It starts with a drink, or one hit, or just a one-time thing. Sometimes it’s under pressure from others, sometimes it’s because you feel like you just need it right now. Other times, it’s because it’s the thing to do and you never thought about doing it differently.
It’s clear that no one chooses to be addicted, for obvious reasons. An addiction is a terrible thing, with a great many terrible symptoms. Yet millions of Americans struggle to quit, trying repeatedly without avail.
Why? Why is it so hard?
Being an addict is not easy. Being an addict is not pleasant. And those who are addicted, and realize it, want to get better. But there’s no overcoming addiction than simply wanting to do so.
That’s because addiction is, for all intents and purposes, a brain disease.
Addiction is a Disease
Addiction is a chronic illness, not a matter of choice. That basically means that even when you want to stop, you’ll find it very difficult to do so without help.
Many Americans quit using drugs despite being heavy users for many years, but that’s because addiction is not guaranteed. It affects some drug users, but not all of them.
For any given history of drug use, there’s a percentage chance that it will lead to substance use disorder – depending on the drug, and the person. For example, an estimated 10 percent of heavy drinkers will struggle or are struggling with alcohol use disorder. The other half are simply drinking too much.
For those who are unaffected by substance use disorders, they can quit when they feel ready. People go through stages in their life where they party and make friends, use drugs, get busy, and stop. They give it up because it’s too expensive, or too time consuming.
But some people get stuck. They can’t just give it up. They can’t just stop.
That’s when addiction has kicked in, and like any disease, addiction requires treatment. Just as how anyone with a cold would like to get better but can’t without giving their body enough time to recover, an addiction takes time to overcome.
The most important element of addiction treatment is quitting. When the body is deprived of drugs, it begins to change and heal. It’s then that therapy becomes useful, as a recovering addict can begin to make quantitative changes in their life and reshape the way they live.
But that first step – quitting – is often the one people get stuck on. This is because of how addiction reshapes the brain.
Addiction Affects Reward
When you take a drug, addictive or not, it enters the bloodstream and travels throughout the body. Receptors in the cells of the body – particularly in the brain – pick up the drug molecules. The relationship between a receptor and a drug molecule is that of a keyhole and a key.
Yet drugs aren’t the usual keys we have floating around in our bloodstream – they closely mimic other molecules, using that similarity to hook into our cells and affect change.
Addictive drugs are deemed addictive because they represent a subset of substances that affect a collection of systems in the brain related to reward. This reward system is what essentially reinforces behavior through positive feedback. It’s what makes us feel good when we exercise, taste good food, or have sex.
The reward system is integral to human behavior, and addictive drugs hijack this system by introducing the high – a burst of chemically-induced euphoria that often overpowers us. The brain struggles to adapt to this new experience, and does so by trying to quantify it, and then normalize it.
The result is predictable. The high becomes normal, so we need something stronger. This happens with non-addictive substances as well, as the body can build a resistance to the effects of a certain drug by metabolizing it more quickly.
But with addictive drugs, this simply incentivizes taking even larger doses, further increasing the danger of reaching a ‘tipping point’ where the drug has changed the way we prioritize reward-inducing behavior to the point that a high overshadows everything else.
At some point, in some people, the brain becomes mechanically and behaviorally dependent on a drug, inducing cravings and triggering crippling withdrawal symptoms within hours of being sober. At this point, the drug has hijacked our reward system, and our brain.
Addiction Affects Planning
Drug use is often destructive. While addicted behavior in itself is destructive, as it prioritizes the addiction before most other things, addictive substances are often dangerous in high quantities.
Drugs like methamphetamine are particularly neurotoxic, with drastic long-term consequences such as anhedonia as a result of affecting the way the brain releases and experiences serotonin.
Alcohol, cocaine, and opioids all have long term effects on the grey matter of the brain, diminishing cognitive abilities and decision-making, affecting our capacity to think ahead, think about risk, and stop ourselves from making certain decisions.
These drugs also increase the risk of stroke, and affect working memory, as well as our ability to process new information and learn. Because teens and children have developing brains, they are most at risk for these long-term effects.
Addiction Affects Motivation
Motivation is intrinsically linked to our brain’s reward system, as we are inherently motivated by bursts of endorphins and other ‘feel-good’ chemicals. But motivation is also linked to the more complex systems that trigger both ‘feel-good’ chemicals, as well as feelings of shame and guilt.
As part of a vicious cycle, addiction is often linked to depression and anxiety, and as a person struggles with addiction, they become less and less likely to motivate themselves to commit to meaningful changes (including sobriety).
In other words, the addiction itself makes it harder to get motivated to do anything. Some drugs reinforce motivation, and even improve it (stimulants like cocaine and amphetamines come to mind), but these effects are tied to the high these drugs create and fade right after.
Relearning to Be Sober
So how can someone quit an addiction? It starts with abstinence.
Unless you break the cycle of addiction, you can’t start down the path to getting used to sobriety. Sober living homes and residential rehab centers help with this by placing a recovering addict in a space where they can’t be tempted to use again. But that’s just the first step.
Making lifestyle changes that set your new life apart from the one you led while addicted is important to long-term recovery. As is working on developing new meaningful relationships with other sober people, and mending relationships with sober friends and family members. It’s important to find something to excel at, be it physically, socially, or mentally.
Accomplishing things can be a great source of satisfaction in sobriety, and satisfaction is critical to breaking the link between drug use and reward. To overcome addiction, you have to love being sober. And there’s a long road ahead for many recovering addicts looking to accomplish that.
But with time, support, and the right treatment, it’s all within reach.