A new definition of addiction, part 3

As we continue our way through Szalavitz's Unbroken Brain, having mentioned in the two previous posts some of children’s risk factors in developing future addiction (such as other learning disorders like ADHD and autism, high levels of sensitivity, hurdles in self-regulation), there is one more risk factor to cover: trauma. Plus, we'll take a closer look at the link between addiction and learning disorders.

There is a substantial role for childhood trauma in the potential for substance use disorder for an individual. Sexual abuse, physical abuse, neglect, death, violence, disease, poverty, bullying, and others - these "adverse childhood experiences" (ACEs) increase alcoholism risk 7 times for individuals who had four or more ACE's in their younger years. Such traumas also affect social status, opening the door to shame and the strong correlation between shame and obsessive thinking/compulsive behavior that accompanies addiction(p. 70).

Pete was a bullied boy. In his time, he was one of the coolest guys at Lincoln Senior High in Bloomington, MN. He was also profoundly bullied from a young age. By his father.

A family friend who babysat Pete from his toddler years described how my father Karl would berate and hound a sensitive little boy about not doing things right and about not being enough, consistently through his growing years. I remember it better in Pete's early teenage years, when I was old enough to remember what I witnessed.

Bullying diminishes a child's sense of status and exacerbates a feeling of helplessness in the world, says Szalavitz (p. 89-91). It create high levels of stress hormones (glutamate) in the brain, which in turn shrinks the hippocampus, where memory and emotion are processed. During childhood, our brain is growing and rapidly incorporating lessons into circuitry. Because of this, severe stress is linked to a future of long-term depression (p. 91), one that would likely include depression's characteristics of demotivation and social isolation. It is not surprising then, that childhood bullying victims, as adults, face greater risk of losing jobs, being unable to support themselves, and poor health (p. 93). This echoed Pete's life experience; the symptoms of bullying he exhibited betrayed some of the foundations of his substance use disorder.

In addition to linking those with learning disorders to a predisposition to substance use, Szalavitz, to her credit, delves deeply into brain structures and chemistry for a data-driven explanation correlating substance use disorder and learning disorders. Particularly during adolescence, when brain growth involves "pruning", or editting of cells and connections, priority goes to the new and the novel at the expense of risk-aversion. For that reason, we see experimentation of all kinds among adolescents, including drug use. The brain growth then adapts to the substance use. It takes until our early 20's to develop the areas of the brain responsible for modulating feelings and desire (our executive function) (p. 99).

Previously, this desire for the new and the novel was assigned exclusively to dopamine's role in the brain managing "pleasure". Szalavitz takes that idea further and, in additional layers of complexity, demonstrates the weaknesses of that simple concept that more strongly link addiction to learning disorders.

Research (p. 111-16) has differentiated two types of pleasure: the pleasure of the hunt (excitement, desire, lust) versus the pleasure of the feast (comfort, satisfaction, relaxation), or, wanting versus liking. Wanting is associated with dopamine and action. It is the aspect of pleasure both prioritized in addiction and most closely associated with learning. Wanting is a quest for the novel, just as learning is - reinforcing the learning of addiction. Wanting and addiction incorporate emotional associations as well - to a location, a person, a situation, that may later become subconscious triggers “out of proportion to the value that results”. Conversely, liking as a pleasure is less motivating to action and learning, and corresponds with opioids, naturally produced with in the brain or self-administered.

Drugs elevate dopamine, whether the drug is a stimulant or a depressant or an opioid, and over a duration of regular use, the brain adapts to repeated highs by correspondingly reducing joy or liking, a process of building "tolerance" in which it takes more and more drug to achieve the same pleasure. However, the brain will also become “sensitized” to the dopamine resulting from the drug, that is, have a greater and greater reaction yielding more craving, with repeated use yielding less pleasure. Despite this reduction in liking, the wanting continues or even escalates. This process of becoming tolerant to novelty parallels learning processes, where we become tolerant of information that is no longer new, which allows us to differentiate it from the exciting new information. Addiction is an amplified learning process.

One key here in understanding addiction is how learning is affected by irregularity - of dose, of environment, of frequency, of supply - it creates a sensitized environment of learning, versus small, regular dosing in familiar environments with confidence of supply, which bolsters tolerance. This is the basis for the idea that legalization and needle exchanges are harm reduction, because taking the thrill of the hunt out of the equation diminishes a drug's hold on a mind.

A final installment will review Szalavitz's recommendations.