substances into our brains. The less effective our own internal chemical happiness system is, the more driven we are to seek joy or relief through drug-taking or through other compulsions we perceive as rewarding. 

Cocaine, Dopamine and Candy Bars: The Incentive System in Addiction

Many addicts admitted to the author that cocaine is a tougher taskmaster than heroin, and harder to escape. Although it doesn’t cause physical withdrawal symptoms nearly as distressing, the psychological drive to use it seems more difficult to resist – even after it no longer gives much pleasure. 

Cocaine increases brain levels of the neurotransmitter dopamine by blocking it from being transported back into the never cells that release it. Cocaine’s effects wear off very quickly because it occupies its receptors sites for only a brief time. The urge to use, to get the next dopamine hit, then redoubles. Like other stimulant drugs – speed, nicotine, and caffeine – cocaine taps directly into a brain system that, in its way, is just as powerful as the opioid attachment/reward system described in the previous chapter. It plays a key role in all substance addictions and also in behavioral addictions. 

There’s an area in the midbrain that, when triggered, gives rise to intense feelings of elation or desire. It’s called the ventral regimental apparatus, or VTA. When researchers inserted electrodes into the VTA of lab rats and the animals are given a lever that allows them to stimulate this brain center, they’ll do so to the point of exhaustion. They ignore food and pain just so they can reach the lever. Human beings may also endanger themselves to continue self-triggering this brain area. One human subject stimulated himself fifteen hundred times in three hours, “to a point that he was experiencing an almost overwhelming euphoria and elation, and had to be disconnected despite his virus protests.” 

Dopamine is the neurotransmitter chiefly responsible for the power of the VTA and its associated network of brain circuits. Nerve fibers from the VTA trigger dopamine release in a brain center that plays a central role in all addictions: the nucleus accumbens, or NA, located on the underside of the front of the brain. A sudden increase in dopamine levels in the nucleus accumbens set off the initial excitement and elation experienced by drug users, and this is also what rats and people are after when they keep pushing those levers. All usable substances raise dopamine in the NA, stimulants like cocaine most dramatically.

As in the case of the opioid apparatus, nature did not design the VTA, the NA, or other parts of the brain’s dopamine system just so the addicts and drug users of the world could feel happier or more energized and focused. If opioids help consummate our reward-seeking activities by giving us pleasure, dopamine initiates these activities in the first place. It also plays a major role in the learning of new behaviors and their incorporation into our lives. 

Along with its connection in the forebrain and the cortex, the VTA thus forms the neurological basis of another major brain system involved in the addiction process: the incentive motivation apparatus. This system responds to reinforcements and reinforces all have the effect of increasing dopamine levels in the nucleus accumbens. 

Environmental circus associated with drug use – paraphernalia, people, places, and situations – are all powerful triggers for repeated use and relapse, because they trigger dopamine release. People trying to quit smoking, for example, are advised to avoid poker if they are used to having a cigarette while playing cards. 

Reinforcement is important in all addictions, drug-related or not. 

Needless to say, life-essential reinforcements such as food and sex trigger VTA activation and dopamine release in the NA, since the performance of survival-related behaviors is the very purpose of the incentive-motivation system. Accordingly, this system is decisive in initiating activities such as foraging for food and other life-sustaining necessities, seeking sexual partners, and exploring the environment. The VTA and NA and their connections with other brain circuits are also active when we explore novel objects and situations and evaluate them in light of previous reinforcing experiences. In other words, nerve fibers in the VTA are triggering dopamine release in the NA when a person needs to know, “Is this new whatever-it-is going to help me or hurt me? Will I like it or not?” The role of the dopamine system in novelty-seeking helps explain the way some people are driven to risky behaviors such as street racing. It’s one way to experiment with the excitement of dopamine release. 

Addiction inevitably involves both opioid and dopamine circuitry. The dopamine system is most active during the initiation and establishment of drug intake and other addictive behaviors. It is key to the reinforcing patterns of all drugs of abuse – alcohol, stimulants, opioids, nicotine, and cannabis. Desire, wanting and craving are all incentive feelings, so it’s easy to see why dopamine is central to non-drug-related addictions too. On the other hand, opioids – innate or external – are more responsible for the pleasure-reward aspects of addiction. 

Opioid circuits and dopamine pathways are important components of what has been called the limbo system, or the emotional brain. The circuits of the limbic system process emotions like love, joy, pleasure, pain, anger, and fear. For all their complexities, emotions exist for a very basic purpose: to initiate and maintain activities necessary for survival. In a nutshell, they modulate two drives that are essential to animal life, including human life: attachment and aversion. We always want to move toward something positive, inviting, and nurturing, and to repel or withdraw from something threading, distasteful or toxic. These attachment and version emotions are evoked by both physical and psychological stimuli, and when properly developed, our emotional Brian is an unerring, reliable guide to life. It facilitates self-protection and also makes possible love, compassion, and healthy social interactions. When impaired or confused, as it often is in the complex and stressed circumstances prevailing in our “civilized” society, the emotional brain leads us to nothing but trouble. Addiction is one of its chief dysfunctions.

Like a Child Not Released

We know which brain controls actions like, say, the rotation of the thumb. If that area of the cortex is destroyed, the thumb doesn’t move. The same principle applies to formulating decisions and regulating impulses. They, too, are governed by specific brain circuits and systems, but in a much more complex and interactive fashion than simple physical movements. 

As with motor activities, we’ve discovered which parts of the brain are responsible for volition and choice by studying people whose brains have been injured. When certain brain areas are damaged, there are predictable patterns of impaired rational decision-making and diminished impulse regulation. Brain-imaging studies and psychological testing indicate that the same areas are also impaired in drug addiction. And what is the result? If it wasn’t enough that powerful incentive and reward mechanisms drive the craving that powerful incentive and reward mechanism drive the craving for drugs, on top of that the circuits that could normally inhibit and control those mechanisms are not up to their task. They are complicit in the addiction process. 

To understand how this work, we need another glimpse at brain anatomy and physiology.

The man’s brain is the most complex entity in the universe. It has between 80 billion and 100 billion nerve cells, or neurons, each branched to form thousand of possible conventions with other nerve cells. In addition, there are a trillion “support” cells, called Liga, that help the neurons thrive and function. Laid end to end, the nerve cables of a single human brain would create a line several hundred thousand miles long. The total number of connections, or synapses, is in the incalculable trillions. The parallel and simultaneous activity of innumerable brain circuits and networks of circuits produce millions of firing patterns every second of our lives. 

In general, the higher in the brain we ascend physically, the more recent the brain centers in evolutionary development and the more complex their functions. In the brain stem, automatic functions such as breathing and body temperature are regulated; the emotional circuits are higher up; at the very top surface of the brain is the cortex or grey matter. None of these areas works on its own; all are in constant communication with other circuits near and far, and all are influenced by chemical messengers from elsewhere in the body and brain. As a human being matures, higher brain systems come to exert some control over the lower ones. 

