Thread by @garwboy

This Sunday is #WorldMentalHealthDay2021, so here is a #BrainStuff thread about one of the less often discussed, and more readily stigmatised, disorders; addiction.

What happens in the brain to make addiction so harmful? Suffice to say, it's not 'just a matter of willpower'

/1

At present, practically all 'recognised' forms of addiction concern a type of psychoactive chemical substance. Alcohol, nicotine, caffeine, heroin, cocaine, etc.

The only 'official' non-chemical type of addiction so far is gambling.

ncbi.nlm.nih.gov/pmc/articles/P…

/2

There's much debate as to whether other types of addiction should be recognised, like shopping, porn/sex addiction, video games or social media etc.

These are all essentially marked 'TBC' right now. They may end up being recognised addictions, they may need a new label

/3

In any case, most recognised addictions concern chemicals, drugs (illegal or otherwise). Hence the term 'substance abuse disorder' gets mentioned alongside addiction so often. They're even sometimes used interchangeably.

/4

But there remains much of stigma/judgement about people with addictions. Why can't they just stop taking their drug of choice, when it's clearly affecting them so negatively? Why would stopping be more unpleasant?

It's not that simple though, thanks to how our brain works

/5

I'm guessing a lot of people assume that if you just stop taking a drug, once it leaves your system, you're back to normal, same as you were before you started taking it.

You're not, though. Because your brain is very flexible, and adapts and changes quite readily

/6

A drug may be a substance introduced into the body and brain from the outside, so stopping that happening means it leaves our systems via our usual metabolism pretty quickly. But if it's been around long enough, the changes it's induced, they linger for far longer.

/7

Here's how I think about addiction and the brain.

Imagine your brain is a small town, with all the usual setup and infrastructure. In the centre is the town hall, where the 'fun stuff' happens. Live events, gigs, parties etc.

The town hall is your brain's reward pathway

/8

The reward pathway is the part of your brain that produces, and allows us to experience, pleasure.

sciencedirect.com/topics/neurosc…

Events in the town hall are the normal activity of the reward pathway in this analogy.

Stay with me, I promise it'll make sense soon

/9

Normally, the goings on at the town hall are just one aspect of the town's day to day functioning, so everything ticks along fine. Ditto normal reward pathway activity in your standard brain. Nothing to worry about here.

/10

But then, one day, the town hall is suddenly, unexpectedly, and mysteriously replaced, with a huge stadium. One with a major live show or sporting event going on inside, and a capacity crowd of about 80,000

This is going to have a big effect on the rest of the town.

/11

In some ways, the stadium's sudden appearance will be good. Every town business is going to make a lot more money from all these new people who need food, accommodation etc. So much of the town will be glad the stadium appeared.

/12

On the other hand, tens of thousands of extra people will put a huge burden on the town's infrastructure. Roads will be jammed, stocks will be depleted, services will be overwhelmed. Money may be made, but a lot of things will grind to halt while that's happening.

/13

A stadium with capacity crowd suddenly appearing in a small town? That's like what happens in your brain when you first take a powerful narcotic like heroin. The reward pathway activity is amplified way beyond normal. While it's pleasurable, but also causes much disruption.

/14

If the stadium is there one day and gone the next, it need not lead to lasting issues. The town cleans up the mess, puts things back in order, and returns to normal, while always remembering that weird, profitable, but disruptive day when a stadium appeared.

/15

However, what is the stadium *doesn't* go away? What if it looks like it's there to stay? In this scenario, the town can't just sit there and be constantly overwhelmed. It'll have to change, adapt, to better accommodate and deal with the stadium crowds.

/16

New roads will be built, more transport provided, more police and service people employed. New businesses will pop up to utilise the massively-expanded customer base. More housing built for the people who come to the town to work for them, and so on.

/17

Basically, if the stadium sticks around long enough, the town around it will change to deal with it without disruption.

But more than that, eventually the town will *depend* on the stadium. The money and custom it provides is now a vital aspect of the local economy.

/18

Any decision or action that happens in the town will incorporate the stadium in some way. It'll infuse into every aspect of the community.

At this point, far from causing disruption and problems, the town in its current *needs* the stadium for everyday functioning.

/19

Then, suddenly, the stadium vanishes again, leaving the old town hall in its place.

Does everything go back to normal around it? Hell no. Countless businesses go to the wall very quickly, people are left jobless, mortgages aren't paid, budgets are slashed, and so on.

/20

The old town would have coped fine, but this isn't the old town any more. This is a town that has had a stadium in it for a long time, and has changed considerably as a result. It *can* go back to how it was, but it'll be a prolonged, painful, damaging process.

/21

This, in a nutshell, is what happens in the brain of someone experiencing addiction. They *had* a more typical brain, but the presence of a powerful drug in their system over so long has drastically altered how their brain functions, so much so that it *needs* the drug

/22

Our brain adapts, basically. And it usually means our brain's systems saying "Something has changed, and we need to compensate for that change, so as to resume our normal operations".

When you make your brain adapt to things it *shouldn't* be doing, it causes problems

/21

Case in point; heroin, and other opioids, are (among other things) powerful analgesics. Painkillers. They seriously suppress our ability to feel pain. So, to balance, or offset, this, our brain *increases* our ability to feel pain. Drastically.

/22

That's why, if you suddenly deprive a long term heroin addict of heroin, you don't leave them with a normal brain. You leave them with a brain which has A HUGELY AMPLIFIED ABILITY TO FEEL PAIN. The heroin normally cancels this out. But the heroin's gone now.

/23

You often hear long-term addicts saying "I don't take [drug] to feel pleasure, I take it to feel normal". This is why. It's how tolerance happens; our brains rapidly change to compensate for the presence of a drug, an externally-administered substance.

/24

It also means why 'going cold turkey' can be so painful, even fatal, for heroin/opioid addicts. Without the drug, their default state is one where pretty much anything can cause them extreme pain. And that's not a healthy existence.

/25

It's more insidious than even that, though. Evidence suggests long-term drug use can alter the relationship between the reward pathway and the complex, decision-making parts of our higher brains. It means it literally alters our thinking.

/26

A real problem with addiction is that those experiencing it often aren't aware of it, or are at least unwilling to admit it. Possibly because the drug (if it's that) has altered the pathways concerning thinking and reward, making us increasingly prioritise the latter

/27

In a sense, it's like an addicted brain recognises that it needs the drug to function, and adapts in ways that help to ensure it keeps coming. These can include changes to our very thinking, our insight. Hence addicted behaviour often seems illogical from the outside

/28

So, that's why breaking and addiction is not 'just a matter of willpower' or a lack of fortitude/self-discipline in the afflicted individual. It's hard to do something, even if it's beneficial, when your own brain is insisting you don't, and will hurt you if you do

/29

I go into this in even more detail in my latest book, Psycho-Logical

amazon.co.uk/Psycho-Logical…

hive.co.uk/Product/Dean-B…

I know you don't give people gifts for #WorldMentalHealthDay, but if you did, this would be a good one.

#Brains #MentalHealth #Drugs #SciComm

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