At Malvern Private Hospital (MPH) we see addiction as a symptom of underlying difficulties of living, rather than primarily a disease of the brain. Addictions involve all aspects of our humanity, including our brain, emotion, cognition and behaviour, stemming from the interaction between an individual’s genetics, environment and personal narrative. Our model of addiction is based in a neuropsychoanalytic approach, which means that we take both depth-psychology and neuroscience seriously.
Many contemporary models share a reductionistic understanding of addiction as primarily a disease of the brain. MPH views this understanding as limited. Whilst there are clearly brain changes, a focus on underlying emotional conflicts and trauma are essential for healing. A view of addiction which focuses on objective brain-based issues rather than the internal subjective world of the addict, is likely to miss the most important aspects of addiction.
The fact that addiction is a behavioural condition occurring within an individual remains the focus at MPH. It is the internal, subjective world of the person existing within the brain which must be understood and treated to alleviate the burden of addiction.
Brain
Scientific advances have determined that addictions involve neuroplastic changes in the brain. The fact that addictions involve and alter core brain circuitry involved in our basic motivations and behaviours remains poorly understood by many. Addictive substances strongly stimulate brain-areas which include our core motivational and emotional circuitry. Brains become re-wired in a way which leads those suffering from addictions to turn to a particular drug or alcohol (or behavior) to deal with emotional triggers.
This understanding reinforces what those working with addictions have always known – that people with addictions are not merely weak of character, ethically bad, chasing pleasure or inherently broken.
How to understand the brain changes remains an open question for all of us to ponder. Are the changes reflective of a disease, or do they reflect a process of experiential learning, whereby individuals learn to deal with emotional pain from unmet needs in particular ways? Is dopamine a pleasure chemical, or is it associated with the brain’s motivational, seeking and learning circuits?
Along-side the brain-based neurological changes discovered by researchers, exist patterns of experiences, emotions, cognitions and behaviours which also form the foundations of the addiction.
Experiences
Prior to the development of emotional, cognitive and behavioural patterns characteristic of addiction, are experiences which set the foundation for these patterns. Further difficulties subsequently experienced by the person with the addiction reinforce and exacerbate these patterns.
The way one experiences any event is based on the interaction between their genetics and environment. Along-side the neurological findings from addiction research, are those findings which reveal that people suffering from addictions have had difficult experiences in their past. These experiences often occur in childhood, and are formally known as Adverse Childhood Experiences (ACEs). To understand addiction requires an understanding of how emotionally difficult events impact, form and shape the personality in ways which lead the addicted individual to rely on a given chemical or behavior to cope with their dysregulated emotional worlds. It is important to understand that a dysregulated internal emotional world occurs when an event is overwhelming to the individual subjectively. One cannot measure the emotional distress caused by an external event merely by how traumatic it appears to the observer. It is the interplay between the person’s genetic and personality factors in combination with the external event which determines the emotional impact of any given experience.
Difficult emotional experiences lead to a psychological syndrome of disconnection. The disconnection occurs between the person and themselves, their cognitions (head) and emotions (heart), and between themselves and others. Difficult experiences lead to particular patterns of emotions, cognitions and behaviours.
Emotions
The emotional circuits of the brain are essential to the function and understanding of addictions. There is perhaps no area of neuroscience undergoing as much change as the neuroscience of emotion. Emotions were once literally ignored and sidelined by researchers of the brain. Contemporary neuroscientific views understand emotional circuits as essential and core to human nature (personality), human psychological growth (learning and development), human behavior and thoughts (cognitions). It is these particularly these neurological emotional circuits (including the ‘dopamine circuits’) which appear to be particularly impacted by difficult experiences, and lay the foundations for all of our automatic behaviours, including addictive behaviours. People with addictions tend to be overwhelmed by feelings, which leads to an experience of having too much (overwhelming) or too little (numb) emotion (as the mind maneuvers itself to remove the overwhelming feelings). Particular substances are addictive because they trigger these emotional circuits which are associated with particular experiences which form the core of the addictive process.
Cognition (thoughts)
It has long been noted that people with addictions have particular patterns of thinking. Contemporary neuroscientific views suggest that emotions are able to control thoughts in powerful ways. This type of ‘emotional thinking’ leads to manipulations of thought which occur outside of the awareness of the individual with the addiction. For example, ‘denial’ is not a lie. When a person with addiction is in denial about their alcoholism, they are not merely lying. The problem is much deeper – they are lying to themselves but are not aware of the lie. There are many types of ‘emotional thinking’ patterns which maintain and perpetuate addictions.
Behaviour
Addiction itself is a behavior. However, the underlying emotional difficulties, arising from distressing experiences will always have a number of ways to express themselves in behaviours. This is why people with addictions often have multiple addictions, other behavioural disorders (such as eating disorders), and other disordered and damaging behaviours (such as unhealthy relationship patterns).