BY FELICE J. FREYER
Journal Medical Writer
Why don’t they just stop? Seeing all the harm to themselves and those they love, why do addicts keep taking drugs?
To those who aren’t afflicted, that’s the central mystery of addiction. But research has shown that for addicts, “just stopping” is not an option: the drugs have commandeered the brain, causing a complete loss of control.
“Drugs of abuse change the structure of the brain,” says Dr. Robert Swift, professor of psychiatry and human behavior at Brown University. “It’s a brain disease, not a weakness of character.”
Dr. John Femino, an addiction medicine specialist and medical director of Meadow’s Edge Recovery Center, in North Kingstown, puts it this way: “I’ve never met an addict that planned on being one. Their brain gets co-opted.”
People take drugs because it makes them feel good or relieves pain and distress, including underlying disorders such as depression, anxiety and posttraumatic stress.
The drugs’ positive effects can lead people to keep taking them, and that repeated drug use distorts two brain systems. The first, the limbic system, bestows pleasure: it makes things such as eating and sex enjoyable to ensure survival of the species. Counterbalancing this system is the frontal cortex, the cop in charge of judgment and decision-making.
There is a constant give-and-take between these two systems, between impulse and self-control. Your limbic system makes sure you don’t starve; your frontal cortex dissuades you from that second piece of cake.
Drug use primes the limbic system and saps the frontal cortex. That means the urge for drugs strengthens just as one’s ability to control that urge becomes impaired, or as Femino puts it, drugs are “turbocharging your engine and weakening your brakes.”
Eventually, the urge to consume drugs becomes so powerful that “a person will give up everything that’s important to them as a human being –– their relationships, their job, their health –– because it changes your brain and it alters your thinking,” Swift says. “You literally do lose yourself.”
Drug use doesn’t do this to most people, only those with a certain type of brain anatomy.
The vulnerability to addiction is caused by a variety of factors: genes, social circumstances and traumatic experiences, such as childhood abuse or military combat.
European studies of twins raised by separate families found a powerful genetic effect: the children of addicts were at much higher risk for addiction. “About 95 percent of the people that get treated have a family history of alcohol or drug problems,” Femino says.
Another sign of danger is having an atypical response to drugs, such as feeling energized after taking a painkiller (most people get sleepy) or being able to drink large amounts of alcohol without getting a hangover.
Among those prone to addiction, the next step is exposure, usually repeated exposure, to addictive drugs. It typically takes weeks to months of drug-taking to develop an addiction, Swift says.
Adolescents are especially vulnerable, in two ways: the parts of the brain controlling judgment are not fully developed until the mid-20s, leading to risk-taking. And those who become addicted in adolescence will have a much harder time recovering.
Once you’ve become addicted, your brain is forever changed. That’s why those who undergo treatment frequently relapse.
“People who are struggling with addiction work harder than anyone I know,” says Swift. “They have to fight the urges and compulsion to use the drug.”
To recover, people learn to develop support systems and mental tricks to keep the urges at bay. Especially in the beginning, they need to avoid the places and circumstances that can trigger the compulsion to use again. One drink, one pill, can destroy months of carefully nurtured self-control.
In other words, addiction needs to be vigilantly managed like any chronic illness, such as diabetes and asthma, which have similar rates of relapse.
This doesn’t mean that people should avoid painkillers or treatments for mental illness for fear of addiction, both doctors say. But they should be mindful of the risks.
If you have a family history of addiction or have had an atypical response to an addictive substance, watch yourself. If you are prescribed a painkiller, take only the amount prescribed and then stop; switch to a non-narcotic painkiller or other treatments if your pain doesn’t abate. If you drink, stick within the recommended parameters (no more than one drink a day for women, two for men). Use your frontal cortex to follow the rules, lest you lose the ability to do so.