MALFUNCTIONING BRAIN: Understanding Substance Use Disorder as a Disease

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I have 10 years of experience working in a Substance Abuse Disorder (SUD) detox unit in a local hospital.  Over the years, I have worked with many people and families who struggle with the idea that simply quitting won’t work.  People have often commented that they don’t understand why a person would choose drugs and alcohol over everything and everyone in their life. Families often feel hurt, frustrated, and angry.  The individual using feels despair, guilt, confusion, and helplessness. I have done my best to explain that there is an actual disorder at play in these situations.  However, it is a difficult idea to explain to the families of substance users and for them to understand and accept as real. In the following paragraphs, I hope to explain SUD to anyone who might be dealing with addiction.

Most people do not understand SUD is a brain disease.  It is not a matter of willpower.  Telling someone who is addicted to a substance to just quit is futile.  People, who do not understand, wonder why self-destructive people with a SUD don’t just quit.  Addiction is defined as continuing to do something despite negative consequences.  Using that definition, there are many things people do that could be considered “addictive”.   However, when considering people with SUD, they have the added challenge of their addictive behavior causing biochemical changes in their brains.

Chemical dependence happens in the brain

The first difficulty in understanding SUD is being able to wrap your mind around the idea that biochemical changes have occurred in the brains of people who suffer from the disorder. Once these changes occur the brain never goes back to being normal.   This makes SUD a disorder that is not all in someone’s head, but in their brain.  Because this is a brain disease, it is different than diabetes, a disease often used as a comparison to SUD. When a person has diabetes it is his or her pancreas that is malfunctioning.  The unstable blood sugar levels, a primary symptom of diabetes, may have an effect on energy and some hormones that communicate with neurotransmitters, but not on the brain directly.  SUD is a malfunction of the brain due to exposure to a substance with chemically dependent properties.   Although neurobiologists are learning new things about the brain at an amazing rate, the brain is still too complicated for us to fully understand.

Gaining a better understanding

Paying attention to how people with SUD experience their disease can help us understand the ramifications of the malfunctioning brain. When people think of brain diseases they think of schizophrenia, which alters the perception.  SUD is a brain disease that does not dramatically alter a person’s perception of reality.  They know what is going on around them.  However, a person with SUD will do things they would never do if they were clean and sober.  SUD like all diseases has characteristic symptoms and progression. Most of these are well documented and include increased tolerance, withdrawal symptoms, and cravings.   It is these cravings that are the psychological manifestation of the brain disorder.

Cravings are the result of the biochemical malfunction of the brain. Cravings are obsessive in nature.  The person with SUD cannot stop thinking about their drug of choice. Even when thinking about other things the thought of their drug of choice lurks about the edges of their consciousness.

Another symptom that demonstrates that SUD is a brain disease is that it is not only obsessive but also compulsive in nature.  The person with SUD feels a compulsion or irresistible urge to use the preferred substance. This is where people who have never struggled with an addictive behavior, (and sometimes even people who are struggling with an addictive behavior) have trouble comprehending the true nature of the situation.  Irresistible is the key word in defining a compulsion.  People without SUD become confused and frustrated with the people who have SUD.  Why can’t they just stop? They ask.

Quitting and withdrawals

Many People with SUD would stop if they could.  Most people with SUD need to be in a protective secure setting where they can go through a safe withdrawal and get a few days of sobriety under their belts. Without that type of protective environment, someone with SUD is not able to resist the irresistible urge.  This is made worse by the onset of symptoms of withdrawal. Withdrawal is very painful and, with alcohol and benzos like Xanax and Valium, can be life-threatening.  With opiate withdrawals, the person wishes they were dead. A person trying to stop using a substance to which they are addicted needs to be in a protective medically supervised setting for the physiological withdrawals.   They need to be in a secure setting to help them not act on the irresistible urge to use. I don’t mean locked unit, but somewhere where they cannot leave, and where there is someone to discuss the decision with them.  I have seen a trained professional sit with a person whose cravings were overwhelming them and talk them through it.   The person often decides to stay and complete the program, but not always.

As a brain disease,  SUD has a way of influencing a person’s thinking.  People with SUD experience intrusive thoughts about using, and have dreams about using.  More subtle and difficult to understand is how people with SUD accept irrational destructive thoughts as reasonable. It may seem like the thing to do to lie cheat and steal to get their drug of choice, including alcohol.  It as if they don’t consider consequences at all when they make the decision to do something irrational and dangerous.   The person with SUD cannot think clearly especially when they are not in recovery.  Even in recovery people experience these intrusive thoughts, compulsions to use, and obsessive preoccupation with their drug of choice, including alcohol.  How the malfunctioning brain of a person with SUD influences their thoughts and behaviors is very complicated and somewhat of a mystery.

Mastering addiction

The family, friends of a person with a SUD and the person with a SUD would be wise to keep in mind that mastering an addiction is the hardest thing a person will ever do, period.  It is inside them with the brain chemistry changes and outside them with temptations and life’s stressors.  It is powerful and should never be underestimated.  As a reflection of how powerful the obsessive thoughts and compulsions to use are, think about this.  The two strongest instincts for all living things, plants, animals, and people is the survival of the individual and survival of the species.  SUD attacks both of them. People with SUD often put their lives in danger.  Left untreated it is a fatal disease.  Regarding the second instinct common to all living things, survival of the species is compromised when people with a SUD cannot take care of their children.  How often do people with a SUD, neglect their children, put them in harm’s way, abandon or abuse them.  Even people who are “functional” alcoholics or drug abusers cannot be there emotionally and psychologically for their children.

People seeking and in recovery have to have the social support of others and are given a variety of strategies to manage their cravings.  If a person wants recovery, it is possible.  None of the tasks associated with treating SUD are difficult.  The problem is that the treatment is labor intensive.  Every day the person with a SUD needs to do something to treat their illness.  Most commonly this involves going to a 12 step support group AA and NA.  It also involves working the 12 steps and utilizing coping strategies the person thinks will help them manage their cravings. A person with a SUD has to be determined and self-aware.  They have to be on guard to prevent their altered brain chemistry from instigating a relapse.   As they say in AA/NA the person is not responsible for their addiction, but they are responsible for their recovery.  No one can make a person quit using, but no one can stay clean and sober without social support.

About Tanes Moore, MA, LLP

Tanes  Moore spent  10 years working with people struggling with SUD and her primary area of expertise is in the treatment of individuals with SUD, with a special interest in neuropsychology, and psychotropic medications. She currently works as a Clinical Care Manager at BHPI, one of the premier Managed Care Provider Networks in Wayne County, Michigan. Ms. Moore graduated Cum Laude from Central Michigan University with an MA in Clinical Psychology and has completed post Masters work towards a Ph.D. in clinical psychology at the University of Detroit. Her hobbies are watercolor painting and choral and choir singing.


About Behavioral Health Professionals, Inc.:

Established in 2002 and headquartered in Detroit, Michigan, BHPI is a Managed Behavioral Health Organization offering behavioral health services through a fully integrated network of world-class healthcare providers.  Our emphasis is on adding value for our customers by offering expert behavioral care management, medical coordination, chronic behavioral condition management. We are a fully accredited NCQA Managed Behavioral Health Organization (MBHO) & CARF Behavioral Health Business Network. BHPI offers collaborative solutions by building strong partnerships with health plans, health systems, community mental health organizations, and employer groups.   

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