Government statistics suggest that one in 10 Americans is struggling with addiction. The CDC estimates that excessive alcohol use cost almost $250 billion in 2010. And opioid overdoses last year overtook car accidents as the leading cause of accidental deaths in the U.S.
Our understanding of how addiction plays out in the brain has increased dramatically in recent years. But treatment options are still limited.
Judy Grisel is in a unique position to appreciate both the challenges and the stakes involved in addiction research. She is a neuroscientist and professor of psychology at Bucknell University. But, in her early twenties, she was a college dropout and daily drug user. Her new book Never Enough: The Neuroscience and Experience of Addiction is equal parts textbook and memoir.
The book opens with an account of her descent into addiction and homelessness. Her introduction to mind-altering substances happened when she first got drunk at age 13.
Why did she get addicted? There are both biological factors and life experiences that lead to a substance abuse disorder, Grisel said.
“I just seem to be one of those one in 10…that had an unlucky hand,” she said.
A visit with her father was a turning point. She had been out of contact with him and he offered to take her out to lunch.
“He said, ‘You know I really just want you to be happy,’” she recalled. “I just sort of fell apart.”
Her parents convinced her to go to a treatment center, which was not at all like the “spa” she had expected.
“When I saw the nurses, I was kind of backing out the door. But I was in the middle of nowhere, so I decided to stick it out,” she said.
In treatment she began to hear about how the brain is involved in drug and alcohol addiction, which led her back to college and into the field of neuroscience.
“When I heard in treatment that people thought I had a disease, and that I might not be able to use without self-destructing, I think my mind—typical of most people like me—thought, ‘There's got to be a back door. There's got to be another way.’”
But it was much harder than she expected. One reason: our brains are constantly working to keep us at a kind of happiness set point. No matter how fantastic or terrible an event in our lives may be, our moods return to normal after a short period.
“That stable state is due to the brain's ability to counteract any kind of perturbation that causes happiness or sadness,” Grisel said. “And the reason for that you could probably imagine is that if we were just bouncing around from elated to despairing all of the time it would be really hard to tell if something important was happening.”
For addicts, this means they need more of the drug over time to get any positive brain response. Also, any treatment that would block the receptors in the brain that make drugs pleasurable would also block all the other pleasures in life. Not a tenable treatment.
As a neuroscience researcher for the last 25 years, Grisel has come to believe that a medical “cure” for addiction is unlikely, but that doesn’t mean that getting clean is hopeless, she said.
“I thought it was going to be a simple problem in the brain,” she said. “I'd flip the switch and be able to drink champagne. And it's not that simple. It's very much more complex but that gives us lots of opportunities for intervening.”