What is Going on in that Head of Yours?

By Shari Scott, MSN, Director of Nursing, Midwest Detox

When my children were little and made less-than-desirable choices I would ask them, “what was going on in that head of yours?” Then I would let them explain what they were thinking or how they impulsively acted. Working in the field of addiction, I often hear some form of that same question from loved ones…Why can’t they stop? Why are they doing this? What is wrong with them? Why don’t they understand?

Those who have never experienced addiction are often unable to understand why a person with a substance use disorder does not simply stop. According to the American Society of Addiction Medicine (ASAM), addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.


People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Changes in brain circuits often remain long after the withdrawal period or stopping of a substance. Understanding these changes in the brain can help clarify why “just stopping” is often not possible and why in some cases it is dangerous to abruptly stop using.


Each of us has a reward system within our brain. Initially, this system encourages behaviors that keep the human species alive, like eating and sexual reproduction. These behaviors are rewarded with feelings of pleasure. The chemical responsible for these pleasurable feelings is the neurotransmitter dopamine.


While addictive substances have different effects on the brain, one thing they all have in common is they all  mediate the release of dopamine. This release of dopamine from an addictive substance is powerful. In the initial stages of addiction, as more of a substance is used there is a surge of dopamine in response.


To adapt to this increase in dopamine, the brain decreases the number of dopamine receptors and decreases the amount of dopamine released. The person then needs to increase the amount of drug they use to have the same pleasurable experience. Dopamine not only impacts the reward circuit but also impacts the prefrontal cortex and executive functioning as well as memory.


These changes result in drug seeking behaviors that are driven more by habit than by conscious thought. The executive functioning center of the brain is rewired to do whatever is necessary to get the substance. Planning to get the substance can also trigger a dopamine release. These changes do not go away quickly as the brain circuitry has been rewired for seeking drugs and using.


Understanding the changes in brain circuitry (the one discussed above, and others not discussed here) that accompany substance use disorders helps us understand that addiction is not a character flaw, moral failing, or lack of willpower. Addiction changes the brain, making it difficult to overcome.


Add these changes in brain circuitry to socioeconomic factors, maladaptive responses to stress, trauma, mental illness, or genetics and it is clear that addiction is a multifaceted issue. For most, it will require a multilayered response. Underlying trauma exposure certainly may be at the root of addiction but there are also changes in the brain as the addiction progresses.


As the belief that addiction is, in some respects, a brain disease continues to grow, some of the stigma associated with substance use disorders may decrease. It may also result in higher quality services for those with substance use disorders. These services can be based on respect and compassion rather than judgement and punishment.


If you are watching a loved one struggle with addiction it may be helpful to consider these changes in the brain. Understanding these brain changes will not make the situation easier to manage, but it can be beneficial to understand the reasons why someone may not be able to “just stop.”

If you or a loved one is struggling with substance use, please call for help. 414.409.5200