Gotta Have It Now

Part One: How Addiction Works

By: Jean Johnson for Body1

“‘Gotta have it’ is the driving thought of the addict,” writes Ronald D. Rudgen, M.D., Ph.D., in “The Craving Brain.” “‘Gotta have it.’ A drink, a drag, a hit, a line, a pill, another piece of chocolate.”

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Dealing with Addiction People struggling with addictions often do not have adequate coping skills for dealing with emotions like pain, fear, anger, anxiety and joy. Vigorous physical exercise that helps blows off stress enables addicts to keep emotions from gaining so much steam that they are perceived as threats to well-being. Environments in which people with addictions can learn to trust others can help counteract histories of childhood neglect and trauma. Types of activities like yoga and meditation that help balance the emotional mind are useful aids in managing addiction. Experiences in which those with addictions learn they are valued and respected also work toward building a sense of self-worth useful in overturning addictive behaviors.

Addictions can ravage people’s health, their relationships and unfortunately all too often, their whole lives. Understanding the problem is often the first step towards help, and modern science is continually uncovering more biological and psychological clues as to how addiction works.

“Getting it is all that matters. Scrounging in the garbage for cigarette butts, stealing pills from a friend’s medicine chest, driving into a dangerous neighborhood at night to meet a drug dealer, wiping out a child’s bank account,” Rudgen goes on. “Nothing is more important than smoking, swallowing, snorting, shooting, somehow securing and consuming it, and feeling its effects, now. This urgent inner demand overrides all others, undermines reason, resolve, and will. It is relentless. It does not stop until it is satisfied. And then, it starts again. ‘Gotta have it!’”

Addictions – Clues on How They Work

On the question of how feasible it is to consider all addictions under a single rubric, psychologist and program manager of adult outpatient behavioral health services at Providence Portland Medical Center in Portland, Ore., James Mol, Ph.D. said, “We can paint with a fairly broad brush in terms of addressing some common issues that are relevant to all addictions, although we can provide greater detail when we focus on discrete types of addiction.”

Mol explained that since “cross addictions – that occur when a person has started to better manage the symptoms of their primary addiction and another addictive pattern emerges – are a common phenomenon; there is some credence to the idea of talking about addictions in a broader way.”

Given the idea, then, that there are threads running through various types of addiction, insights into the nightmarish lack of control that plagues so many can be drawn from research focused on alcoholism by neuropharmacology professor at Scripts Research Institute, George F. Koob, Ph.D.

“Alcohol tends to activate the whole brain reward system,” said Koob. “They may be drinking to feel normal or they may drink to tame a hyperactive CRF stress system in the brain.”

That some individuals have abnormal brain chemistry including higher than normal levels of corticotrophin releasing factor (CRF), a major hormone related to stress, lends support to a nature over nurture theory, at least when taken at face value. But, according to chair of the department of behavioral sciences at Emory University School of Medicine, Charles B. Nemeroff, M.D., Ph.D. the distinction between biology and psychology is way more complex.

In particular, Nemeroff looked at CRF hypersecretion and depression – a phenomenon often present in individuals with addictions. “Many if not most depressed patients hypersecrete CRF which is responsible for many of the signs and symptoms of depression,” wrote Nemeroff. “Our hypothesis is that if you are traumatized early in life, provided that you have a genetic diathesis [or predisposition], there is some kind of plasticity-associated increase of CRF neuronal activity; either you have more neurons expressing CRF than do people who haven’t been traumatized or your CRF neurons are more active.”

To explore his supposition, Nemeroff and colleagues undertook a 1999 study on hooded rats. “The hooded rat mother is very attentive,” he said. “She takes very good care of her pups.”

The team separated several pups chosen at random from their mother at between two and 14 days of life, keeping each pup away for a total of three days. Once returned to the litter box, pups that were removed, along with their mother, had high levels of CRF, presumably from the stress of separation.

Then what followed were patterns of neglect by the mother. She waited longer before returning the removed pups that strayed to her nest, only allowed them to nurse once their other littermates were finished, and occasionally even trampled the pups in the experiment.

After the pups reached maturity at 90 days, their CRF levels were re-examined, and Nemeroff’s team was “just taken aback.” Pups subjected to the childhood trauma had two and a half times the CRF stress hormone than did their normal siblings. The team came away from the project convinced that early childhood neglect or abuse – particularly when there is already a genetic susceptibility present – will permanently change CRF neurons in ways that result in hyperactivity.

This makes perfect sense according Ruden. When people are chronically stressed, they will do the intelligent thing. Try to self-medicate to relieve the symptoms that are forever prompting them to take action. The question is, according to Ruden: “How do you escape from an inescapable stressor?” Enter the world of the addict.

Indeed, Mol noted that “since some studies indicate that the brain chemistry and resultant fundamental mood of the addict is different from non-addicts, oftentimes they will report that until they started engaging in their addiction, they never felt normal.

“To me,” Mol continued, “this knowledge really helps everyone whose lives are touched by people with addition problems to be less judgmental. Instead of assuming that addiction is a lack of willpower or the product of an overly-hedonistic nature, perhaps it is fairer to see addicts as people who are often driven by overwhelming impulses. I’m talking about that loud, almost screaming voice that wants to numb out or run away and says ‘I got to have it now.’”

Mol added a caveat – almost a plea on behalf of those he works with on a daily basis. “I would say that the biggest myth about addictions predominant in our culture is that addictions are a sign of weak character or a sign of criminal or antisocial leanings. This is very unfair when you consider some of the biological and environmental bases for these problems.”

Last updated: 06-Jul-06