Addiction is not a faraway problem affecting an unfortunate few. It is a behavioral pattern that is woven into the very fabric of our modern-day existence. When we think of an addict, we may imagine a homeless man, lying in an alley, strung out on heroin, or the word may elicit memories of a loved one who drinks way too much at family gatherings. Yet, if we look closer we may find that there is an addict who lives in us, carefully masquerading our addictive behavior as a form of “innocent” activity.
What is Addiction?
Addiction is any repeated behavior that a person can’t refrain from despite the negative consequences it has on their life. It is categorized by compulsion, lack of control, relapse, and a feeling of irritability or dissatisfaction when the object of the addiction – whether drug or activity – is not immediately available. Addiction can also be understood as an unhealthy dependency.
While the more often we do something the more likely it is to become a habitual pattern, the issue of addiction is less about frequency and more about the negative impact that the behavior has. Think of the potential consequences of drinking a glass of wine with dinner every night versus slamming a whole bottle of vodka on the weekend.
We most readily associate addiction with drug use but it can also arise from various activities even those which we consider positive. For example, resistance training can contribute to health but in bodybuilding, it can be taken to extremes where both health and relationships are hurt in the pursuit of an ideal physique.
Some of the most prevalent addictions in the modern-day world include:
- Drug Addiction
- Gambling
- Sex Addiction
- Social media and internet addiction
- Video game addiction
- Food Addiction
- Shopping addiction
- Work addiction
What Causes Addiction?
Addiction is a complex issue stemming from biological, psychological, social, and cultural causes. The biggest misconception our society has about addiction is that a drug alone will cause it. Extensive evidence shows that most people will not get hooked on drugs even after using them many times. In his seminal book “In the Realm of Hungry Ghosts” trauma and addiction expert Gabor Mate writes “4.6 percent of Canadians have tried crystal meth, but only 0.5 percent had used it in the past year. If the drugs by itself induced addiction, the two figures would have been nearly identical.”
Addiction is a problem that lives in humans, not in drugs. Only a small percentage of people become addicted when exposed to certain substances. A person’s susceptibility to addiction is most strongly influenced by their development within a certain context and is continuously maintained through environmental factors.
Even those who aren’t particularly susceptible to addiction can become addicted under stressful conditions. Yet as the circumstances subside, so does the addictive drive. For example, a study conducted on a sample of 470 veterans who used heroin during the Vietnam war found that only 5% of them continued to use it after returning home. Simply taking the soldiers out of a stressful environment was enough to get most of them to kick the habit.
Early childhood trauma’s impact on brain development and addiction
Often overlooked in the medical field, brain development both in utero and childhood plays a critical role in determining a person’s susceptibility towards addiction. Optimal brain development depends on adequate nutrition, physical security, and emotional nurturing. In the developed world most parents can meet the first two but many struggle with the last. Emotional nurturing or attunement requires us to be receptive to our child’s emotional state. This is critical because a child’s ability to handle both psychological and physiological stress is dependent on their relationship with their parent(s).
Positively attuned interactions provide an infant’s brain with a natural release of opioids. This surge of endorphins promotes the attachment relationship and helps the child further develop their opioid and dopamine circuitry. Inadequate attunement hurts this development process and inhibits the brain from producing these feel good chemicals.
Emotional attunement is not a matter of love or being physically present. We can love our children unconditionally, be with them physically, and yet fail to provide the proper mirroring. Parents that are emotionally distracted and chronically stressed find it hard to supply adequate attunement. Inevitably, they create the same physiology in their children.
Several studies have shown that children of clinically depressed mothers will exhibit chronically elevated stress hormone levels especially if their mother was depressed during their first year of life. A parent who lacked attuned caring as a child will find it hard to attune to their own infants. Such patterns form vicious cycles that are passed down generations until an extraordinary effort is made to work through them.
