How Much Are You Really in Control?
The Fine Line Between Abstinence and Addiction
Belonging to the species of Homo sapiens, we are easily the most intelligent and advanced species which we know of. We have perfected means of communication which are versatile and specific, allowing information to be transcribed, stored and passed down to future generations. This system has paved the way for technological advancements more rapid than anyone could have predicted, resulting in the large societies which we thrive in.
However, with this unique intelligence comes a natural feeling of a boosted ego and complacency. Most of us view ourselves to be above nature, the ones who control and oppose nature. We not only influence and change the environment around us, including actively altering the atmospheric composition, annihilating whole populations of organisms if they harm us or if we simply don’t like them, or cloning dolly the sheep from a somatic cell, but we too try to push our biology to the very limits. Our vast medical knowledge and technologies extends our lifespans, and many of us choose to be vegan, which is something our ancestors could not have done.
We are also complacent to the point where we have confidence in using our well-developed brains to oppose our human nature and biological systems. We believe in mind-over-matter, trusting our brains to be able to carry out our individual intentions, even if our bodies are against it.
However, what many do not realise is that the brain is more primal than it seems. There are many things under our control, and yet there is a whole world of other things which we do not have an influence over, ranging from simple systems such as the knee-jerk reflex, to a complex network of survival instincts which has benefited our ancestors, but have yet to adapt to our current society. The involuntary activity in our brains is commonly underestimated by many, which can lead to severe repercussions, such as in the case of addiction.
The Biology of Addiction
It is a widely known fact that addiction is a biological phenomenon. The increasing reliance on a certain substance, for without it will lead to withdrawal symptoms, is caused by the complex biochemical systems in the addict’s body. The biochemical systems involved for the different types of addiction, such as nicotine, caffeine or drugs such as cocaine are different, but all of them revolve around a similar concept, which involves receptors and their substrates.
Let’s use dopamine, the neurotransmitter most relevant to drug or nicotine addiction, which is involved in the mesocorticolimbic pathway, a more extensive version of the pleasure pathway in the brain, as an example. In simple terms, dopamine is linked to pleasure. The consumption of dopamine-inducing substances such as certain drugs and nicotine causes a spike in dopamine levels in the synaptic cleft, which is the space in between two neurons, in this case inside the brain. When the consumption of these addictive substances become frequent, the chronic abundance of dopamine in the synaptic cleft causes a lot of dopamine to bind to the relevant receptors in the postsynaptic neuron, which is important in creating that pleasurable feeling. However, the body is adapted to react to and compensate for the high levels of dopamine by reducing the number of dopamine receptors, promoting dopamine reabsorption or degradation, or by other means. Over the long run, each molecule of dopamine is able to cause less of a pleasurable effect due to these neuronal changes, resulting in the bodily desire of more and more of such addictive substances to feel the same amount of pleasure, without which would result in withdrawal symptoms. This positive feedback loop is the primary neurological mechanism for addiction.
On top of this, particular drugs also interacts with neurotransmission directly. Some compounds, such as heroin, marijuana and nicotine mimic different neurotransmitters structurally, and hence can bind to the respective receptors. These drugs are simply additional molecules of the neurotransmitter, which induces a greater response from the dendrite. In some cases, these drugs are even much better stimulants as compared to their neurotransmitter counterparts. Other drugs such as cocaine reduces dopamine reuptake into the axon terminal of the sending neuron by binding to the dopamine transporter, preventing it from doing its job. Lastly, some drugs like benzodiazepines directly affects the receptors themselves, increasing or decreasing the strength of the signals sent out of them.
Besides affecting the neurotransmitters and their receptors, drugs also cause changes in gene expression for particular genes, which results in addiction. For example, the overexpression of one very prominent and important transcription factor in addiction, ΔFosB, is necessary and sufficient for many of the neural adaptations and behavioral effects seen in addiction. Drugs of abuse induce gene expression of ΔFosB in the nucleus accumbens, a part of the brain which mediates reward behaviour, and chronic acquisition of these rewards can result in a similar pathological addictive state through ΔFosB overexpression. Finally, many neuroepigenetic mechanisms such as histone modifications, DNA methylation of particular CpG sites and epigenetic downregulation or upregulation of microRNAs (miRNAs) also regulate gene expression which could result in addiction.
