Addiction is often thought of as a decision or selfish behavior. What if I told you that the process of addiction is an automatic unconscious process of the brain that acts like a reflex? Dopamine is a big player in how the brain works and continues cycles of addiction. Dopamine is released in abundant amounts while using drugs or engaging in compulsive behaviors (e.g. gambling, sex, and compulsive eating.) But dopamine is also released as a reaction to stress, which creates the cycle of addiction.
When an individual experiences stress, they release Corticotropin-releasing factor (CFR) which activates a stress reaction in the body. To counter this reaction and create homeostasis, the body activates dopamine to oppose CFR and drop the CRF response. Once dopamine is released, individuals will want to seek whatever their body associated with dopamine. Individuals suffering from addiction, this would most likely be their substance/s of choice. Because these substances have such a high association with dopamine, the individual will have a "reflex" to automatically desire the substance. This would be a trigger to the reward effects of the compulsive behaviors. This state is unconscious and automatic and is not controlled by the individual.
Four Major Effects on the Brain
When an individual uses a substance, high unnatural levels of dopamine flood the brain and four major effects occur.
Stress and boredom are often the sources which release CRF but also deeper-rooted problems like unresolved loss, history of untreated trauma or attachment and abandonment issues within relationships. After examining the process of CRF, it is easier to understand why individuals would avoid sources which activate CRF. This can be avoiding therapy, avoiding triggers of stress, or through activating reward systems by using substances that activate dopamine to deplete CRF.
The presence of CRF and spikes of dopamine decreases frontal lobe functioning. We refer to this low functionality of the frontal lobe as, Hypofrontality. Hypofrontality would result in reduced abilities to reason, logically plan and categorize, problem solve, maintain attention, proper judgement and reasonably reduce or avoid habitual responses or tempting behaviors.
Treatment and Recovery
What does this mean for treatment and recovery?
The good news is the brain can recover. We know it can take 18 months for the brain to have reached maximum recovery. The majority of recovery happens quickly within the first few months. The brain recovery then slows down but continues to improve over the following months. Clients and family members must understand the neurophysiology of addiction. Understanding neurophysiology of addiction will not only help reach recovery and remission, but help maintain empathy and compassion throughout the treatment process.
Ann-Marie Sands, LCSW, CADC