For centuries, substance use disorders have been puzzling to scientists, clinicians, and others. But now, as a result of scientific discoveries, addiction is beginning to be more understandable. Much of the discoveries are driven by advances in visualizing the brains of people in a waking state especially with functional magnetic resonance imagery (MRI) and positive emission tomography (PET) scans.
Many of the behavioral changes in people suffering from addiction can now be understood as resulting from a shift in the balance of brain functioning from “top down” to “bottom up.”
Let me explain. Psychological health requires input from both the newer, more intellectual centers at the top of the brain and the older, more emotional centers in the limbic area located beneath them. Human beings are distinguished from other animals by the dominance of the upper centers.
Being able now to visualize brain activity in living, awake people allows us to see that the addictive use of substances suppresses activity in the pre-frontal centers at the top of the brain and enhances the activity of the limbic ones at the bottom. So in the addicted brain, mature judgment and restraint begin to be replaced by more impulsive, less thoughtful actions.
When, in recovery, substance use stops, the natural healing processes of the brain take over and the normal balance in the brain is gradually restored. An analogy would be the relationship between a horse and its rider. Working together with the rider in charge, they can get to places safely. If the rider is weakened or the horse becomes unruly, they both can be endangered. The goal is not to get rid of one or the other, but to re-establish “top-down” control.
The evidence for a biological contribution to addiction reinforces the approach to it as a disease that requires treatment, rather than a moral condition to be stigmatized and punished. I recently spoke about these exciting new developments with a group of people in recovery at an AA-sponsored workshop. The audience was highly engaged and asked thoughtful questions. I value the opportunity to talk to such groups. If you know of a group that would be interested, please contact me here.