Must-Read: : The Elusive Science of Addiction: "By the time people seek treatment for an addiction...
...the highs have for the most part burned out. Their brain function has changed. Their stress- and aversion systems are out of control. The chief complaint that brings patients into my office is that, without drugs, they become anxious and suffer from depression, anxiety, and disrupted sleep. This is a very painful state to be in, and they have had years to learn that there is a quick fix: to resume their drug use.... The basic science on this process once nurtured hope for anti-stress addiction treatments.... It failed miserably, as have similar approaches to every other stress-related psychiatric disorder, including depression and anxiety.... What have we been missing?... I think an important part of the answer is that people with addictions are very different from the mice and rats we have mostly been using in the pursuit of new treatments....
Stress is indeed a critical factor in triggering relapse. But in people, the most important stressors are social. For many patients, exclusion, marginalization, poverty, and loneliness are part and parcel of the addictive process. Research is beginning to find that social exclusion drives the same brain circuits that drive drug seeking. I hope that research guided by these insights will finally result in new treatments. At a minimum, however, it should make it obvious that confrontational, repressive approaches to addictive disorders are very likely to make things worse, rather than better. And that is a neurobiological fact.
