For Family Members: Addiction Explained:

A Disease in the Brain

Here is a new working definition for the disease model of addiction: A disease is a dysregulation of normal cell function. In addiction this takes place in the brain, making addiction a brain disease. The natural production and transference of up to 9 neurotransmitters (the chemical messengers that traverse between cells) becomes altered by the persistent flooding of artificial sources. The flood or rush of the artificial source of neurotransmitters is the pleasurable rush of doing drugs, alcohol, nicotine, and caffeine and taps into our primitive brain’s pleasure  regions. The natural production of these neurotransmitters shut down in order to balance the brain chemistry (Homeostasis). The downside is, whenever you are not using there are no happy neurotransmitters which causes an increased need for using addictive substances or stimulating behaviors, and when chemical addictions are ceased, natural production of these happy chemicals can take between 12 – 24 months to normalize. Some drugs like alcohol, meth, and ecstasy can do permanent brain damage. The lack of endorphins and dopamine’s are the root cause of dope sick, pangs, urges, cravings and relapse.

Addiction has always carried a lot of social shame. Western civilization has always judged behavior in respect to social norms, holding its citizens accountable for their actions. Most people fail to this day, to believe the powerlessness associated with addiction. Yes, addiction begins with a choice, but very quickly the options close down and the process becomes a self fulfilling prophecy.

Science as of late has traced the reinforcing nature of addiction, and its resistance to recovery and relapse. Yes it still has a heavy behavioral component, but not as much as you might think. Science has taught us that some require medication assisted detox and or maintenance.

Let’s examine some of the statistics of addiction and recovery. Recovery tables show some very interesting facts. I mentioned earlier that Alcoholics Anonymous had about a 45% retention rate. Recovery rates for successful treatment when poled at 1 year average 9 - 14%. Some treatment centers claim a much higher rate than that but these are usually calculated at a shorter intervals than 1 year post treatment. After 3 months relapse rates begin to overtake successful outcomes. Some of the best rates come from a combination of drug courts and treatment. Time in treatment is often longer with a referral by drug courts and county health departments, up to 60 to 90 days versus the standard 28 to 30 days. Aftercare and follow up periods are longer as are the control periods of up to a year or more with the court system. The Pavlovian reinforcement pattern of addiction is broken, giving the brain chemistry the time it needs to repair itself. I see the beginnings of scientific research following the brain chemistry patterns into non-chemical assisted addictions, such as gambling, rage, and sexual addiction, these compulsive behaviors mimic drug and alcohol addiction utilizing the same pathways and are called process addictions.

It seems heredity has little causation in addiction, just a predisposition. This is an attribution error. Genetics alone does not explain why one person reaches the level of frequency to start shutting down some of their brain chemistry. The true drive of addiction is stress.

Addiction is an exacerbation of viable options in people under some times extreme stressors. Look at all the recent mass murders depicting people who have lost their jobs, options have disappeared, stress increases till finally fear morphs into anger and is focused outward. Most of us still feel that the addict and alcoholic are victims of their own choices. They harm themselves, family members, friends and community members with their behavior and self-centeredness. I was no different when I was using.

Two large hurdles to finding treatment are affordability and availability. Loudoun County has been without a residential treatment facility for some time now. There have been two attempts in the past; both were for profit based and therefore dependent upon insurance contributions. Although recently mandated by Virginia law as a covered Medicare expense, most insurance companies are reluctant to offer coverage. With a more than 80% relapse rate and costs ranging between $20,000 and $80,000 per month, I don’t blame them. It seems the most viable option for treatment is from a non-profit Treatment Center partnering with community based Mental Health Departments or a Recovery Community Organization which helps develop recovery inroads and foster a recovery life style. This holds costs down and many county health departments have sliding scales and grant programs that support referrals for treatment. The biggest problem here is, these treatment centers tend to stay full. Finding an available bed in treatment can be exhausting. Often the best alternative is to find a bed in an area detoxification ward at a hospital while the client is waiting to be placed at a treatment center. Even these beds are disappearing as hospitals reduce liability. More often than not, affordable treatment is not found, and family members raise their arms in frustration and exclaim, “What do I do now?”

Jim Gross