How you become dependent

Now that you’ve got a basic understanding of how your brain works to change how you feel, let’s look closely at how you get hooked on addictive substances. No one intends to become addicted. No child says, ‘I’m going to be an alcoholic when I grow up.’ No adolescent who experiments with drugs thinks, ‘I want to become a junkie.’ No one, when taking the first puff, drink, sniff, pill or injection, plans on getting addicted to cigarettes, marijuana, caffeine, alcohol, cocaine, speed, prescription medication or heroin. Yet for a great number of people, that first drink, smoke or hit leads, deceptively and often slowly, to physical dependence.
Mood-altering substances change the balance of the neurotransmitters in your brain and nervous system. They sensitise the brain to drug-related stimuli, and alter brain ‘organisation’.

Why the brain gets hooked

It is impossible for anyone who has never been chronically addicted to comprehend the power of addiction. It seems logical and reasonable to stop doing something so harmful to yourself and others, especially those you care about most. But the addiction process does not involve the part of the brain that is reasonable and logical. It involves a part of the brain called the limbic system. This is the brain’s pleasure and reward centre; concerned with our survival, it is the part that tells us to eat, drink, fight or take flight. It monitors the body’s need for survival, and when it senses our survival is dependent on a certain behaviour it creates a compulsion so strong that it becomes extremely difficult to resist taking that action. Without it we might forget to breathe or eat or reproduce.
How addiction becomes like survival

As you become hooked on any substance, this part of the brain begins to react to the presence or absence of the substance as it does to the need to eat or breathe, as though it is a substance necessary for survival. The reward systems of the brain may become hypersensitive (‘sensitised’) to drug-associated stimuli so that anything associated with drug use sets off a craving for the drug, even after the drug experience is no longer pleasurable.
We should point out that in the later stages of addiction to some substances, such as alcohol, withdrawal can be so serious that it is possible to die as a result. In the case of nicotine, caffeine or sugar you will not die, but the reward system doesn’t distinguish between those circumstances when we might die and those when we feel that we might.
How the brain is tricked

To understand this process completely, it is important to know that the neuron’s receptors will also accept mood-altering chemicals that mimic natural brain chemicals: dopamine, serotonin and endorphins. In other words, mood-altering chemicals can sneak into the letterbox (as we described on page 34) intended for neurotransmitters like dopamine and serotonin and fool the brain into acting as though they are the real thing. For example, cocaine docks onto the receptor for dopamine; heroin mimics endorphins, fitting into the same docking port; and alcohol mimics GABA. That’s why these substances make you feel stimulated, motivated, euphoric or relaxed. They are taking over the role of the natural substances.
Any substance you crave, or any substance that makes you feel good, is either promoting your ability to make or restore the balance of your neurotransmitters, or it can mimic the neurotransmitter, docking onto its receptor site.

A short explanation of addiction

Probably none of us would become addicted if nature had not built in a mechanism whose goal is to prevent us from being too elated for too long. Remember the kick from your first cigarette, alcoholic drink or coffee? Have you ever wondered why you don’t experience that any more? Why do you need more and more caffeine, nicotine, alcohol or drugs to get the same effect, or at least to keep thinking that if you only had a little more you would get the same effect?
When we boost our feel-good neurotransmitters, as we do with a cup of coffee, a cigarette or a drink, the dopamine released causes a feeling of well-being. However, in response, the receptors gradually shut down, deflating our high. A key concept in the body and brain, as in all of nature, is balance. Much as a thermostat keeps our home at a desired temperature, our body has ways of maintaining a state of equilibrium. It doesn’t want us to be too high for too long! Is nature a killjoy? A likely explanation is evolution. Blissed out, happy monkeys get eaten. It’s the paranoid, edgy, pessimistic ones, who are always on the lookout, who survive!
Why you become dependent