 “Cortex” means bark and the multilayered cerebral cortex envelops the rest of the brain like the bark of a tree. About the size and thickness of a table napkin, it contains the cell bodies of neurons organized into many essential centers, each with highly specialized functions. The visual cortex, for example, is in the occipital lobe at the back of the brain. If it sustains damage, as in the case of a stroke, vision is lost. The most recently evolved part of the cortex, distinguishing us from other animals, is the prefrontal cortex, the grey matter in the front of the brain. 

It’s a simplification, but an accurate one, to say that the frontal cortex – and particularly its prefrontal portions – acts as the chief executing y officer of the Brian. It is here that alternatives are weighed and choices are considered. It is also here that emotionally driven impulses to act are evaluated and either given permission to go ahead or inhibited. The prefrontal cortex (PFC), writes psychiatrist Jeffrey Schwartz, “plays a central role in the seemingly free selection of behaviors” by inhibiting many of the alternative responses that are used in a situation, allowing only one to proceed. It makes sense, then, that when this region is damaged patients become unable to stifle inappropriate responses to their environment. In other words, people with impaired PFC function will have poor impulse control and will behave in ways that to others seem uncalled for, childish, or bizarre. 

It is also in the frontal cortex that social behaviors are learned. When the executive parts of the cortex have been destroyed in rats, they are still able to function – but only as immature youngsters who haven’t acquired any social skills. They are impulsive, aggressive, and sexually inappropriate. 

The executive functions of the prefrontal cortex are not restricted to any one area, and its proper workings depend on healthy connections and input from the emotional, or limbic, centers in the lower parts of the brain. Conversely, dysfunction in the cortex helps to facilitate addictive behavior. 

Many studies link addiction to the orbitofrontal cortex (OFC), a cortical segment found near the eye socket, or orbit. Drug addicts, whether they are intoxicated or not, it doesn’t function normally. The OFC’s relationship with addiction arises from its special role in human behavior and its abundant supply of opioid and dopamine receptors. It is powerfully affected by drugs and powerfully reinforces the drug habit. It also plays an essential supporting role in non-drug addictions. 

Through its rich connections with the limbic (emotional) centers, the OFC is the apex of the emotional Brian and serves as its Mission Control room. In normal circumstances in a mature human being, the OFC is among the highest arbiters of our emotional lives. It receives input from all the sensory areas, which allows it to process environmental data such as vision, touch, taste, smell, and sound. Why is that important? Because its the OFC’s job to evaluate the nature and potential value of stimuli, based on present information – but also in light of previous experiences. For example, a smile that in early memory is associated with a pleasurable experience will likely be positively judged by the OFC. Through its access to memory traces, conscious and unconscious, the OFC “decides” the emotional value of stimuli – for examen, are we intensely drawn to or repelled by a person or object, or activity, or are we neutral? It is constantly surveying the emotional significance of situations, and their meaning to the individual. Since our likes and dislikes, preferences, and aversion strongly influence what we focus on, the OFC helps us decide to what or whom we should devote our attention to at any given moment. 

The OFC – particularly on the right side of the brain – has a unique influence on social and emotional behaviors, including attachment (love) relationships. It is a deep concern with the asset, not of international between the self and others, and plays a ceaseless game of “Who loves, whose loves me not.” 

While the explicit meaning of words spoken is decoded in specialized portions of the left hemisphere, the right OFC interprets the emotional content of communications – the other person’s body language, eye movements, and tone of voice. One cue the OFC watches for is the size of the other’s pupils: in social interaction, especially with eyes set on smiling faces, dilated pupils mean enjoyment and slight. 

The OFC also contributes to decision-making and to inciting impulses that, if allowed to be acted out, would be harmful – for example, inappropriate anger or violence. Finally, brain researchers have also linked the orbitofrontal cortex to our capacity to balance short-term objectives against longer-term consequences in the process of decision-making. 

Imaging studies consistently indicate that the OFC works abnormally in drug abusers, showing malfunctions patterns in blood flow, energy use, and activation. No wonder, then, that psychological testing shows drug addicts to be prone to “maladaptive decision when faced with short-term versus long-term outcomes, especially under conditions that involve risk and uncertainty.” Due to their poorly regulated brain systems, including the OFC, they seem programmed to accept short-term gain – for example, the drug high – at the risk of long-term pain: disease, personal loss, legal troubles, and so on. 

A regular finding of brain-imaging studies on drug addicts is under activity of the OFC after detoxification. In a similar vein, psychological testing of cocaine addicts has shown impaired decision-making. In one study, some key aspects of their decision-making ability were a mere 5o% of normal. Only people with physical injuries to the frontal cortex would score lower.

It may seem paradoxical, but the OFC is also highly activated during craving – not the enchanted decision-making but to initiate craving itself. It turns out that different parts of the OFC have different functions: one part is involved in decision making; another in the automatic and emotional aspects of craving. In imaging studies, the OFC lights up when an addict so much as thinks about their drug. 

An abnormally functioning OFC has also been implicated in compulsive behaviors in both human and animal studies. A rat with a damaged orbitofrontal cortex will preserve reward-seeking, addiction-type activities even after the rewards are removed. As a researcher comments, “these findings are reminiscent of the reports of drug addicts who claim that once they start taking a drug of abuse they cannot stop even when the drug is no longer pleasurable.”

Their Brains Never Had a Chance

 Brain development in the uterus and during childhood is the single most important biological fact in determining whether or not a person will be predisposed to substance dependence and to addictive behaviors of any sort, whether drug-related or not. 

To state that childhood brain development has the greatest impact on addiction is not to rule out genetic factors. However, the empathy placed on genetic influences in addiction medicine – and in many other areas of medicine – impedes our understanding. 

The view that genes play a decisive role in the way a person’s brain develops has been replaced by a radically different notion: the expression of genetic potentials is, for the most part, contingent on the environment. Genes do dictate the basic organization, developmental schedule, and anatomical structure of the human central nervous system, but it’s left to the environment to sculpt and fine-tune the chemistry, connection, circuits, networks, and systems that determine how well we function. 

Of all mammals, we humans have the least mature brain at birth. Early in their infancy, other newborn animals perform tasks far beyond the capability of human babies. Those, for example, can run on their first day of life. Not for a year and a half or more can most humans muster the muscle strength, visual activity, and neurological control skills – perception, balance, orientation in space, coordination – to perfume that activity. 

