Addiction: disease or learning disorder?
Jul 16, 2021
When we talk about addictions, we are still somewhat weighed down by a moral vision, which points to the addicted person as being selfish, a liar and prone to committing crimes. We believe that, in a way, he has asked for it and does not deserve compassionate treatment.
Faced with this approach full of prejudices, addiction has been incorporated into the list of mental illnesses that must be treated in a sanitary setting. It is understood that the addict's brain has replaced its "natural" mechanisms with external substances or behaviors, which make it totally dependent. And we must "cure" it, so that the individual can reintegrate into society. This second option is much more in line with what we know about the addicted brain.
However, the transition between these two conceptions has not been completed, and in a certain way they intertwine at times, just as as in 12-step programs, those provided by religious communities or opportunistic herb gurus miraculous. More and more a different conception is gaining strength, in which the nature of the addiction is related to a learning disability
Generating dependency through learning
The consensus reached by the scientific community is that addiction is associated with learning systems distorted in which pleasure is overvalued, risk is undervalued and learning is failed after repeating mistakes. Addiction alters an unconscious brain to anticipate exaggerated levels of pleasure or pain reduction (when dependency is consolidated).
What we are learning about addiction has changed over time. How a person who uses drugs becomes addicted or becomes mentally ill is not clear.
In fact, a report by the United Nations Office for the Control of Drugs and Crime (UNODC), states that only 10% of users end up having problems with these substances. It is true that it seems somewhat intuitive, since if all the people who claim to consume alcohol and drugs, end up being addicts, the number of patients who go to treatment centers would multiply exponentially.
We are forgetting the entire learning process, which makes the individual progressively substitute his interests and affections for his addiction. On this path, fortunately, many people discover or learn many other experiences much more rewarding than substance use. Our interest, from psychology, focuses on those who, despite the fact that there are other rewards more attractive and despite the damage caused by their addiction, they persist in their behavior, reaching the dependence.
The neurobiology of addictions
We are talking about a disorder based on the functioning of the brain, which works abnormally in addicted people. But it is not an irreversible degenerative disease; at least, not most of the time. It is a learning problem that changes the way the brain works, altering its connections through new mechanisms of reward, motivation and punishment. Like other learning disorders, it is also influenced by genetics and environment throughout our evolutionary process.
As Maia Szalavitz collects, in her book Unbroken Brain, “Science has studied the connection between learning processes and addiction, managing to recognize which brain regions are related to addiction and in what way. These studies demonstrate how addiction alters the interaction between the mid-brain regions such as the ventral tegmentum and the nucleus accumbens, which are linked to motivation and pleasure, as well as parts of the prefrontal cortex, which help to make decisions and establish priorities ”.
One of the functions of these systems, called dopaminergic, is to influence the decisions we make, turning them into rewards, if necessary, increasing their perceived value, raising expectations about them The dopamineA chemical messenger of pleasure in our brain, it responds to primary rewards such as food, water, or sexual intercourse. But it also applies to secondary rewards like money. In the latter case, our expectations play an important role in our brain's response to stimuli. Addiction makes us learn that, if we continue, for example, gambling, the probability of winning increases. There is a random negative reinforcement where, despite almost never obtaining the anticipated reward, the behavior (gambling) is consolidated. Despite losing a lot of money.
The drug-altered brain
In non-addicted people, the dopamine signal is used to update the value assigned to different actions, leading to choice and learning. You learn when something unexpected happens. Nothing focuses us more than surprise. We learn by trial and error.
With addiction, this learning process is disrupted. The signals surrounding the addictive experience are overrated, causing the dopaminergic systems to assign an excessive value to the contexts that surround it. Dopamine continues to be released, through the artificial signal produced, for example, by the psychoactive substances.
This causes a disproportionate desire for the drug, a craving for consumption that goes far beyond the pleasure or pain relief it can actually produce. In summary, thanks to the distortion in the addiction assessment system, their dependence seems to increase desire without increasing the enjoyment of the addicted object.