In response to an increase in the amount of neurotransmitter available – for example dopamine from drinkng coffee – there is a ‘down-regulation’, a desensitising of the receptor sites. This means that some receptor sites shut down, making the neuron less responsive. Consequently, you need more of the substance – caffeine, nicotine, cocaine or whatever – to release neurotransmitters into the synapses and get the message across. It’s as if, in order to block out the yelling of the neurotransmitters, the receptors put on earplugs, leaving the neurotransmitters no alternative but to yell even louder.
The body’s self-regulation process, then, makes it impossible for us to gain any long-term benefit from the mood-altering substances. Herein lies the rub. The net result of addiction is that once the initial effect has worn off, the body’s normal ‘talking voice’ just isn’t loud enough to get the now-somewhat-deaf neighbouring cells excited. So you need more and more. No longer will that regular cup of coffee (around 100mg of caffeine) give you the kick-start you need. You need a large ‘special’ coffee (around 400mg), perhaps with a cigarette thrown in, or even a mochaccino (chocolate plus coffee – two different sources of caffeine), or some coke or a stimulant drug.
The desired effects get less and less

Of course, the more you have and the more often you have it, the more your brain cells ‘down-regulate’ by shutting down receptor sites. Continue along this slippery path for long enough and the effects of the substance become nothing like they used to be. The cup of coffee that gave you a rush of energy, now only relieves your ever-increasing fatigue. You need it just to feel normal. You’ve been trying to cheat the system and it’s fighting back.


Down-regulation and up-regulation

So why don’t you stop? For most of us wanting the substance becomes the driving force, not necessarily liking it. Your desire for the substance becomes almost irresistible when you’re in the setting or situation, or with friends that you associate with the substance, or even when you see something that you associate with it. This makes you crave the substance even though it doesn’t really work for you any more.16
What happens when you stop?

Unfortunately, by the time you realise this and stop using the substance, your body’s chemistry doesn’t give you an unconditional pardon. Two things have been occurring. The reward system has become sensitised to the regular intake of the addictive substance to the point that anything associated with drug use can trigger severe craving and the sense that life depends upon continued use. For example, if you have associated smoking with a cup of coffee, then a cup of coffee following a meal may trigger a craving for a cigarette so strongly you can feel you might die without it. In addition the brain has adapted to the intake and punishes you with withdrawal when you stop using the substance. In effect, the withdrawal period is the time it takes from the moment you quit using stimulants until your neurons ‘up-regulate’ to hear your neurotransmitters’ normal speaking voice once again. In the case of caffeine this is only a matter of days. For nicotine or heroin it can take weeks. In many cases it never recovere. less you follow our How to Quit programme, which provides an adequate supply of nutrients that nourish and repair the brain.
Does this happen to everyone?

Before we go on, we need to point out that this does not happen to everyone who drinks alcohol, smokes cannabis, tries cocaine or drinks coffee. Some people have a form of a gene that causes the reward receptors in the brain to become rapidly sensitised to the drug.17 Other people may have a form of a gene that causes them to be deficient in certain neurotransmitters or receptors.18 There may be other genes or combinations of genes or environmental factors that cause other people to be more susceptible to becoming addicted.19

Case study  JAMES AND RICHARD

James and Richard are brothers. As teenagers they took drugs together. They used the same drugs in the same quantities. But as they reached college age James began to see that his drug use was interfering with what he wanted out of life. He quit using illegal drugs, though he continued to drink infrequently and always in moderation. But by the same age Richard realised that what he wanted out of life was drugs. James enrolled in college, established a career, had a family and became politically active and a respected member of his community. Richard enrolled in college, too, many times; but he never completed a term before some drug-related incident interfered. He got married a couple of times, but when each of his wives asked him to choose between them and drugs, he chose drugs. He is now in prison, serving an 18-month sentence for possession of cocaine.

