The Addictoholic Deconstructed: An irreverently quick and dirty education by a doctor who says f*ck a lot

by Nicole Theresa Labor

Emotional healing is about telling stories. We do this so that we remind ourselves and others that there is a beginning, middle and end to a disease process, and this helps create hope, generate determination and empathy.

Early on in my work, several people asked what it would be like if there ever were a pill that could be taken to “cure” addiction, and I would reply that it would be a loss. I still see 12-step work, like the work that gets done in good psychotherapy, to be remarkable, transformative and probably the most important thing that people can do with their lives. Now, however, I am seeing a significant value to that pill.

Another reason I choose to talk about this is that I believe addicts need to understand what is going on within themselves. As much as we love to condemn an addict, no one, and I mean NO one is better at condemning them than they are. Addicts will beat themselves up, but then keep doing the same thing, and not know why.

Addiction is a conformational change in the brain that renders the individual unable to stop using substances without help. The symptoms of the disease range all the way from neurological underactivity to overt behaviors. The change does not occur in everyone that uses substances, but for those that do experience this biological rewiring, it can be devastating.

“I have multiple sclerosis” followed by a handful of people rolling their eyes, someone else walking out of the room, while another person announced, “My mom has cancer and she is a good person.

Additionally, every time a diabetic dies from a seizure, ketoacidosis, or kidney failure because of how they chose to eat, there is nobody talking about how their kids are better off without them.

My point is, as a society, even as treatment providers, we keep playing the whack-a-mole game. You know, that game where you bop one mole down and then another one pops up and you try to bop that one. What we really need to be focusing on his how do we unplug the machine? How do we stop the game altogether? Because the problem is addiction. The problem is not a specific drug. We focus on how to treat the disease, not the drug.

Then there is the educated group of pro disease believers who actually feel that there is a neurobiological component to this as well as a very strong genetic component that the person has very little, if any control over. However, in this particular camp of believers, most believe that an addict has some control of their behavior. I am a card carrying member.

On the other hand, I learned that if, when my mother asked how I was, I told her I was ‘fine,’ that she seemed relieved and could focus on other things. I didn’t want to worry her. Without realizing it, I was manipulating other people’s emotions in an effort to control the outcomes. No one told me that I didn’t have the right to deny people their own emotions.

We have no control over this part of our brain. We cannot fix it or change it or make demands of it.

Because in times of extreme duress, humans will often behave in ways that violate their own core value systems just to survive. In this desert scenario, after you drank the water and the midbrain is satiated (at least temporarily), the frontal cortex re-engages and you are flooded with guilt about giving up so many important things just for some water.

We don’t get addicted to specific drugs; we get addicted to higher than normal levels of dopamine.

We had a fever as a result of our body and brain adapting to a situation. This adaptation can be seen elsewhere in the biological system and is critical to understanding addiction.

When the reward center gets repeatedly exposed to these massive spikes of dopamine, it begins to adapt. The brain says, ”Hold on, there is so much dopamine being dumped in here, we don’t need to have all of these receptors for dopamine.” Because the brain is a very efficient system. It doesn’t want to expend a lot of energy maintaining receptors for dopamine.

We call this ‘hedonic dysregulation’ or ‘pleasure deafness’

There is a scenario where someone can use drugs for really long period of time and then just stop and never use again. That is not addiction.

There has to be a biological change in the brain for it to be true addiction.

For example, if we throw people in a jail cell and do nothing else, when they get out they certainly have increased activity in the cortex, but they have not spent any time actually strengthening the areas of the cortex that would be necessary to fight off the urge to use again, should something stressful show up.

looking at this dopamine receptor depletion of the midbrain, it starts to become more clear that it doesn’t really matter what the actual drug was. What matters is how the brain responds to it. That response is the disease.

And when a person is utilizing substances as their coping skill or pleasurable experience, they are not relearning or repaving those pathways behaviorally.

True craving is the psychological and physiological response created when the midbrain becomes active because it is feeling threatened. It is an overwhelming, obsessive need to feel different or to change the way that one is feeling in that moment.

Remember the midbrain does not plan ahead or weigh consequences.

While the argument could be made, that this is the moment when the addict has a choice, what the addict cannot choose is whether or not he is craving. He cannot choose to stop feeling that extreme discomfort because he does not even realize what the source of it is. True craving is equivalent to true suffering and nobody is choosing to suffer. Without adequate behavioral skills to combat that suffering, an addict will ultimately use.

Glutamate is the most abundant neurotransmitter in the brain, and it is responsible for laying down memories of positive experiences.

Let’s say that every time an addict was dishonest, they were able to get drugs (or money for drugs). Over time, dishonesty starts to be linked (Thanks, glutamate!) with the pleasure of using the substance. Soon, dishonesty itself allows a small amount of dopamine to be released.

1. Addicts have little to no patience for anything and become entitled and demanding 2. The constant use of instant reward as a coping mechanism causes the deterioration of the skill pathways for coping (remember the highway falling into disrepair).

But trust me on the sleep. In most cases, for my patients at least, it’s not the sleep that is the problem, it’s the need for instant gratification.

For evolutionary reasons far above my pay grade, when we have high levels of this CRF circulating in our brains, we respond by down regulating certain dopamine receptors. Did you get that? Our brains start taking away the dopamine receptors. So for those of you paying attention a few chapters back, this is the same thing that happens when people use drugs over and over.

When addressing trauma and addiction, however, the addiction is the more acute problem. That is, we have to address the addiction first. Why? Because addicts have no coping skills. So if we put them with even the most skilled trauma therapist, and they start digging through the quagmire of their past trauma, how the fuck are they supposed to handle that?

That I actually needed to fix it first. Without a properly working coping system, I would never be equipped to deal with what I found. She was right, of course.

However, due to all the fancy schmancy talk early about dopamine and the reward system, there is a very very high probability that marijuana, specifically the THC component, will both prevent the reward system from healing properly and prevent the cortex from developing other behavioral coping skills. If you need to smoke pot because it’s Tuesday and work was a little busy, then what will your brain need to deal with the stress of a house fire or loss of a loved one?