Addiction issues are so widespread that chances are, even if you don’t have personal experience with drug and alcohol problems, you probably know a few people who have been impacted by substance abuse in some way. Despite this, there remains some confusion among families with addicted loved ones who just want to know: Why do they keep using/drinking?
Through nearly a century of information gathering, we’ve come to classify substance addiction as a medical disease. This understanding is a result of decades of research that has uncovered the biological changes people experience when using and abusing substances. Addiction is not a moral deficiency or a failure of willpower or a marker of laziness. and it is also untrue that people who abuse substances just don’t want sobriety badly enough. These were the predominant assumptions made before our knowledge base was expanded, and even the ways in which we provided professional help to those struggling with addiction were very different from what we see today. Treatment was once guided by a theory that the addict can either choose to use a substance or choose to cease using and live soberly. Though treatment facilities have shifted their approaches as we’ve learned more about the biopsychosocial aspects of addiction, many family members and loved ones are still left wondering why they can’t just stop. The answers to the “why” are very complex, but I’ll outline a few considerations that may help bring clarity and compassion for the experiences of those with Substance Use Disorders.
Part of the beauty of the well-oiled machine that is our brain is that it learns very quickly what helps us in life and what hurts us. We learn everything about our world as information travels on neurotransmitter pathways, or “communication circuits,” then our brains store the information in memories over time. Our brains also scan our environment 24/7 and alert us to potential threats. Among the threats commonly identified by our brains is any unpleasant feeling or sense of discomfort, which is a direct threat to our sense of pleasure. The discomfort can manifest physically, emotionally, and/or mentally, and our brains are usually quick to jump on a “solution” that will help us feel better.
As the brain develops, it continuously evaluates solutions and responses and determines which ones are used the most while it “prunes” or diminishes the use of other responses. If you experience a stressor and your brain often goes down the “I’m stressed so I’m going for a 1-mile run” circuit, that’s great! It means that your brain learned along the way that running helps you channel and eventually alleviate some distressing feelings. You may have tried running 3 miles once and found yourself overly exhausted, so your brain took note and pruned the response “I’m stressed so I’m going to run a half-marathon;” in other words, it found a more efficient way for you to experience relief from discomfort.
When substances are involved, though, the brain can become almost too efficient in “fixing” problems, and typically the responses that would be most helpful for a person’s overall well-being are pruned away over time. If you’ve wondered “Why do they keep using after having these consequences?” you aren’t alone. For people without substance addiction, a healthy capacity for judging choices and consequences is present because the parts of the brain responsible for discernment are not impaired. For people with drug and/or alcohol problems, impairment in those parts of the brain means that despite their vivid memories of consequences, they still often perpetuate the same behaviors in active addiction.
One answer to the “why” question may be found within the brain’s reward centers. These areas are disrupted during active addiction as the brain learns what things in our environment produce more desirable rewards. Activities generally agreed upon as being healthy or acceptable—food intake, sex, exercise, quality time with loved ones—don’t stand a chance in competing with substances in the production of certain “feel-good” chemicals (think: endorphins, serotonin, and sometimes dopamine). Substance use can lead to the production of these chemicals in the body up to ten times the amount that certain foods or sex produce. Once the brain observes this, it wants more. Instead of identifying running or some other healthy leisure activity as most effective in relieving uncomfortable or painful feelings, the brain will learn that nothing provides a sense of relief quite like the drug does.
As addiction continues, tolerance increases; it’s at this point that many in active addiction increase their use in amount and frequency in an attempt to “chase the high,” but the high is no longer attainable. The brain cannot sustain chemical production at those levels, and using substances then becomes a way to avoid feeling the effects of withdrawal symptoms. and as consequences occur for people struggling with addiction, feelings of pain, discomfort, and hopelessness multiply. The vicious cycle continues as long as the addicted person continues using the substance that has been deemed by the brain to be the most desired source of relief. Patience is key for both the person in recovery and their loved ones because while the brain learns quickly, it takes awhile for a person in recovery to “unlearn” the responses reinforced during active addiction.
We may not have all the answers to the “whys” of substance abuse, and the information outlined here only scratches the surface of the complex nature of addiction. But we do know that compassion and understanding are cornerstones for managing life as a person impacted by substance abuse. I hope to provide more insights for families to consider as we work to navigate the “hows” of successful recovery. In the meantime, if you’re a person who is struggling because your loved one is still in the throes of active addiction, please find compassion for yourself and give yourself grace as you grow.