Natalie Frank, a Ph.D. in clinical psychology, is the Managing Editor for Novellas & Serials at LVP Publishers. She also publishes fiction.
Addiction is known to have an intense and chronic effect on the brain, and subsequently, a person's life. This is evidenced by cravings for the substance or activity, inability to control its use, and continued use despite the negative consequences associated with the effects.
Overcoming addiction is possible, although the process is frequently long, arduous, and fraught with physical and psychological withdrawal symptoms. Withdrawal symptoms and cravings often lead to one or more relapses prior to the individual being able to sustain a full recovery. This cycle often requires professional help to interrupt. It has taken many years for researchers to scientifically determine this fact, and even longer for them to disseminate the knowledge to positively influence healthcare providers and policy makers.
It wasn’t until the 1930s that the scientific community first started investigating the causes of addictive behaviors. However, the implications and lessons taken from the results of these early studies were prejudicial. This resulted in an inaccurate picture of addiction as the research was based on the consensus that individuals who developed an addiction were morally flawed and weak. These characteristics were believed to contribute to a general lack of willpower to resist the pleasurable effects of a substance. This consensus lead to an equally inaccurate assumption that the way to rid a person of an addiction was through harsh punishment or motivating them to develop the will to crush the habit.
The research community no longer takes this view of the addiction disorders, now recognizing that it is a chronic condition like other types of mental and physical disorders. It has been established that substance abuse disorders change the structure and function of different parts of the brain. Addiction has been compared to physical conditions such as cardiovascular disease which damages the heart and diabetes which decreases pancreatic function. In the case of substance abuse disorders however, it has been said that addiction “hijacks” the reward center of the brain (Teresi, 2011).
The ability to overcome an addiction certainly requires being motivated to do so as well as the willpower to resist falling off the wagon when withdrawal symptoms and cravings develop. However, it is not enough to “just say no,” as the 1980’s anti-drug campaign taught. It usually takes several different approaches for individuals to stop using the substance to which they are addicted. These approaches may include medical and medication interventions, psychotherapy, social support, self-care techniques, problem solving, self-monitoring and regular accountability methods such as random drug testing.
The most recent shift in perceptions of addiction involve the conceptualization of the factors that can lead to condition. Originally it was believed that only strong drugs could cause addiction. This was because physical withdrawal and cravings were thought to be required symptoms that resulted when the addictive substance was stopped.
While it was originally theorized that certain activities such as gambling, shopping and sex could become addictive as well due to their pleasurable effects, there were many who criticized this position based on the lack of a physiological foundation for the addictive process. In the past few years however, research utilizing new neuroimaging techniques have shown that these types of pleasurable activities can also hijack the brain in a manner that appears to be similar to what occurs with drug and alcohol addiction.
The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 2013), continues to portray a number of addictions which are associated with a single substance or activity. Yet neuroimaging studies have suggested that different addictions may be different manifestations of the same predisposing brain processes. For example, research has demonstrated that the activated areas of the brain in gambling addiction corresponded to the brain circuit representing the mechanism of substance use disorder (Hall, Carter, & Forlini, 2015).
These findings suggest that the neurological mechanism of behavioral addictions may be similar to what is found in substance use disorder. This means that the causes of the physiological symptoms related to the withdrawal of the substance or pleasurable activity to which one can become addicted are similar if not the same. Using advanced imaging techniques to study the brain of those who have chronic addictions would likely shed light on the pathophysiology of addictions as well as determine if there are neurological factors common to all addictions.
Technological advances in imaging techniques has afforded investigators the opportunity to study the neurophysiology of addiction. Moving from animal studies to human studies, research has continued in order to determine which factors can be altered to help someone with an addiction overcome their habit. Investigation of behaviorally based addictions have also been increasing along with the realization they have similar characteristics to substance addiction. For instance, it has been determined that gamblers have significant lower amounts of norepinephrine in the brain compared to healthy individuals. This is consistent with the research on substance abuse disorders.