There is a direct correlation between trauma and addiction. The more adverse experiences a child has the more likely they will become chronic substance-dependent adults. As Gabor Mate says “not all traumatized people become addicted, but all addicted people were traumatized in some way.”It is important to remember that trauma doesn’t require physical abuse; it can result from neglect.
The lack of emotional attunement is already a form of neglect that leaves traumatic imprints on a child. While few – if any- of us got perfect attunement as children, many hardcore drug addicts experienced physical, emotional, and sexual abuse at unimaginable levels. The worst effects of trauma are not the immediate pain but the long-term distortions they impose on a person’s view of the world.
Addiction and connection
Human connection plays a pivotal role in self-regulation and stress management, two factors that are necessary for mitigating addiction. In moments of physical touch, our bodies release Oxytocin, a hormone that helps keep our brain’s opioid system receptive to its natural pain killers. Humans that are incapable of creating intimate connections with others exhibit low levels of oxytocin which makes it harder to deal with pain. For opiate addicts, the drug brings them the same relief that most people get from relationships. In most cases of obesity, a person eats compulsively to try to fill the void of being emotionally starved as a child.
For children, a deep emotional connection with a parental figure is the strongest safeguard against addiction. Teens who rely mostly on peers for emotional support are more likely to get hurt, and subsequently more prone to addiction. In the western world, many parents work long hours to provide their children with “the good life”. Inevitably, they sacrifice quality bonding time and increase their child’s susceptibility to addiction. We’re often surprised when children from affluent homes who were given “everything” struggle with addiction as adults. Unfortunately, no amount of gifts or after-school programs can replace a strong connection with a parental figure.
How Addiction Works and Affects the Brain
All addictions work through 3 brain systems:
- The opioid attachment system – which helps us manage pain and social bonding
- The dopamine network – which is responsible for motivation and drive
- The Self-regulation areas of the prefrontal cortex – which help us manage thoughts, emotions, and behavior
When our brain’s opioid attachment system isn’t working properly, we become less sensitive to endorphins and perceive pain to be worse than it is. Diminished levels of dopamine drain our motivation and drive. An under-developed self-regulation system makes it hard to manage oneself. In people struggling with addiction, all of these systems are out of balance and for many, this is because their brains never properly developed as children.
Nicknamed “the molecule of more,” dopamine is a neurotransmitter that is largely responsible for actuating addiction. All addictions temporarily upregulate the brain’s dopamine levels, increasing a person’s motivation, drive, and pleasure. Food seeking can increase dopamine levels by 50% while sexual arousal, nicotine, and alcohol increase them by 100%. Cocaine is even more powerful with the ability to triple dopamine levels. Yet this is nothing compared to crystal meth which catapults dopamine levels to a staggering 1,200%.
An excessive flood of dopamine sends a signal to the brain to prune dopamine receptors. Chronic users have diminished levels of dopamine which leads to a lack of motivation, low energy, and withdrawal. Increased tolerance reduces the pleasurable feelings of the high while the destruction of dopamine receptors continues to magnify the lows. Seeking to escape pain, the addict slides down the slippery slope of addiction.
Once in the grips of addiction, there is a fundamental distortion in a person’s salience attribution process. This means their brain begins to assign a higher value to false needs while depreciating true ones. Negative consequences become less apparent as the drive for immediate pleasure overpowers the need for long-term health and well-being. Environmental cues such as paraphernalia, people, places, and situations play a powerful role in triggering use and relapse. Repeated use of certain drugs and behaviors results in the deterioration of parts of the brain that are responsible for learning, making choices, and adapting to new situations.
Is Addiction a Choice?
There is an ongoing debate over the role of choice in the addict’s behavior. Is the addict continuously choosing to use the drug? Or is addiction a disease that the addict is a victim of? While it is easiest to collapse into black or white thinking, the question of free will both in addiction and in life may best be answered in a shade of gray.
