On Addiction

Disease model and neuroscience behind it

In regards to addiction and the disease model, science can actually back this claim through understanding the insular cortex and anterior cingulate cortex in regards to decision making with substances, and the neurotransmitter frequency alteration after the substance is ingested. The disease model of addiction was first used by AA founder Dr. Robert Holbrook Smith one of the founders of Alcoholics Anonymous and later was backed by Dr. Carl Jung. It states that in the addict there is a mental obsession to use the drug that when acted on creates a phenomenon of craving for more of the substance and unless an entire psychic change (a more developed superego) happens, the addict will continue to use. After reading “Behave” by Dr. Robert Sapolsky (a neuroscientist at Stanford), the idea behind Dr. Bob’s disease model can be understood at a neurological level. Due to elevated cortisol in the system, the insular cortex which appears as horns protruding from the brain stem through the amygdala, activates and bypasses the prefrontal cortex and dopaminergic limbic system and makes decisions through the anterior cingulate cortex. This is the same area responsible for decision making in lying, and deceit and actually is bigger than the prefrontal cortex (utilizes more energy). The insular cortex is responsible for feelings of disgust, resentment (to self and others), and aggression. The mental obsession is due to this part of the region being activated which happens due to elevated cortisol levels in the body. In order for it to be activated the amygdala gives a fear signal and when confirmed activates the insular cortex. Since the obsession is basically a resentment of reality (whether self, others, ecology) the insular cortex can be thought of as being active. Once the anterior cingulate cortex makes a decision with this region and chooses to use drugs after bypassing the prefrontal cortex, the craving occurs due to the substances alteration of amount of neurotransmitters and the frequency of the transmitters as well; the receptors being flooded with the neurotransmitters at new frequencies or frequencies of high intensity, starts to reject the neurotransmitters by closing or literally melting away at the high intensity of the signal. The person consuming the substance, having some of the receptors reject the signal, craves more of the drug. The only thing that bypasses this altogether is not making the decision with an active insular cortex (sitting with the stress and discomfort) or rerouting to the prefrontal cortex and dopaminergic limbic system through a variety of practices centered in bypassing the fear confirmation of the amygdala and sitting with the stress until it passes. Prayer (faith), meditation, gratitude, or seeing the bigger picture diverts from the self centered aspect of the insular cortex designed for fight or flight response. Maybe highs aren’t as harmful as people say, but making the decision with an active insular cortex to the anterior cingulate cortex seeking escape and disgust with reality will only result in conditioning the brain to use this region as well as create decision making that is overly complicated like a person in a web of lies. People think the brains as growing in the final part of development but as Sapolsky points out, it actually loses mass from the age of ~15-25 becoming more efficient and developing the prefrontal cortex and developing the superego by the feeling of belonging to something bigger than yourself. Your brain might actually be bigger if you used substances at this time because it complicated things and became self absorbed and has a less efficient wiring. Hope still exists, if you are like me and used during this time of your life, remember to keep things simple, don’t act on pain and suffering and examine the experiences that shaped it and acknowledge it rather than act on it. Remember that you aren’t the center of the universe and pray and meditate if it helps you. Faith can also be in leaders or laws, so recognize everyone’s experience is different and know that having faith in a narcissistic leader gives you power over others but there are better ways to develop your superego than this as well. If all you seek is power, then you are still self centered in your thinking and will ultimately result in the same phenomenon as addiction where instead of substances you are seeking power. It’s okay to sit with nothing and practice gratitude and not acting on fear.