How difficult and possible is it to overcome an addiction

The story of MerryJane (Name invented to maintain her privacy)

According to a well-known patient, she injected heroin, consumed alcohol and cocaine, and smoked marijuana when she attended Columbia University in the 1980s; some days, she did it several times and was left with scars that can still be seen. She continued to consume, even after being expelled from school, after an overdose, and after being arrested for distribution, which she did to hide the high expenses of her consumption.

Her parents were overwhelmed: they could not understand what had happened to their "talented" daughter, who had always excelled in school. They still had hope that, at some point,t she would stop using drugs, although every time she tried, she relapsed after a few months.

In general, there are two lines of thought about addiction: the first says that my brain was chemically "hijacked" by drugs, which had left it without control over a chronic and progressive disease. The second says that I was simply a selfish criminal who did not care about others, as most people still believe (when the person with an addiction is a loved one, we lean toward the first explanation; when it is not, we lean toward the second.)

We need a new perspective because our knowledge of the neuroscience underlying addiction has changed and because all existing treatments simply do not work.

Addiction is indeed a brain problem, but it is not a degenerative pathology like Alzheimer's or cancer, nor is it evidence of a criminal mind. Instead, It is a learning problem, a difference in how the brain makes connections that affect how we process information about motivation, reward, and punishment. Also, like many learning problems, addictive behavior is shaped by genetic influence and the environment during development.

Scientists have studied the connection between learning processes and addiction for decades. Now, through animal research and radiological studies, neuroscientists have been able to recognize which brain regions are linked to addiction and how.

Studies show that addiction disrupts the interaction between midbrain regions like the ventral tegument and nucleus accumbens, which are linked to motivation and pleasure and parts of the prefrontal cortex, which help make decisions and set priorities. These networks determine what we value to ensure that we achieve specific, important biological goals, namely survival and reproduction.

Addiction occurs when these brain systems are focused on the wrong goals: drug-addicted or self-destructive behavior like excessive gambling instead of focusing on a new partner or a baby. Once that happens, it can cause big problems.

If you grew up, as she did, with a hypersensitive nervous system that made you feel constantly overwhelmed, abandoned, and unloved, finding a substance that soothes social stress becomes a blessed escape. Heroin gave her a sense of comfort, security, and love that she couldn't get from anyone else (the key agent of addiction in these regions is the same as that of many pleasurable experiences: dopamine). Once I experienced the relief that heroin gave me, I felt as if I couldn't survive without it.

Understanding addiction from this neurodevelopmental perspective offers much hope. First, like other learning disabilities—for example, attention deficit hyperactivity disorder or dyslexia—addiction does not affect general intelligence.

Second, this view suggests that addiction distorts decisions but does not eliminate free will: after all, no one shoots up in front of the police. This means that people with a substance use disorder can learn to take actions that improve their health, such as using clean syringes, as she did. There is research showing that such programs not only reduce HIV transmission but also aid in rehabilitation.

The learning perspective also explains how the compulsion for gambling, alcohol, or drugs can be so strong as to why addicted people continue even when the harm far outweighs the pleasure they get and why they may appear to be acting irrationally. If you believe something is essential for your survival, your priorities will not make sense to others.

The learning that leads us to feel desires such as love and reproduction is very different from learning emotionally uncharged facts. Unlike memorizing the taboos and the rules of life, learning to live a life of love and reproduction is very different from teaching facts without emotional charge.