UNDERSTANDING ADDICTION:

PATHOLOGICAL PURSUIT OF RELIEF AND REWARD

Forty years ago when Mel Schulstad shared his stories of addiction and recovery, one question haunted me night and day: What happened? 

What happened to this intelligent, compassionate human being─a man of deep faith and personal integrity, a decorated war hero, the loving husband and father of four children─to warp his thoughts and behavior to the point that he put his marriage, the safety of his children, his career, his reputation, and his own life at risk? 

Something momentous had to happen, I knew that, and whatever it was had little or nothing to do with morality or character defects because when Mel stopped drinking and freed himself from the fiercely tenacious prison of his addiction, he "came back" to himself.  He became the person he used to be, before the addiction took hold of him. 

Even more stunning, Mel emerged from his decades-long battle with an inner strength built on an unshakable foundation of honesty, humility, and gratitude for the gift of a second chance at life.  

Back in the 1970’s and 1980’s when I started researching and writing about addiction, the scientific data was well established but encased in scholarly tomes rarely seen or read by the lay public -- people like you and me.

I spent hundreds of hours in libraries studying books with terms such as “mitochondrial disfigurations” and “tetrohydroisoquinolines,” requiring my non-scientific brain to do ever more research in an effort to ferret out the facts that I could then reconstruct into language easy on the eyes and brains of the similarly uninitiated.  (Phew, that was a sentence!)

Determining “what happens” in addiction is not simple or easy, as witnessed by the 2011 American Society of Addiction Medicine (ASAM) definition consisting of a “long version” of 2,879 words and a “short” 110 word description, which I cut by more than half below: 

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

Four critical words in that short definition deserve closer attention.

Pathological:  If we keep engaging in behaviors that are harmful to our mental or physical health and, significantly, the health and well-being of others, that's "pathological.”

Pursuit:  I once heard a story about an alcoholic Civil War soldier who described the depth and breadth of his craving for alcohol this way:  "If a bottle of whiskey stood on the other side of this field with cannons shooting at me from all sides, nothing would stop me from trying to reach that bottle." 

The soldier's pathological pursuit was underlain by a physiological imperative -- an intense craving or need driven by maladaptive brain circuitry, resulting in his willingness to risk life and limb to obtain the relief he desperately needed.

Reward:  The human brain evolved to respond to “natural” rewards -- food, water, sex –essential for health, survival, and reproduction.  Alcohol and other addictive drugs activate the same brain reward systems to create similar sensations of pleasure, satisfaction, and euphoria, which over time can take precedence over natural rewards essential for survival.

Relief:  As addiction progresses, rewards gradually diminish and pursuit of relief intensifies.  The pleasurable jolt the drugs deliver to our brains is overpowered by withdrawal symptoms and addicted individuals find themselves wanting, craving, needing -- and finding a way to acquire -- more. 

What happened to Mel Schulstad?  What is happening today to more than 20 million people struggling and suffering from addiction? 

Brain circuitry goes awry.  Pleasure decreases as pain increases, intensifying the need for the drug that started it all in the first place, but which no longer works its artificial magic.

“Cunning, baffling, powerful," in AA co-founder Bill Wilson's words, the disease gains power as it hacks away at our ability to understand or stop what is happening.

The very last line in ASAM’s short description is not comforting:  “Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

And yet . . . the hope is right there, too, for with appropriate treatment and continuing, compassionate recovery support, addiction can be stopped dead in its tracks. 

That’s what happened to Mel Schulstad

And that’s what’s happening to 23 million Americans who are in recovery today.