Addiction as a disease of the brain: psychological theories and treatments

¶ … Psychology: Alcohol & Drug Abuse

The over-all focus of this paper is to show how alcohol, drug addictions and abuse is fundamentally a disease of the brain. It will focus on various psychological aspects of addiction, such as some theories as to why people get addicted to drugs or alcohol in the first place, and some theories for treatments of those addictions; some psychological processes of how certain drugs work; how those drugs shape addiction through their processes; and finally analyzing the understanding of addiction within the brain.

Some major theories for why people begin to use substance such as drugs (legal or not), and alcohol are the reward and reinforcement theory, recreational use, and the stress-reduction theory. Some theories for treatments include using combinations of cognitive/social support rehabilitation, or using some form of rehabilitation with medications as well. The types of drugs and their effects that will be discussed consist of stimulants, depressants (including alcohol), and narcotics. Finally, this paper will analyze the mechanisms in the brain that allow the disease of addiction to grab hold of a person, and what medication treatments are being used to treat addiction as a brain-based disease.

Psychological Theories

Many people may wonder (this author included), why a person decides to use drugs or alcohol in a manner that is not considered "normal," or "social." Some reasons may be that a younger population of users find drugs being glamorized in careers like modeling or professional sports; some may give in to peer pressures in order to socialize with certain groups at school, some may just be curious and find the experience more than they bargained for; and still some may have stress related incidents in their history that they just rather forget (Feldman, 2009). More often than not it boils down to two reasons how addicts get their start: the first is they were just curious which activates the reward and reinforcement pathways within their brain (more on this later), or they are highly susceptible to stress and start self-medicating to cope (Anton, 2010). The theory of reward and reinforcement will be fully explained the in the Brain Pathways section later in this paper, but to basically lay out the premise of the theory we can begin with a cigarette example. Let's say a person may smoke a cigarette for the first time and notice that after their first inhalation they feel a great sense of relaxation and stress-reduction, mostly because nicotine has activated the brain's "pleasure center," (the reward) and because of that they seek out cigarette's again in order to feel relaxed and stress-free once more (reinforcement) (Drummond, 2001; Oltmanns, & Emery, 2010). This type of addiction is also known as a "biologically based" based addiction, because the body is literally craving the same feeling/substance repeatedly and cannot perform normally without it (Feldman, 2009).

Stress-reduction theories are equated to layman's term such as "self-medicating," and "using drugs to escape one's problems." (Anton, 2010). Indeed, in Raymond Anton's article on substance abuse he states that there is an increasing amount of research done on genetic and developmentally at risk persons for lower levels of stress tolerance, which may induce certain people to turn to drugs or alcohol at any time during their lives. Some events in a person's history may be too much for them to take, such as past sexual abuse, war (especially for soldiers in Iraq), and childhood trauma (Anton, 2010). What usually happens for a person who is self-medicating is that there is some stress, either from the above mentioned reasons, or just daily life in general, and a person will turn to alcohol to help them relax, or to help them forget (Feldman, 2009). Of course, after several drinks the stress is gone, the person feels happier, looser and continues this nightly ritual until the person can no longer feel relaxed or forget the haunting memories normally and now needs alcohol to do this for them, in ever increasing quantities. This is also known as the "psychologically based addiction," where the person feels that they need the substance of choice in order to cope with the stress because they feel they cannot cope with it normally (Feldman, 2009). Substance used for stress coping can be something legal, such as cigarettes, alcohol, or prescription drugs; to something illegal like cocaine or marijuana.

The two main types of therapy that can be provided for an addicted person is rehabilitation, either inpatient or outpatient, and medication coupled with rehabilitation; recently treatment is leaning towards the latter due to the more accepted notion that addiction should be classified as a disease (Anton, 2010). Inpatient rehabilitation treatment usually occurs when a patient with a substance addiction is sent to a residential-type home outfitted with doctors and therapists specializing in substance abuse, where the patient usually goes through detoxification, attends counseling sessions, group sessions, and receives medication for a certain period of time (Anton, 2009; Oltmanns, & Emery, 2010).

Outpatient rehabilitation treatment is when a patient does not stay at a residential center, but goes through programs like Alcoholics-Anonymous, seeks out a cognitive-behavioral therapist specializing in addiction, or may go to some other type of group support therapy (Anton, 2009; Oltmanns, & Emery, 2010). Alcoholics-Anonymous, and other similar support-based self-help groups, are thought to help addicts based on the "personal growth process," coping strategies, and the social support and motivation that is offered by those who attend and have remained sober for a long time (Oltmanns, & Emery, 2010). Cognitive-Behavior therapy helps addicts recognize thoughts, feelings, situations, or behaviors that bring on substance abuse; and teaches them coping skills to deal with those issues in a healthy way (Oltmanns, & Emery, 2010).