As individuals and as a species, it is these brain systems that tell us what we care about and what not, being associated with food, reproduction and our survival. Addiction distorts these vital goals, replacing them with the object of it, drugs, gambling, sex, or even money. It is, in essence, self-destructive behavior. We could compare it to the engine of a car to which we are gradually degrading its fuel with, for example, water. The car will run with more and more difficulty, and no one will understand why we continue to put adulterated gasoline on it.
Understanding the context of addiction
If to an addicted brain, characterized by focusing on a simple source of satisfaction, we add social pressure to consume drugs, for example, or to use drugs. medications that help us regulate our emotions or our affective deficiencies, we will understand how, little by little, the person who suffers from an addiction is trapped in her. It is her life, in a way, her comfort zone. As terrible as it may seem from the outside.
To understand all kinds of self-destructive behaviorsWe need a broader conception than the simple idea that drugs are addictive. Addiction is a way of relating to the environment and those who inhabit it. It is a response to an experience that people get from an activity or an object. It absorbs them because it gives them a series of basic and necessary emotional rewards.even if it damages your life over time.
There are six criteria by which we can define an addiction.
1. It is powerful and absorbs our thoughts and feelings
2. Provides essential sensations and emotions (such as feeling good about yourself, or the absence of worry or pain)
3. Produce these feelings temporarily, while the experience lasts.
4. It degrades other commitments, implications or satisfactions
5. It is predictable and reliable
6. By getting less and less out of life without addiction, people are forced, in a way, to return to the addictive experience as their only form of satisfaction.
It is, as we can see, a full-blown learning process. Y understanding addiction from this perspective changes things a lot, in addition to significantly modifying the focus of health intervention.
Reversing the learning process
In no case are we considering that, for example, a drug addict cannot become a patient with a dual disorder. It happens, on some occasions. Let's say the brain has been so hacked that it is no longer possible to reinstall the original operating system. But until we get here, the drug addict, goes a long way where learning and consolidating new routes in his brain can be modified.
Therefore, although the jump from vice to disease represented an important advance in the approach to addictions, treating all people who use drugs or are addicted to certain behaviors such as patients, may be getting the effect contrary. To treat a learning disorder, such as a phobia, the active participation of the person is essential. It is also essential to know in detail how the disorder has occurred in order to deactivate it.
The same goes for the psychological treatment of addictive disorder. We have in front of a person who must gradually substitute a harmful behavior for another that is not. And for it it is imperative that you are involved in it from the beginning.
The classical health approach, by classifying all addicts as sick, does not need their collaboration, at least initially. In the case, for example, of drug addiction, the patient is asked not to fight, to let himself be done, to detoxify him.
Then we would move on to psychosocial rehabilitation which, until not long ago, was considered an accessory part of treatment. In a way, we are telling the brain of the drug addict that the solution continues to come from outside and that we are going to provide it with more psychotropic drugs. Fortunately, we have been evolving towards a treatment that addresses addiction as a learning disorder with biopsychosocial components that are at least as important.
Try to understand why a person continues to self-destruct even though it has been a long time since the pleasure it gave them his addiction disappears, it is much better explained as a neuroadaptative learning process, than based on the classic model of disease.
It is a parallel process of unlearning and relearning that requires the active participation of the person to ensure its success.. If not, in a way, we are reproducing what the addicted brain thinks: that there is a quick, external solution to her discomfort.
The implications of this new approach to treatment are profound. If addiction is like unrequited love, then companionship and changes in relational dynamics are a more effective approach than punishment. Treatments that emphasize the role of the addicted person in their recovery, such as cognitive therapy, with an important motivational component, or the most recent ones, based on Mindfulness, work much better than traditional rehab in which patients are told they have no control over their addiction.
In short, if we have known for a long time that only a few people who gamble, consume alcohol or drugs, become addicts, Isn't it time that we consider studying why this happens and that we move away from maximalist approaches? It is more important to know what protects these people to the point of turning them away from the easy solutions that addictions provide. This will help us design better prevention programs and help us understand where we should direct the treatment processes.