“I see addiction as an accelerated form of learning. I see it as the result of a natural learning process that has gone way too fast and way too far, yielding habits that are extremely difficult to “unlearn”.
A Brain's-Eye View of Addiction as a "Disease"
“…the dopamine system is altered so that only the substance of choice is capable of triggering dopamine release to the nucleus accumbens (ventral striatum), while other potential rewards do so less and less. The nucleus accumbens (NAC) is responsible for goal-directed behavior and for the motivation to pursue goals.”
“ …that dopamine metabolism is seriously altered by addiction, and that’s why it counts as a disease. The brain is part of the body, after all. It explains the helplessness addicts feel: they are in the grip of a disease, and so they can’t get better by themselves. It explains the incredible persistence of addiction, its proneness to relapse; and why “choice” is not the answer (or even the question), because choice is governed by motivation, which is governed by dopamine, and your dopamine system is “diseased.”A Matter of Choice?
High levels of dopamine take the freedom out of free choice
"So choice becomes increasingly irrational, increasingly spontaneous, and increasingly uncontrollable. Then should we still call it “choice” at all?""What’s wrong is that the "choice" model ignores the brain. Big mistake! From a brain’s-eye view, the reason people choose the immediate reward is that dopamine highlights immediate possibilities.""...the addictive act is a choice. Each and every time. That means that there is always the possibility of saying No. Yet, saying No is incredibly difficult, and that’s a problem the “choice” camp can't solve...without the help of neuroscience."
Addiction as Choice: Part II
To understand addictive choices, we must first understand choice
"When you focus on your breath, you seem to be right there, present, at the moment when each breath begins. You say: ok, I'm going to inhale now, and you do. But when you relax a bit more, or when your mind wanders, you find that the breath comes anyway. There you find that the choice to begin another breath coincides with an impulse that's already underway. Similarly, the "choice" to reach for that bottle or that phone (to call your dealer) It's also part impulse—the gathering and then discharging of an underlying urge or plan—mixed together with conscious volition."
Part III: This is your Brain on Choice
Addicts can maximize good choices by building the right neural habits.
"Driving is a great metaphor for how we negotiate the attractions and hazards of life, which is also complex and difficult, and which also comes at us around each corner quickly and sometimes unpredictably. Being a good driver requires good habits, to give choice a chance (paraphrasing John Lennon). Being a good ex-junkie or ex-drunk also requires good habits, so that we can choose our actions well, smoothly, without the wear and tear of anxiety at each and every turn. Our job as a recovered or recovering addict is to build and strengthen those habits. Then we can feel confident about making the right choice when the road takes an unexpected turn."
Addiction as self-medication
"At the very least, drugs, booze, gambling and so forth take you out of yourself. They focus your attention elsewhere. They may rev up your excitement and anticipation of reward (in the case of speed, coke, or gambling) or they may quell anxiety directly by lowering amygdala activation (in the case of downers, opiates, booze, and maybe food). The mechanisms by which this happens are various and complex. But we all know what it feels like. If we find something that relieves the gnawing sense of wrongness, we take it, we do it, and then we do it again."
Self-medication or self-destruction?
"I think we often see clear connections between personal hardships and addiction. This sort of “anecdotal” evidence, subjective and biased though it may be, is often the strongest reason, deep down, for accepting (or rejecting) the self-medication model. The self-medication model portrays addictive behaviours as attempts to diminish the feelings of anxiety, loss, shame, and loneliness left in trauma’s wake."
