Substance Use Disorder: Is it a Mental Illness?

Addiction is a common disease that impacts millions of people across the United States, but the lens through which we see addiction can change significantly. Many of us are familiar with the stereotype of an underachiever suffering from alcoholism or drug addiction. It’s easy to see addiction when its effects have created visible marks throughout a person’s life, such as financial difficulties or a criminal record. However, addiction also has a hidden side.

Substance Abuse Disorder - Is It A Mental Illness?

Many high-achieving individuals use drugs and alcohol in ways that cause harm, but the effects of this abuse isn’t visible to the outside observer. There isn’t a typical drug or alcohol addict. This disease impacts people from all walks of life equally. However, people who are able to effectively hide their addiction are less likely to receive treatment than those who wear their addiction on their sleeve.

For high-achieving individuals, addiction is a deeply personal issue. Many professionals facing substance abuse issues may view their addiction as a sign of personal weakness or as a moral defect in their personalities. However, it’s important to remember that addiction is simply a misapplication of the brain’s natural reward circuitry. At its core, addiction is an issue where the brain has trained its reward circuitry to respond to harmful, artificial stimuli (such as drugs and alcohol) instead of natural, beneficial ones.

The reward circuitry in the human brain is driven by a complex chemical cascade. At the core of most reward pathways in the brain is dopamine. Dopamine is a neurotransmitter that helps regulate mood. It’s also used by the brain as part of its reward system. When the human body does something that is considered beneficial (in terms of evolutionary survival and reproduction), the brain releases a burst of dopamine.

Lonely woman on pier

Human reward circuitry is designed to respond to activities and environments that improve the odds of passing on genes to the next generation. When we eat a delicious meal, our brains are flooded with dopamine. This is the way that our body tells us what we’re doing is a ‘good thing’ in terms of survival of the human species. When we engage in sexual activity, our brains are also flooded with dopamine, since reproduction is one of our core purposes in life (in evolutionary terms).

Unfortunately, this reward circuitry often backfires in the modern world. In the past, humans were primarily a hunter-gatherer society. To get that hit of dopamine from food, our early ancestors may have had to march dozens of miles across the savannah before they could capture game to eat. Their desire to hunt was driven by a combination of hunger and an unconscious desire to trigger the reward circuitry in their brain. The same applied to gatherers: Each sweet berry that a forager managed to find might trigger a small release of dopamine. Likewise, each time an early human copulated, their brain rewarded them with a hit of dopamine, helping to make sure that we, as humans, would still be around today.

Empty street with benches in autumn

While our brain’s reward circuitry helped humanity survive and flourish in a harsh environment, our modern world has caused problems for many of these systems. Instead of dopamine serving as a reward for behavior that benefitted ourselves (both on an individual and species-level), we can get that same hit of dopamine through many activities that are harmful or detrimental to our health.

Many of us know the dangers of consuming too much fat, sugar or salt. Overconsumption of this trifecta can cause Type II diabetes, high blood pressure, and the many health problems associated with obesity. However, our brains are primed to love foods with these ingredients. For early humans, fruits like berries contained natural sugars, which served as a valuable energy source. This sweet tooth led early humans to forage for hours for these small tastes of sweetness nestled among bushes and trees.
Things have changed. Now, we can now go to the grocery store and buy a two-liter bottle of concentrated sugar water for only a few dollars. A single glass of a soft drink may contain the sugar equivalent of several pounds of berries or natural fruit. The same applies for fat and salt.

While fat and salt are essential for human health, our modern lifestyles allows us to consume these substances in amounts that can leave our arteries riddled with plaque and our heart valves crusted with cholesterol.

Drugs and alcohol hijack this reward circuitry in even more insidious ways. While fat, sugar and salt are now available to us in quantities that are harmful to health, they trigger our reward circuitry in the same way as our early ancestors. Drugs and alcohol, on the other hand, hijack this reward circuitry, causing a massive release of dopamine for little or no effort.

Young girls out at night

Just like a computer hacker gaining illegal access to a network, drugs and alcohol cross the blood-brain barrier to trigger specific clusters of neurons in the brain. The reason that drugs and alcohol feel good is because they activate our reward circuitry for an extended period of time. Instead of this reward circuitry being activated for brief moments throughout the day, drugs and alcohol allow us to open the dopamine floodgates in our brains, triggering euphoria in ways that aren’t naturally possible.

Not all drugs are the same. Some milder drugs, such as nicotine, may only trigger a small release of dopamine in the brain. Very addictive drugs, like methamphetamine and heroin, can trigger a release of dopamine that is greater than anything an individual has experienced in his or her life.

One of the reasons that drugs are so addictive is because our reward systems aren’t designed to be continually activated. When we hijack the reward pathways of our brains with addictive substances, we’re literally rewiring the way we pursue pleasure. Instead of getting enjoyment from a nice meal and a romantic evening with a loved one, addiction unconsciously teaches us that we can get an even better substance from a chemical.

Drug or alcohol addiction isn’t a moral failing, nor does it represent a weakness in character. Addiction is a learned behavior that has embedded itself so deep in our psyche that it can drive every decision we make. When the reward circuitry of the brain has been completely hijacked, an individual suffering from addiction will do whatever he or she can to achieve another cascade of dopamine. Addiction completely rewires an individual’s motivations from healthy ones to malicious ones.

 

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