As a whole, there are many complex biological systems and processes working behind the scenes when we consume drugs or addictive substances such as nicotine. These bodily systems are inbuilt into us and cannot be easily modified, even with medication, let alone using the sheer willpower of our minds. Whether you like it or not, if you consume such compounds, a tendency towards addiction is inevitable because of how we have evolved. That leaves us with the question: Are our minds sufficient in preventing us from falling into that never-ending downward spiral of addiction and self-destruction?
Mental Willpower vs Bodily Systems
There are many instances in which human mental willpower is relied on to achieve different purposes. For one, let’s take a look into new year’s resolution. On every new year, a popular trend is to reflect upon the past year, and set new personal goals for the new year. The purpose of a new year’s resolution is to let go of past regrets, only looking forward and hopefully spurring productivity into the new year. However, failure rates of such resolutions are high year after year. A study from 1989 tracked 200 people living in Pennsylvania as they attempted to make changes based on New Year’s resolutions. 77% of respondents managed to hold to their pledges for 1 week, but the success rate dropped to 19% over 2 years. This is but a mere indication of the frailty of human determination, as there are many flaws with using new year’s resolutions as a measurement of willpower, such as the lack of commitment from the start, or the creation of the resolution out of peer and societal pressure.
How about the determination in dealing with a more pressing issue, such as obesity, which could possibly lead to other health problems such as heart disease and diabetes? Weight loss is one of the common goals people make, with around half of our new year’s resolution having to do with weight loss. However, it is also notorious for its failure rates. Dieting is one way to reduce body weight, but it certainly is difficult, because it simply isn’t natural. Hunter-gatherers in the past need to eat their fill whenever possible in order to survive, and that innate want for food has been passed down to the current generation. Forcing our bodies to consume less food opposes our very nature, resulting in a variety of hormones to be secreted, which basically tells us that we are hungry. Staying on that diet becomes increasingly difficult, and in the end, people rarely lose more than an average of 10 pounds (4.5kg) even after a year of trying. The other method of losing weight, exercising, is not easy for many as well. The incentive to exercise is significantly dependent on genes, as different people derive varied amounts of enjoyment out of exercising. Real-life interventions, such as community-wide campaigns or even hiring a personal fitness trainer only increase daily calorie use of 35 and 80 calories respectively.
These simple examples show that our minds are not as strong-willed as we think they are. We commonly fall prey to our bodies’ instinctual and involuntary needs and wants, unable to effectively execute our plans for change.
Addiction vs Free Will
As established earlier, the addictive feeling is a complex combination of biological feedback from our bodies when we consume addictive substances. When we consume such substances frequently, an automatic and unconscious response builds up in the body, resulting in, say, cravings for said substance. However, since the act of consuming the drug is ultimately a conscious effort, there presents one last hurdle to cross before spiraling into addiction, which is the conscious response. But how strong is our conscious response? Will we still possess free will and limit our substance intake?
Let’s use one of the most common, and most dangerous forms of addiction as an example: smoking, with relation to the nicotine inside the cigarettes. There has been many papers describing the effects on smoking, as well as other forms of addiction, on free will, but these views are quite contrasted.
On one hand, addiction is viewed as a form of ‘brain disease’, and this perspective is named as the brain disease model of addiction (BDMA), which has been advocated for by the US National Institute on Drug Abuse, since 1997. The BDMA has been backed out by a fair share of experiments and evidences, including the use of animal models, ie. using mice to mimic human behavior in addiction, and neuroimaging studies in ‘normal’ and ‘addicted’ human brains showing that dopamine-mediated changes in cortical areas correlate with impaired decision making and poor impulse control. This is further fortified by the fact that genetic factors play a significant role in an individual’s susceptibility of being addicted. Hence, the BDMA has been a dominant perspective for addiction.