Analyzing Physiological Effects & Treatments

Addiction begins when a person feels a craving for a substance, which has activated the "pleasure center" of their brain, which are the dopamine reward pathways and endorphins located in the limbic system (Oltmanns, & Emery, 2010). In chronic abusers of substances like alcohol, heroin, or cocaine, these pleasure centers have been so artificially high, repeatedly, that according to Raymond Anton, the brain has been literally "hijacked" by the floods of dopamine, that when the user is not high the limbic system does not have normal responses to pleasurable things like food or sex anymore. Therefore, according to Anton, the drug is increasingly needed for users to feel any sense of well-being, and explains why users have an escalating feeling of depression when coming down from a high, and lends to the rising popularity of the theory that addiction is a brain-based disease. These pathways are so addicted to the drug that when a substance abuser just looks at pictures of alcohol or drugs, or the paraphernalia such as needles, or even pictures of the environment where they may use, these pathways are abnormally activated vs. participants who did not have a substance abuse problem (Anton, 2010).

Thankfully, because the idea that addiction is indeed a physiological disease of the brain that users suffer from for the rest of the lives even after being sober for many years there have been tremendous strides in using medication as treatment for addictions (Oltmanns, & Emery, 2010). According to Anton, there has been an increase in research for a cocaine vaccine, where clinical trials are being performed, and there have also been some new developments for other medication treatments for methamphetamines, opiates, and nicotine. Additionally, Colin Drummond, in his article solely concerning cravings, strongly recommends more research on the effects of using medications to treat alcoholism, as well as more investigations of the limbic systems neurotransmitters and their influence on cravings and addiction.

As it stands today there are many medications being used to help facilitate detoxification, and to help substance abusers of illegal drugs "maintain a state of remission." (Oltmanns, & Emery, 2010). A drug called Antabuse is a fairly common medication treatment for those wishing to abstain from alcohol, and its main function is to make the patient violently ill when they drink even the smallest amounts of alcohol (Oltmanns, & Emery, 2010). Of course, the only problem with this form of medication is that the patient can simply stop taking it if they want to drink again, however, they can take a different drug called Revia, which helps to block the reward pathways that alcohol would normally activate, thus dampening the affects of alcohol and curbing the rewarding aspects (Oltmanns, & Emery, 2010). Another drug for alcoholism called Campral, which has the highest success rate, is used for those seeking relief from withdrawal symptoms and is meant to be used in conjunction with psychological therapies like cognitive-behavioral, group therapy or inpatient rehabilitation (Oltmanns, & Emery, 2010).

An important drug that has been used to help treat heroin addiction is Methadone, which works to replace the psychological addiction to heroin with the Methadone, and help the user lead a normal life, which slowly weaning themselves off the Methadone altogether (Feldman, 2009). The only downside to this treatment is that it is possible for heroin addicts to become addicted to Methadone, because unfortunately is does not remove the biological addiction, so it is very important for this medicine to be used in a controlled environment like an inpatient resident center, under the care of an addiction specialist (Feldman, 2009).

Another form of medication treatment doesn't use a medicine to replace or block the drug, but uses the same drug to wean a user off, which, of course, is the nicotine patch or gum used by those who wish to give up smoking. The patch, or gum, is used in strong amounts a the beginning and starting out everyday a smoker will use the patch, but slowly start to use the lesser amounts and start to wear it less often. The idea is to start out with the normal amount of nicotine a person is used to and then gradually get them used to less and less, until (hopefully), the smoker no longer has such strong cravings, and can eventually go without smoking and work on their will-power.

Conclusion

This paper aimed to show the various theories, processes, effects, and physiological analyses of alcohol and drug dependency based on the idea that it is a disease of the brain. Major theories discussed included why people become addicted to substances like alcohol or drugs in the first place, which could be attributed to reward and reinforcement, or stress-reduction behaviors, also known as biologically-based or psychologically based addictions. The cognitive-behavioral theories of treatments was discussed at length, as well as how groups like Alcoholics-Anonymous help their group members recover from addictions. The processes and effects of how certain substances, both legal and illegal, manifest in the body, and what consequences produce within the user was discussed at length, and illustrated how biological and psychological addictions can occur. Lastly, the physiological aspects of addiction was analyzed to give a more clear representation of how drugs affect the human brain, and what medical treatments can be used to counteract these devastating consequences of substance abuse and addiction.

In closing, it is highly suggested for research psychologists to increase their efforts into developing more effective treatments featuring medication used in combination with outpatient therapies. More specifically, medication that helps to treat the more serious addictions of methamphetamine, cocaine, and heroin.