A different viewpoint Addiction as a disease of choice – a loss of choice.

Morality in a nutshell is defined as choosing to conform to social norms and behaviour.  Thus, for an addict not to be immoral, it would require that the addict has no choice over their behaviour.

We used to think that addiction took place in the frontal cortex of the brain, this is where we have free will, rationality, consciousness and, yes, morality.  With advances in neuroscience and the help of many brave mice, we have learned that addiction actually takes place in the midbrain, where unconscious and involuntary survival instincts are based.  Mice will actually self-administer cocaine to the midbrain to the exclusion of all other survival instincts, to the point of death.  But we know that mice don’t choose to be addicts.

When an addict becomes stressed their brain releases cortisol which inhibits the production of dopamine (the pleasure neurochemical).  We all need pleasure and the one thing that all drugs of choice have in common is that they all release large amounts of the dopamine.  When an addict becomes stressed and all pleasure disappears they reach for the dopamine quick fix.  The drug then becomes survival strategy number one; this is what is referred to as craving.

In a healthy brain, the frontal cortex exerts a kind of top-down control over the lower survival midbrain.  But if stress is severe enough, this normal control reverses, allowing midbrain to take control so that the complete focus is on dopamine producing substances or behaviours.  This is where the addict loses choice.  At Life Works we see people every day that have “chosen” the drug above all else including their health, family, children, career, freedom, etc.  This is enabled by denial, as the addict cannot “survive” and be aware of the consequences of their behaviour.

Addiction is a disease of choice – a loss of choice.  This loss of choice is why addiction is not a moral issue.  It is progressive, incurable and ultimately fatal brain disease.  This is where treatment and self help programmes like AA come in.  Treatment works to help the individual gain abstinence in order to begin to restore the functioning of the brain, break denial and start a programme of recovery.  AA provides a sophisticated set of tools for coping with stress, allowing the frontal cortex to exert power over the midbrain and have choice over the drug.  Millions have successfully paved the way and there is a lot of hope if the necessary intervention is made by medical professionals, family, employers and friends.