The experts at the National Institute on Drug Abuse (NIDA) are very clear: "Addiction is defined as a chronic, relapsing brain disease." (Here's the NIDA party line in a bit more detail.) As you can see, addiction is viewed as a chronic disease much like cardiovascular disease or diabetes. And they should know, right? After all the National Institutes of Health (the parent organization) funds 90% of addiction research around the world. They'd better know what they're talking about.
But wait a minute. The brain is a very different organ than the heart or pancreas. You want your heart and your pancreas to change as little as possible as you grow up and age. Most organs are supposed to maintain their structure throughout life. But the brain is designed to change — rapidly, radically, with learning, with experience. If your brain changed as little as possible, you'd live the rest of your life in a coma.
Self-perpetuating brain change (brought about through repeated experience) is called neuroplasticity. That's the source of all learning. Brain change caused by learning is "natural" brain change. Now there are some forms of brain change that you want to avoid, like the accumulation of plaques and tangles that lead to cell death, causing Alzheimer's Disease. That's "unnatural" brain change (of course everything in nature is "natural," but you know what I mean). So, is addiction a chronic brain disease like Alzheimer's? Or are the brain changes seen in addiction simply a result of entrenched learning, caused by the repetition of a particular kind of experience (e.g., repeatedly pursuing drugs, booze, gambling, sex, or video games — to get your jollies)?
Those of us who see addiction as learned (e.g., Stanton Peele, Maia Szalavitz, Bruce Alexander, and me) think the answer is pretty clear. And the best evidence is that it can be unlearned, or relearned: that is, most addicts recover (e.g., the rate of "stable" [lasting] recovery for alcohol-dependent subjects is over 20% per year without treatment).
The term neuroplasticity has become popular in recent years — see Norman Doidge's fabulous books, explaining what neuroplasticity is and how it can be applied to solve learning problems. But the idea itself has been around for at least a century. In Donald Hebb's (1940s) memorable words: What fires together wires together — neurons that activate each other become more strongly connected — through adjustments (increased efficiency) in their synapses. Neuroplasticity is the brain's natural starting point for all learning processes — processes that might include not only addiction but also recovery.
Neuroplasticity is strongly amplified when people are highly motivated. Which is why all learning requires some motivational thrust. Entrenched habits like addiction may simply grow from intense desire, breeding repetition. But can desire also cultivate recovery? Maybe desire plus neuroplasticity is all you need to recover from addiction.
Let's take a closer look at how neuroplasticity works when old habits are replaced by new ones.
In 1993, Mogilner and colleagues looked at the brains of people born with webbed fingers. That means that some of their fingers were connected and could not move separately — they functioned in total unison. A few weeks after surgery allowing the fingers to move on their own, these authors looked at changes in the (somatosensory) cortex. What they found was that clusters of neurons that had always fired together now fired partially independently.
So the brain adjusted its wiring, breaking down a coherent habit and replacing it with a new habit. Might recovery work the same way?
When people recover from strokes or concussions, the same sort of rewiring takes place in many regions of the cortex. (And this rewiring can be accelerated by clinical techniques — see Norman Doidge.) Even language can be relearned after it has been demolished by brain damage, through the synaptic rewiring of cortical regions previously devoted to other functions. Thus, neuroplastic change can and does occur, in real life, with a speed and vigor we rarely imagine.
Back to addiction. People learn addiction through neuroplasticity, which is how they learn everything. They maintain their addiction because they lose some of that plasticity for a while. As if their fingers had become attached together, they can no longer separate their desire for wellbeing from their desire for drugs, booze, or whatever they rely on. Then, when they recover, whether in AA, NA, SMART Recovery, or counting backward by 3's while holding their breath in the bathtub, their neuroplasticity returns. Their brains start changing again. Just as in Mogilner’s study, their brains begin to grow new synaptic patterns, allowing them to separate familiar goals (like drugs) from long-term rewards (like wellbeing and security).
The take-home message here is simple: Recovery involves a major change in thoughts and feelings, and such changes require ongoing neural development or neuroplasticity. The question is, how does desire work together with neuroplasticity to establish new mental habits? I'll begin with this question next post.