Most of us agree that choice must be driven by conscious intent, yet many of our behavioral patterns are driven by unconscious mechanisms in the brain. This automatic functioning can bypass conscious awareness and even override our intentions. Both the reptilian (instinctual) and mammalian (emotional) parts of the brain are highly reactive. The natural response of someone who touches a hot stove is to pull their hand away. This is not something that has to be thought about; it happens automatically. Similarly, in highly charged emotional situations, most of us can’t help but react. If we only possessed the instinctual and mammalian parts of the brain, we would be predetermined animals. Yet every human has a prefrontal cortex – the thinking part of the brain – which grants us the ability to choose.
Even in a well-developed prefrontal cortex, the gap between the awareness of an impulse is only one-tenth to one-fifth of a second. This means we only have a brief moment to interrupt a behavior, and this requires mindfulness. Free choice doesn’t come from our instincts or our emotions but only from our ability to think. The way we learn to override emotional reactions is by reflecting on them. Only by thinking about our emotions and our behavior can we train ourselves to act differently in the future. Yet, all prefrontal cortexes are not equal. As mentioned earlier, children who lack attunement or experience adverse experiences early in life often fail to fully develop this part of the brain. In these people, the automatic unconscious mechanisms of the brain have a much stronger control.
Based on some of this exploration, it seems that we both have free will and we don’t. Our prefrontal cortex grants us choice but within limitations. The unconscious parts of the brain in many instances are more powerful and overriding them takes significant effort and mindfulness. The amount of control we have depends on how developed our prefrontal cortex is. Those who lack development in this part of the brain are more likely to become addicted. As the addictive behavior is repeated, there is a further weakening of the conscious parts of the brain. So even if we have some choice when we first use a drug, this level of choice is gradually diminished with continued use.
Is Addiction Genetic?
Continuous controversy exists over the role that genetics play in addiction. While many sources maintain that addiction has a large genetic component, the emerging study of epigenetics shows that many diseases and conditions require a combination of genes to be expressed simultaneously. These genes can only be activated through behavioral and environmental factors. No single gene can determine a simple behavior, much less a complex one like addiction. Still, genetic explanations remain popular partly because they absolve us of responsibility. If addiction is mostly hereditary then the addict is a victim and society doesn’t have to acknowledge its role in contributing to addiction.
Culture’s Effect on Addiction
Fueled by the advertising industry, modern-day culture perpetuates our addictions to work, money, power, status, gambling, consumerism, social media, tobacco, alcohol, sex, physical image, and junk food. While addiction to illegal drugs is typically frowned upon, entire industries and professions have been built around these socially acceptable addictions. In many entrepreneurial and corporate circles, workaholism is worn like a badge of honor. Over 20 million people admit that their gambling habit has adverse effects on their work and social life. Over 5% of men and women are addicted to shopping. We don’t need to look up social media addiction stats because we all know someone who can’t put down their phone. Tobacco and alcohol addiction is widespread, taking more lives annually than the rest of all illegal drugs combined. While it’s hard to measure sex addiction, estimates suggest that about 3-5% of the adult population is addicted to some form of sexual behavior. Addiction to steroids, Botox, and plastic surgery fuel the endless pursuit of an ideal physical image. Obesity is found at an alarming rate of 40% nationwide and in most cases, is sustained by an addiction to junk food.
All of these socially acceptable addictions work just like hard drugs. They provide us a short-term escape from mental states we rather not inhabit. One of the most intolerable of such states is boredom, a state rooted in the inability to be with ourselves. As the French philosopher, Blaise Pascal so accurately noted “All of humanity’s problems stem from man’s inability to sit quietly in a room alone”. Interestingly enough, the concept of boredom didn’t exist until the late 1700’s. Boredom is largely a modern-day phenomenon, perpetuated by our fast-paced life and hyper-stimulating technologies, which ramp up our anxiety and make it difficult to inhabit simple states of being. The lack of any addictive behavior in the natural world makes it clear that addiction is a human problem greatly magnified by our ways of living.
