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Thoughts on Addiction

Luuk L. Westerhof, MSc



Introduction

There are prevailing theories on addiction as a generic, endogenous disease or individual moral failure. Yet, none of those theories “hold water.” Addiction of any kind cannot be fully understood unless it is placed within contexts such as trauma, environmental, parental attachment issues, and early childhood experiences. Addicts are part of our culture and society. Yet, they are often considered second-class citizens due to a lack of scientific knowledge on what addiction is—a misperception of how addiction evolves in the wake of a lack of a workable scientific definition. Therefore, we must grasp what addiction means and does not mean. How does the environment shape addiction? How does trauma in childhood influence addiction? The goal of this paper is to document that addiction is not an inherited sickness but is relational and socially contingent.    

 

Addiction

 Addiction has two distinct meanings. First, addiction is understood as a dysfunctional dependence on substances, gambling, sex, eating, or behavior. This view on addiction has existed for over a century and has not proven to be that fruitful. For centuries ago, though, addiction referred to an activity that one was passionate about or committed to and therefore gave time to. In the twentieth century, the pathological definition of addiction was introduced to the world. Addiction comes originally from the Latin addicere, “assign to.” Addicere traditionally means a habitual activity of interest, often with a positive purpose (Maté, 2008). The Romans had a more ominous definition, getting very close to our present-day definition: an addictus was a person who, having defaulted on a debt, was assigned to his creditor as a slave-hence, addiction was being enslaved to a habit (ibid).  


Secondly, addiction is defined by many experts as a “chronic, neurobiological disease … characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.” From this definition, addiction's key features are defined as the use of substances despite harmful consequences and relapse. The quantity or frequency of substance intake does not play an important role. The impact matters. People striving with addiction continue to use even when their body and environment demonstrate that their habit is doing them and the environment harm. Identification of addiction occurs when the individual displays a consistent pattern of preoccupation and compulsive use, often with periods of relapse (Mate, 2008).  


As mentioned earlier, the definitions may have some value and utility. Still, for a definition to be helpful, we must put it in a broader context to understand addiction more clearly. Addiction expresses itself in various ways and through an array of habits. Most addictions, e.g., alcohol, hard drugs, and benzodiazepines, are linked to medical and physiological risks. Too there are addictions, such as sex and eating disorders, that can prove destructive to social relationships, physical and psychological health, and well-being (Mate, 2008). With all these reflections and thoughts in mind, I consider Dr. Gabor Mate’s definition of addiction very useful:


“Addiction is any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.”   


Addiction is thus about preoccupation and compulsive thoughts. Temporary relief or elation from the substance or behavior. Impaired behavioral control. Persistence or relapse despite evidence of harm. Dissatisfaction or craving when the substance or object is out of reach.

Compulsion, short-term relief, impaired control, persistence, irritability, relapse, and craving are all hallmarks of addiction. It is worth noticing that not all harmful compulsions are addictions (Mate, 2008). In one of his lectures, Dr. Mate points out that an obsessive-compulsive, for example, also has impaired control and persists in ritualized and psychologically debilitating behavior such as repeated hand washing. The difference is that he has no craving for it, and unlike the addict, he gets no kick out of his compulsion.


Addiction may be viewed as an attempt to self-medicate, alleviate, evade, and escape from the intense psychological or physical distress induced by the enduring effects of trauma on the body. There are recurring underlying pulsating reasons why addiction becomes a perpetuation in a person's life, and compulsive use of any addictive substances is a person’s attempt to alleviate the intense pain trauma reminders bring with them. Addiction and compulsions are thus not about right or wrong but about a perpetuating attempt to gain some control over the overwhelming pain and fear trauma brings with it. How can a person striving with addiction or compulsion know that he has impaired control?


