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Addiction and the Midbrain
To begin an addiction recovery process, it is important to understand what addiction is.
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The Midbrain
Understanding that addiction is a brain disease.
Addiction is a stress- induced defect in the midbrain’s ability to properly perceive pleasure.
The midbrain is the survival part of the brain. It is not conscious. It keeps us alive. It gets us through the next 30 seconds; a life - or - death processing station for arriving sensory information.
The cerebral cortex is responsible for morality, personality, sociality and conscious choice. As humans, we have a bias in favor of the cortex: we believe that the cortex should have control over the libidinal impulses of the midbrain. Normally that is exactly what happens.
But in addiction a defect occurs at a level of brain processing far earlier than cortical processing. The midbrain becomes stronger than the cortex and when this happens, top down control is lost. The memories of what happened last time, the loved felt for significant others, and family member's, is not assessable.
Chronic stress is seen as the main culprit in addiction; why?
Because when the chronic stress is not relieved the midbrain begins to interpret it as a threat to survival.
Unrelieved Chronic stress is seen as the culprit; why?
When stress hormones rise and the cortex has no tools to relieve the stress eventually the burden falls on the midbrain, and the midbrain doesn't play around. The midbrain says, "Listen you, this stress we are picking up, is becoming life or death and is starting to affect our ability to make it so you must go out into the world and get something, anything, to relieve it.
The individual increases the risk taking behavior and, at the same time, the brains ability to perceive pleasure and reward - mediated through dopamine- becomes deranged. The individual becomes anhedonic which means the inability to obtain pleasure through things that used to be pleasurable.
Since normal things are no longer pleasurable there is only one thing that can produce pleasure and that one thing is substances. So it is easy to see how the midbrain hijacks the cerebral cortex when cravings emerge so that morality is no longer a hindrance.
It's not that addicts don't have morals. It's that in the heat of that survival panic, the addict cannot draw upon them to guide their behavior. Their morals and behaviors become progressively out of congruence, thus increasing stress. In order to consummate the craving, the addict’s cortex will shut down. But this is not the same as badness.
The absence of one thing (cortical function) cannot stand for the presence of another thing (criminal intent).
And so today we have over two million people in prison- many of them are non-violent drug offenders, many more were convicted for offenses committed under the influence of drugs or alcohol. Because doctor's abdicated their responsibility to addicted patients, the US deals with addiction punitively, and has one of the highest per capita incarceration rates in human history. When you start getting into numbers like two million, this problem stops looking like a criminal justice problem and starts looking like a public health catastrophe.
Treatment and abstinence is the key to recovery. This is a biological disease and for that reason an alcoholic cannot "drink just one beer".