Addiction: illness or learning disability?

When we talk about drug addiction, we are sort of burdened with a moral view, which designates the addict as a selfish, liar, and crime-prone being. We believe that in some way he was wanted and does not deserve compassionate treatment.

In the face of this detrimental approach, drug addiction has been added to the list of mental illnesses that must be treated in healthcare settings for many years. It is understood that the addict’s brain has replaced its “natural” mechanisms with external substances or behaviors, which make it totally dependent. And we have to “fix it” so that the individual can reintegrate into society. This second option is much more consistent with what we know about the dependent brain.

However, the transition between these two conceptions is not complete, and in some ways they are sometimes linked, as in 12-step programs, to those that provide religious communities or opportunistic gurus with miraculous herbs. A different view is gaining ground, in which the nature of the addiction is linked to a learning problem..

Generate dependency through learning

The consensus reached by the scientific community is that addiction is associated with distorted learning systems in which pleasure is overestimated, risk is underestimated, and learning fails after repeated mistakes. Addiction changes an unconscious brain to anticipate exaggerated levels of pleasure or a reduction in pain (when the addiction is consolidated).

What we know about addiction has changed over time. It is not clear how a drug user becomes addicted or suffers from a mental illness.

In fact, a report by the United Nations Office on Drugs and Crime (UNODC) states that only 10% of consumers end up having problems with these substances. It is true that this sounds intuitive, because if all the people who claim to use alcohol and drugs ended up becoming addicted, the number of patients going to treatment centers would increase exponentially.

We forget the whole learning process, which leads the individual to gradually replace his interests and his affections by his dependence. Fortunately, along the way, many people discover or learn experiences that are far more rewarding than substance use. Our interest, from the point of view of psychology, is focused on those who, although there are other more attractive rewards and despite the harms caused by their addiction, persist in their behavior, become addicted.

The neurobiology of addictions

We are talking about a disorder based on the functioning of the brain, Which in dependent people works abnormally. But it is not an irreversible degenerative disease; at least not most of the time. It is a learning problem that changes the way the brain works, altering its connections through new mechanisms of reward, motivation and punishment. Like other learning disabilities, it is also influenced by genetics and the environment throughout our evolutionary process.

As Maia Szalavitz recounts in her book Unbroken Brain, “Science has studied the link between learning processes and addiction, by recognizing which regions of the brain are linked to addiction and how. These studies show how addiction changes the interaction between the mid-regions of the brain, such as the ventral roof and nucleus accumbens, which are related to motivation and pleasure, as well as parts of the prefrontal cortex, which help in making decisions and setting priorities ” .

One of the functions of these systems, called dopaminergics, is to influence the decisions we make, to turn them into rewards, if necessary, to increase their perceived value, to raise expectations about them Dopamine, messenger pleasure chemical in our brain, responds to primary rewards such as food, water or sex. But he also does it with secondary rewards like money. In the latter case, our expectations play an important role in our brain’s response to stimuli. Addiction teaches us that if we continue to bet, for example, the probability of winning increases. Random negative reinforcement occurs where, although it almost never gets the expected reward, the behavior (bet) is consolidated. Despite the loss of a lot of money.

The brain damaged by drugs

In non-addicts, the dopamine signal is used to update the value assigned to different actions, leading to choice and learning. You learn when something unexpected happens. Nothing focuses us more than surprise. We learn by trial and error.

With addiction, this learning process is altered. The signals surrounding the addictive experience are overestimated, causing dopamine systems to over-value the contexts around them. Dopamine continues to be released, through the artificial signal produced, for example, by psychoactive substances.

This causes a disproportionate desire for the drug, a craving for consumption that goes far beyond the pleasure or pain relief it can actually produce. In short, thanks to the distortion of the evaluation system of drug addicts, their addiction seems to increase desire without increasing the enjoyment of the object of the addiction.

