Brain, heal thyself
His wife was no longer the woman he married. He wasn’t leaving her. He still loved her. But he seemed a little lost, a little bewildered, by what had happened to her, to them. She used to laugh easily. It first drew him to her. Her crazy sense of humor complemented his quick and grinning wit. He made her laugh. She made him funnier.
Then she developed a benign tumor in her brain’s frontal lobe, he explained. Even “benign” is bad word when a tumor is in the brain. Just the presence of an invader crowds the busy circuitry, disrupting normal function. By the time surgeons successfully carved the tumor away, she was a different person. Her sense of humor diminished, replaced, it seemed, by irritability.
A brain tumor illustrates, as little else can, that the behaviors that make us “us” are as much a product of biology as the color of our eyes. It’s disarming to realize there is no immutable “me,” that this thing inside my skull is vulnerable to change, that the me-ness of me is up for grabs, subject to severe and careless editing by stroke, or tumor, or injury, or drugs and alcohol.
We’ve all been told that alcoholism and other addictions are diseases. But understanding what that means is tough, especially when you watch someone repeat senseless, self-destructive behavior. The most compassionate find themselves thinking, “I wish he’d grow a backbone,” or, “Why is she so weak?”
In fact, some forty percent to sixty percent of recovering addicts fall back into alcohol or drug abuse — roughly the same relapse rate shown by people with what we immediately recognize as “physical” diseases, such as diabetes and asthma, the National Institute for Drug Abuse reports. Addiction is, I’ll wager, one of the few — if not the only — disease where people must rely entirely on the diseased organ to grope their way to recovery. It’s their addicted brain — a brain refashioned by alcohol or drugs — that must deliver the self-control, the perspective, the fortitude to free them from disease. That’s a heck of an order. Viewed that way, it seems I've paid inadequate respect to those who fight their way to recovery. It’s a monumental achievement.
Accumulated research shows that addiction arises due to a combination of genes and environment. Of course, the No. 1 environmental factor is exposure to alcohol, drugs, or nicotine. But exposure is far from enough. If that were all it took, a few glasses of wine would undo us all. Researchers at the Indiana University School of Medicine demonstrated the strong pull of genes when they raised more than twenty generations of alcoholic mice, with each generation more addicted than the last. At the same time, they raised another line of mice that refused alcohol. They didn’t like it. They wouldn’t drink it.
Their temperance was in their genes. They didn’t just say “no.” They didn’t attend abstinence lectures. They simply didn’t like the stuff.
Alcohol and drugs do their work in the parts of the brain wired for pleasure and reward. Jaak Panksepp, a researcher at Washington State University, refers to the brain circuits driven by the neurochemical dopamine as the “seeking system.” When not co-opted by addiction, these circuits send us to the fridge when we’re hungry and to our sweetie when we’re in the mood. They make us feel good. They make us enjoy the chase. And they’re crucial for addiction.
Research by Nora D. Volkow, director of the National Institute for Drug Abuse, tells part of the story. Her work showed that the number of dopamine receptors we are born with plays a role in our susceptibility to addiction. Receptors are the intake valves for brain chemicals. People with a smaller number of one type of dopamine receptor simply enjoy drugs more than the rest of us, her research shows. The greater the pleasure, the fewer the receptors. Those with lots of these receptors find drugs unpleasant.
These addictive substances remodel the brain. The dopamine neurons become more responsive in the presence of drugs or alcohol. Neuron structures change. The area in charge of the brain’s so-called executive function — the prefrontal cortex, right behind your forehead — alters. This part of the brain helps us exercise self-control. It helps us to ignore our impulses and do the right thing. In cocaine addiction, researchers note, this part of the brain remodels to look like the brain of someone with obsessive-compulsive disorder.
In short, the drug rewrote the addict’s “me-ness.”
That people do recover, and every day, is a tribute not only to them, but to the people who work with them, and groups like Alcoholics Anonymous and Narcotics Anonymous. On the horizon is promising research for new drugs to treat addictions, including findings that one common blood pressure medication reduced cocaine cravings in rodents. Some physicians are already making use of pharmaceutical treatments for alcoholism.
We need to let go of the notion that our brains are somehow divorced from our bodies, that biology obeys different rules between our ears. It’s a little humbling. It sort of kicks us off the throne in our own life; but for a lot of people, this way lies hope.