These advances in brain imaging technologies have started to mold our comprehension of the neurobiology of addictions and have provided a new conceptualization of the molecular influences of addictive behaviors. The precise neurological processes leading to addiction have not been fully determined. However, it has been theorized that such behavior is caused by the interaction of genetic, biological, psychosocial and environmental factors. The research needed to examine the various links within the equation which accounts for addictive behavior is just beginning to be conducted.
In order to obtain a better understanding of addictions, researchers have begun using imaging techniques with homogeneous addiction groups. This is intended to limit variability in the data so as to be able to more clearly interpret the findings. Recent studies have begun to delineate some of the functional and structural differences in the nervous system of individuals with addictive disorders. Yet no studies could be more innovative than the one conducted at the MedUni Vienna's Department of Forensic Medicine
Cravings have been shown to be a crucial factor accounting for continued use of a drug or repeatedly engaging in a behavior to which the individual has become addicted. These hungers for the experiences, sensations and emotions connected to the addictive stimuli can also lead to relapse even years after the individual has become abstinent.
While cravings tend to subside the longer an individual has been free of the substance or behavior, objects or situations that have been paired with the pleasurable outcomes of addictive substance or behavior can trigger a lapse. A person addicted to heroin may be in danger of a setback when he sees a hypodermic needle, for example, at an appointment for a routine physical. Another person might start to drink again after seeing people in a commercial enjoying the effects of a particular brand of alcohol. Conditioned learning contributes to our understanding of why people with a history of addiction are still at risk for relapse even years after successfully becoming abstinent. Thus, one research focus on addiction involves the contribution of cravings to continued drug use and other addictive behaviors,.
In a groundbreaking study examining cravings and addiction conducted at MedUni, researchers have determined that substances associated with addictive cravings can still be found after death (Seltenhammer, Resch, Stichenwirth, Seigner & Reisinger 2016). It has been determined that chronic drug use alters a protein called FosB which is concentrated in the reward center of the brain. This occurs due to the protein being genetically altered, split off and shortened. When such modifications occur, drugs such as heroin and other opiates lead to FosB becoming more stable and, as a result, remaining in the brain for longer periods of time than they normally would.
In this study, FosB was found to still be detectable in the brain of those who suffered from a chronic substance addiction nine days post mortem. The researchers have hypothesized that the amount of time this substance is detectable will be far longer in living subjects, possibly even months. The consequences of the longer presence of FosB is a persistent craving for the drug. Cravings have been associated with continued drug use leading to addiction or with relapse in those trying to cease taking the drug. The physiological information and knowledge about the craving related addiction and withdrawal process is stored in a type of dependence memory function which researchers were surprised to find was still detectable after death.
The memory process associated with addiction and relapse leads to an automatic script being generated about the desirability of taking the drug. It has been shown that several target genes for FosB are a part of the molecular process which leads to addictive behavior. This comes about through memory for and learning about the pleasurable consequences of the substance. This process occurs in the hippocampus, a structure which is one of the main memory structures and has been identified as the primary reward center in the brain.
The outcome of chronic drug use was found to result in the FosB lingering in the brain despite the complete removal of the drug from the body. One outcome of this concentration of FosB is sustained neuronal plasticity which can lead to addiction. Rapid, transient synaptic plasticity in addiction. Neuropharmacology, 76, 276-286. This plasticity is associated with impaired glutamate homeostasis which has been linked not only to drug seeking behavior but also to high relapse rates. Pharmacotherapy to restore glutamate homeostasis has included the commonly prescribed antibiotic ceftriaxone, and the antioxidant N-acetylcysteine. This therapy has proven successful in rats but has yet to be tested in people. There has been a call for clinical trials to determine if such therapy would benefit individuals with addiction disorders (Gipson, Kupchik, & Kalivas, 2014).
