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Forget What You've Heard: This Is Your Brain on Drugs

Admittedly, there is more to addiction than the neurochemical pleasure process described above. If there weren't, pretty much everyone who ever experimented with an addictive substance would be hooked, and that is definitely not what occurs.
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In the late-1980s, the Partnership for a Drug-Free America ran a series of public service ads. In their most well-known ad a man holds up an egg and says, "This is your brain." Then he points to a hot frying pan and says, "This is drugs." Then he cracks the egg and drops it into the pan, showing us the sizzling mess and telling us, "This is your brain on drugs." The implication is clear: If you do drugs, your brain will cease to function and you will automatically become a weak-willed moral degenerate.

As awesomely concerning as that frying egg looked, the campaign was mostly ineffective (as was the Reagan-era "Just Say No" campaign that preceded it). Essentially, kids saw the fried egg ad, and then they saw other kids (and adults) drinking and smoking pot and maybe even using other drugs without becoming brain-fried zombies. So instead of working as a scare tactic, the ad became a dare tactic.

Unfortunately, most anti-drug ads aimed at young people still rely on over-the-top fearmongering, forgetting (or ignoring) the fact that kids are mostly intelligent little creatures who can smell parental BS a mile away. So antidrug ads are no more effective now than in the 1980s. Hmmm. Maybe instead of trying to scare kids, we should just tell them the truth about addictive substances and their effects on the brain.

That truth starts out gently, like this:

• A small portion of the brain, the nucleus accumbens, controls the experience of pleasure. For obvious reasons, this tiny region is often referred to as "the pleasure center" or "the rewards center."
• The pleasure center is activated when we engage in life-affirming actions -- eating, being sexual, socializing, and the like.
• This neurochemical pleasure response is two-pronged, involving the release and reception of various neurochemicals (mostly dopamine, but also adrenaline, serotonin, oxytocin, and a few others).
• Some brain cells release these neurochemicals. Other brain cells receive them. And both actions need to occur before we experience pleasure. It's like a lamp. It doesn't turn on until you plug it in and complete the electrical circuit.
• Meanwhile, the pleasure center is in constant contact with other parts of the brain -- in particular regions in charge of mood, memory, and decision-making. Essentially, the pleasure center tells these other areas, "Wow, sharing a pizza with our friends is awesome. Let's remember that, so the next time we feel hungry or lonely we'll know what to do."

OK, that's all pretty cool. We experience pleasure when we engage in life-affirming activities, and our brains are set up in ways that recognize this and encourage us to engage in those life-affirming behaviors again, thereby ensuring survival of both the individual and the species. This is intelligent design at its finest.

Unfortunately, the pleasure center responds to more than just life-affirming stimuli. Addictive substances (and behaviors) also stimulate the system. In fact, they overstimulate it, flooding the pleasure center with two to ten times the normal amount of pleasure-related chemicals. This, of course, feels kind of awesome. And per usual the pleasure center shares this info with its mood, memory, and decision-making neighbors. Is it any wonder that we sometimes want to go back for more, more, and still more?

Unfortunately, that's only part of the story. And it's not the ugly part. The ugly part, the part where the brain does start to look like a fried egg, is this:

• The brain is highly adaptive. Essentially, it "heals itself" based on the inputs it receives and the actions it takes. So when the brain is repeatedly hyper-stimulated, as occurs with drug abuse, it recognizes the ongoing imbalance and adjusts by reducing the number of cells that release pleasure-related neurochemicals and/or the number of cells that can receive these chemicals. Essentially, it unplugs the lamp.
• As the brain adjusts in this fashion, drugs become less effective and users must take more of a substance or a more intense substance to create the pleasure response they seek. And then the pleasure center adjusts yet again!
• Despite this loss of pleasure, the mood, memory, and decision-making regions expect the same pleasurable rush we got the first time we used. (This is because our initial experience with anything tends to imprint very strongly, and to control how we think and feel about that experience for a very long time.) So we continue to use drugs with or without in-the-moment pleasure.
• Eventually, drugs no longer get us high. At best, they get us back to normal. When addicts hit this unpleasant stage, they are "feeding the beast."

And that isn't the worst part. The worst is this:

• Because the same pleasure circuitry is used for both addictive and life-affirming pleasurable experiences, it is becomes more and more difficult to enjoy not only addictive substances but life in general -- hanging out with friends and family, eating ice cream, playing games, etc. This is why addicts usually look miserable - their brains have adjusted so thoroughly that they are unable to fully enjoy any aspect of life, with or without drugs.

Admittedly, there is more to addiction than the neurochemical pleasure process described above. If there weren't, pretty much everyone who ever experimented with an addictive substance would be hooked, and that is definitely not what occurs. Genetics and environment are also in play, and some people are much more at-risk than others. However, when addiction does kick in, the neurochemical chain of events described above is almost inevitable. And that, my friends, is a heck-of-a lot scarier than a fried egg.

Robert Weiss LCSW, CSAT-S is senior vice president of clinical development with Elements Behavioral Health, creating and overseeing addiction and mental health treatment programs for more than a dozen high-end treatment facilities, including Promises Treatment Centers in Malibu, The Ranch in rural Tennessee, and The Right Step in Texas. For more information please visit his website.

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