“Advances in medical imaging have revealed that addiction is a complex disease of the brain,” said the director of the National Institute on Drug Abuse (NIDA) Nora Volkow four years ago. “By understanding how addiction affects different neuronal processes, we can gather insights that give us a better understanding of why the behaviors of people who are addicted are so disruptive to their lives and frequently that of others,” Dr. Volkow said.
What nearly every misused substance that results in addiction—whether it be cocaine, alcohol, opioids, or nicotine—has in common is not only that they activate the reward circuit of the brain but also that their repeated use modifies the function of the prefrontal cortex (PFC).
This was also one of the main points emphasized by Ward Blanchard, MA, MBA, CCS, LCAS, the founder and CEO of The Blanchard Institute during his recent Family System Workshop presentation. “Most mental health issues—including addiction—are dysregulation of the frontal cortex and all substance use chemicals affect the brain the same way: they shut off the activities in the frontal cortex.”
The feel-good neurotransmitter dopamine is a crucial element in the addiction cycle. It functions as a motivator and reinforces behaviors we need to survive such as eating by releasing a jolt of pleasure and satisfaction. Addictive substances like alcohol, cocaine, opioids, or cannabis trigger an unnaturally extreme response when they reach the brain. Instead of a simple, pleasurable surge of dopamine, these substances cause dopamine to flood the reward pathway, many times more potent than an endogenous release.
In the workshop, Blanchard called this “society’s nemesis.” While dopamine motivates us toward our goals and needs and helps us “get stuff done,” it also has the potential to form “neural connections that DO NOT help us survive.”
Drug and alcohol use shuts down the PFC and with it any motivation to stop. “Substance use severely diminishes the frontal cortex,” explained Blanchard. Addiction changes “how the prefrontal cortex assigns incentive values to behaviors associated with drug-taking, fixating them,” Dr. Volkow said in 2020 and noted that people who are addicted cannot degrade the intense motivation to take the drug once they have consumed it, which results in compulsive drug-taking behavior. People with addictions often report they can no longer control their behavior, even when taking the drug is no longer pleasurable.
Ironically, many medical professionals—while acknowledging the brain disease concept—still expect patients with addiction to be motivated to stop. “We keep saying it’s a disease but when it comes to dealing with it we still often treat it like it’s a choice: if only you went to school or had a job, the disease would go away,” Blanchard said. “If they go to school, they don’t need to go to treatment. We also tell them, ‘You have to hit rock bottom to get better which is categorically false.’ Why would I tell a person they have to be motivated to fight a disease that eliminates motivation?” Blanchard asked, comparing it to a person coming into the doctor’s office with pneumonia and a temperature of 103 and who is being told ‘Sorry, I can’t help you until the temperature goes down.’ Ultimately, all the addictive chemicals affect the brain the same way: they shut off the activities in the frontal cortex which controls executive functioning, common sense, judgment calls, and problem-solving.”
Blanchard often hears family members describing the behavior of their addicted loved ones as that of a “Dr. Jekyll and Mr. Hyde” from the famous Robert Louis Stevenson novella which—among other things—can be seen as an allegorical depiction of addiction.
COMPLIANCE NOT MOTIVATION
Blanchard thinks it’s a mistake to rely too much on motivation in early recovery because it is the very nature of the disease to destroy motivation. As 12-Step programs found out long ago, “we don’t need motivation, we need compliance,” he told the webinar participants and quoted the popular motto “Fake it until you make it” reflecting a therapeutic technique developed by Austrian psychotherapist Alfred Adler that he called “acting as if,” asserting that “if you want a quality, act as if you already have it.” Adler wanted to allow his clients to practice alternatives to dysfunctional behaviors.
Enforcing compliance has proved to be a highly successful method with professionals like lawyers, doctors, and airline pilots. If those professionals develop an addiction, their associations will require them to participate in treatment programs and regular drug testing (compliance) or their licenses will be revoked—a powerful incentive.
“If professionals want their license back they have to go to treatment and are forced to comply—this has resulted in a success rate of around 90 percent,” Blanchard said. “For the general public, it’s more like 7–14 percent.”
FAMILIES ENSURE ACCOUNTABILITY
Family involvement is crucial in the journey toward recovery. At The Blanchard Institute, we empower families to become active participants in the healing process. By learning and applying specific strategies, families can have a significant impact on the recovery trajectory of their loved ones.
With the help of the Blanchard programs, families provide a compassionate environment where feelings can be openly expressed and validated. Importantly, family members help maintain the structure of recovery by supporting adherence to treatment protocols and encouraging participation in therapy sessions and meetings.
For doctors and lawyers, this accountability structure is provided by the AMA and bar associations, respectively. “Over here in the general population, we depend on educating the family, giving them enough accurate information to create a safe and substance-free environment that reduces triggers and supports a lifestyle conducive to recovery,” said Blanchard.
Relapse is a normal part of the brain disease of addiction. Recognizing the warning signs of relapse and implementing strategies to intervene appropriately is crucial to sustain long-term recovery.
The Blanchard Institute cultivates a safe, comfortable environment for clients and their families across North Carolina. Our family-centered approach is designed to educate, support, and empower families to play a crucial role in the recovery journey. Family members need to understand the complexities of addiction and their role in the recovery process.
Our admissions process is discrete, confidential, and non-invasive. Call us at (704) 288-1097—our experienced admissions specialists will guide you through the process and treat you with the dignity and compassion you deserve.