Dr. Sudir Shetty

The most commonly encountered two facts about the drug or alcohol use by our addicted kids are drugs/ alcohol are something which they really like those are something which they find really hard to give up. They know that the drug can kill them in a long run, but still they go with the immediate rewards by consuming the drug. The whole addiction thing is about being in the moment and choosing what your brain craves for right now at the expense of other rewards and possibilities. So what we observe is that drug hijacks a person's rational thinking for the long term consequences.

Addiction has to do with changes in the brain that come about gradually, become more and more central, more and more powerful as the time passes by. The drug use becomes the axis of the person, around which the other activities in life takes turn. It takes on the central meaning and role in the person's life in such a way that the most irrational idea about taking the drug or alcohol may seem to the person the most rational in that particular situation, as the drug compromises the person's clear thinking. So yes an addict can make choices for his drug cravings but the way they make choices is the thing we must think about. In an addict the brain does what it needs to do, but in a very non-adaptive way. In simple words addiction hijacks the very parts of the brain that are supposed to fix it.

Craving is the fundamental psychological experience of an addict because of which addiction occurs. Dopamine serves as the fuel for craving and is the common pathway for all kinds of addictions. Natural goodies like the food and sex certainly release dopamine in brain and follow the progression from liking to wanting i. E. Wanting more of those. As per studies, among the natural rewards sex can provide a person with the maximum natural high of upto 200% dopamine levels in brain. But the drugs cause a higher than 200% dopamine levels, which thus is the magic mark for addictive processes to occur. Also with repeated drug use there are changes in the arrangement of the inner landscape of synaptic architecture in brain, such that the thoughts, the images, the memories about the drug use behavior takes over many parts of the cortex of brain and thus the person see the drug cues wherever he gets a dopamine rush, be it with sex or food or social gatherings. Thus dopamine drives the person with a feeling of craving for the drug. Also with repeated dopamine increments of higher than natural amounts, there is maladaptive learning in brain in form of the shrinkage of dopamine cells, decrease in dopamine receptors and depletion of the dopamine stores. Thus the real natural goodies like sex or food are than not able to give a dopamine high and the only way left is to have more drugs. The person becomes impulsive and compulsive in his drug taking behavior. Repetition compulsion feedback loop keeps the person going after the drug use, narrowing the sense of meaningful world for the person. This causes a vicious cycle of incremental drug intake and thus addiction. Dopamine pathways are subdued by chronic drug use and thus the drug addicts are never able to keep up with their promises of staying away from the drug.

But then our brains have enormous reparative capacity and so a lot of the things that drugs do to damage the brain are probably reversible. One of the things that last the longest are the memories associated with drug use and the learning/ operant conditioning that occurs with it. The acute memory of brain over stimulation with drug is captured in amygdale which designates an important part of the instinctual brain i. E. The brain part which can't be controlled. So if a drug related cue is presented to a recovering addict, all that they can remember is the greatest high which they ever had with the drug. Thus the person remains preoccupied and thinks about the drug even when not using it. When this occurs, it is for the lifetime and we can't undo it. Their amygdale are going to light up seeing the drug cues for rest of their lives. This is why we say recovery from drug is a lifelong experience. Studies show a much faster depletion of our brain neurotransmitters by drug use (less than 12 months), than their replenishment in recovery from addiction (5 to 7 years). Thus during recovery an ongoing treatment for the imbalanced brain neurotransmitters and the visible symptoms due to the same is always essential.