Compulsive addictive behavior is characterized by an inability to quit despite experiencing negative effects. The assumption that addicts have made peace with their fate is mistakenly wrong. The repetitiveness of addictive behavior suggests to others that the individual does not care and is not trying to improve. It may lead others to believe that if the person truly wanted to be drug-free, they would have quit a long time ago. If you ask any person striving with addiction if he has not promised himself to quit, the answer will be yes. Yet it is hard to keep promises in the constant presence of intense emotional or physical pain, peril, and utter despair. Relapse is not a sign of lacking the will to quit the addiction but a sign of the omnipresence of intense pain that needs remedy, even if it is just for a while. There are exceptions in that some people striving with addiction never recognize the harm their addictive behavior imposes on the environment and thus never have made any resolution to quit the addiction.


 Addiction persists as long as it fulfills a purpose for the person struggling with it. The question must, therefore, never be, what is wrong with addiction, but what is right with it? Where does the pain come from? What does addiction help the addict with? The great and world-renowned Norwegian writer Henrik Ibsen once said in his fabulous piece, “Villanden,” – “Never take a “life lie” from a human being.” I understand these words as every human, at times, needs something to believe in that can sustain him through life in a tolerable way, even if that “something” is not always generally accepted as morally correct.


All addictions share the same brain circuits and brain chemicals. Biomedically, the purpose of addiction is to create an altered physiological state in the nervous system (Mate, 2008). Daily excessive intake of, for example, alcohol or drugs achieves just that. This means that addiction is never solemnly psychological; in all addictions, there is a biological substrate. We must be aware not to relegate addiction to neurobiological and psychological phenomena. Understanding the underlying causes of addiction is complex and multifaceted and must be viewed within a comprehensive framework if we are to comprehend the individual struggling with addiction truly.


Dr. Mate’s definition of addiction is a salutogenic one, not making any reference to “disease.” Viewing addiction as a disease facilitates the idea of having acquired or inherited the addiction, relegating it to a medical issue. The application of a disease model is problematic since it does not consider context, psychological, and sociocultural premises. Therefore, promoting the disease model jeopardizes our ability to understand what addiction is about entirely. People have lived lives often filled with painful experiences that create lasting memories in their brains and bodies. These memories can lead to substance abuse as a way to temporarily numb emotional and physical pain.


Addiction is a complex phenomenon that requires a multilevel approach and exploration to understand the complex interaction between human beings and the environment. Addiction is not a phenomenon in itself but a complex, interactive activity between a person and his environment. Therefore, it must be viewed from different perspectives, such as biological, psychological, neurological, emotional, sociological, spiritual, and economic perspectives, to name a few. We must look at: “What are the patterns that connect?” (Bateson, 1972) and remain inquisitive so we can focus on what patterns emerge and connect (ibid).

 

The role of trauma in the development of addiction

Our society teaches us to believe that our experiences result from our free choices and have a straightforward cause-and-effect relationship. As a result, we often fail to examine the root causes of problems when they arise. When we encounter trauma, our bodies go into survival mode as a way to protect us. Substance abuse is a way of coping and surviving the perils of trauma. Our bodies remember the impact of trauma.


Trauma can throw our bodies and nervous systems out of balance. When trauma hits, our sense of safety is replaced by defensiveness and hypervigilance, causing us to see and experience everything as a potential threat or danger. Traumatic events cause emotional and physical pain that feels, at times, intolerable. Substance abuse promises temporary relief from this pain. By ignoring the underlying issues, we fail to recognize the signals of addiction and understand why the addicted person is struggling.


Once you are traumatized, you become out of sync with your environment, and your body feels different than before. That is why engaging in activities such as making music, playing theatre, or any other movement-based activity is important for traumatized people. When the body is activated through such activities, it starts to feel different and more in sync with the environment, helping you feel alive again.


Before time, it was thought that trauma occurred seldom. That trauma was about exceptional and one-time events. By now, we know that most people will experience trauma at some stage in their life. And that trauma, in most cases, is long-lasting, e.g., a violent relationship. The subjective experience of trauma is dependent on several factors.