Why are we saddled with such disadvantages in comparison to a horse? We can think of it as a compromise imposed by nature. Our evolutionary predecessors were permitted to walk upright, which freed forelimbs to evolve into arms and hands capable of many delicate and complicated activities. Those advances in manual versatility and dexterity required a tremendous enlargement of the brain, especially of its frontal areas. Our frontal lobes, which coordinate the movement of our hands, are much larger even than those of our closest evolutionary relative, the chimpanzee. These lobes, particularly their prefrontal areas, are also responsible for the problem-solving, social, and language skills that have allowed humankind to thrive. As we became a two-legged species, the human pelvis had to narrow to accommodate our upright stance. At the end of the nine months of human gestation, the head forms the largest diameter of the body, the one most likely to get stuck in our journey through the birth canal. It’s simple engineering: any further brain growth in the uterus and we couldn’t be born. 

To ensure that babies can make their way out of the birth canal, the bargain forced upon our ancestors was that the human brain would be relatively small and immature at birth. On the other hand, it would undergo tremendous growth outside the mother’s body. In the period following birth, the human brain, unlike that of the chimpanzee, continues to grow at the same rate as in the womb. There are times in the first year of life when, every second, multiple millions of nerve connections, or synapses, are established. Three-quarters of our brain growth takes place outside the womb, most of it in the early years. By three years of age, the brain has reached 90% of adult size, whereas the body is only 18% of adult size. This explosion in growth outside the womb gives us a far higher potential for learning and adaptability than is granted to other mammals. Were we born with our brain development rigidly predetermined by heredity, the frontal lobes would be limited in their capacity to help us learn and adapt to the many different environments and social situations we humans now inhabit. 

Greater reward demands greater risk. Outside the relatively safe environments of the womb, our brains in. progress is highly vulnerable to potentially adverse circumstances. Addiction is one of the possible negative outcomes – although, the brain can already be negatively affected in the uterus in ways that increase vulnerability to addiction and to many other chronic conditions that threaten health.

The dynamic process by which 90% of the human brain’s circuitry is wired after birth has been called “neural Darwinism” because it involves the selection of those nerve cells (neurons), synapses, and circuits that help the brain adapt to its particular environment, and the discarding of others. In the early stages of life, the infant’s brain has many more neurons and connections than necessary – billions of neurons over what will eventually be required. This overgrown, chaotic synaptic tangle needs to be trimmed to shape the brain into an organ that can govern action, thought, learning, and relationships and carry out its multiple varied other tasks – and to coordinate them all in our best interest. Which connections survive depends largely on input from the environment. Connections and circuits used frequently are strengthened, while unused ones are pruned out. 

Through this weeding out of unutilized cells and synapses, the selection of useful connections, and the formation of new ones, the specialized circuits of the maturing human brain emerge. The process is highly specific to each person – so much so that not even the brains of identical twins have the same nerve branching, connections, and circuitry. In large part, an infant’s early years define how well her brain structures will develop and how the neurological networks that control human behavior will mature. And it is precisely here where the problem arises for young children who will, in adolescence and beyond, become chronically hooked n hard drugs:  too much bad stimulation. In many other cases, it’s not a question of “bad stimulation” but of a lack of sufficiently “good stimulation.”

Our genetic capacity for brain development can find its full expression only if circumstances are favorable. To illustrate this, just imagine a baby who was cared for in every way but kept in a dark room. After a year of such sensory deprivation, the brain of this infant would not be comparable to those of others, no matter what his inherited potential is. Despite perfectly good eyes at birth, without the stimulation of light wags, the third or so neurological units that together make up our visual sense would not develop. The neural components of vision already present at birth would atrophy and become useless if this child did not see light for about five years. Why? Neural Darwinism. 

What is true for vision is also true for the dopamine circuits of incentive motivation and the opioid circuitry of attachment reward, such as the orbitofrontal cortex. In the case of these circuits, which process emotions and govern behavior, it is the emotional environment that is decisive. 

The three environmental conditions essential to prima human brain development are nutrition, physical security, and consistent emotional nurturing. In the industrialized world, expected in cases of severe neglect or dire poverty, the baseline nutritional and shelter needs of children are usually satisfied. The third prime necessity – emotional nurture – is the one most likely to be disrupted in western societies. The importance of fit points cannot be overstated: emotional nurturance is an absolute requirement for healthy neurobiological brain development. The child needs to be in an attachment relationship with at least one reliable available, protective, psychologically present, and reasonably non-stressed adult. 

Attachment is the drive to pursue and preserve closeness and contact with others; attachment relationships exist when that state has been achieved. It’s an instinctual drive program made into the mammalian brain, owing to the absolute helplessness and dependency of infant mammals – particularly infant humans. Without attachment he cannot survive; without safe, secure, and no stressed attachment, his brain cannot develop optimally. Although that dependency wangles as we mature, attachment relationships remain important throughout our lifetime. 

Require more than the physical presence and attention of the parent. Infants read, react to, and are developmentally influenced by the psychological states of their parents. They are affected by body language: tension in the arms that hold them, tone of voice, joyful or despondent facial expression, and the size of the pupils. In a verity real sense, the parent’s brain programs the infant’s, and this is why stressed parents will often rear children whose tress apparatus also runs in high gear, no matter how much they love their children and no matter that they strive to do their best. Infants of stressed or depressed parents are likely to encode negative emotional patterns in their brains. 

The long-term effect of parental mood on the biology of the child’s brain is illustrated by several studies showing that concentrations of the stress hormone cortisol are elevated in the children of clinically depressed mothers. At age three, the highest cortisol levels were found in those children whose mothers had been depressed during the child’s first year of life, rather than later. Thus we see that the brain is “experienced-dependent.” Good experiences lead to healthy brain development, while the absence of good experiences or the presence of bad ones distorts development in essential brain structures. 

Since the brain governs mood, emotional self-control, and social behavior, we can expect that the neurological consequences of adverse experiences will lead to deficits in the personal and social lives of the people who suffer from them in childhood.

We know that the majority of chronically hardcore substance-dependent adults lived, as infants and children, under conditions of severe adversity that left an inedible stamp on their development. Their predisposition to addiction was programmed in their early years. Their brains never had a chance. 

Trauma, Stress, and the Biology of Addiction

The idea that the environment shapes brain development is a very straightforward one, even if the details are immeasurably complex. Think of a kernel of wrath. No matter how genetically sound a seed may be, factors such as sunlight, soil quality, and irrigation must act on it properly if it is to germinate and grow into a healthy adult plant. If it does develop some sort of pant ailment in the course of its life, it would beast to see how a deprived environment contributed to its weakness and susceptibility. The same principles apply to the human brain. 

The three dominant brain systems in addiction – the opioid attachment-reward system, the dopamine-based incentive motivation apparatus, and the self-regulation areas of the prefrontal cortex – are all exquisitely fined-tuned by the environment. To various degrees, in all addicted persons, these systems are out of kilter. The same is true of the fourth brain-body system implicated in addiction: the stress-response mechanism. 