What was different in these brothers? To answer this we need to look at what happens in the brain of some people that predisposes them to be more susceptible to becoming dependent on mood-altering substances.
Reward deficiency can lead you to addiction

Remember that in the last chapter we said that when your brain is working properly it rewards you? It creates a sense of well-being, pleasure and satisfaction with normal activities. But what happens when the brain is not working like this? When there is too much of one neurotransmitter or not enough of another, it sends out a powerful message to correct the imbalance. We become restless and anxious, feel empty, unsatisfied and have vague or specific cravings.
When your brain does not provide the normal reward, you will often feel as though you are constantly in need of something to fill the emptiness, reduce the anxiety, soften the environment, elevate the mood, quiet the restlessness or satisfy the cravings. People in this state are reward-deficient and look for something to relieve the imbalance and help them feel good. This is the brain telling us to take action to correct the imbalance. When you do not find healthy ways to do this, you will find unhealthy ones. You might think that the reward-deficient person would crave what is good for them (like broccoli) rather than what is not good for them (caffeine). Much of the time they don’t know what it is they are craving. They are just seeking something to satisfy the lack, to fill the feeling of dissatisfaction, like when we eat something when really we are thirsty. Broccoli, for example, doesn’t provide the almost-instant lift that coffee does, even though in the long run broccoli might help correct the imbalance – but coffee works in just 15 minutes. For some of us, however, that isn’t fast enough and we find that cocaine does it better and faster – in 15 seconds. Crack, on the other hand, does it instantly. Now you’re in heaven, heading for the hell of reward deficiency.
What causes reward deficiency?

There are many causes of reward deficiency, and it’s worth going through a few of the major ones.
Genetics Some people are born with a genetic make-up that interferes with normal brain chemical balances so that mood-altering substances become more appealing. Studies have shown that numerous genes are associated with conditions that manifest as symptoms of reward deficiency.20 There’s growing evidence that if you inherit fewer receptors for dopamine you will be more likely to choose substances such as alcohol, and to become addicted.21 It’s a hot and complicated area of research.22 Among the inherited conditions linked to reward deficiency is ADHD. In fact, there’s a strong link between ADHD symptoms in a child and addiction as an adult23 and people with ADHD are more likely to have the genetic tendency to reward deficiency.24 Many ADHD kids are reward-deficient and so they seek stimulating behaviour such as being hyperactive and taking risks to stimulate their brains into giving them what they don’t have naturally. Alternatively, they may become addicted to sugar and caffeinated drinks, and in adolescence they may begin using nicotine and alcohol and, frequently, illegal substances.
People born with the genetic predisposition to reward deficiency are more likely to become addicted.


Case study  TWILA

Twila’s father was an alcoholic. Although she didn’t realise it while she was growing up, looking back on it, Twila realises that her father also had symptoms of adult attention deficit disorder. She was diagnosed with ADHD as an adult recovering alcoholic. In remembering her childhood, she recalls that she was always restless, had difficulty concentrating, felt high levels of anxiety, was easily stressed and was distracted by noise and competing sounds. She remembers that she never felt comfortable, at ease or satisfied. She believed there was something seriously wrong with her, but she had no idea what it was. She just knew from an early age that she was different. It wasn’t until she discovered alcohol in her early teens and began using it to change her brain chemistry that she began to fit in and feel comfortable and satisfied. Twila was probably born with reward deficiency that she inherited from her father. And her reward deficiency put her at risk of addiction.
One way in which your genes could tip you towards reward deficiency is fewer receptors for the feel-good neurotransmitter dopamine because of an abnormal form of the D2 receptor gene. In effect, this form of the gene renders the dopamine system inefficient.25 The number of dopamine D2 receptors are consistently lower among substance abusers.26 Inheriting this tendency is associated with more severe problems with alcohol.27
Non-genetic causes of addiction

