Fighting Addiction Needs More Than Willpower

Fighting Addiction Needs More Than Willpower

People who have a substance use disorder may go to extreme lengths to reach a high, often jeopardizing their own lives and the lives of those around them. Judging solely from these maladaptive behaviors, outsiders believe that exercising willpower is enough to rise above addiction. This belief implies that addiction is a choice; if you choose drugs over responsibilities like work and family, then it must be a reflection of your poor character. If it really were that easy to just say no to drugs, then hardly anyone would choose to become addicted since it wreaks so much havoc on one’s life. Though beginning the use of a drug may be a conscious decision, the decision to terminate use becomes more and more difficult to make because addictive substances rewire the brain. Those with substance use disorder experience impairments in brain functioning in areas that affect judgment, decision-making, memory, and self-control. These impairments may persist long after drug use is over, keeping the user in a vicious cycle of addiction.

When a drug is ingested, the user experiences a euphoric feeling which is caused by the release of a neurotransmitter called dopamine in the brain. Dopamine is also released by other pleasurable stimuli like food and sex. This chemical is essential in the activation of a mechanism in our brain called the reward system, which is made up of several neural pathways. Research suggests that this system helps us remember actions that bring us gratification so that we can repeat them. It is advantageous to human survival because it reinforces life-sustaining behaviors like eating and procreating.

While addictive substances also activate the reward system, the amount of dopamine that they produce is significantly higher than that of any naturally rewarding behavior. The brain recognizes this difference and begins to attribute more value to the intense feelings of pleasure that are produced by the drug. Say if you had a choice of whether to eat a cookie or a carrot, what would you go for? You may think, “Is there really a choice here? Obviously I’m going for the cookie.” That’s how the brain perceives drugs compared to other kinds of reward inducing stimuli. 

With continued drug use, receptors in the brain actually become less sensitive to the dopamine that is released from natural rewards. Someone with a substance use disorder can feel incredibly depressed and unmotivated while not under the influence because they no longer find natural rewards like work, school, and interpersonal relationships gratifying. This effect can be likened to the experience of someone who has depression caused by a chemical imbalance in the brain which leads them to lose interest in activities that they once enjoyed. In order to achieve even a baseline amount of pleasure in one’s day, one starts to depend on the drug. Over time, the body develops a tolerance for it, meaning that a higher dose is needed for the user to feel the effects, or the high, that they felt when they first started using the drug. Abruptly ending substance use often causes painful symptoms of withdrawal. The nature of the symptoms varies from drug to drug but may come in the form of intense muscle and bone pain, restlessness, insomnia, or cold flashes, to name a few.

It is especially hard to prevent relapse in substance use because the brain learns to associate environmental cues with the drug itself. Being in the setting where the drug was frequently used or around the group of people who engaged in substance use with you may trigger drug-seeking compulsions. These cues become emotionally salient to someone with a substance use disorder, triggering the urge to use the drug even when it isn’t around. 

When you have a substance use disorder, you are no longer just seeking the highs; You are avoiding the lows. Although drug users are aware of all the negative consequences of addiction, their body and mind become so dependent on a substance that they cannot operate without it. Because the withdrawal symptoms are so intense, choosing whether to quit is like trying to choose the lesser of two evils. Substance use disorder is a chronic medical condition just like diabetes and heart disease, so it’s time to start treating it like one if we want to help people overcome addiction. 



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