FACT: Addiction is a chronic, often relapsing brain disease that causes compulsive
drug seeking and use, despite harmful consequences to the addicted individual and
to those around him or her. Although the initial decision to take drugs is voluntary for
most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his
or her ability to resist intense impulses to take drugs.
The American Society of Addiction Medicine states:
“Addiction is not about drugs, it’s about brains. It is not the substances a person uses that make them
an addict; it is not even the quantity or frequency of use. Addiction is about what happens in a
person’s brain when they are exposed to rewarding substances or rewarding behaviors, and it is more
about reward circuitry in the brain than it is about the external chemicals or behavior that “turn on”
that reward circuitry.
Many people do not understand why or how other people become addicted to drugs. It is often mistakenly
assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by
choosing to change their behavior. Whereas choice is involved, there are brain change barriers that must be
overcome in order to return to a sober life. Like Cancer and Diabetes, Addiction cannot be cured, but it can be
managed. First and foremost however, we must have a clear understanding of this complicated disease.
There is a natural chemical that our brain produces called Dopamine. Dopamine is a neurotransmitter that helps
control the brain's reward and pleasure centers. Dopamine also helps regulate movement and emotional
responses, and it enables us not only to see rewards, but to take action to move toward them. This chemical is
what stimulates our pleasure center and also lets our brain interprets what measures it needs to take for
survival. Dopamine is released naturally after we see or experience things we like; say a steak dinner, a kiss,
hearing a funny joke, etc. Dopamine makes live enjoyable. Without it we become unbearably depressed.
THE GAME RULES
Think Pac-Man for a minute: The game brain hurls out little Pac-Dots called Dopamine. In order for Dopamine to
do its job of making us feel good, it must be eaten by a Pac-Man receptor. A few balls of Dopamine get tossed
out with a pleasurable activity and a few receptors grab it up to allow us to feel the joy.
Understanding Addiction via Pac-Man
By Susan Bartz Herrick, MFA, Ed.D., Mom
Let’s say candy bar might toss out 1 ball of Dopamine. Drugs like Heroin, Cocaine, Oxycodone, even Alcohol,
release up to 100 times the normal amount of Dopamine - or 100 balls. This dumping causes euphoria which is a
definite feel good! It’s easy to see why swallowing one little pill that causes euphoria may induce one want to
swallow another one. – 100 more dopamine dots instead of just one.
After doing this continually however, we see that there are obviously going to be too many balls out on the field
for the normal amount of Pac-Men to consume as they simply cannot eat up the unusually high amount of
Dopamine balls that are being supplied. But our brains, being creative little organs, seek any and every means
for survival and therefore they simply grow other Pac-Men to help it accommodate the overload and the game
speeds up. 100 dopamine balls – 100 Pac-Men.
This means 200 times the normal amount of Dopamine Dots is being released and the process continues: Not
enough Pac-Men to eat the dots so the brain grows another, and another and another.
This is called drug tolerance. With continued use, tolerance grows due to the extra Pac-men that need to be fed,
and fed on a consistent basis This is why drug addicts can take drugs in a high enough dosage that it would kill a
normal person. For them it is the amount that they need to feed all those critters and keep feeling normal. Too
much of these drugs however can close down the heart, lungs, kidneys, etc and this is when overdose death
Soon the need for pain relief and/or feeling euphoria is up to 6 or 7 pills a day. At this point the brain brain is led
to believe that it now HAS to have this chemical to survive, just as it knows that it needs food and sex to live and
to reproduce. However the chemical foundation of the brain has now been permanently changed as these Pac-
Men simple do not return from whence they came if there is not enough food. They arrived hungry and are
here to stay and will make the brain feel starved if they are not fed.
So, now we have 100 Pac-Men running around wanting to
be fed when the dopamine balls run low. They are not
happy little campers when they are hungry so they start
chasing along with the original Pac-Man to gobble up the
dopamine dots as they can. This action then places a
demand for more drug dots. But now instead of needing to
only take 1 or 2 pills a day, suddenly people find that they
need 3 or 4 to get relief or to experience a ‘feel-good.’
WHY ‘JUST SAY NO’ DOES NOT WORK
Just saying NO to Drugs is a well-intentioned phrase but biologically impossible at this point. When Pac-Men are
denied food they simply don’t lie down and get absorbed back into the grey matter. Instead they go into panic
mode and start savaging for dopamine dots. They think they are dying which in turn translates to the conscious
mind as it thinks it is dying. It is a violent physical sensation of deprivation that puts the body into a panic state.
Just as an individual would try to claw their way out a burlap bag that was about to be tossed into the ocean, so
a brain addicted to drugs will try to do anything to get what substance it needs to survive. This is where deviant
behavior, criminal actions and immoral choices begin. ‘Survival at all Cost’ is the brains mandate and the mind
seeks out the substance that will end the torment.
Most addicts want to stop but feel they cannot as the fear of drowning in their own head it too frightening. On
and off for months or years they try to give it up but the cravings, those pesky hungry Pac-Men are relentless.
At this point also, one part of the brain has greatly reduced
making its own dopamine as it now relies directly on the
drug. The other part of the brain now thinks that without it
drugs it will die. The brain does not care where the
dopamine comes from – it just knows it MUST have the
substance or it will die. In a very short period of time the
normal brain that has its one Pac-Man running around
eating dopamine dots an addict may have scores of Pac-
Men running around searching for food.
To keep the game alive, people cycle through justification stages keeping their addiction in place.
It would be nice if the stages just came step by step and faded into acceptance. They don’t however. They go
back and forth day to day – sometimes hour to hour before one gets a crack at acceptance. Family members go
through the same stages with the addict as they try to save the lives on their loved one. It’s is a heartbreaking
rollercoaster ride for everyone until professional help is sought or forced upon them - which is usually the case.
Acceptance: “This is my problem and I must do something about it. If not I will die as the demon always
wins in the end. “Hitting Bottom” is the final stage. If you love someone with a drug accept you will
allow them to get to this point ASAP. It’s called “Tough Love.” Don’t enable them to keep using. Don’t
get hooked into their game. You didn’t cause their Addiction. You can’t control their addiction and you
can’t change their addiction.
Intervention is a professionally directed, education process resulting in a face to face meeting of family
members, friends and/or employer with the person in trouble with alcohol or drugs. Intervention helps the
person make the connection between their use of alcohol and drugs and the problems in their life. The goal of
intervention is to present the alcohol or drug user with a structured opportunity to accept help and to make
changes before things get even worse.
Consulting an addiction professional, such as an alcohol and addictions counselor, social worker, psychologist,
psychiatrist, or interventionist, can help you organize an effective intervention. A substance use or addiction
professional will take into account the particular circumstances surrounding the alcohol or drug use, suggest the
best approach, and provide guidance for what type of treatment and follow-up plan is likely to work best. So off
to Detox they go. You breathe easy again – they go through hell.
Denial: “I don’t have a problem. I can quit at any
time.”” Now you may argue that they don’t see it!!
You are right - and that is a good example of what
denial looks like. It is not t