Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

The relevant areas of the brain include the prefrontal cortex (PFC), which imagines possible futures and plans and makes decisions accordingly. Of particular importance within the PFC is the orbitofrontal cortex, which helps determine the relative emotional and psychological value of your options and, therefore, your level of motivation and your tendency to make particular choices. The PFC works in concert with the nucleus accumbens (NAC), the region famed as the brain’s “pleasure or reward” center. This area is involved in determining the desirability of particular options and how much you want to seek or avoid them. Another region related to reward and motivation, the ventral pallidum, is also part of this brain system, as is the habenula, which seems to be involved primarily in aversion and disliking. The insula, which processes emotions like lust and disgust and also monitors internal states like hunger and thirst, is another node in this circuitry. So is the anterior cingulate, which looks for conflicts and errors and changes emotion accordingly. The anterior cingulate seems to be especially important for obsessive behaviors, perhaps because it creates a sense that things are “not right” until they are perfect or complete. In OCD, it may wrongly detect errors, which could cause constant anxiety. Finally, the amygdala is also in the loop. While best known for its role in processing fear, the almond-shaped amygdala is also involved in a variety of other emotions, includ...