As individuals and as a species, it’s these brain systems that tell us what matters to us and what isn’t, To be associated with food, reproduction and our survival. Drug addiction distorts these vital goals, replacing them with their purpose, drugs, gambling, sex, or even money. It is, in essence, self-destructive behavior. We could compare it to the engine of a car whose fuel is gradually degraded with, for example, water. The car will run with increasing difficulty and no one will understand why we keep putting adulterated gasoline in it.

Understanding the context of addiction

If to an addicted brain, characterized by focusing on a simple source of satisfaction, we add social pressure for the use of drugs, for example, or the use of drugs that help us to regulate our emotions or our emotional deficiencies. , We will understand how, little by little, the person who suffers from an addiction is trapped there. It’s your life, in a way, your comfort zone. As terrible as it may seem to us from the outside.

To understand all kinds of self-destructive behavior, we need a bigger picture than just the idea that drugs are addictive. Addiction is a way of relating to the environment and to those who live in it. It is a response to an experience that people get from an activity or an object. It absorbs them because it gives them a number of basic and necessary emotional rewards., Even if it hurts your life over time.

There are six criteria by which we can define a dependency.

1. It is powerful and absorbs our thoughts and feelings.

2. Provides essential sensations and emotions (such as feeling good about yourself, or lack of worry or pain)

3. It produces these feelings temporarily, while the experience lasts.

4. It degrades other commitments, implications or satisfactions

5. It is predictable and reliable

6. By coming out of life without addiction less and less, people are forced, in a way, to return to the addictive experience as their only form of satisfaction.

This is, as we can see, a learning process in its own right. I understanding addiction from this point of view makes a big difference, In addition to significantly changing the approach to health intervention.

Reverse the learning process

In no case do we consider that, for example, an addict cannot become a patient with a double disorder. He sometimes happens. Let’s just say that the brain has been hacked so much that it is no longer possible to reinstall the original operating system. But until you get here the addict, goes a long way where learning and nurturing new pathways in their brain can be altered.

Therefore, although the transition from vice to illness meant a major breakthrough in the fight against addictions, treating all people who use drugs or are addicted to certain behaviors as patients, can have the opposite effect. To treat a learning disability, such as a phobia, the active participation of the person is essential. It is also essential to know in detail how the disorder occurred to turn it off.

The same goes for the psychological treatment of addictive disorders. We are dealing with a person who must replace one harmful behavior with one that is not. And that’s why it is imperative that you are involved in it from the start.

The classic health approach, classifying all drug addicts as sick, does not need their collaboration, at least from the start. In the case, for example, of drug addiction, the patient is asked not to fight, to let go, to detoxify himself.

Then we would move on to psychosocial rehabilitation which, until not long ago, was considered an ancillary part of treatment. In a sense, we are telling the addict’s brain that the solution keeps coming from outside and that we are going to provide more psychotropic drugs. Fortunately, we have evolved into a treatment that addresses addiction as a learning disability with at least as important biopsychosocial components.

conclusion

Trying to understand why a person continues to self-destruct even though the pleasure of their addiction has been gone for a long time is much better explained as a neuroadaptive learning process than on the classic disease model.

It is a parallel process of unlearning and relearning that requires the active participation of the person to be successful.. Otherwise, in a way, we are reproducing what the dependent brain thinks: that there is an external and quick solution to their discomfort.

The implications of this new approach to treatment are profound. If addiction is like unrequited love, then companionship and changing relationship dynamics are a more effective approach than punishment. Treatments that emphasize the addict’s role in recovery, such as cognitive therapy, with a strong motivational component, or newer mindfulness-based treatments, work much better than traditional rehabilitations in which they are said to be. to patients who have no control over their addiction.

In short, if we have known for a long time that only a few people who gamble, consume alcohol or drugs become dependent, Isn’t it time we started to study why this is happening and move away from maximalist approaches? It is more important to know what protects these people to the point where they end up moving away from the easy solutions that addiction offers. This will allow us to design better prevention programs and understand where we need to steer treatment processes.

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