This I Believe

Nora - Rockville, Maryland
Entered on May 15, 2006
Age Group: 50 - 65
Themes: addiction
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I saw my mother cry when I was 8, she had not wanted me to see her, so she closed the door behind her and I was left outside with the magical thinking of a child who thinks that by pure will we can protect those we love. Next morning I would learn that my grandfather had died. However, it was not until I had already finished medical school and completed my training as a psychiatrist that she told me her father had been an alcoholic and unable to control this had committed suicide. My mother had kept this a secret because she was afraid that if I knew he was an alcoholic this would decrease my love for him. But of course it did not, it just made me keenly aware of the loneliness and the isolation of those afflicted with addiction and of the suffering of their families. I realized then that I wanted to devote my life to help treat drug addiction just as I had been taught to treat other diseases and I believe that through science I can help in doing so.

The human brain is an extraordinary complex network of billions of cells that communicate with one another generating our thoughts, emotions, perceptions and motivations. Drugs of abuse can unbalance this extraordinary complex system overtaking the desires and motivations of an individual to the point that everything else that she or he perceives pales in comparison, eventually undermining the circuits that guide our actions and allow us to exert free will.

How does this happen? Drugs activate the same circuits in our brains as those activated by behaviors that are indispensable for survival such as eating, bonding, procreating albeit in more efficient ways.

There are two basic mechanisms that operate in our brains to motivate these behaviors–pleasure and distress- and both are hijacked by drugs. We seek food because it’s pleasurable, but when food is not available the mounting distress from hunger overtakes other competing motivations to ensure that we will do everything that is necessary so we can eat. Similarly, while drugs are initially sought because they are pleasurable, with repeated use and as addiction develops, their absence can generate the same level of distress as hunger does, overtaking other competing motivations and making everything else seem irrelevant. When this happens the drug is no longer sought because of want (pleasure) but because of need (relieve distress) and the desire becomes overwhelming making the addicted person seek the drug regardless of its consequences.

My mother died so I cannot tell her not to be ashamed of addiction, that it’s a disease and that no one chooses to be addicted. I believe that science through knowledge, and medicine through empathy, will help us overcome the stigma against addiction so that we can treat rather than hide those suffering from drug addiction.