The Truth About the War on Drugs
The war on drugs has been one of the most fruitless and disastrous campaigns that America has ever embarked on. Built on the erroneous belief that drugs cause addiction; it was destined for failure from the start. Putting our efforts and resources towards policing, prosecuting, and punishing drug users has not led to a decrease in drug use. Instead, it has contributed to mass incarceration, violent crime, and increased deaths from overdose.
Since President Nixon waged the drug war in 1971, it has cost our nation over a trillion dollars, most of which is used to jail minorities for non-violent drug offenses. The illegality of drugs creates a black market and a violent war between cartels to control drug production and distribution. The artificially inflated prices drive addicts to commit petty theft to maintain their drug habits. The worst part about the drug war is that it does nothing to help heal highly traumatized people.
While the drug war remains active in many parts of the world, countries like Switzerland, Holland, and Portugal have taken a radically different path by decriminalizing drugs. Instead of spending their national budgets on punishing and policing users, they are investing funds towards harm reduction programs. The harm reduction approach seeks to make the lives of addicts more bearable and worth living. This includes providing clean needles, prescription heroin or methadone, and easier access to social work services.
Countries employing such policies are already seeing a substantial decline in drug overdoses and crime. Besides reducing harm, drug decriminalization helps transform our perception of the addict from a criminal into a human being. It is only in seeing another’s humanity that we may find the compassion that can help them heal and recover.
Healing & Overcoming Addiction
The journey of healing and recovering from addiction is not a simple, smooth, or easy path. No one treatment plan works for everyone, thus an individualized approach is required. Detox and 12 step programs are some of the most popular and widely used methods for overcoming addiction and while successful initially, they often fail long-term. Within a contained sober living situation, sobriety is the only option. However, when an addict returns to their regular environment they are easily pulled right back into addictive patterns. For many, recovery will entail staying clear of people, places, and situations that were intertwined with their addiction. While avoiding provocative environments is a necessary first step, permanently resolving addiction requires pulling out the root from which it grows.
Trauma and addiction recovery
Nearly all addictions stem from unresolved trauma. Processing and healing this trauma plays a vital role in one’s recovery from addiction. Such healing is never done in isolation but within the context of a relationship. Whether it’s with family, friends, therapists, or a spiritual community, finding an environment that provides emotional and physical safety is a prerequisite to healing trauma. Some therapeutic modalities that can heal trauma include Eye movement desensitization reprocessing (EDMR), Internal Family Systems (IFS) Somatic experiencing, and Psychomotor therapy.
Mindfulness in addiction recovery
Mindfulness is a powerful practice for disrupting the automatic brain patterns that drive addiction. Through this practice we learn to non-judgmentally watch our experience without clinging to it or pushing it away. Our ability to be mindfully aware is fueled by what the psychiatrist Daniel Siegal calls COAL (curiosity, openness, acceptance, and love). When mindfully aware, we can explore the thoughts, emotions, and automaticity driving our addictive behaviors. Most addictions decrease self awareness and numb us to some part of experience. Mindfulness does the opposite.
Psychedelics for addiction treatment
Psychedelics are proving to be a formidable ally in the battle against addiction. One study has found that combining psilocybin (the psychoactive active ingredient in psychedelic mushrooms) with CBT therapy resulted in substantially higher smoking abstinence than using other medications or CBT alone. Another example is a meta-analysis of randomized controlled studies done by Krebs & Johansen which showed that LSD could improve alcohol abstinence for at least 12 months.
As of late, clinics are popping up in different countries where psychedelics such as psilocybin, ayahuasca, 5-Me0-Dmt, and Iboga are being used to treat addiction. Iboga (an African psychedelic root bark) seems to be particularly effective in helping people deal with heavy conditions such as opioid addiction by eliminating withdrawal symptoms after one session.