However, this view has been recently challenged by scientists, such as Marc Lewis, who argued that brain-changes related to addiction are similar to everyday changes of the brain, and that addiction can and should not be viewed as a disease. Lewis proposes that addiction is a mere bad habit, which is accompanied by a change in control from neural circuits involving the ventral striatum to circuits involving the dorsal striatum. Several cases in Lewis’ book show that individuals can stop addiction with just will-power without any special treatment. Similar to the neurological process of learning, Lewis argues that addiction is a habit that grows more quickly and becomes more deeply rooted in our neural circuitry than other habits, because of the intensity of the motivation of wanting to repeat them.
Despite Lewis’ convincing stand on the subject, there are some ‘black swan’ cases where addiction leads to brain disease. This is true for many cases of Korsakoff’s syndrome, a neurological condition affecting memory, which is caused by thiamine deficiency, which is in turn always caused by alcoholism, for those who have sufficient thiamine in their diet. Furthermore, other studies concludes that drug dependence can impair parts of the brain that are necessary in recovering from addiction. For instance, neuroimaging studies depict a pattern of generalised prefrontal cortex (PFC) dysfunction in drug-addicted individuals related to higher levels of drug use, worse PFC-related task performance and greater likelihood of relapse. In some cases, severe reliance on drugs and addictive substances also damage the brain to the point in which autonomous choice is largely lost.
Moreover, even though ‘free will’ seems to still be present when an individual is addicted, some scientists argue that the availability of a conscious choice is illusory in many cases. A famous study from Benjamin Libet demonstrated that neural signals that reliably predict a subjective feeling of choice appear about 350 milliseconds before the subjective experience of that same choice. Daniel Wagner also shows that circumstances can be manipulated such that participants experience “free will”, even though this is ostensibly untrue. These experiments have led to many neuroscientists and neurophilosophers abandoning the notion of ‘free will’ altogether, as it is merely an illusion. Our unconscious processes can more or less make the decisions even before we know that the decision has been made, and we only experience the decision-making process after the outcome has been decided, although it might seem as if we are guiding our own actions and making our own decisions.
Evidently, the overarching question of control and free will when consuming addictive substances have yet to be answered conclusively. There are many cases where people could quit and escape from the addiction cycle using sheer willpower, and there are also cases where addiction renders a person to lose his/her autonomy in decision-making. Both stances are well-justified, and the answer lies as a blurred point somewhere in between the two extremes, also varying from person to person, depending on environment and/or genes. Further studies and neurological experiments might shift the scales to either side, but as of now, this is all we know.
But instead of locating the exact location of this point in the spectrum, we can look at the question from another perspective, which is to ask, “Which stance is more helpful?” Research has actually shown that the BDMA perspective is actually counterproductive in helping addicts quit. Smokers who perceived smoking as an addiction had more trouble quitting than smokers who viewed it as a bad habit, because the smokers can easily shrug of the personal blame from their shoulders, instead pointing their fingers at their programmed biological systems, or that “brain disease”. On the other hand, I feel that the BDMA is a beneficial perspective for non-smokers to adopt, as it discourages them from smoking in the first place, in view of the high likelihood of losing their free will and spiraling into addiction.
Regardless of whatever stance you lean more towards, it is clear that different individuals react to addictive substances differently, and our susceptibility to smoking varies from person to person, which is influenced by the environment, and also importantly, our genes. An important point to note is that you do not actually know how susceptible you are to being addicted to whatever substance, unless you have already tried it yourself. In other words, no matter how strong-willed you think you are, or how sure that you are in control of your actions and decisions, you will never be sure if that first attempt will cause you to lose control, or if you are extremely resistant to addiction.
My stance is that it is never worth it to take that first step, to smoke that first stick or to consume that first drug dose. It is almost universally known that these substances destroy lives and livelihoods alike. The effects of these poisons not only affect your health, but the people around you as well. If you put that first foot into the unknown, and somehow happen to be particularly susceptible to addiction of that substance, it will be a point where few will return to. It is not impossible to return, but this is how many lives were ruined, just from that first step. For me, the risk is all too high, for that fleeting feeling of pleasure. Before you take that first step, you have to be prepared to walk that endless journey without stopping. If you are unwilling to bear the consequences and take responsibility for that outcome, then don’t even start to begin with.
They say prevention is better than cure, and in this case, the phrase most definitely holds true, even if cure is not impossible in most cases. Consider very thoroughly before taking the first step, and don’t be surprised if your mind and body betrays you.