How Science Has Revolutionized the Understanding of Drug Addiction. For much of the .. These items and others are available to the public free of charge. An earlier version of this paper was published in Addiction Research in , Volume 8. The Macrocosm: Free Market Society, Dislocation, and Addiction. The Digest is available in two versions: a PDF Ebook, and a soft-back, HELP: Since the Ebook version may be downloaded for free, we encourage you to learn Naturally Caffeinated: Addicted to Entrepreneurship is a different kind of book.
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Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in the brain structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behavior. In this article we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. Introduction The view of addiction as a neurobiological disease characterized by compulsive and relapsing drug use has come under renewed attack by several philosophers and psychologists 1 — 7. According to the empirical criticism, the disease view is not supported by the empirical evidence appealed to by its proponents.
Recovery from addiction involves willpower, certainly, but it is not enough to "just say no" — as the s slogan suggested. Instead, people typically use multiple strategies — including psychotherapy, medication, and self-care — as they try to break the grip of an addiction. Another shift in thinking about addiction has occurred as well. For many years, experts believed that only alcohol and powerful drugs could cause addiction.
Neuroimaging technologies and more recent research, however, have shown that certain pleasurable activities, such as gambling, shopping, and sex, can also co-opt the brain. Although the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV describes multiple addictions, each tied to a specific substance or activity, consensus is emerging that these may represent multiple expressions of a common underlying brain process.
From liking to wanting Nobody starts out intending to develop an addiction, but many people get caught in its snare. According to the latest government statistics, nearly 23 million Americans — almost one in 10 — are addicted to alcohol or other drugs. More than two-thirds of people with addiction abuse alcohol. The top three drugs causing addiction are marijuana, opioid narcotic pain relievers, and cocaine. Genetic vulnerability contributes to the risk of developing an addiction.
But behavior plays a key role, especially when it comes to reinforcing a habit. Pleasure principle. The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal.
In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex see illustration. Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain's pleasure center.
The brain's reward center Addictive drugs provide a shortcut to the brain's reward system by flooding the nucleus accumbens with dopamine. The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli.
All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.
Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse. Learning process. Scientists once believed that the experience of pleasure alone was enough to prompt people to continue seeking an addictive substance or activity.
But more recent research suggests that the situation is more complicated. Dopamine not only contributes to the experience of pleasure, but also plays a role in learning and memory — two key elements in the transition from liking something to becoming addicted to it.
According to the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to take over the brain's system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival such as eating and sex with pleasure and reward. The reward circuit in the brain includes areas involved with motivation and memory as well as with pleasure.
Addictive substances and behaviors stimulate the same circuit — and then overload it. Repeated exposure to an addictive substance or behavior causes nerve cells in the nucleus accumbens and the prefrontal cortex the area of the brain involved in planning and executing tasks to communicate in a way that couples liking something with wanting it, in turn driving us to go after it.
Making healthier choices One way to stop gambling is to remove the elements necessary for gambling to occur in your life and replace them with healthier choices. The four elements needed for gambling to continue are: A decision: For gambling to happen, you need to make the decision to gamble.
If you have an urge: stop what you are doing and call someone, think about the consequences to your actions, tell yourself to stop thinking about gambling, and find something else to do immediately. Money: Gambling cannot occur without money. Get rid of your credit cards, let someone else be in charge of your money, have the bank make automatic payments for you, close online betting accounts, and keep only a limited amount of cash on you.
Schedule enjoyable recreational time for yourself that has nothing to do with gambling. A game: Without a game or activity to bet on there is no opportunity to gamble. Tell gambling establishments you frequent that you have a gambling problem and ask them to restrict you from entering. Remove gambling apps and block gambling sites on your smartphone and computer. Finding alternatives to gambling Maintaining recovery from gambling addiction depends a lot on finding alternative behaviors you can substitute for gambling.
When a gambling craving strikes: Avoid isolation. Call a trusted family member, meet a friend for coffee, or go to a Gamblers Anonymous meeting. Postpone gambling. As you wait, the urge to gamble may pass or become weak enough to resist. Visualize what will happen if you give in to the urge to gamble.
Distract yourself with another activity, such as going to the gym, watching a movie, or practicing a relaxation exercise for gambling cravings.
Overcoming a gambling addiction is a tough process. You may slip from time to time; the important thing is to learn from your mistakes and continue working towards recovery. Talk to your doctor or mental health professional about different treatment options, including: Inpatient or residential treatment and rehab programs.
These are aimed at those with severe gambling addiction who are unable to avoid gambling without round-the-clock support. Treatment for underlying conditions contributing to your compulsive gambling, including substance abuse or mental health problems such as depression, anxiety, OCD, or ADHD. This could include therapy, medication, and lifestyle changes. Problem gambling can sometimes be a symptom of bipolar disorder , so your doctor or therapist may need to rule this out before making a diagnosis.
Cognitive-behavioral therapy. CBT for gambling addiction focuses on changing unhealthy gambling behaviors and thoughts, such as rationalizations and false beliefs. It can also teach you how to fight gambling urges and solve financial, work, and relationship problems caused by problem gambling. Therapy can provide you with the tools for coping with your addiction that will last a lifetime. Family therapy and marriage, career, and credit counseling.
These can help you work through the specific issues that have been created by your problem gambling and lay the foundation for repairing your relationships and finances. How to help someone stop gambling If your loved one has a gambling problem, you likely have many conflicting emotions. You may have spent a lot of time and energy trying to keep your loved one from gambling or having to cover for them.
At the same time, you might be furious at your loved one for gambling again and tired of trying to keep up the charade.
Your loved one may have borrowed or even stolen money with no way to pay it back. They may have sold family possessions or run up huge debts on joint credit cards. While compulsive and problem gamblers need the support of their family and friends to help them in their struggle to stop gambling, the decision to quit has to be theirs. As much as you may want to, and as hard as it is seeing the effects, you cannot make someone stop gambling.
However, you can encourage them to seek help, support them in their efforts, protect yourself, and take any talk of suicide seriously.
Preventing suicide in problem gamblers When faced with the consequences of their actions, problem gamblers can suffer a crushing drop in self-esteem. This is one reason why there is a high rate of suicide among compulsive gamblers.
If you suspect your loved one is feeling suicidal, call the National Suicide Prevention Lifeline in the U. Four tips for family members: Start by helping yourself. You have a right to protect yourself emotionally and financially. Ignoring your own needs can be a recipe for burnout. Reaching out for support will make you realize that many families have struggled with this problem.
Set boundaries in managing money. To ensure the gambler stays accountable and to prevent relapse, consider taking over the family finances.
Your first responsibilities are to ensure that your own finances and credit are not at risk.
Consider how you will handle requests for money. Problem gamblers often become very good at asking for money, either directly or indirectly. They may use pleading, manipulation, or even threats to get it. Canada: Centre for Addiction and Mental Health offers resources and a helpline at