Nobody ever intends to develop an addiction, but many people get caught in its trap. According to the latest government report, nearly 23 million Americans — almost 10 percent of the populations — become addicted to alcohol or other drugs at some point during their lifetimes (Grant, Saha, Ruan, Goldstein, Chou, Jung, J. & Hasin, 2016). It has also been estimated that over 10 percent of the American population suffers from a behavioral addiction such as Hypersexual Disorder, Pathological Gambling or Compulsive Shopping (Fong, Reid, & Parhami, 2016). 1
Changes in our conceptualization of addictions have led to the understanding that addictions are not strictly a matter of will power to resist the desire to use a particular substance or the impulse to engage in a certain behavior. A big factor in addiction is the craving that develops for the addictive element. Neuroimaging studies are providing new insights into the nature of addiction disorders. In particular, the role of glutamate homeostasis and the presence of FosB in the brain as related to cravings and relapse are being investigated.
Unfortunately, the neuroimaging studies conducted to date have not suggested why different people become addicted to different drugs. Additionally, the reasons that some people are more likely to become addicted to activities such as gambling or shopping as opposed to substances have not been elucidated.. However, with continued investigation into individual addictions and the overlap among addictions, it is hoped that improved treatment options for addiction and relapse prevention will become available.
In particular, efforts are underway to discover better medical intervention addressing not just symptoms but etiology as well for addiction disorders. While real behavioral and lifestyle changes need to be made for lasting abstinence to occur, psychopharmalogical treatment may help make such changes easier. Ultimately, by increasing the ability to maintain an addiction free life, such treatment will help improve the outlook and quality of life for those who are suffering from an addiction disorder.
 There is a significant co-occurrence of substance and behavioral addictions. This has made it difficult to obtain an accurate prevalence rate for all individuals with these disorders since the percentages cannot simply be added together.
American Psychiatric Association. (2013). DSM 5. American Psychiatric Association.
Fong, T., Reid, R. C., & Parhami, I. (2016). Behavioral addictions. Pocket Guide to Addiction Assessment and Treatment.
Gipson, C. D., Kupchik, Y. M., & Kalivas, P. W. (2014). Rapid, transient synaptic plasticity in addiction. Neuropharmacology, 76, 276-286.
Grant, B. F., Saha, T. D., Ruan, W. J., Goldstein, R. B., Chou, S. P., Jung, J., ... & Hasin, D. S. (2016). Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA psychiatry, 73(1), 39-47.
Hall, W., Carter, A., & Forlini, C. (2015). The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?. The Lancet Psychiatry, 2(1), 105-110.
Seltenhammer MH, Resch U, Stichenwirth M, Seigner J, Reisinger CM (2016) Accumulation of Highly Stable ΔFosB-Isoforms and Its Targets inside the Reward System of Chronic Drug Abusers - A Source of Dependence-Memory and High Relapse Rate?. J Addict Res Ther 7:297. doi:10.4172/2155-6105.1000297
Teresi, L. (2011). Hijacking the Brain: How drug and alcohol addiction hijacks our brains the science behind twelve-step recovery. Author House.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2017 Natalie Frank
Natalie Frank (author) from Chicago, IL on September 20, 2018:
Thanks for reading and for taking the time to comment, Ravi.
Ravi Kkapkaa from India on September 20, 2018:
This is so true and honest.
Darla Sue Dollman on January 28, 2017:
This is a fascinating article. I shared this piece with many friends and what seemed to surprise them the most was learning that there are so many different types of addiction. I think sometimes people with addiction problems feel as if they are alone in their battle and information and research helps give them the strength to fight to take their lives back. I have lost friends and family to addictions and cannot even begin to express how much I appreciate researchers who take the time to help others with their disease. Thank you for this carefully researched work.
Natalie Frank (author) from Chicago, IL on January 10, 2017:
Thanks for your feedback. I'm so glad it came across well and you liked it.
Sakina Nasir from Kuwait on January 10, 2017:
Awesome hub! So detailed and polished. Loved it! ☺