Experiencing prolonged trauma could have a significant impact on a person, especially if the trauma occurred during childhood. When you grow up in a traumatic environment, the trauma can become intertwined with your personality. If you experience trauma as an adult, you have a sense of who you were before the traumatic event. However, if the trauma occurs during childhood, it can shape your development without giving you a chance to form a separate identity. This can make the process of healing more Complex. 


Studies confirm a correlation between adverse childhood trauma such as physical, sexual, and emotional abuse and substance abuse (Khoury et al., 2010). Adults with any history of ACEs (Adverse Childhood Events) have a 4.3-fold higher likelihood of developing a substance use disorder. Female adults had a 5.9-fold higher likelihood of developing an alcohol use disorder. Emotional neglect, sexual abuse, and physical abuse were the strongest individual ACE predictors for this association (Broekhof et al., 2023).


According to the (U.S.) National Institute on Drug Abuse in 2002, (Logan et al., 2002) “the rate of victimization among women substance abusers is found to meet the criteria for post-traumatic stress disorder … those experiencing both physical and sexual abuse were at least twice as likely to be using drugs than those who experienced either abuse alone.” “Overall, studies provide evidence that stress and trauma are common factors associated with consumption of alcohol at an early age as a means to self-regulate negative or painful emotions.” (Anda et al., 1995-1997; Felitti et al., 1998).


Substance abuse often stems from an attempt to self-medicate, self-regulate, and soothe emotional pain. Trauma can disrupt normal brain development and lead to the onset of substance addiction. This can affect various brain circuits and systems, including the dopamine and opioid circuits, the limbic system (emotional brain), the stress response system, and the impulse control areas of the cortex. Childhood trauma can impact an adult's ability to regulate behavior and respond to stress, which can contribute to substance abuse and addiction.

 

How does the environment affect addiction?

Research shows that environmental factors shape the brain (Anda et al., 1995-1997; Anda et al., 2002; Badenoch, 2018; Bremner & Marmar, 1998). For example, planting ten identical seeds and allowing them to germinate in different conditions will produce ten different results. Some will develop as expected, while others will exhibit stunting, unproductiveness, and wilting. Despite starting from identical conditions, environmental factors will cause the seeds to grow differently. These various outcomes are not determined genetically but rather by the environment. They indicate that a deprived environment weakens the seed and makes it susceptible to distorted development. These same principles apply to the human brain (Mate, 2008).

 

Four major brain systems are affected by all addictions (Mate, 2008):

(1)   The opioid attachment-reward system

(2)   The dopamine-based incentive-motivation apparatus

(3)   The self-regulation areas of the prefrontal cortex

(4)   The stress-response mechanism


Trauma and environmental factors can influence the development of the brain. When a person struggles with addiction, it can lead to varying degrees of imbalance in the brain. In a nurturing environment where parents encourage the expression of emotions, the child's brain releases natural opioids, which help form a strong attachment relationship and support the child's ongoing mental development (Mate, 2008). Stress can lower the number of opioids and dopamine receptors in the brain. The healthy development of these systems, which are responsible for drives such as love, pain relief, connection, pleasure, and motivation, depends on the quality of the attachment relationship. Maldevelopment occurs when a child lacks secure attachments and safety, preventing the formation of safe attachment relationships.

 

Adverse Childhood Experience and Addiction

Levels of dopamine in a baby's brain fluctuate based on the presence or absence of the parent. In his book “Scattered Minds.” (Mate, 1999), Gabor Mate writes[1]:


A neuroscientific study published in 1998 showed that adult rats whose mothers had given them more licking, grooming, and other physical-emotional contact during infancy had more efficient brain circuitry for reducing anxiety and more receptors on nerve cells for the brain’s own natural tranquilizing chemicals. In other words, early interactions with the mother shaped the adult rat’s neurophysiological capacity to respond to stress.


In another study, newborn animals reared in isolation had reduced dopamine activity in their prefrontal cortex — but not in other areas of the brain. That is, emotional stress particularly affects the chemistry of the prefrontal cortex, the center for selective attention, motivation, and self-regulation. Given the relative complexity of human emotional interactions, the influence of the infant-parent relationship on human neurochemistry is bound to be even stronger.

