Dr. Kevin McCauley turns complex neuroscientific concepts into easy-to-understand visual images that will help people in recovery feel better understood and their families and friends feel hope that recovery is possible.
Addiction is never an escape from responsibility for our choices and our actions, but it does affect our brains like a disease that is difficult to control. Because addiction rewires the brain, the substances and behaviors we are addicted to may seem impossible to quit. However, there is hope; the brain can change.
“We find healing and relief only when we bring ourselves to the feet of the great physician: our Savior, Jesus Christ,” said Elder Patrick Kearon of the Quorum of the Seventy.
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[MUSIC PLAYING] I've been helping people with addictions for 15 years. People that are addicted aren't bad, but addiction can destroy their life. If there's anything I could teach people, it's that addiction is a disease. The next 12 minutes could change or even save your life. Join me as I explore the landscape of the mind.
I wonder what it would be like if I could walk through the brain the way I could hike through Utah. I find the comparison quite striking. The brain has bumps and grooves the same way this land has mountains and canyons. The brain is shaped by experience over the course of a lifetime the same way this land is shaped by wind and water over countless lifetimes. One is made of genes, the other geology.
When I compare the anatomy of the brain to the geography of Utah, it helps me understand that the brain is a place. We can go to these places. We can even photograph them.
There are two places in the brain that are important in addiction. One is deep inside: the midbrain. The other is on the outside. It's called the frontal cortex.
If we landed on the surface of the brain, we would find ourselves walking on the bumps and grooves of the cortex. The bumps are called gyri, and the grooves are called sulci. All of our conscious lives--all of that thinking, feeling, speaking, everything we see and hear and taste and touch--occurs here in the cortex. Our memories are here, carved somehow into the brain, like these petroglyphs left by the Native Americans and these names carved into the rock by the Mormon pioneers. But the parts of the cortex that we're interested in, the bumps and grooves that matter most to us, are up there in the frontal cortex.
This is the area of the brain that is most linked with our thoughts, choices, and agency. Morality, judgment, personality--all the things that make a conscious, self-aware being are recognized up here, in the bright sunlight of rationality. Our spirits came from God with desires to choose the right and keep the commandments. The righteous exercise of our agency--loving God and others and knowing right from wrong--comes with our spirit.
Much of what the Apostle Paul in the Bible's New Testament referred to as the "natural man" can be found in the physical body with its emotions and drives. In addition to our spirits giving life, agency, and action to the physical body, God also uses the brain as a place of emotion.
Current research shares that it's up here in the frontal cortex where we evaluate the world. This is where we weigh options and understand consequences. So this is where we exercise our agency.
The frontal cortex is where we give things emotional meaning. So this is the part of the brain where we attach. So this is where a mother loves her child or where we love Mom back. The frontal cortex is where we select our romantic partners and our friends. This is where we give things moral meaning. And this is the part of the brain where we give things spiritual meaning.
It's easy to see how doctors once believed that the defect of addiction was up here in the frontal cortex. If this is the thinking, loving, moral, spiritual, social, choice part of the brain, then drugs must somehow break the frontal cortex to create all that nasty, addictive behavior. It's a powerful idea that drugs work in the frontal cortex and that addiction is due to a moral failing or a personality disorder or a bad upbringing.
There's only one problem with that idea: it's wrong. Drugs do not begin their work up in the frontal cortex, and addiction does not begin up here. Where do drugs work? Deeper down, in a far older part of the brain called the midbrain.
The midbrain does not think. It does not make choices or understand consequences. It handles the next 15 seconds. It gets us from moment to moment alive.
The midbrain tells us to eat. It tells us to defend ourselves, even kill. It fires our sex drive. These are all behaviors that are critical for survival. This is similar to what the scriptures teach us as the "natural man," or where we have our carnal drives.
Ordinarily, the frontal cortex keeps the midbrain in check. It exerts a top-down control over the midbrain. But in addiction, this top-down control fails and the midbrain becomes more powerful at guiding behavior than the cortex. In other words, in addiction, something goes wrong at a level of brain processing long before morals or personality or choice.
Now, how do we know all of this--that drugs work primarily in the unconscious, survival midbrain and not in the rational, decision-making cortex? We know this because of a very famous set of experiments done in the 1950s on mice. The midbrain's role in reward was discovered by Dr. James Olds and Dr. Peter Milner.
They found that a mouse will press a lever to deliver a tiny electric current to two very small, very specific areas of the brain: the ventral tegmental area and the nucleus accumbens. And not only will a mouse press a lever to deliver an electric current to these two areas of the brain; that's all he will do. He won't eat. He won't mate with other mice. If you put an electrified grate in front of the lever and shock the mouse, he won't step off the grate. He just continues to press the lever, ignoring all other survival drives until he dies.
