Why do addicts seek their drug? Why can’t they stop? The 21st
century view is that an addict’s brain becomes literally hardwired to crave the
drug. It’s called “incentive-sensitization” – the theory has been around since
1993 and was made mainstream by an article in the journal Addiction in 2000. Basically, the incentive-sensitization view of addiction
says that drugs tip the scale of how our brains calculate incentives: drugs
rewire the brain so that the drug is the brain’s only reward and thus its only
motivation.
Now, a new
article published online last week in the journal Neuroscience and Biobehavioral Reviews shows that it’s not just
addictive substance, but addictive behaviors as well that can rewire the brain
in this way. Not just what you consume but what you experience can make your
brain crave the experience in the same way it can be taught to crave a drug.
A couple weeks ago, I
wrote about whether or not food addiction is real and here’s another piece
of evidence that it very well may be: behavioral addictions like gambling,
food, sex and others can change your brain, making it hypersensitive to the
rewards of these behaviors. For a person addicted to food, chocolate cake acts
like heroin in the brain: the brain considers food its only reward and its only
motivation, and so seeks food and can’t stop seeking it, even at great
consequence to health and wellbeing.
Not only do substance addictions and behavioral addictions
make addicts more sensitive to the rewards of their addiction, they make
addicts less sensitive to natural rewards like love or safety or belonging. An
addict wants their addiction and nothing else can provide the same fix – it’s
true of heroin and it’s likely also true of gambling, sex and food. And check
out this powerful point: in the brains of addicts, seeking a substance or a
behavior has everything to do with “wanting” and nothing to do with “liking.”
You may not even like the thing
you’re addicted to...but still, you want it.
Seeing behavioral addictions through the lens of
incentive-sensitization can help us treat these addictions. The article points
out that if addictive behaviors are written in the brain, the challenge is to
rewrite the brain in a way that erases these patterns of behavior. The article
points out that treatments with therapeutic drugs can mask the brain’s
addictive desires, but don’t tend to lead to the long-term fix of new patterns
in the brain. Instead, the authors write that cognitive behavioral therapy can,
“increase awareness of cues that trigger craving and teach skills that enable
new patterns of thinking and acting.”
Unfortunately, cognitive behavioral therapy (CBT) depends on
these cues and cravings being conscious.
What about all the unconscious cravings?
The article recommends mindfulness-based interventions, which “can potentially
target unconscious ‘wanting’ mechanisms by increasing awareness of bodily and
emotional signals.”
And so if addiction – substance or behavioral – depends on
“incentive sensitization,” the solution may be to make these cravings conscious
with mindfulness and deprogram them with cognitive-behavioral therapy. If
addiction is written into the brain’s system of incentives and motivations, the
secret to addiction recovery may be to rewrite or at least rebalance this
system.
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Richard Taite is founder and CEO of Cliffside Malibu,
offering evidence-based, individualized addiction treatment based on the Stages
of Change model. He is also co-author with Constance Scharff
of the book Ending
Addiction for Good.