 

Studies performed with a four-month-old baby monkey show that significant alterations in dopamine and other neurotransmitter systems occurred when it was separated from its mother for more than six days. According to Professor Steven Dubovsky, Professor of Psychiatry and Medicine at the University of Colorado:


“Loss of an important attachment appears to lead to less of an important neurotransmitter in the brain. Once these circuits stop functioning normally, it becomes more and more difficult to activate the mind”.


Animal studies demonstrate that social and emotional stimulation is essential for the growth of the nerve endings that release dopamine and for the growth of receptors to which dopamine needs to bind to function (Mate, 2008; 2019). Study (Lampert et al., 2017; Yorgason et al., 2016) Studies with animals, rats, and mice show that when they are kept in long-term isolation, they have a reduced number of dopamine receptors in the mesencephalon (midbrain) incentive circuits and, notably, in the frontal areas implicated in addiction (Mate, 2008). Abnormalities in the midbrain play a significant role in the development of addiction and craving. Predictably, these maternal-deprived animals have a greater propensity to self-administer cocaine (ibid).


The onset of addiction and craving has correlated to the absence of consistent parental care in infancy and childhood. Consistent parental contact is a primary factor in the normal development of the neurotransmitter systems; the absence of consistent parenting makes the child vulnerable and can cause the onset of addiction in adolescence as a supplement to what the brain is lacking. This implies that addiction is not an inherited sickness but rather the brain's attempt to get what it needs.


Parental quality also plays a vital role in the onset and development of addiction. The quality of contact between the child and the parent is a mitigating stress-level variable. Parent-infant contact and relationship play a significant role in sensory stimulation in the child and have long-term effects on their offspring's brain. Sensory stimulation is necessary and a prerequisite for healthy biological development.


During the transition from dictatorship to democracy in Romania, the media showed orphanages with many babies lying in cradles alone, deprived of maternal care. It became evident that many of these babies died, never been caressed. Babies deprived of proper care and never picked up stress themselves to death. Babies that, for lengths of time, are on incubators have faster brain growth if they are stroked and talked to with warm melodic intonation for at least ten minutes a day.


A rat study in 1998 (Caldji et al., 1998) found that baby rats developed more brain circuitry if they were licked daily and experienced other maternal nurturing contact. Daily maternal quality grooming mitigated stress levels, reducing anxiety. They also had an increased number of receptors on their nerve cells for benzodiazepines, which are natural tranquilizing chemicals found in the brain (Mate, 2008).

 

 

Attachment and Addiction

Bowlby and Ainsworth (Bowlby & Ainsworth; Bowlby et al.) Shows that parental nurturing plays a vital role in a healthy child’s development. It also plays a vital role in dopamine levels and determines other pivotal levels of chemicals in the brain, e.g., serotonin, the mood messenger enhanced by antidepressants like Prozac. An imbalance in the availability of, e.g., serotonin and dopamine is manifested in aberrant behaviors like anxiety and hyperactivity, increasing the person’s sensitivity to stressors and increasing the risk for addiction.


Monkey studies with peer-reared monkeys show that when they are separated from their mothers, they show more aggressive behavior in adolescence, and humans tend to solve this issue by excessive alcohol consumption. The absence of sufficient neurotransmitters, e.g., norepinephrine, impacts social behavior since they are essential in mood regulation and behavior.


Feelings of love and connection are partly due to the release of oxytocin, one of our "love chemicals.” Early maternal deprivation can impact corticosterone reactivity and oxytocin expression in both males and females. (Carter, 2022a, 2022b, 2023; Carter & Kingsbury, 2022; Danoff et al., 2023) Early maternal deprivation increased corticosterone reactivity in both sexes and oxytocin expression in female magnocellular neurons. Maternal deprivation has a critical impact on our love attachments and the maintaining of a committed relationship (Strathearn, 2011).