Happy, attuned emotional interactions with parents stimulate a release of natural opioids in an infant’s brain. This endorphin surge promotes the attachment relationship and the further development of the child’s opioid and dopamine circuitry. On the other hand, stress reduces the numbers of both opiate and dopamine receptors. Healthy growth of these crucial systems – responsible for such essential drives as love, connection, pain relief, pleasures, incentives, and motivation – depends, therefore, on the quality of the attachment relationship. When circumstances do not allow the infant and young child to experience consistently secure interactions or, worse, expose him to many painful stressing ones, maldevelopment often results. 

We know from animal studies that social-emotional stimulation is necessary for the growth of the nerve endings that release dopamine and for the growth of receptors to which dopamine needs to bind to do its work. Even adult rats and mice kept in long-term isolation will have a reduced number of dopamine receptors in the midbrain incentive circuits and the frontal areas implicated in addiction. Rats separated from their mothers at an early stage display permanent disruption of the dopamine incentive-motivation system in their midbrains. Predictably, in adulthood, these maternally deprived animals exhibit a greater propensity to self-administer cocaine. And it doesn’t take extreme deprivation: in another study, rat pups deprived of their mother’s presence for only one hour a day during their first week of life grew up to be much more earner than their peers to take cocaine on their own. So the presence of consistent parent contact in infancy is one factor in the normal development of the brain’s neurotransmitter system; the absence of f it makes the child more vulnerable to “needing” drugs of abuse, later on, to supplement what her brain is lacking. Another key factor is the quality of the contact the parent provides, and this depends very much on the parent’s mood and stress levels. 

All mammalian mothers – and many human fathers, as well – give their infants sensory stimulation that has long-term positive effects on their offspring’s brain chemistry. Such sensory stimulation is so necessary for the human infant’s healthy biological development that babies who are never picked up simply die. They stress themselves to death. Premature babies who have to live in incubators for weeks or months have fathers” brain growth if they are stroked for just ten minutes a day. 

Parental nurturing determines the levels of other key brain chemicals, too – including serotonin, the mood messenger enchanted by antidepressants like Prozac. Peer-reared monkeys, separated from their mothers in laboratory experiments, have lower lifelong levels of serotonin than monkeys brought up by their mothers. In adolescence, these same monkeys are more aggressive and are far more likely to consume alcohol in excess. Scientists see similar effects with other neurotransmitters that are essential in regulating mood and behavior, such as norepinephrine. Even slight imbalances in the availability of these chemicals are manifested in aberrant behaviors like fearfulness and hyperactivity and increase the individual’s sensitivity to stressors for a lifetime. In turn, such acquired traits increase the risk of addiction. 

Another effect of early maternal deprivation appears to be a permanent decrease in the production of oxytocin, which is one of our love chemicals. It is critical to our experience of loving attachment and even maintaining committed relationships. People who have difficulty forming intimate relationships are at risk for addiction; they may turn to drugs as “social lubricants.” 

Not only can early childhood experiences lead to a dearth of “good” brain chemicals; but they can also result in a dangerous overload of others. Maternal deprivation and other types of adversity during infancy and childhood result in chronically high levels of the stress hormone cortisol. In addition to damaging the midbrain dopamine system, excess cortisol shrinks important brain centers such as the hippocampus – a structure important for memory and processing emotions – and disturbs normal brain development in many other ways, with lifelong repercussions. Another major stress chemical that’s permanently overproduced after insufficient early maternal contact is vasopressin, which is implicated in high blood pressure. 

A child’s capacity to handle psychological and physiological stress is completely dependent on the relationship with his parents. Infants cannot regulate their stress apparatus, and that’s why they will stress themselves to death if they are never picked up. We acquire that capacity gradually as we mature – or we don’t, depending on our childhood relationships with our caregivers. A responsive, predictable nursing adult plays a key role in the development of our healthy stress response neurobiology. 

Children who suffer disruptions in their attachment relationships will not have the same biochemical milieu in their brains as their well-attached and well-nurtured peers. As a result their experiences and interpretations of their environment, and their responses to it, will be less flexible, less adaptive, and less conducive to health and maturity. Their vulnerability will increase, both the mood-enhancing effects of drugs and becoming drug dependent. 

Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trainmen of various sorts, including physical, sexual, and emotional abuse. The renowned Adverse Childhood Experiences (ACE) Study, looked at the incidents of ten separate categories of painful circumstances – including family violence, parental divorce, drug or alcohol abuse in the family, death of a parent, and physical or sexual abuse – in thousands of people. The correlation between these figures and substance abuse later in the subjects’ lives was then calculated. For each adverse childhood exercise or ACE, the risk for the early initiation of substance abuse increases two to four times. Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than those with none. 

The ACE researchers concluded that nearly two-thirds of injection drug use can be attributed to abusive and traumatic childhood events – and keep in mind that the population they surveyed was relatively healthy and stable. A third or more were college graduates, and most had at least some university education. Of course, not all addicts were subjected to childhood trauma – although most hardcore injection users were – just as not all severely abused children grow up to be addicts. 

Alcohol consumption has a similar pattern: those who had suffered sexual abuse were three times more likely to be drinking in adolescence than those who had not. For each emotionally traumatic childhood circumstance, there is a two-to-threefold increase in the likelihood of early alcohol abuse. 

It’s just as many substance addicts say: they self-medicate to soothe their emotional pain – but more than that, their brain development was sabotaged by their traumatic experiences. The systems subverted by addition – the dopamine and opioid circuits, the limbic or emotional brain, the stress apparatus, and the impulse-control areas of the cortex – just cannot develop normally in such circumstances. 

Scientists know something about how specific kinds of childhood trauma affect brain development. For example, the vermis, a part of the cerebellum at the back of the brain, is thought to play a key role in addictions because it influences the dopamine system in the midbrain. Imaging of this structure in adults who were sexually abused as children reveals abnormalities of blood flow, and these abnormalities are associated with symptoms that increase the risk of substance addiction. In one study of the EGGs of adults who had suffered sexual abuse, the vast majority had abnormal brain waves, and over a third showed seizure activity. 

It gets worse. The brains of mistreated children are smaller than normal by 7% or 8%, with below-average volumes in multiple brain areas, including the impulse-regulating prefrontal cortex; in the corpus callosum (CC), the bundle of white matter that connects and integrates the functioning of the two sides of the brain; and in several structures of the limbic or emotional apparatus, whose dysfunctions greatly increase vulnerability to addiction. In a study of depressed women who had been abused in childhood, the hippocampus (the memory and emotional hub) was found to be 15% smaller than normal. The key factor was abuse since the same brain area was unaffected in depressed women who had not been abused. 

The corpus callosum facilitates the collaboration between the brain’s stow halves or hemispheres. Not only have the CCs of trauma survivors been shown to be smaller, but there is evidence of a disruption of functioning there as well. The result can be a “split” in the processing of emotion: the two halves may not work in tandem, particularly when the individual is under stress. One characteristic of personality disorder, a condition with which substance abusers are very commonly diagnosed, is a kind of flip-flopping between the idealization of another person and instead dislike, even hatred. There is no middle ground, here both the positive and the negative qualities of the other are acknowledged and accepted. 

