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What's Happening in the Brain When Someone's Addicted?

Dierk Schaefer

One in every twelve kids in Greene County between 6th and 12th grades is misusing prescription drugs—that’s according to the Missouri Department of Mental Health’s Behavioral Health Profile. And take a guess at the average age for taking that first sip of alcohol: here in Greene County, it’s 13 years old.

All this week, we’re looking at what substance abuse means for our region. 

But to understand substance abuse, we need to explore many aspects, including what’s going on in the brain.

Dr. Jesse Rhoads is a psychiatrist and the Medical Director of Behavioral Health Care at Ozarks Medical Center in West Plains.

So, pull out your notebooks, class. And Dr. Rhoads begins with a disclaimer:  the brain’s role in addiction is not easily simplified.

Credit Jennifer Moore / KSMU
Dr. Jesse Rhoads is a psychiatrist and the Medical Director of Behavioral Health Care at Ozarks Medical Center in West Plains, Missouri.

“In looking at addiction, you need to really understand the concept of reward, and what happens in the brain with reward,” Rhoads said.

In the 1950s, researchers used rats to determine which parts of the brain were involved with intense pleasure.

“And so, we think, and it’s perhaps overly simplistic, but there’s a reward pathway in the brain. There are actually several pathways,” Rhoads said.

Think of these pathways as super-highways where nerve cells race along to their destinations. And one of the main reward pathways ends up at the nucleus accumbens—a part of the brain involved in motivation and reward and the diminishment of activities that get in the way of that.

“And so, if you look at this, and you have a pleasurable meal, a good conversation, or read a book or go to the symphony, whatever it may be—there’s a release of dopamine there and it’s pleasurable. When it comes to illicit substances, things of that sort, there’s a huge release of dopamine there. So it’s extremely pleasurable. And over time, the brain adapts and you need more and more stimulus to get that reward. So, that’s basically, in a nutshell, the reward system,” Rhoads said.

I ask Dr. Rhoads whether we know if substance abuse is likely caused more by a person’s DNA or by life experiences.

“There are many different models of addiction historically—everything from the moral model of addiction, and now we’re in an era where we really talk about the biological model of addiction. But I think all of that is overly simplistic. I don’t think it’s one or the other.  But there’s definitely a biological component because we actually have medicines that work. And they work beyond placebos. So if this had no biological basis whatsoever, we wouldn’t be giving biological agents to treat it,”

The most recent model is the disease model of addiction, he said:  treating it as if it’s a disease.

By definition, he says, addiction is where you can’t control your use. If you can control your use, then you’re not an addict.

And he illustrates that with a true story from his time as a psychiatry intern, where he encountered a patient on an addiction unit in Columbus, Ohio.

“His story was:  he was a severe alcoholic up until the age of early 30s,” Rhoads said.

“And then he got involved with a church. He worked with psychologists. He ended up becoming sober. He was sober for years and years and years. He was sober for over 30 years,” Rhoads said.

Then, the man’s daughter had a wedding, and at the wedding, there was punch with alcohol in it.

“And he’s thinking to himself, ‘You know, I’ve been sober 30 years, I’ve got this kicked.’ So he took some of the punch, then within a month, he’s dying because he couldn’t control his use. There were severe problems,” Rhoads said.

The patient ended up dying.

“So I do believe that, when someone’s addicted, they’re always addicted. They just may not have access to it, or may not be using,” Rhoads said.

Credit Jennifer Moore / KSMU
Ricky Maggard, of West Plains, is a volunteer coordinator of a 12-step recovery program in southern Missouri.

Ricky Maggard, a volunteer coordinator of a 12-step recovery program in West Plains, has felt that lack of control firsthand. He used whatever he could get his hands on to get high—but he’s been clean for three and a half years.

“I just don’t know if you can imagine doing something against your will. Using against your will. I’ve been in a situation where someone would show up with my drug of choice and would offer it to me. And I would say, ‘No.’ I’d be feeling bolstered and strong for whatever reason. And before they got out of earshot, I was like, “Well, is it any good?’” Maggard said.

He still refers to himself as an “addict,” and he still feels the urge to use daily.  

“The obsession becomes so intense that it’s almost physical. You just crave it…like…like you would miss a loved one,” Maggard said.

Maggard says once a person realizes the problem is out of his or her control—that’s where the personal choice comes in:  it’s the choice to seek outside, professional help, and to work very hard following the path to recovery.  For someone like Maggard, who started at age 13, and whose family and friends were abusing drugs, that’s extremely hard to do.

After having his children taken away by the state, Maggard made it through inpatient and outpatient rehab.

Today, he says he’s learned to make sure his brain still gets a reward—but that surge of dopamine is now coming from things like playing with his kids, starting a non-profit organization, and outdoor activities like bow hunting and fishing.