Addiction and the Brain: Dependence, Comorbidity, and Recovery in the Context of Substance Abuse

The word ‘addiction’ refers to the physical and/or psychological dependence a person develops towards a substance, stimuli, or behaviour. While it is most often associated with drugs and alcohol, addiction can also be linked to behaviours like gambling, gaming, or compulsive shopping. Both substance- and behavioural addictions rely on similar brain mechanisms, and they can have a profound impact on a person’s life. 

In this article, we take a look at the neurobiology of addiction, as well as some common comorbidities that exist between addiction and other mental health conditions.  

We also cover some of the key coping strategies to prevent relapse and boost resilience.

The neurobiology of addiction and substance dependence 

When we talk about the neurobiology of addiction, we’re referring to the complex interplay between brain circuits, neurotransmitters, and various genetic factors.  

Below, we explore which parts and processes within our brains are impacted by the addictive substance or stimulus. This helps us to gain a better understanding of why people get addicted, why they experience withdrawal symptoms, and which treatment options are best suited to their recovery journey.

The brain reward system 

Within our brains, there are neural pathways responsible for the release of hormones like dopamine and serotonin – the neurotransmitters associated with pleasure and reward. The mesolimbic dopamine pathway – also sometimes referred to as the reward pathway – plays a critical role in addiction. Drugs and addictive behaviours hijack the system, leading to an increased release of dopamine in the brain’s reward centre. This causes the brain to halt the natural and regulated release of dopamine, meaning that the person becomes dependent on the substance or behaviour for feelings of pleasure or reward. That’s why addiction is often characterised by intense cravings and withdrawal symptoms when the substance or behaviour is discontinued. 

Also, addictive substances and behaviours can affect the release of our other feel-good hormone serotonin - the neurotransmitter responsible for regulating mood, impulse control, and reward processing. When this system is impacted, it can contribute to the development and maintenance of addictive behaviours because the person may struggle to regulate emotional states and impulses brought on by the substance or stimulus.

Neuroplasticity  

Addiction can result in long-lasting changes to the brain's structure and functioning. Repeated exposure to the substance or addictive behaviour leads to neuroplastic changes. This makes it increasingly difficult for the brain to produce and transmit the chemicals we need for analytical thinking, memory, and decision-making. That’s why we often hear people say that they need the substance or behaviour to cope or just to ‘feel normal’ – because their bodies are no longer used to producing and transferring the necessary chemicals on their own.

Genetic vulnerability 

Some people may have certain genetic factors that place them at a higher risk of developing an addiction. For example, they may be born with atypical functioning of their neurotransmitter systems, or may have more sensitive reward systems in general – causing the effects of certain substances or stimuli to be felt far more intensely. Another reason could be the underdevelopment or atypical functioning of certain brain regions, like the frontal lobe or anterior cingulate cortex, which can make it more difficult for a person to practise impulse control or regulate their emotions. 

Comorbidity 

Addiction frequently coexists with other mental health conditions, such as depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) – amongst others. For instance, individuals with depression may turn to substances or certain behaviours as a means of self-medication to alleviate their feelings of sadness and hopelessness. Similarly, individuals with post-traumatic stress disorder (PTSD) may use drugs or alcohol as a coping mechanism to numb or escape distressing memories and emotions. 

On the other hand, anxiety disorders can lead to heightened stress levels, making individuals more susceptible to seeking relief through addictive substances or stimuli. In the case of ADHD, characterised by impulsivity and difficulties with attention and self-regulation, there may be an increased likelihood of engaging in impulsive behaviours, including substance abuse and experimentation with drugs. These co-occurring mental health disorders can interact with addictive processes, creating a complex interplay where the addiction reinforces the underlying psychological condition, and vice versa, making recovery from both conditions more challenging.

Recovery 

When embarking on an addiction recovery journey, there are several key points to remember for building resilience and preventing relapse:

• Mindset – Develop a strong commitment to change and maintain a positive mindset throughout the recovery journey. Believe in your ability to overcome the addiction. 
  
  
• Professional Support – Seek professional help from addiction specialists or therapists who can provide guidance, support, and evidence-based treatment options tailored to your needs.
  
  
• Social Support – Engage with support groups or recovery communities to connect with individuals who understand your struggles and offer encouragement and shared experiences. Also, surround yourself with loved ones who care about you and who want to see you succeed, while minimising contact with individuals who enable or engage in the behaviours or substances you’re trying to avoid.
  
  
• Healthy Coping Strategies – Identify healthy coping mechanisms to replace addictive behaviours. These may include activities like physical exercise, practicing mindfulness and meditation, pursuing hobbies, or seeking creative outlets.
  
  
• Know your triggers – Recognise triggers that may lead to relapse, such as certain people, places, or emotions. Develop strategies to avoid or effectively cope with triggers, such as developing an action plan, utilising stress-management techniques, or seeking immediate support.

• Prioritise self-care – Focus on activities that promote physical, emotional, and mental wellbeing, such as getting enough sleep, maintaining a balanced diet, practising self-compassion, and engaging in activities that bring you joy.
  
  
• Relapse doesn’t mean failure – Embrace the understanding that addiction recovery is a lifelong journey and treat relapse as a learning opportunity to identify triggers, reassess coping strategies, and adjust your recovery plan accordingly. 

• Celebrate Milestones – Acknowledge and celebrate milestones along your recovery journey, no matter how small. Recognise progress and reinforce positive behaviours to boost motivation and resilience.

By keeping these key points in mind, implementing healthy coping strategies, and seeking support, those struggling with addiction can boost their resilience, prevent relapse, and work towards a successful and sustainable recovery journey. 

Reflections 

As we navigate the complexities of addiction and recovery, let’s remember that these struggles present us with important opportunities for personal growth and transformation. By broadening our understanding of what causes addiction, how it can affect us, and how it can be treated, we can minimise the impact that this mental health issue has on us, our loved ones, and our communities.

References 

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  
• National Institute on Drug Abuse. (2021). Comorbidity: Substance Use Disorders and Other Mental Illnesses.
  
• National Institute on Drug Abuse. (2021). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). 
• National Institute on Drug Abuse. (2021). Understanding Drug Use and Addiction.
• Substance Abuse and Mental Health Services Administration. (2016). Behavioral Health Trends in the United States: Results from the 2015 National Survey on Drug Use and Health. 
• Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States.
• Substance Abuse and Mental Health Services Administration. (2018). Treatments for Substance Use Disorders.