Although the risk of addiction is very high among those genetically predisposed, reward deficiency can also result from non-genetic causes.
Prenatal conditions such as malnutrition or use of alcohol or drugs by the mother during pregnancy can result in conditions related to reward deficiency. Plenty of research has linked drinking during pregnancy with the risk of numerous problems in children, including behaviour, attention and impulse problems, alcohol disorders and even criminal behaviour.28
Malnutrition As we have already explained, neurotransmitters are produced from amino acids, vitamins and minerals, many of which are derived from food. So if you eat poorly over an extended period of time this can weaken the production and interaction of brain chemicals. Malnutrition can result from very low-calorie dieting, anorexia or bulimia, an unidentified food allergy (perhaps to gluten), or a diet simply lacking in adequate nutrition (due to any number of causes). When these ‘building block’ nutrients are lacking, the neurotransmitter system breaks down.
Severe or ongoing stress can do long-term damage to the reward system of the brain. This may be in the form of a single traumatic event (such as if you were in an earthquake or witnessed a murder), intermittent or chronic stressful events (such as child abuse), a series of highly stressful situations (a death followed by a serious injury followed by the loss of your job), or an ongoing condition of unrelenting stress (if you live with an alcoholic or drug-addicted person). It’s important not to underestimate the relationship between extreme stress and altered brain chemistry. When you are under normal stress, your brain’s neurotransmitter balance returns to normal as the stress passes. But when stress is severe or prolonged, these chemical levels may never return to normal without the correct nutrients to repair the damage. And when you are in a state of chronic stress you are more likely to turn to the use of mood-altering substances to lower it.
Lack of sleep If you go without sufficient sleep on a continuous basis this can also lead to reward deficiency. As you’ll see in Chapter 13, sleep is a vital component of health. In fact, it’s how the limbic system (the part of the brain involved with addiction) discharges negative, unexpressed emotions from the day before. Without enough sleep the stress and tension builds up and upsets the brain’s normal night-and-day cycle of feel-good neurotransmitters.
Physical trauma Damage to the head can also lead to an imbalance in the brain’s chemistry. Damage to the brain caused by the brain slamming against the skull results in many of the symptoms we have been describing and is frequently diagnosed as some other condition such as ADHD.
Heavy or long-term use of mood-altering substances can alter brain chemistry. So people who may not have the gene or be malnourished or traumatised may develop reward deficiency just by their excessive use of mood-altering substances. This is especially true if the chosen substance is a super-addictive substance (discussed below).
Not all drugs are equal

Your risk factors for reward deficiency are not all there is to consider. Although your genes are a strong risk factor, the risk of addiction also depends upon which drug you use and how you use it.
How susceptible you are + the addictiveness of the substance + the frequency and quantity of use = your risk of addiction

But then, of course, there are social factors too: the company you keep, the availability of the drug and other triggers in your life. Addiction is a complex business.
The super-addictive substances

There are some substances that are addictive to almost anyone who uses them. Nicotine is a good example. The majority of people who smoke for any length of time become addicted and find it very difficult to give it up. Nicotine has been reported by many researchers to be more addictive than crack cocaine. (This is unlike alcohol, which is only addictive to a minority of people who drink.) However, there are a few people who smoke without becoming addicted. These people may be able to quit cold turkey and can’t understand why other people cannot do the same. There are other people, usually those with a certain genetic make-up, for whom smoking is extremely addictive, who start smoking at a younger age and find it so difficult to quit that repeated efforts usually prove futile. Other substances that are super-addictive include the benzodiazepines (tranquillisers), which are exceptionally difficult to get off. If you are one of these people it does not mean that you are weak willed. It means that you need extra help to reset your brain’s chemistry and unaddict your brain. That’s where the nutritional approach contained in the How to Quit programme in this book will be able to help you.
Why we seek feel-good substances

