Part 9 of an Eleven-Part Series
on “A Brain Gone Wrong”
The brain mechanism in all types
of addiction is similar. This includes substance abuse and dependency,
as well as harmful effects from behavioral addictive disorders,
such as pornography, sexual perversions and gambling.
A recent study conducted by the National
Institute of Health and specifically mental health on drug abuse
and other addictive disorders is worthy of note. Some 39% of
the population reported using one or more illicit substances in
their lifetime. Thirteen percent had used illicit substances
in the past year. Seven percent had used them in the month before
the survey was taken.
More than 2/3 of people ages eighteen
to twenty-five have used an illegal substance or exposed themselves
to addictive problem behaviors. Twenty percent of the U.S. population
older than eighteen have continued having problems with addictions.
Many of these have had serious substance dependency and use problems.
About 2/3 of this group abuses primarily alcohol and the other
1/3 preferred primary illicit substances, including tobacco.
The same study indicated serious
problems with total annual cost to society as being more than
250 billion dollars per year. The mortality rate from the indulgence
in tobacco, alcohol and drugs is now exceeding 500,000 deaths
per year in the United States.
The effects are various and widespread
and may take decades to reveal themselves in each individual case.
For instance, people whose parents took illicit substances have
a greater chance of developing both physical and psychological
difficulties, which will have an impact on the fabric of society
as measured by education, employment and socioeconomic levels
in the population.
The effect tends to carry on for
multiple generations. The statistics support this particular
problem. It has been determined that about 12.5% of the population
is prone to become dependent on alcohol or illicit drugs. It
is very noteworthy that the incidence of those with addictive
predispositions is 34% in the children of such individuals.
Aside from the staggering cost to
society, the phenomenon of addictive disorders has many implications
for clinical psychiatry. Simply stated, some addictive behaviors
can affect both internally perceived mental states, such as mood
and externally observable activities, such as behavior.
The ramifications of this simple
statement, however, are astonishing. The addictions can cause
neuropsychiatric symptoms indistinguishable from those of common
psychiatric disorders with no known causes (for example, schizophrenia
and mood disorders) and thus primary psychiatric disorders and
disorders involving addictive dependency, whether physiological
or social problems are related.
Thus, the depressive symptoms seen
in some people who have not taken a brain-altering substance are
indistinguishable from the depressive symptoms in a person who
has a brain-altering pattern of addiction. There is a brain based
commonality between the addictive disorders and depression. Information
accumulated over the past decade has shown not only an actual
alteration of the nucleus of nerve cells in the brain, but an
additional alteration of the DNA genetic make-up of the nerve
cells.
Addictive Disorders Involving Behaviors,
as Well as Substance Dependency
Addiction has also been proven with
such disorders as money addiction, gambling, sexual deviance and
the current major challenge of pornography, and other social challenges,
as well as individual abnormalities, such as stealing and eating
disorders. It is noteworthy that these various addictions have
similar effects on the activities and specific reward areas of
the brain, such as the interrelationship between the limbic nervous
system and the uniquely human prefrontal lobe and the basoganglia
or instinctual areas of the human brain.
Alteration of Brain Pathways Characteristic
of Addictive Abnormalities
A brief summary of the neurophysiology
and the biopsychiatric bases for addictive disorders would be
appropriate. Unique to the human is an advanced prefrontal cortex.
This is a part of the prefrontal lobe of the brain and collectively
with the frontal cortex constitutes approximately 35% of the whole
brain structure. The function of the prefrontal cortex of the
brain is unique to humans and is not an area or function found
within the brains of animals.
The prefrontal cortex has a separate
and unique function in the right hemisphere of the brain that
is compared with the prefrontal cortex on the left side of the
brain. The prefrontal cortex in the right hemisphere is a focus
for morals and values determination. All thoughts that are processed
through the various parts of the nervous system come eventually
to the right prefrontal cortex for moral and value determination
and a matter of conscience formation. This is a uniquely human
characteristic, in that there is a freedom of choice, existent
not only in this portion of the prefrontal cortex, but also the
left prefrontal cortical area as well.
The prefrontal cortex is the final
point to which all information is relayed in order to carryout
behavioral decisions or actions. The left prefrontal cortex of
the brain allows for the individual to analyze the thought process
and engage in what is called by psychologists, inner speech.
This allows for the free determination under normal circumstances
of what we call executive function and information is then relayed
from the prefrontal cortex to various parts of the brain in order
to carryout the purpose of the thought and its associated actions.
In a central portion of the brain
is the limbic system. This is the area of emotional feeling and
includes aesthetic feelings and those characteristic of the uniquely
human endowments of feeling joy.
The basoganglia are nuclei that function
at the base of the nervous system in order that individuals can
gather a sense of anxiety-provoking experiences or allowing them
to feel the four basic instinctual impulses, which not only animals
have, but man as well. These four basic instinctual areas are
self-preservation, lust, bodily appetite and fear of death.
The relationship between the prefrontal
cortex and the limbic system can bring a fullness of joy, a feeling
of ecstasy, wellbeing, and all of the aesthetic feelings that
man is able to experience at a level much higher than the animal
world. The characteristics of this functioning, as well as other
aspects of the role of the prefrontal cortex, involve combinations
of conscience and freedom of choice — that which we also call
free agency.
The limbic system under certain circumstances,
however, can relate primarily to the basoganglia or primitive
aspects of the nervous system at the base of the brain. This
particular relationship is able to carry on and develop patterns
which result in addictive disorders.
The limbic portion of the brain can
perform either as a servant to the prefrontal cortex in allowing
it to experience the highest feelings capable of mankind, or it
can reject its relationship to the prefrontal cortex and serve
primarily the basoganglia of the brain to elicit on a continual
basis the addictive patterns associated with the instincts of
self-preservation, lust, bodily appetite and fear of death.
To bring about this change of neurological
functioning there is a necessity, a change within the nucleus
of the nerve cells of the nervous system, that of the prefrontal
cortex and in severe cases an alteration of the nerve cells in
the basoganglia. There is not only a rearrangement of the electrical
functioning of each nerve cell or neuron, which performs a singular
and specific function, but an interrelation between those nerve
cells and other aspects of the brain that can very often elicit
severe nerve pathways and different functions of neurons.
Very serious, however, is the actual
change of DNA, the chemical and genetic determination found within
the chromosomes or nucleus of the nerve cell. Unless this change
is altered, it can become a permanent change.
We will discuss this mechanism and
influences on the mind in the next article of this series, “The
Brain Gone Wrong.”