Dr. Martin Teicher, Director of the Developmental Biopsychiatry Research Program at McLean Hospital in Maryland, suggests the very intriguing possibility that our “negative” views of a person are stored in one hemisphere and our “positive” responses, in the other. The lack of integration between the two halves of the brain would mean that information from the two views, negative and positive, is not melted into one complete picture. As a result, in intimate relationships and other areas of life, the afflicted individual fluctuates between idealized and degraded perceptions of himself, other people, and the world. This sensible theory, if proven, would explain a lot not only about drug-dependent persons but also about many behavioral addicts.

Early trauma also has consequences for how human beings respond to stress all their lives, and stress has everything to do with addiction. 

Stress is a psychological response mounted by an organism when it is confronted with excessive demands on its coping mechanism, whether biological or psychological. It is an attempt to maintain internal biological and chemical stability, or homeostasis, in the face of these excessive demands. The psychological stress response involves nervous discharges throughout the body and the release of a cascade of hormones, chiefly adrenaline, and cortisol. Virtually every organ is affected, including the heart and lungs, the muscles, and the emotional centers in the brain. Cortisol itself acts on the tissues of almost everything part of the body – from the brain to the immune system, from the bones to the intestines. It is an important part of the infinitely intricate systems of checks and balances that enables the body to respond to a threat. 

A stressor “is a threat, real or perceived, that tends to disturb homeostasis.” What do all stressors have in common? Ultimately they all represent the absence of something that the organism perceives as necessary for survival – or its threatened loss. The threat itself can be real or perceived. 

Early stress establishes a lower “set point” for a child’s internal stress system: such a person becomes stressed more easily than normal thought their life. 

The hormone pathways of sexually abused children are chronically altered. Even a relatively “mild” stressor such as maternal depression – let alone neglect, abandonment, or abuse – can disturb an infant’s physical stress mechanisms. Add neglect, abandonment, or abuse, and the child will be more reactive to stress throughout their life. 

A brain pre-set to be easily triggered into a stress response is likely to assign a high value to substances, activities, and situations that provide short-term relief. It will have less interest in long-term consequences, just as people in extremes of thirst will greedily consume water knowing that it may contain toxins. On the other hand, situations or activities that for the average person are likely to bring satisfaction are undervalued because, in the addict’s life, they have not been a rewarding intimate connection with family. This shrinking from normal experiences is also an outcome of early trauma and stress.

Hardcore drug addicts, whose lives invariably began under conditions of severe stress, are all too readily triggered by a stress reaction. Not only does the stress response easily overwhelm the addict’s already challenged capacity for rational thought when emotionally aroused, but also the hormones of stress “cross-sensitize” with addictive substances. The more one is present, the more the other is craved. The addition is a deeply ingrained response to stress, an attempt to cope with it through self-soothing. Maladaptive in the long term, it is highly effective in the short term. 

Predictably, stress is a major cause of continued drug dependence. It increases opiate craving and use, enhances the rewarding efficacy of drugs, and provokes relapse to drug-seeking and drug-taking. 

Stress also dismisses the activity of dopamine receptors in the emotional circuits of the forebrain, particularly in the nucleus accumbens, where the craving for drugs increases as dopamine function decreases. The research literature has identified three factors that universally lead to stress for human beings: uncertainty, lack of information, and loss of control. To these, we may add conflict that the organisms are unable to handle and isolation from emotionally supportive relationships. 

It’s Not in the Genes

Genes certainly appear to influence, among other features, such strategies as temperament and sensitivity. These have a huge impact on how we experience our environment. In the real world, there’s s no nature vs. nurture argument, only an indefinitely complex and moment-by-moment interaction between genetic and environmental effects. The author argues that even if it was demonstrated conclusively that 70% of addiction is programmed by our DNA, he would still be more interested in the remaining 30%. After all, we cannot change our genetic makeup. It makes sense to focus on what we can immediately do: how children are raised; what social support parenting receives; how we handle adolescent drug users; and how we treat addicted adults. 

The current consensus is that predisposition to the disorder is about 50% genetically determined. Equally extravagant estimates are applied to other addictions. Heavy marijuana use is said to be 60%-80% heritable, while the inherited liability to long-term heavy nicotine use has been calculated to be an astonishing 70%. Cocaine abuse and dependence are also reported to be “substantially influence by genetic factors.” Some researchers have even suggested that alcoholism and diverted may share the same genetic propensity. 

Such high figures are beyond possibility. The logic behind the rest on mistaken assumptions that we are less to science than an exaggerated belief that the power of genes determines our lives. In the genetic theory of mental disorders, “unscientific beliefs play a major role,” write the authors of a research review. 

It’s not that genes do no matter – they vertically do; it’s only that they do not and cannot determine even simple behaviors, let alone complex ones like addictions. Not only is there no addiction gene, but there also couldn’t be one. 

Far from being the autonomous dictators of our destines, genes are controlled by their environment, and without environmental signals, they could not function. In effect, they a red turned on and off by the environment; human life could not exist if it wasn’t so. Every cell in every organ in our bodies has the same complement of genes, yet a brain cell does not look or act like a bone cell, and a liver cell does not resemble or function like a muscle cell. It is the environment within and outside the body that determines which genes are switched on, or activated in which cell. 

There is a new and rapidly growing science that focuses on how life energies influence the function of genes. It’s called epigenetics. As a result of life events, chemicals attach themselves to DNA and direct gene activities. The licking of a rat pup by the mother in the early hours of life turns on a gene in the brain that helps protect the animal from being overwhelmed by stress even as an adult. In rats deprived of such grooming, the same gene remains dormant. Epigenetic effects are most powerful during early development and have now been shown to be transmittable from one generation to the next, without any change in the genes themselves. Environmentally induced epigenetic influences powerfully modulate genetic ones. 

How a gene act is called gene expression. It is now clear that “the early environment, consisting of both the pregnant and post-natal periods, has a profound effect on gene expression and adult patterns of behavior,” to quote a recent article from The Journal of Neuroscience. One example is related to alcohol consumption. A certain variation of a particular gene, found in some monkeys, reduces alcohol’s sedative effects and also its disorganizing and unpleasant influences on balance and coordination. In other words, monkeys with this gene are less likely to feel semi-comatose from drinking and less likely to lurch about like a drunken sailor. They can imbibe greater amounts of alcohol without side effects and are more likely to drink until they’re drunk. However, it was found that in mother-reared monkeys the gene was not expressed – that is, it had no impact on drinking behavior. It did so only in monkeys who had been stressed in early life by being deprived of maternal contact and reared amongst peers. 

The overemphasis on genetic determination in addictions is based largely on studies of adopted children, especially twins. The important point to explore here is how stress during pregnancy can already being to “program” a predisposition to addiction in the developing human being. Such informational places the whole issue of prenatal care in a new light and helps explain the well-known fact that adopted children are at greater risk for all kinds of problems that pre-dispose to addictions. The biological parents of an adopted child have a major epigenetic effect on the developing fetus. 