Whether the cause of reward deficiency is genetic or environmental or a combination of both, it puts you at a higher risk of beginning to use a substance to relieve the discomfort of the deficiency and of becoming dependent on it. To understand this better let’s look at what happens when people with reward deficiency discover a substance that provides what they are missing.
When the normal process of neurotransmission is impaired, the discomfort that results can lead you to the use of mood-altering substances to self-medicate the discomfort. Remember that mood-altering substances fit into the same receptors as neurotransmitters or increase the amount of neurotransaddicted the synapse. So, if there is a deficiency, the appropriate substance becomes a substitute for the natural chemical and temporarily corrects the deficiency. Suddenly your anxiety, restlessness, emptiness, hypersensitivity and craving have gone. You may feel good for the first time in your life. But the substance does more than allow you to feel normal. The brain is flooded with the substance, which produces feelings of intense pleasure and euphoria.29
Are people who are reward-deficient more likely than the average person to continue using a mood-altering substance once they have found one that ‘works’ for them? Of course. It is highly unlikely that, having discovered a way to feel better instantly, you will not do it over and over again. And the reward is immediate. It works, it works now, and it works every time (at least in the beginning). It relieves your discomfort and gives you pleasure. You are no longer reward-deficient. You feel good – and perhaps you never knew that you could feel this good.
How mind-altering substances affect reward-deficient people

If you have reward deficiency you are likely to become addicted because the continued and regular use of the mind-altering substance works for what ails you. Also, if you have the genetic tendency to reward deficiency you are more susceptible to becoming addicted because it seems the very same genes that predispose reward deficiency also cause something different to happen in your brain when you use mood-altering substances. The experience for you is not just pleasant, but exhilarating. You get a higher high.
This is common, for example, among alcoholics. People with a genetic predisposition to become alcoholic do not metabolise alcohol in the same way as other people. Many people prone to alcoholism produce more of a liver enzyme called alcohol dehydrogenase II (or II ADH).30 This means they metabolise acetaldehyde (the by-product of the breakdown of alcohol by the liver) more slowly, allowing more of it to build up in the bloodstream.
The early warning signs

It is very difficult to detect addiction in the early stages because, for the people most susceptible, it is more beneficial to their daily lives than harmful. It provides what their brains lack normally. Just as Ritalin (a mood-altering substance) can allow some children with ADHD to function better, other substances are beneficial for other reward-deficiency conditions and allow improved functioning and performance. With alcohol, in spite of a common belief that as the quantity of alcohol consumed increases the ability to function decreases, some people may actually be able to perform some tasks better when a little intoxicated than they can when totally sober.
This early warning sign that addiction may be occurring (i.e. the ability to function well) makes it difficult for people affected to recognise they have a problem. The ability to ‘hold your drink’ (or drug) actually conceals the problem and creates the belief among early-stage addicts that they are immune to the painful consequences that they see others experience. It is difficult for a person who gets so much pleasure from a cigarette, or someone who gets such comfort from a piece of cake or someone who gets a much-needed lift from a cup of coffee, to believe the beloved substance can be harmful. Addiction is a condition that appears in the early stage to be a benefit, allowing you to experience the good feelings without paying any of the penalties.
Addiction: a gradual process

This is the process you will probably go through:
1. Tolerance You can consume larger quantities than other people without becoming impaired. You gradually increase the amount you use to get the same effects, still without becoming impaired.
2. Painful consequences You begin to experience the consequences of using the substance but often do not connect the consequences with use. You then use the substance to relieve the pain of using.
3. Dependence Now you need the substance to function, so regular use is necessary. When you don’t use it you experience withdrawal symptoms. So now you need to use it to relieve the pain of not using.
4. Tolerance decreases It is impossible to consume the same amount as before without suffering. The magic is gone and the painful consequences are worse. Now there is pain whether you have it or not. At this point many people choose to do something about the problem.
5. Abstinence symptoms Even after the acute withdrawal symptoms are gone, there are lingering abstinence symptoms that don’t improve with time.

Developing tolerance

Your brain changes and adapts to you taking the substance regularly. If you are becoming addicted to alcohol you can gradually tolerate larger and larger quantities without becoming intoxicated and without experiencing harmful consequences. If you are becoming addicted to caffeine you can gradually increase the amount of coffee you consume without becoming overstimulated and jittery. This is tolerance. But, over time, continued heavy use, especially if you have a genetic predisposition, will lead to addiction.
The more you consume, the more your brain adapts to the presence of these large quantities until you must use larger and larger quantities to get the same effect, causing more and more changes in the brain.


