Some Assembly Required

Musings on addiction, recovery, mindfulness, and chronic pain

Who Is an Addict?

Lessons from Phillip Seymour Hoffman

It seems safe to assume that Phillip Seymour Hoffman never expected to become addicted to drugs—no one does. Nobody ever plans to become an addict. Addiction is an insidious and patient disease. Although it overtakes some people with great speed, grabbing them by the throat and refusing to let go in a few short months or in some cases even weeks, usually it bides its time. Addiction can pull people in slowly; its seduction so gradual that people often have no idea they’re falling under its spell. In Greek mythology, the Sirens were fabled seductresses whose enchanting songs lured sailors on nearby ships to their deaths. The sailors were so entranced that they never knew they were in danger until their vessels crashed against the rocky coast of the Sirens’ island and sank. So it is with addiction; by the time most people have any clue that they’re in trouble, they’re already in too deep.

What begins as an intermittent path to pleasure, as well as a transitory escape—initially from the stresses of life, and subsequently from emotional and physical pain—grows into a dogged preoccupation that over time metastasizes into an obsession and a ruthless compulsion. We start out gently floating on a raft off a beach in the Caribbean and end up being blown out to sea and lost in the middle of the ocean during a typhoon. Using substances and activities to change the way we feel often begins as a vacation and turns into a kidnapping, with a compelling case of Stockholm syndrome.

Initially, the decision to use substances is a conscious choice, but as addiction progressively takes over a person’s life, he or she loses more and more of the ability to exercise control over his or her thoughts, feelings, impulses, and actions. The ability to make conscious choices fades as the unconscious influences of the "reward system" located deep within the primitive survival-focused midbrain override the sophisticated decision-making abilities of the more highly evolved prefrontal cortex. At a certain point in the progression of active addiction, beneath the surface of conscious awareness, drug taking becomes equated with survival. The need to use assumes highest priority, becoming so strong that it suffocates all other needs. What originated as an experience that provides temporary freedom from the stresses and hassles of everyday life has evolved into a prison.

Addiction is a chronic, progressive, and potentially fatal illness, similar to other chronic life-threatening diseases such as diabetes, asthma, and heart disease. Like these other diseases, there is no cure for addiction. However, it can be treated and managed successfully through the process of recovery, allowing those who suffer from it to live long, full, and healthy lives.

There are plenty of people who continue to believe that categorizing addiction as a disease is bullshit. However, addiction is a brain disease that actually changes the brain’s structure and functioning. Brain imaging studies provide empirical evidence that addicts experience physical changes in the areas of their brains that involve judgment, decision-making, learning and memory, and behavior control. These changes affect how the brain works in extremely important ways. They help to explain the vicious circle of obsessive thinking, compulsive actions, and tunnel vision inability to delay gratification (including the decreased capacity to consider the consequences of one’s actions) in which addiction traps those who struggle with it.

The National Institute on Drug Abuse (NIDA) of the US Department of Health and Human Services defines addiction as a “chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences.” In 2011, the American Society of Addiction Medicine (ASAM) revised its definition of addiction, classifying it as a primary chronic disease of the brain’s circuitry related to reward, motivation, and memory, rather than simply a problem based in behavior. This brain dysfunction is reflected in impaired behavioral control, craving for the object(s) of addiction, and the inability to abstain consistently, as well as diminished recognition of significant problems with one’s behaviors and interpersonal relationships.

The use of drugs and mood-altering behaviors directly affects the brain’s chemistry and anatomy by changing how it sends and receives information. When the reward system is activated through messages sent by particular neurotransmitters, most notably dopamine, people experience pleasure. This is what produces the mood-changing effects sought by people through drugs and activities like gambling, eating, sex, etc. Research has been very clear that drug use effectively carjacks the brain’s reward system by changing the levels of specific neurotransmitters—think of the reward system on steroids.

The brain adapts to repetitive experiences by forming unconscious memory connections or tracks through a process known as neuroadaptation. When such repetitive experiences revolve around using drugs &/or activities, the memory tracks that are laid become the neurological foundation of the “habits” of addiction. Such habits can be so difficult to control because they are created by changes in brain functioning and work in the brain’s operating system—outside of conscious awareness.

These unconscious learned responses are strong enough that they remain operative even after years of abstinence. As a result, their memory tracks tend to pull people back toward the experiences and behaviors with which they are familiar and comfortable, making it more difficult to stop such behaviors and stay stopped. Like petroglyphs etched in rock formations that are clearly visible hundreds of years later, despite the often horrific consequences of active addiction, the rhapsodic recollections of drug use are engraved deep within the midbrain—beckoning sweetly and seductively.

With recovery, the addict’s brain has the opportunity to heal and rebuild the connections that were altered by active addiction. This notwithstanding, active addiction trips an electrochemical switch that can never reset to “normal,” Among the lessons of Phillip Seymour Hoffman's tragic death is that no addict is immune to relapse no matter how long he or she has been abstinent, and recovery from addiction is an ongoing, life-long process.

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Copyright 2014 Dan Mager, MSW

 

Dan Mager, MSW is the author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain. He received his MSW from CUNY's Hunter College.

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