Numerous studies in both animals and human beings have found that maternal stress or anxiety during pregnancy can lead to a broad range of problems in the offspring, from infantile colic to later learning difficulties and the establishment of behavioral and emotional patterns that increase a person’s predilection for addiction. Stress on the mother would result in higher levels of cortisol reaching the baby and, as already mentioned, chronically elevated cortisol is harmful to important brain structures, especially during periods of rapid brain development. The study’s results are consistent with previous evidence that stress on the mother during pregnancy affects the brain of the infant, with long-term and perhaps permanent effects. This is where the father comes in because the quality of the relationship with her partner is often a woman’s best protection from stress, or on the other hand, the greatest source of it. 

It has been demonstrated that both animals and humans who experienced the stress of their mothers during pregnancy are more likely to have disturbed stress-control mechanisms long after birth, creating a risk factor for addiction. Maternal stress during pregnancy can increase the offspring’s sensitivity to alcohol. As mentioned, a relative scarcity of dopamine receptors also elevates the addiction risk. 

For these reasons, adoption studies cannot decide questions of genetic inheritance. Any woman who has to give up her baby for adoption is, by definition, a stressed woman. She is stressed not just because she knows she’ll be separated from her baby, but primarily because if she wasn’t stressed in the first place, she would never have had to consider giving up her child: the pregnancy was unwanted or the mother was poor, single or in a bad relationship or she was a drug user or was raped or confronted by some other adversity. Any of these situations would be enough to impose tremendous stress on any person, and so for many months, the developing fetus would be exposed to high cortisol levels through the placenta. A proclivity to addiction is one possible consequence. 

Why, then, are narrow genetic assumptions so widely accepted and, in particular, so enthusiastically embraced by the media? The neglect of developmental sciences is one factor. Our preference for a simple and quickly understood explanation is another, as is our tendency to look for one-to-one causations for almost everything. Life in its wondrous complexity does not conform to such easy reductions. 

There is a psychological fact that provides a powerful incentive for people to cling to genetic theories. We human beings don’t like feeling responsible: as individuals for our actions; as parents for our children’s hurts; or as societies for our many failings. Genetics – the neutral, impassive, impersonal handmaiden of nature – would absolve us of responsibility and its ominous shadow, guilt. If genetics ruled our fate, we would not need to blame ourselves or anyone else. 

Succumbing to the common human urge to absolve ourselves of responsibility, our culture has to avidly embrace genetic fundamentalism. That leaves us far less empowered to deal either actively or proactively with the tragedy of addiction. We ignore the good news that nothing is irrevocably dictated by our genes and that, therefore, there is much we can do. 

“A Void I’ll do Anything to Avoid”

 It’s not the action or object itself that defines an addiction but our relationship to whatever is external for us of our attention or behavior. Just as it’s possible to drink alcohol without being addicted to it, so one can engage in any activity without addiction. On the other hand, no matter how valuable or worthy an activity may be, one can relate to it in an addictive way. The distinguishing features of any addiction are compulsion, preoccupation, impaired control, persistence, relapse, and craving. 

Substance addictions are often linked to one another, and chronic substance users are highly likely to have more than one drug habit: for example, the majority of cocaine addicts also have, or have had an active alcohol addiction. In turn, 70% of alcoholics are heavy smokers, compared with only 10% of the general population. In research surveys, more than half of opiate addicts are alcoholics, as have the vast majority of cocaine and amphetamine addicts, and many cannabis addicts as well. 

All addictions, substance-related or not, share states of mind such as craving and shame, and behaviors such as deceptions, manipulation, and relapse. On the neurobiological level, all addictions engage the brain’s attachment-reward and incentive motivation systems, which escape from regulation by the “thinking” and impulse control areas of the cortex. What does research show about non-substance addictions?

Looking into pathological gambling, scientists write, “preliminary results suggest the involvement of similar brain regions in drug and non-drug related urges.” Gamblers have abnormalities in the dopamine system, as well as in neurotransmitters other than dopamine. For example, like drug addicts, gamblers have diminished levels of serotonin – a brain chemical that helps regulate moods and control impulses.

It’s safe to say that any pursuit, natural or artificial, that induces a feeling of increased motivation and reward – shopping, driving, sex, eating, TV watching, extreme sports, and so on – will activate the same brain systems as drug addictions. PET scanning revealed that playing video games raises dopamine levels in the incentive-motivation circuits. Personal history and temperate not will decide which activities produce this effect for any particular individual, but the process is always the same. For someone with a relative shortage of dopamine receptors, it’s whichever activity best releases extra quantities of this euphoric and invigorating neurotransmitter that will become the object of addictive pursuit. In effect, people become addicted to their brain chemicals.

The evidence is compelling in the case of overeating, where we most clearly see that a natural and essential activity can become the target of faulty incentive-reward circuits, aided and abetted by deficient self-regulation. PET imaging studies in addictive eaters have, predictably, implicated the brain’s dopamine system. As with drug addicts, obsessed people have diminished dopamine receptors; in one study, the more obese the subjects were, the fewer dopamine receptors they had. Recall that reduced numbers of dopamine receptors can be both a consequence of chronic drug use and a risk factor for addiction. Junk food and sugar are also chemically addictive because of their effect on the brain’s intrinsic “narcotics,” the endorphins. Sugar, for example, provides a quick fix of endorphins and also temporarily raises levels of the mood chemical serotonin. 

Not only are the identical incentive-motivation and attachment-reward circuits impaired in the brain of overeaters and drug addicts, but so are the impulse-regulating functions of the cortex. Scientific authors noted that obese people are more prone to stress since their hormonal stress-response apparatus is disturbed – another characteristic is common with other addicts. 

Finally, the phenomena of tolerance and withdrawal are also connected with behavioral addictions, if not nearly to the same degree as with drug addictions. Tolerance means needing more and more of the same “hit” to get the same effect. Withdrawal consists of irritability, a generally glum mood, restlessness, and a sense of aimlessness. The journey from addictive self-indulgence to depression is rapid and inexorable. 

(Title) Too Much Time on External Things: The Addiction-Prone Personality 

Popular lore has it that the addict has to “hit bottom” before gaining the motivation to give up his habit. That may be true in some individual cases, but as a general rule, it fails because what constitutes the lowest point is highly personal to each addict. 

People are susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional. That need expresses a failure of self-regulation – an inability to maintain a reasonably stable internal emotional atmosphere. Self-regulation is a developmental achievement, we reach it only if the conditions for development are right. Some people never attain it; even in advanced adulthood, they must rely on some external support to quell their discomfort and soothe their anxiety. They just cannot make themselves feel ok without such support, whether they be chemicals or food or an excessive need for attention, approval, or love. Or they seek to make their lives exciting by engaging in activities that trigger elation or a sense of risk. A person with inadequate self-regulation becomes dependent on “outside things” to lift his mood and even to calm himself if he experiences too much undirected internal energy. 

