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"I learned that my addiction is really a disease, a chronic medical condition that will require treatment for the rest of my life," says Rob Ford, the freshly rehabilitated mayor of Toronto, at a recent press conference.
Ford is right. Among the many steps he must take, he literally has to reboot his brain circuits.
Abusing substances may start off as a habit, either as a lifestyle choice or a way to drown out the blues. But when you cross the line of addiction, brain chemistry takes over.
The high, buzz or euphoria that substance abusers experience reinforces the brain's pleasure circuits, making it crave more and more. According to the U.S. National Institute on Drug Abuse, these are the very same brain pathways that prompt us to seek the basics like food, water and sex.
What do people experience when they do drugs? It varies with the drug and with the user, but patients say you "feel like you can fly," "you're all-powerful," "you're the centre of the universe," "you the man," and "you're god."
Society sanctions the use of many pleasurable, potentially addictive substances – like caffeine, nicotine, alcohol. (Some would add sugar, salt and fat to this list.) But start mixing in harder drugs like crack cocaine, heroin or crystal meth, and it's harder for the brain to forgive and forget. From the brain's viewpoint, it's the difference between listening to music with a single earbud versus being in the front row at a rock concert.
A brain on hard drugs is flooded with a cocktail of chemicals – dopamine, serotonin, endorphins, glutamate and adrenaline. With a single drug hit, you can feel like you bought a Ferrari, won an election, made love to your sweetheart and won a gold medal – all in the last hour.
Real life, of course, is much tamer. It's hard to reproduce that kind of overflowing chemical excitement in our day-to-day, working world. So addicts and their brains substitute chemical life for real life. And the more you light up the reward pathways, the more your brain demands that you do little else. You are no longer in the driver's seat. The brain's pleasure centres do the talking and give the orders.
As Freud said, "Anatomy is destiny." These pleasure centres have unfamiliar names – the ventral tegmental area, nucleus accumbens, amygdala and the prefrontal cortex. You may have never heard of these, but in a real sense they are you, especially when you're seeking pleasure, rewards or satisfaction.
These brain regions talk to each other, reinforce each other and demand that you not forget them. It seems they become self-aware and take over.
Fortunately, the brain also has a built-in override system, the frontal cortex. This is the part of the brain that makes a person moral, humane, social and altruistic – in a word, civilized. But the frontal cortex needs regular nurturing. If it's long-silenced because of abused circuitry, if a person becomes a devotee of the pleasure-pathway, then the civilizing circuits decay.
Use it or lose it, in other words.
Combatting addiction requires multiple approaches, none of them cures in themselves. Building self-awareness, removing trigger environments and trigger friends, finding other healthy outlets and having a mentor or support group – all of these strategies are used to help addicts, with varying degrees of success.
But even with all these therapies, an addict can fall back into abusive patterns, often without even remembering why.
It's the brain calling from our depths, from the subterranean recesses of our mind. That's why addiction and substance abuse is not easy to deal with.
As Ford recognizes, "It's a long, long road to recovery."
Dr. Shafiq Qaadri, MPP, is a Toronto family physician, Continuing Medical Education (CME) lecturer and medical writer. His first novel, a medical thriller, is BioJihad & the Pleasure-5 Surgery.