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Better than the real thing: How drugs hot wire our brains’ reward circuitry

Plenty of people have tried drugs. Enough of them, in fact, that about 25 million in the United States alone feel like they can't go without them, according to Keith Humphreys, PhD, a Stanford authority on drug abuse and former senior drug-control policy advisor for the White House. And that's not counting nicotine.

An excerpt from my just-out Stanford Medicine article, "Neurophysiology of Need: Understanding the Addicted Mind:"

All addictive drugs appear to share a rather mysterious property: They're "better than the real thing." Better, that is, than the real things our [brains'] reward circuitry was designed by evolution to reward: food, sleep, sex, friendship, novelty, etc. At least, it sure seems that way to the addict. . . . Addictive drugs fire up the reward circuitry in a way that natural rewards can't - by, in a sense, pressing a heavy thumb down on the scale of pleasure. Over time, the desire for the drug becomes more important than the pleasure the addict gets from it. By the time the thrill is gone, long-lasting changes may have occurred within key regions of the brain.

Humphreys was one of the sources I interviewed for the article. Another was neuroscientist Rob Malenka, MD, PhD, who has attained world renown for his delineation, in rodents, of the underlying neurophysiological circuitry and processes that cause some - but, mysteriously, not nearly all - users of addictive drugs to, in fact, become addicted. Yet another was psychologist Sam McClure, PhD, who has used advanced imaging techniques to show that Malenka's delineation of the pathways of addiction in rodents' brains holds for (presumably human) undergraduate volunteers, as well.

Mapping out the complex pathways of addiction hasn't been easy, because it requires diving into the most complex collection of electrochemical circuitry in existence and fishing out just the right wires and plugs and outlets that play a role in the odd illusion that we now understand addiction to be. Imagine:

The brain is a little bit like the big snarl of tangled wires snaking their way out of that six-outlet surge protector behind your bed. They know where they're going, even if you don't.

That's why igniting the reward circuitry with drugs of abuse may take you places you didn't plan on going. Or maybe it won't. You really don't know, until you do. By then, you may have a problem.

My advice (and Humphreys'): Tell the kids to steer clear.

Previously: Brain imaging, and the "image management" cells that make it possible; New York's growing oxycodone problem; The wrong reason to lionize Christopher Hitchens.
Photo by Ed Schipul

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