Olds and Milner had discovered the pleasure centers in the brain. Our brains have these same two areas. And the nerve pathway that runs between the ventral tegmental area and the nucleus accumbens is known as the pleasure circuit.
Later, scientists discovered that a mouse will press a lever to deliver drugs to these same two areas. And again, that's all he will do. He won't eat. He won't mate. He just sits on that electrified grate and fries and keeps on pressing the lever until he is dead.
So mice can get addicted to drugs. Big deal. Well, think about it. Drugs produce a very powerful, rapidly fatal addiction in a mouse. A mouse has no personality. A mouse does not weight the moral consequences of pressing the lever. There are no mouse gangs selling drugs to other mice. And yet mice can still become addicted.
This research dramatically weakens the idea that the cause of addiction is a personality disorder or bad morals or a bad social or family environment. These things might accompany addiction, but they cannot be the cause of addiction.
It shows that in addiction, the drug hijacks the survival mechanism of the midbrain. Now the drug is in the number-one survival spot. The solution to starvation is no longer eating; it's the drug. And the relief from being burned by an electrified grate is no longer in simply stepping off that grate. The relief is in the drug.
The drug and survival are now so close together that as far as this addicted midbrain is concerned, they're the same thing. In other words, the drug and actual survival are indistinguishable. This is what happens when someone is in the throes of their addictive cycle and craving a substance or to engage in a behavior. The midbrain overpowers the frontal cortex and takes control.
It's important to remember that even with addiction, people can still make choices and still be held accountable. Addiction can never be used as an excuse to escape responsibility for our choices and our actions. But understanding the brain helps us make sense of the chaos of addiction.
Addiction can come upon us quickly, without us being aware. As we use substances and engage in addictive behaviors, our brains can quickly become addicted. It's hard to say how long it takes or just what exactly we've become addicted to.
But once we've become addicted, the substance or behavior becomes extremely important. The pleasure center of the brain has changed and now prioritizes the substance or behavior. It becomes as though it were life itself.
So in addiction, something goes wrong with the very part of the brain we use to tell the difference between things that are good for survival and things that are harmful. A neuroscientist would call this the brain's hedonic capacity. We can simply call it the brain's pleasure sense. For instance, we can tell the difference between things like broccoli and things like chocolate cake.
And why do we have a pleasure sense? Because we have to tell the difference between something that is good and bad for us. If I am sick to my stomach and nauseous, then even though I like candy, chicken noodle soup might be better for me. And so, to identify and prioritize those things in the environment that are good for survival, the midbrain makes them pleasurable. In addiction, this is the sense that breaks.
Now think about that. If you can't perceive light correctly, that's called blindness. No one is going to question your morality if you're blind. If you can't perceive sound correctly, that's called deafness. No one's going to try and throw you in jail and take away your child if you're deaf.
But that word, pleasure, is very morally loaded. It comes with a lot of moral baggage. And so perhaps you can see, if a person has a defect in this brain sense, they're far more likely to be interpreted as being immoral than they ever are as something akin to deaf or blind.
What addiction is is a defect in the brain's ability to perceive, process, and then act upon pleasurable experiences. And it's because this brain disorder's about pleasure that these patients are seen in moral terms and they make bad decisions in response to being addicted.
Because addiction rewires the brain and causes us to see things differently, there are many implications for us. First, it helps us to understand why it is so hard to quit an addiction. Many times we were able to get some sobriety and clean time and may think that we have finally beaten it.
When we have cravings or temptations to use, these are not signs that we have failed or are somehow a sinful people. Rather, it signifies to us that our brains have not yet healed. The midbrain has not had the necessary time to adjust and revert back to normal.
But there is hope. We learn from neuroscience that the brain is plastic, or than it can change. Just as wind and rain have carved this majestic landscape, our brains can change as well. We just have to be patient and to not engage in our addictions long enough for the brain to begin to heal.
Another application of this knowledge is that it helps inform us of what we need in order to overcome addiction. The Savior can heal us and is there for us. However, we should also do all that we can to help heal ourselves as well.
If addiction significantly impacts our brain, we should do everything we can to help our brains heal. The first step is to pray and to ask the Lord for help to heal and resist the cravings. We should also tell a family member, spouse, and bishop.
We should get a mentor or someone who can be there for us when it is hard. We can attend 12-step meetings and perhaps professional counseling. These actions and others will help us as we move forward in giving our brain the time to heal, to overcome addiction, and to change the landscape not only of our mind but of our future.