Case study  TWILA

Twila knew from the first drink that she would continue to use alcohol to feel good. She knew immediately that it took away all the things about her that always made her feel different. At first she could drink with no problems. She could drink larger quantities than her friends could without getting drunk. She was able to function better when she had a few drinks than she could sober. She felt freer to express herself. She started writing poetry and thought she had found or released the creative part of her. She found that as she drank more, she was able to drink even more, then began to find that the amounts she had used before no longer did for her what they used to, and she increased the frequency and quantity of her drinking. She was unaware that neurochemical changes were taking place that were setting her up for problems. She thought she was in no danger of becoming addicted because she could ‘hold her drink’ better than anyone she knew. She was not aware that this was an early warning sign of alcoholism. Alcohol was her best friend and, she thought, her friend for life.

Although Twila’s story is about an addiction to alcohol, this same progression applies to other addictions.
Painful consequences

When you are into heavy and continuous use of addictive substances, the good feelings produced at first are eventually negated by the painful consequences. This can come in many forms: weight gain from excessive sugar, indigestion from too much caffeine, the frustrated response of trying to function while waiting for a cigarette. Problems may arise from drinking and driving or other encounters with the law. Or there may be problems from a ‘nagging’ family who want you to cut down. Or there may be any number of physical complications. Whatever the problems are, you know a way to make the pain of them go away. So you are now using addictive substances to relieve the painful consequences of using addictive substances. The more pain, the more use. The more use, the more pain. The substance blocks the awareness of what is really causing the pain. It’s a vicious cycle.
What is happening in the brain at this point, is that the mood-altering substance is interfering with the release of neurotransmitters and/or blocking the receptors. So, with heavier use, there are fewer neurotransmitters being produced and released than before. And it takes more and more of the substance to fill the receptors and get high – and now the receptors may no longer be working properly.

Case study  TWILA

So what happened to Twila? To her surprise, she began to have problems while she was still a teenager because of her drinking. At first she did not realise that these problems had anything to do with drinking. She began skipping school and thought she was just having a good time. When she was caught and punished at home and suspended from school, she told herself everyone was just over-reacting to her free spirit. She felt misunderstood, and she comforted herself by drinking more.

Becoming dependent

When dependence is increasing most people are unaware that physiological and biochemical changes are occurring as long as they are able to drink, smoke or get their ‘fix’ of sugar or caffeine. They think they are functioning normally. And they may believe they are drinking, smoking or taking drugs responsibly. When enough problems occur, they may attempt to cut back. But by the time they are aware that use of the substace is the problem, they cannot choose to use it in moderation. As the brain adapts to higher levels of the substance, the body accepts this as normal and demands that this ‘normality’ be maintained.
So while tolerance is increasing, so is dependence. ‘Want’ becomes ‘need’. There is a growing need to use the substance. Craving for the substance leads to continued substance use in spite of the painful consequences. The person cannot function without it.
As neurons in the brain adapt to larger and larger quantities, the brain becomes reliant upon the mood-altering substance and shuts down its own production of neurotransmitters.

The hijacked brain

Your brain does not need to keep producing its own feel-good neurotransmitters because the receptors are being filled by copycat substances. When the brain does not get its supply from an outside source, it does not snap into production and start supplying the needed chemicals. Instead, it screams out for more of the ingested substance. This is when the survival part of the brain takes over. It believes it must have the substance to survive. It overpowers the rational part of the brain, and getting the substance becomes as strong a need as breathing. This has been called the ‘hijacked brain’ – the drug has stolen your ability to make rational choices.

