Addiction: A Whole New View

There seems no end to our "dependencies," their bewildering intractability, the glib explanations for their causes and even more glib "solutions."

The news, however, is that brain, mind, and behavior specialists are re-thinking the whole notion of addiction. With help from neuroscience, molecular biology, pharmacology, psychology, and genetics, they're challenging their own hard-core assumptions and popular "certainties" and finding surprisingly common characteristics among addictions.

They're using new imaging techniques to see how addiction looks and feels and where cravings "live" in the brain and mind. They're concluding that things are far from hopeless and they are rapidly replacing conjecture with facts.

For example, scientists have learned that every animal, from the ancient hagfish to reptiles, rodents, and humans, share the same basic pleasure and "reward" circuits in the brain, circuits that all turn on when in contact with addictive substances or during pleasurable acts such as eating or orgasm. One conclusion from this evidence is that addictive behaviors are normal, a natural part of our "wiring." If they weren't, or if they were rare, nature would not have let the capacity to be addicted evolve, survive, and stick around in every living creature.

"Everyone engages in addictive behaviors to some extent because such things as eating, drinking, and sex are essential to survival and highly reinforcing," says G. Alan Marlatt, Ph.D., director of the Addictive Behaviors Research Center at the University of Washington. "We get immediate gratification from them and find them very hard to give up, indeed. That's a pretty good definition of addiction."

"The inescapable fact is that nature gave us the ability to become hooked because the brain has dearly evolved a reward system, just as it has a pain system," says physiologist and pharmacologist Steven Childers, Ph.D., of Bowman Gray School of Medicine in North Carolina. "The fact that some things may accidentally or inadvertently trigger that system is somewhat beside the point.

"Our brains didn't develop opiate receptors to tempt us with heroin addiction. The coca plant didn't develop cocaine to produce what we call crack addicts. This plant doesn't care two hoots about our brain. But heroin and cocaine addiction certainly tell us a great deal about how brains work. And how they work is that if you taste or experience something that you like, that feels good, you're reinforced to do that again. Basic drives, for food, sex, and pleasure, activate reward centers in the brain. They're part of human nature."

New Thinking, Old Problem

What we now call "addictions," in this sense, Childers says, are cases of a good and useful phenomenon taken hostage, with terrible social and medical consequences. Moreover, that insight is leading to the identification of specific areas of the brain that link feelings and behavior to reward circuits. "In the case of addictive drugs, we know that areas of the brain involved in memory and learning and with the most ancient part of our brain, the emotional brain, are the most interesting. I'm very optimistic that we will be able to develop new strategies for preventing and treating addictions."

The new concept of addiction is in sharp contrast to the conventional, frustrating, and some would say cynical view that everything causes addiction.

Ask 10 Americans what addiction is and what causes it and you might get at least 10 answers. Some will insist addiction is a failure of morality or a spiritual weakness, a sin and a crime by people who won't take responsibility for their behavior. If addicts want to self-destruct, let them. It's their fault; they choose to abuse.

For the teetotaler and politicians, it's a self-control problem; for sociologists, poverty; for educators, ignorance. Ask some psychiatrists or psychologists and you're told that personality traits, temperament, and "character" are at the root of addictive "personalities." Social-learning and cognitive-behavior theorists will tell you it's a case of conditioned response and intended or unintended reinforcement of inappropriate behaviors. The biologically oriented will say it's all in the genes and heredity; anthropologists that it's culturally determined. And Dan Quayle will blame it on the breakdown of family values.

The most popular "theory," however, is that addictive behaviors are diseases. In this view, an addict, like a cancer patient or a diabetic, either has it or does not have it. Popularized by Alcoholics Anonymous, the disease theory holds that addictions are irreversible, constitutional, and altogether abnormal and that the only appropriate treatment is total avoidance of the alcohol or other substance, lifelong abstinence, and constant vigilance.