Difficulty in forming intimate relationships can lead to the development of addiction; substances may become the “social lubricants” to ease human relationships. Childhood experiences can lead to the production of beneficial brain chemicals and an overload of others. It all depends on whether a person is raised in a supportive, nurturing context or a maternal and emotionally deprived environment. We know that adversity like maternal deprivation during infancy and childhood evokes high levels of cortisol, which is a stress hormone. Excessive surges of cortisol damage the midbrain dopamine system, shrink important brain centers such as the hippocampus structure vital to memory and the processing of emotions- and interfere with brain normal development, with lifelong repercussions. Another stress chemical that is consistently overproduced due to insufficient early maternal contact is Vasopressin, which is implicated in high blood pressure. (Rice et al., 2023).


A child's ability to cope with psychological and physiological stress depends on their relationship with their parent(s). Infants and young children do not have the developed ability to regulate their stress response, which is why they can experience extreme stress when they are not given attention and comfort. The child's capacity for self-regulation develops through a safe and supportive relationship with their parent(s) and matures over time. Predictability, responsiveness, and a nurturing relationship with caring and safe adults are crucial in developing healthy stress-response neurobiology.


Research shows that “maternal contact alters the neurobiology of the infant.” (Graf et al., 2022). The complex process of regulating physiological functions and maintaining internal balance during internal and external disruptions develops slowly in altricial species, with parental care serving as a co-regulator of infant physiological and emotional balance. Children who experience disruptions in attachment relationships develop a different biochemical environment in their brains compared to their well-attached and well-nurtured peers (Mate, 1999). Less flexibility impairs their interpretations, experiences, and responses to their environment, causing reduced adaptive capability and less conducive to health and maturity.


Disruptions in maternal contact increase vulnerability to mood-regulating and enhancing drugs, and the likelihood of developing drug dependency increases dramatically. Animal studies show that early weaning influences prospective substance intake: rat pups weaned from their mothers at two weeks of age had, as adults’ a greater propensity to drink alcohol than those weaned just one week later (Mate, 2012). Inborn temperamental traits interact with deficiencies in the nurturing environment to produce susceptibility to addiction (Derauf et al., 2011).

 

The effects of stress on addiction

Stress is a physiological response to excessive demands on psychological or physiological coping mechanisms. It attempts to uphold homeostasis in the face of enormous challenges. Physiological stress responses entail nervous discharges throughout the body and a release of a cascade of stress hormones such as cortisol and adrenaline due to activation of the HPA-axis (hypothalamic-pituitary axis), increase of heart rate (HRV), tense muscles, the emotional centers in the brain. Cortisol is your body’s main stress hormone. It works with certain parts of your brain to control your mood, motivation, and fear. Cortisol can derail your body’s most important functions. It can also lead to several health problems, including Anxiety and depression, Headaches, Heart disease, Memory and concentration problems, Problems with digestion, Trouble sleeping, and Weight gain.


Stress can contribute to addiction in various ways, some of which exacerbate each other and others that work together to push some individuals toward self-medication. Stress can trigger the release of cortisol, a hormone associated with the fight-or-flight response. Cortisol can increase feelings of anxiety and make it difficult to cope with stressful situations. When overwhelmed by stress, some people may turn to substances as a temporary coping mechanism. Stress can lower dopamine levels in the brain. Dopamine is a neurotransmitter associated with pleasure and reward. When stressed, dopamine levels decrease, leading to feelings of sadness and despair.


Substances can increase dopamine levels in the brain, providing temporary pleasure and relief. Moreover, stress can affect the prefrontal cortex, responsible for decision-making and impulse control, making it difficult for individuals to make rational choices and control impulses when stressed. This may lead to impulsive behaviors, such as alcohol or drug use. Additionally, stress can lead to social isolation, which is a risk factor for substance abuse. When stressed, individuals may isolate themselves from social interactions and use drugs or alcohol as a way of coping, resulting in a cycle of addiction, where substance abuse contributes to increased social isolation and negative emotions.

 

 

 

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