7
Many substances and behaviors have varying levels
of potential abuse. Alcohol is one example. Alcohol can
be used, misused, and abused, but not everyone who
drinks it is an alcoholic. Some drugs have the poten-
tial to be used, misused and abused, but others can
develop into addictions because they exploit the brain
systems underlying pleasure and pleasure regulation.
Drugs of abuse have their abuse and addictive
potential based on their ability to activate the brain’s
circuitry and neurochemistry that underlie the natural
reward mechanisms. These rewards are the natural,
pleasurable outcome when a drive is satisfied… or
appears to be satisfied. The level to which drugs can
activate these systems is what determines their abuse
and addictive potential.
Addiction
looks an awful lot
like abuse, but it often has the added elements of crav-
ing, increasing patterns
of intake, and an inability
to stop. It is this inability
to stop, or dysregulation,
that is often referred to
when absolving some-
one from responsibility
(moral and/or legal) in
many circles. The addic-
tion is appealed to as the
source of the problems
in the person’s life. The
person is no longer in
control, but instead is
controlled by the addic-
tion. Often this starts off
as abuse, but escalates
into addiction. The body
begins to rely on the
drug to function properly
and then dependence develops.
For addicts, the inability to control themselves is
where psychologists realize the brain has been hijacked
and their level of support is markedly reduced. It is here
that the language of addiction can be seductive for so
many. The label “addict” could be adopted in order
to reduce a person’s accountability. While warranted in
many cases, we have to be careful that it is not misused
or abused. The term “addiction” has typically been re-
served for maladaptive behavioral patterns surrounding
drug use and abuse, but what makes drugs of abuse
and addiction problematic is they act on regions and
circuits in the brain that underlie pleasure, reinforce-
ment and our ability to discern what external cues are
important for our well-being.
So is there such a thing as a behavioral addiction?
If the natural pleasure system is hijacked, could some
behaviors become addictions? Sex is part of the brain’s
natural reward system. It is not uncommon for many
users of drugs to describe the high they get as sexual
in nature. Can other behaviors beyond sex be used,
misused or abused, especially given the number of psy-
chological needs that can be met through these self-
medicating options? The rewarding/soothing payoff the
behavior provides suggests that the same circuits could
be involved in the development of behavioral addic-
tions.
When someone takes an addictive drug, the drug
is absorbed and then travels through the blood stream
to the brain. In one brain region located deep in the
brainstem known as the Ventral Tegmental Area (VTA),
many addictive drugs trigger VTA release of the neu-
rotransmitter dopamine. Other drugs directly activate
dopamine receptors in higher brain regions, which are
target sites of the VTA. These target sites are involved
in pleasure and reward, which are often associated with
satisfying natural drives (i.e., eating, drinking, and sex)
so they can be remembered for later when the drive
state is high. The brain adjusts to the addictive drug’s
effects by decreasing the number of dopamine recep-
tors and levels naturally available. Users then need to
consume more of the drug to get their “high.” How-
ever, given that this system is responsible for more than
pleasure—these receptors are also involved in learning
and memory—the drive satisfaction process causes the
formation of strong associations between the drug’s
pleasurable sensation and the circumstances under
which it was taken. Part of these higher order systems
is the prefrontal cortex (PFC), which is involved in
regulating the pursuit of pleasure (or else we would be
eating and having sex all of the time) and doesn’t fully
develop in most people until they are in their mid-20s.
Many addictive drugs influence these PFC systems and
disrupt impulse control and pleasure seeking, making
it difficult for addicts to self-regulate their intake of the
drug. This VTA-PFC system is complex, plastic, and able
to respond to the changes in the environment. Recent
imaging research reveals that dopamine levels and
brain activity can eventually return to near normal after
prolonged periods of abstinence. As brain research-
ers develop a better understanding of how addiction
disrupts these brain circuits and the impact of environ-
mental and genetic factors influencing both the disrup-
tion and recovery processes, practitioners will be given
valuable, preventative, therapeutic insights and tools to
help their clients.
William M. Struthers., Ph.D.,
is a Profes-
sor of Psychology at Wheaton College
(IL), where he teaches undergraduate and
doctoral courses in neuroscience, phar-
macology, and addictions. He conducts
animal research on the neural mechanisms
that underlie behavioral arousal and the processing of
novel environments and gene expression in the cingu-
late cortex and basal ganglia. His clinical research with
humans is on sexual brokenness and pornography use.
In addition to his empirical work, Dr. Struthers’ theoreti-
cal research interests are in the areas of neuroethics,
the biological bases of spirituality and personhood, and
science/faith dialogue issues. Also, he speaks interna-
tionally as an advocate against various forms of sexual
exploitation (i.e., pornography, prostitution, trafficking).
“Addiction looks
an awful lot
like abuse, but it
often has the
added elements
of craving,
increasing
patterns of
intake, and an
inability to stop.”