Neuroplasticity and Addiction recovery
While the lack of proper brain development in utero and childhood is a major factor in determining one’s susceptibility to addiction, it is not the final verdict. Neuroplasticity is the brain’s ability to modify, adapt and reorganize its structure over time. Not all developmental deficits can be overcome but many can be significantly improved on. By removing chronic stressors and toxins our brains have the space to change and recover. Engaging in therapy, mindfulness, and/or psychedelics in the context of a safe and supportive environment further contributes to this rewiring.
The unhealthy self & the spiritual root of addiction
No case of addiction can be overcome without addressing it at its deepest spiritual root. Wherever there is addiction there is an unhealthy identification or entanglement with the egoic self. As Gabor Mate writes “Addiction is primarily about the self, about the unconscious, insecure self that at every moment considers only its own immediate desires. In all cases the process arises from the unmet needs of the helpless young child for whom this constant self-obsession appears, to begin with, as a matter of survival.”
Those that are traumatized as children often fail to develop a healthy sense of self. This can manifest in a lack of self-esteem but also in excess such as in cases of NPD (narcissistic personality disorder). Those with low self-esteem fail to develop sovereignty and become overly dependent on others. While those with excessive levels of self-esteem become ego-maniacs and invariably push others away. Both excessive dependence and complete independence are extremes that diverge from the middle way of the healthy interdependent self.
A person who more frequently functions from interdependency will find that negative patterns and addictive behaviors begin to dissipate. The self becomes more transparent and less reactive. There is an ease of being and an ability to more gracefully ride the waves of yin and yang. It is from this place of equanimity that we become more receptive to insights that eventually lead to self-transcendence and a remembering of who we really are.
Conclusion: The Truth About Addiction and Recovery
Addiction is any repeated behavior that a person can’t refrain from despite the negative consequences it has on their life. The causes of addiction are complex, including biological, psychological, social, and cultural factors. The biggest misconception about addiction is that a drug alone will cause it. The most overlooked yet strongest contributing factor is the lack of proper brain development in utero and childhood.
Both developmental deficits and addiction are directly correlated with trauma. The more adverse experiences a child has, the more likely they are to become addicted. Human connection plays a vital role in mitigating one’s drive towards addiction. Those who fail to create strong social bonds forego their pain-relieving effects and are more likely to seek relief from a substance.
All addictions work through 3 brain systems: the opioid attachment system, the dopamine network, and the self-regulation areas of the prefrontal cortex. In people struggling with addiction, all of these systems are out of balance and for many, this is the case because their brains never properly developed as children.
The prolonged use of certain drugs further contributes to the degradation of brain circuitry. If our ability to choose exists, it is gradually diminished as the strength of addiction grows. There is ongoing controversy over whether addiction is genetic. Even if there is a genetic component to addiction, such explanations are problematic because they absolve us of any personal responsibility.
Fueled by the advertising industry modern-day culture perpetuates our addictions to money, power, status, gambling, consumerism, social media, tobacco, alcohol, sex, physical image, and junk food. While addiction to illegal drugs is typically frowned upon, entire industries and professions have been built around these socially acceptable addictions.
Ignorant to the true causes of addiction, America’s war on drugs has proven to be an ineffective and disastrous campaign. Luckily, countries like Switzerland, Holland, and Portugal have taken a radically different approach for dealing with addiction by decriminalizing drugs. Instead of spending their national budgets on punishing and policing users, they are investing funds towards harm reduction.
Healing and recovering from addiction doesn’t come easy. Most detox and 12 step programs fail because they don’t address the issue of long-term environment. Removing environmental cues that trigger addictive behavior is vital, but permanent change requires healing the trauma from which the addiction emerges. Such healing can be found in therapeutic modalities such as Eye movement desensitization reprocessing (EDMR), Internal Family Systems (IFS) Somatic experiencing, and Psychomotor therapy. Additional tools proven to be effective for working with addiction include mindfulness and psychedelic-assisted therapy. At its deepest root, addiction grows from the void of forgetting who we are. True recovery requires remembering.