Impulse control is one aspect of self-regulation. Impulses rise from the lower brain centers and are meant to be permitted or inhibited by the cerebral cortex. A salient trait of the addiction-prone personality is a poor hold over sudden feelings, urges, and desires. Also characterizing the addiction-prone personality is the baseline of differentiation. Differentiation is defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” It’s the capacity to hold on to ourselves while interacting with others. The poorly differentiated person is easily overwhelmed by his emotions, absorbs anxiety from others, and generates considerable anxiety within himself. 

Lack of differentiation and impaired self-regulation reflect a lack of emotional maturity. 

Psychological maturation is the development of a sense of self as separate from inner experience – a capacity absent in the young child. The child has to learn that she is not identical with whatever feeling happens to be dominant in her at any particular moment. She can feel something without her actions being automatically dictated by that feeling. She can be aware of others, conflicting feelings, thoughts, values, and commitments that might run counter to the feelings of the moment. She can choose. In the addict, this experience of “mixed feelings” is often lacking. Emotional processes rule the addict’s perspective: whatever they are feeling at the moment tends to define their view of the world and will control their actions. 

Dr. Michael Kerr, a psychiatrist in Washington DC, and director of George University Family Center distinguishes between two types of differentiation: functional differentiation and basic differentiation. Functional differentiation refers to a person’s ability to function based on external factors. The less basic differentiation a person has attained, the more prone he is to rely on relationships to maintain his emotional balance. When relationships fail to sustain such people, they may turn to addiction as the emotional crutch. 

These, then, are the traits that most often underline the addiction process: poor self-regulation; lack of basic differentiation; lack of healthy sense of self; a sense of deficient emptiness; and impaired impulse control. The development of these traits is not mysterious – or more correctly, there is no mystery about the circumstances under which the positive qualities of self-regulation, self-worth, differentiation, and impulse control fail to develop. An addictive personality is a personality that hasn’t matured. When we come to address healing, a key question will be how to promote maturity in ourselves or in others whose early environment sabotaged healthy emotional growth. 

Poor Substitutes for Love: Behavioral Addictions and Their Origins 

Drug addicts have a limited stock of substances to choose from: they have fewer escape routes than those available to behavioral addicts. How, then, is the “choice” made?

Dr. Ariel Goodman, the authority on sexual addictions said the following: “It has a lot to do with which experiences bring relief from whatever pains us.”

The same dynamics come into play with eating disorders. Although it is commonplace to blame the current epidemic of obesity on junk food consumption and sedentary living, these are only the behavioral manifestations of a deeper psychological and social malaise. 

In human development, the ingestion of food has significance far beyond its obvious dietary role. Following birth, the mother’s nipple replaces the umbilical cord as the source of nutrients for the infant, and it is also a point of continued physical contact between mother and child. Proximity to the parent’s body also meets emotional attachment needs that are as basic to the child as the need for physical sustenance. 

When infants are anxious or upset, they are offered a human or plastic nipple – in other words, relationships with either a natural nurturing object or something that closely resembles it. That’s how emotional nourishment and oral feeding or soothing become closely associated in the mind. On the other hand, emotional deprivation will trigger a desire for oral stimulation or eating just as surely as hunger. Children who continue to suck their thumbs past infancy are attempting to soothe themselves; it’s always a sign of emotional distress. Except in rare cases of physical disease, the more obese a person is, the more emotionally starved they have been at some crucial period in their life. 

Invariably, people who eat too much have not only suffered an emotional loss in the past but are also physically deprived or highly stressed in the present. 

The obesity epidemic demonstrates a psychological and spiritual emptiness at the core of consumer society. We feel powerless and isolated, so we become passive. We lead harried lives, so we long for escape. Food is the universal soother, and many are driven to eat themselves into psychological oblivion. 

The roots of sex addiction also reach back to childhood experience. Sex addiction authority Dr. Aviel Goodman points out that the vast majority of female sex addicts were sexually abused as children, as were up to 40% of men. “If a person feels wanted only sexually, as an adult she may look to sex to reaffirm that she is lovable and wanted. Sex addicts who were not abused as children may have had more subtle forms of sexual action protected on them by a parent or they may have felt so unloved or undesirable that they now look to sexual contact as a quick source of comfort.”

The so-called nymphomania, the female sex addict, is not addicted to sex at all, but to the dopamine and endorphins read that flow from the feeling of being desired and desirable. Her promiscuity is not perversity but the outgrowth of a childhood adaptation to her circumstances. As with all addictions, sex addiction is a stand-in for nurturing the person deprived. The dopamine and endorphins reward that love is meant to provide are obtained by having sex – but, as with all addictions, only temporarily. The craving for contact is, perversely, accompanied by terror or real intimacy because of the painful instability of early relationships. 

Addictions can never truly replace the life needs they temporarily displaced. The false needs they serve, no matter how often they are gratified, cannot leave us fulfilled. The brain can never, feel that it has had enough, that it can relax and get on with other essential business.  

The Internal Climate

No organism in nature is separate from the system in which it lives, functions, and dies, and no natural process can be understood in isolation from its physical and biological context. From an ecological perspective, the addiction process doesn’t happen accidentally, nor is it preprogrammed by heredity. It is a product of development in a certain context, and it continues to be maintained by factors in the environment. The ecological view sees addiction as a changeable and evolving dynamic that expresses a lifelong interaction with a person’s social and emotional surroundings and with his own internal psychological space. 

Healing, then, must take into account the internal psychological climate – the beliefs, memories, mind-states, and emotions that feed addictive impulses and behaviors – as well as the external milieu. In an ecological framework recovery from addiction does not mean a “cure” for a disease but the creation of new resources, internal and external, that can support different, healthy ways of satisfying one’s genuine needs. It also involves developing new brain circuits that can facilitate more adaptive responses and behaviors.

So there are two ways of promoting healthy brain development and both are essential to the healing of addiction: by chasing the external environment and by modifying the internal one. 

Even in adulthood, studies have shown, the adult brain can be excepted to be beneficially influenced by the environment. The same has long been known to be true for almost any other organ or part of the body. Unused muscles atrophy, but if well excursuses they grow in size and strength; blood supply to the heart is improved by exercise and a healthy diet; our lung capacity increases with aerobic training. Elderly people who remain physically and intellectually active suffer much less decline in their mental functioning than their more passive contemporaries. 

Early in life the responsiveness of the human brain to changing conditions, known as neuroplasticity, is so great that infants who suffer damage to one side of their brain around the time of birth, even if they lose an entire hemisphere, may compensate for the deficit. The other half develops so that these children grow up to have nearly symmetrical facial movement and only a mild-moderate limp. With age, plasticity declines, but it is never completely lost. Neurological adaptability in adulthood may be seen in the recovery many people make from a stroke. Although never cells that have died will not come back to life, often the patient will once more be able to use a limb that was paralyzed by the stroke. New circuits have taken over and new connections have been made. 

