Addiction: what happens in the brain

A neuroscientist and former drug and alcohol addict has a stark warning about our binge-drinking culture and where it can lead.

Dr Judith Grisel knows all too well. She started drinking and taking drugs at 13 and is now 30 years sober and a neuroscientist who studies addiction and the brain. She is behavioral neuroscientist and a professor of psychology at Bucknell University in Pennsylvania.

In her younger years, Dr Grisel abused marijuana and alcohol, injected cocaine, got kicked out of university and became homeless.

She is the author of Never Enough: The Neuroscience And Experience Of Addiction and joined Afternoons to share the brain science about how addiction happens, why drugs including alcohol and opioids are so hard to quit.

Dr Grisel says she found herself hooked from her first drink, which she remembers very well.

“I was in the basement of a friend’s house and we found her parent’s stash. We opened up half a gallon of wine, probably nothing very good. I drank more than my half, and that was sort of my pattern, I made sure I had at least my share if not more.

“It was just life changing really. It seemed to fill a hole in me that I didn’t even realise was there so that I felt well and complete and warm and competent and funny. I felt it was like a key to my adolescence, if not my adulthood. I remember thinking, ‘A ha! This is how people do it.’”

Apart from feeling a bit insecure, she was a sheltered youth with a stable family environment. There were no external factors that would play an obvious role in addiction that took over her life.

“Until I had the drink I didn’t know that there was something not quite right. But once I had it, and what I thought was the solution, I really was aware that without I didn’t feel nearly as good.”

From fun to necessity

She says she now knows that it’s a sign of addiction to start young and that 80 percent of people with drug and alcohol disorders begin before they’re 18.

“The earlier they begin, the higher the risk. Some people have said it’s a seven percent increase per year before 21. So, when I did the math, I was definitely stacking things against myself for developing an addiction and after that [first] time with the alcohol, I drank as much and as often as I could. Shortly after that I discovered marijuana and then smoked as much and as often as I could. I basically spent 10 years never saying no to anything.”

Binge drinking is seen as a normal part of life, and somewhat of a coming of age ritual, for teenagers in New Zealand. Dr Grisel says that’s “extremely dangerous”.

“It really increases the likelihood of developing alcoholism and, of course, that goes with other drug use disorders. It’s partly the early use, but it’s also partly the pattern; if you were to drink, say, seven drinks a week but you had one a day, it turns out that’s not as bad for your brain and your life as if you have seven drinks a week but they’re all in the same couple hours.

“The binge pattern, of putting high doses on fast, during adolescence changes brain structure and function and it also predisposes towards alcoholism.”

She says addiction begins with enjoyment. Drugs and alcohol are a first wonderful treat we indulge in, but it can become a habit. After becoming a habit, it can becomes a necessity and compulsion and then it’s not something we enjoy, but need.

“By the time I was 23 and stopped, they [drugs] were only making it worth getting out of bed in the morning for. I was definitely dependent psychologically and, in some cases, physically dependent.”

She says she was spurred to quit by a friend who died with a needle in his arm because he couldn’t get enough. She says this is how addiction can kill, the brain adapts to drugs and counters the effects so higher doses become necessary.

“If you drink alcohol to relax, your brain induces anxiety and tension so that you come out kind of even. For me, with alcohol, I could never repeat that first wonderful experience. It was never quite as terrific, so I was always seeking that, and it was never enough.

“With cocaine, which is probably what precipitated my very early bottom, the more you take, the more you want to take and the less satisfying it is. They say that the first time is always the best, and that’s definitely the case with alcohol and other drugs because that’s when your brain is least adapted and as it adapts the pleasurable effects grow smaller and smaller and smaller and smaller so that you can never really get enough.”

Dr Grisel explains that addictive drugs, and even activities such as gambling, activate a core reinforcing system in the brain called the mesolimbic dopamine system. She says it gives the person a feeling of happiness, thrill, and excitement.

“That’s why we like them so much, because alcohol and all these other drugs to this.”

'Diseases can be cured'

But with overuse and abuse, the system becomes less effective leading people to take higher doses. It’s how she ended up injecting cocaine.

“I had been snorting cocaine for a while and I always had this idea that I wouldn’t use needles, I had lots of ideas that went out the window one at a time. In that particular case, it was the first opportunity I got the chance.

“I think what happens with people like me on their way to dying or recovering – hopefully – is that we lose our real ability to choose. A normal person would look at that and this situation and this dirty community bathroom and say nobody in their right mind would do something like this, and I was certainly raised to not do something like this. But, I got the chance and I took very little time in doing something like that. And, of course, once you do it once, I never wanted to snort it again – it seemed like a waste of time to me. I’m lucky to be alive, this was in 1980s and many people I knew contracted diseases or died of other things.”

Dr Grisel says this demonstrates how drug abuse changes the priorities and reasoning of users.

“Your sense of right and wrong kind of pale in comparison to this compelling desire to escape with drugs.”

By the time she got into treatment she felt “like a hollow drum.”

“I felt like I didn’t have any self-respect, I didn’t have any kind of emotional life. I was almost dead, and I think I was on my way to being physically dead.

“I ended up in treatment by mistake in a way. I didn’t know exactly what I was getting into, but when I got there, and I heard that I had a brain disease – it’s funny, I heard the word disease and thought, well, diseases can be cured – so then I got a little bit of hope.”

She says she still has desires for drug and alcohol and often finds herself thinking it’d be nice to have a margarita or some marijuana. But, it’s gotten easier with time.

“I thought my life was absolutely over. I was 23. I thought, I don’t even want to live without drugs, it’s all I really care about. It took a while, but I have got to say that I have such a full, rich life and I probably sound like a crazy old lady with that, but I’ve had so many amazing experiences.

“At the beginning it was hard every day, and most of every day. And then, gradually, my life got a little better and so there were times when I thought ‘this is OK, without it – there can be fun, there can be interest, there can be other things to do besides sit around and get wasted’. So, that was good, but the feelings still occasionally pop up although not nearly as often.”

It’s easier today than ever for young people to get their hands on drugs and alcohol and Dr Grisel says addiction is on the rise, while progress in treatment is more or less flat.

“Your chances of recovering are really no higher overall so it’s a really complicated and difficult problem and it’s costing a lot of lives and wellbeing.”