Hijacking the Brain: The Cunning of Addiction

By Jonathan Kunis, MD

Alcohol and drug addiction is a brain disease that affects 10 percent of the U.S. population.  It is not a defect of willpower; addicts are not moral failures. Instead, addiction hijacks the frontal lobe of the brain and alters a person’s reasoning.

Addiction impacts individuals of any age with various ethnic, socioeconomic and educational backgrounds, and it has physical, emotional and spiritual components. An epidemic of opioid painkiller abuse and dependence in Florida is fueled by the availability of drugs like OxyContin and Vicodin facilitated by pain clinic “pill mills.”

Approximately 50 percent of the risk of developing an addiction problem is inherited, but environmental and developmental factors also play an important part. This is a chronic, relapsing and remitting disease of brain reward characterized by the persistent use of mind-altering drugs in order to deal with life stressors resulting in increasing loss of control with total disregard for mounting negative and often catastrophic consequences.

The active addict knows that what he is doing is wrong but nevertheless is compelled to continue using. He receives a subconscious message that drugs or alcohol are needed for survival-as critical as air and water but not as important as  food, sex, sleep or social interaction.  This message comes from the midbrain where we learn reward and reinforcement from behaviors and substances that drive us to want more or to “do it again.”  We evaluate the consequences of our actions in the frontal lobe – our conscience. The active addict cannot appreciate the negative impact of his behavior and thus he continues to use. Reason alone cannot overcome the compulsion to use. This is the ultimate paradox of addiction – the addict believes he must continue to use in order to survive despite risk of death.

The addict lives in a reality built on denial and misperception that justifies continued use of his drug of choice.  The addict’s family and loved ones also become wrapped up in this altered reality and they suffer along with the addict, becoming anxious, depressed and frustrated.

There is definitely hope and treatment for alcoholism and drug addiction. No addict needs to die without getting desperately needed help. Most addicts don’t wake up one morning deciding to quit and get treatment. Usually someone else recognizes the insanity of the addiction – a spouse, parent, the courts, or an employer – and brings the addict to treatment. Studies show that it doesn’t matter how you get there, once engaged in treatment, the recovery rate is equal to someone who came to treatment “voluntarily.”

Many addicts can achieve sobriety by attending Twelve Step fellowships like Alcoholics Anonymous and Narcotics Anonymous. For those needing detox or have co-occurring psychiatric and medical issues, an evaluation by an addiction specialist is more appropriate. Today, outpatient, office-based detox can be provided for alcohol, opioids and benzodiazepines. Others may need residential treatment.

It is important to recognize addiction as a chronic disease similar to other chronic illnesses like diabetes and hypertension. Addiction must be managed similarly with a comprehensive program of recovery management. Only then will hope for redemption, peace and contentment become a reality.

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Jonathan D. Kunis, MD, CAP, is Board Certified in Addiction Medicine and can be reached at 2401 University Pkwy, Sarasota, 941-359-8700.