The mental activity most critical to the development of emotional self-regulation has been called “dispassionate self-observation” by the authors of an important article on the interface of brain and mind, published in the Philosophical Transactions of the Royal Society in 2005. “How a person directs their attention (i.e. mindfully or unmindfully) will affect both the experiential state of the person and the state of his/her brain. 

Mindful awareness involves directing our attention not only to the mental content of our thoughts but also to the emotions and mind states that inform those thoughts. It is being aware of the process of our mind even as we work through its materials. Mindful awareness is the key to unlocking the automatic patterns that fetter the addicted brain and mind. 

The dominant emotions suffusing all addictive behavior are fear and resentment – an inseparable vaudeville team of unhappiness. One prompts and sets up the other: fear of the way things are and resentment that they are that way; fear of life and resentment that life is as difficult as it is; fear of unpleasant mind-states and resentment that unpleasant moods and thoughts persist; fear that we’ll never feel all right and resentment that we cannot feel the way we want to; fear of the present and the future and resentment that we cannot control destiny. 

 As long as the effects of the addictive substance or behavior last, resentment and fear are temporarily suppressed, but afterward, the emotions always rebound with greater force than before. It’s an endless cycle because the addicted life will unfailingly generate new sources t to feed the energy of anxiety and resentment. 

How to break the cycle? “Everything has a mind in the lead, has a mind in the forefront, is made by the mind,” the Buddha said. With our minds, we created the world we live in. The teachings of Buddhism are that the way to deal with the mind is not to attempt to change it but to become an impartial, compassionate observer of it. Buddhism didn’t have scientific knowledge about the development of the brain, whose activity generates most of what we understand as the mind. It did recognize that once mind structures are in place they determine our perceptions, behaviors, and experiences. By consciously observing the workings of our mind, we can gradually let go of its habitual, programmed interpretations and automatic reactions. Reflections on the addicted brain, not willful resistance to it, is the way to tame it. Brain research is demonstrating that mindful awareness can release the grip of harmful thoughts and also change positively the psychology of the brain circuits where those thoughts originate. The implications for the healing of addiction are far-reaching. 

We can distinguish between two kinds of mind function: awareness and the jumble of automatic processes that dictate our emotional states, thoughts, and much of our behavior. 

The automatic mind, the reactive product of brain circuits, constantly interprets the present in the light of past conditioning. In its psychological responses, it has great difficulty telling the past from the present, especially whenever it is emotionally aroused. A trigger in the present will set off emotions that were programmed perhaps decades ago at a much more vulnerable time in the person’s life. What seems like a reaction to some present circumstances is a relief from past emotional experiences. 

This subtle but pervasive process in the body, brain, and nervous system has been called implicit memory, as compared to the explicit memory apparatus that recalls events, facts, and circumstances. Whenever a person “overreacts” – that is, reacts in a way that seems inappropriately exaggerated to the situation at hand, we can be sure that implicit memory is at work. The reaction is not the irritant in the present but to some buried hurt in the past. 

The other mind entity is what we can call the impartial observer. This mind of present-moment awareness stands outside the preprogrammed physiological determinants and is alive to the present. It works through the brain but is not limited to the brain. It may be dormant in many of us, but is it never completely absent. It transcends the automatic functioning of past-conditioned brain circuits. 

The Four Steps, Plus One

Step 1: Re-label

In step 1, you label the addictive thought or urge exactly for what it is, not mistaking it for reality. 

Essential to the first step, as to all the steps, is conscious awareness. It is conscious intention and attention, not just rote repetition that will result in beneficial changes to brain patterns, thoughts, and behaviors. Be fully aware of the sense of urgency that attends the impulse and keep labeling it as a manifestation of addiction, rather than the reality that you must act upon. 

The point of re-labeling is t observe the impulse with conscious attention without assigning a habitual meaning to it. 

Step 2: Re-attribute 

This step is designed to assign the re-labeled addictive urge to its proper source. You state very clearly where the urge originated: in neurological circuits that were programmed into your brain long ago when you were a child. It represents a dopamine or endorphins “hunger” on the part of brain systems that, early in life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied. 

Re-attribution is directly linked with compassionate curiosity toward the self. Instead of blaming yourself for having addictive thoughts of desires, you calmly ask why these desires have exercised such a powerful hold over you. 

Step 3: Re-focus 

In refocus step you buy yourself time.

Rather than engage in an addictive activity, find something else to do. Your initial goal is modest: buy yourself just fifteen minutes. Choose something that you enjoy that will keep you active: preferably something healthy and creative, but anything that will please you without causing greater harm. 

The purpose of refocusing is to teach your brain that it doesn’t have to obey the addictive call. It can exercise the “free won’t.” It can choose something else.

As you perform the alternative activity, stay aware of what you are doing. You are doing something difficult. No matter how simple it may seem t others who do not have to live with your particular brain, you know that holding out for even a short period is an achievement. 

Step 4: Re-value

This step should be called de-value. Its purpose is to hope you drive into your thick skill just what has been the real impact of the addictive urge in your life: disaster. It’s because of the negative impact that you’ve taken yourself by the scruff of the neck and delayed acting on the impulse while you’ve re-labeled and re-attributed it and while you have re-focused on some healthier activity. In this re-value step, you will remind yourself why you’ve gone through all this trouble. The more clearly you see how things are, the more liberated you will be. 

We know that the addicted brain assigns a falsely high value to the addictive object, substance, or behavior, the process called salience attribution. The addicted king has been fooled into making the object of your addiction the highest priority. Addiction has moved in and taken over your attachment-reward and incentive-motivation circuits. The distorted brain circuits, including the orbitofrontal cortex, are making you believe that experiences that can come authentically only from genuine intimacy, creativity, or honest endeavor will be yours for the taking through addiction. In the re-value step, you de-value the false gold. You assign to it its proper worth: less than nothing. 

Be conscious as you write out this fourth step – and do write it out, several times a day if necessary. Be specific: what has been the value of the urge in your relationship with your wife? Your husband? Your partner, your best friend, your children, your boss, your employees, your co-workers? What happened yesterday when you allowed the urge to rule you? What happened last week? What will happen today? Pay close attention to what you feel when you recall these events and when you foresee what’s ahead if you persist in permitting the compulsion to overpower you. Be aware. That awareness will be your guardian. 

Step 5: Re-create

It is time to re-create: to choose a different life. 

You have values. You have passions. You have intention, talent, and capability. As you re-label, reattribute, re-focus, and revalue, you are releasing patterns that have held you and that you have held on to. In place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivious, meaningless activity, what is the life you want? What do you choose to create?