Case study  TWILA

So how did Twila’s drinking affect her? When she got married, her husband objected to her heavy drinking, so she decided she would cut back. But her attempts were short-lived. She would cut back for a few days and then find that she was back to her regular amount. As this became more and more of a problem in her marriage, she tried many ways to drink in moderation. She would set rules and break them. She would promise herself she would drink only during certain times of the day. Or she would drink only at weekends. Or she would drink only beer. Or she would drink only with other people. But all her promises to herself and to her husband were broken. Fearing her husband was going to leave her, she promised to quit entirely. And she did. For two days. She was sick and miserable for those two days. She never stopped thinking about drinking. She was obsessed with the idea of having ‘just one’. The compulsion to take that one drink was overpowering. Finally, convinced she could have one and stop, she gave in and soon her drinking was out of control again. Her husband did leave her and then she felt she had a real reason to drink, and alcohol took over her life.

The pain of abstinence

Your great friend now becomes your enemy. The substance now creates pain instead of producing pleasure, and now instead of being able to tolerate more, you can tolerate less and less. You have pain when using the substance and pain when not using it. The drug has depleted the brain’s supply of natural feel-good chemicals, the receptors are not working as they should and the drug is no longer a satisfactory substitute. You might continue to use food, alcohol, nicotine or other drugs, prescribed Shrwise, not for any substantial pleasure, but only because the survival part of the brain has taken over and believes it must have the substance. You find your attempts to stop are usually short-lived and futile and you suffer from severe anxiety when an unexpected situation interferes with the substance use or the source of supply.
When you continue to use despite serious consequences, other people believe you to be behaving irresponsibly, unaware that you are not consciously choosing the behaviour. It is being dictated by the survival part of the brain. You may go immediately from the pain of needing the drug to the pain of using the drug. The magic is gone. The pleasure is gone. There is nothing but pain.

Case study  TWILA

Twila doesn’t remember when the pleasure stopped and drinking brought her only pain. At first she thought she was so miserable because her husband had left her. Gradually she became aware that drinking was giving her no comfort. She was getting drunk more and more often. She could drink less and less before getting sick. Where had the magic gone? She was convinced she could find it again if she could just find the secret door. She tried to work at several jobs but was too sick most of the time to go to work. She was lonely and started going out with friends with whom she previously drank, those people who used to talk about her ability to hold her liquor. But now she was passing out and they were driving her home. They didn’t like being with her any more. Every day she would promise herself that tomorrow she would stop. But tomorrow she only remade the promise.

Quitting becomes impossible

Sometimes seriously addicted people may have a moment of sanity when they realise that if they keep doing what they are doing they are going to damage themselves seriously or even die. They may ask for help. People with a nicotine addiction may go to some kind of stop-smoking programme. People who are diabetic or overweight because of an addiction to sugar might join a weight-loss programme. People with an addiction to alcohol, illegal drugs or prescription drugs may enter a treatment centre. If it is a treatment centre without medical detoxification, the pain of abstinence can be so severe that they leave before they have made it all the way through the detoxification process. If they get medical detoxification, many stick it out even though they are uncomfortable. But what happens now to the poor brain, totally depleted of natural brain chemicals and unable to produce an adequate supply? Usually nothing. It stays that way – perhaps for months, but often for years. It is reward-deficient, and more extremely so than before use of the substance began.
The discomfort, prior to substance use, is now even more intense. And the brain continues to crave the substance upon which it has come to depend. After struggling through months of pain and craving, many addicts give up in despair, and, believing there is no way out, go back to what they know will at least relieve the craving, if not the pain.

Case study  IRENE

For 35 yearsht-losd weight controlled Irene’s life. She was overweight as a child and still remembers the pain of hearing people say, ‘She has such a pretty face,’ knowing that they were thinking, ‘It’s a shame she’s so fat.’ Throughout childhood, adolescence and adulthood, her life revolved around feeling the pain of being overweight and eating sweets to assuage that pain. She always knew she could ease it with her tried-and-true friend: sugar.
The first time she went on a diet her doctor told her that she could eat anything as long as it contained no white flour or white sugar. She immediately went home and baked a lemon meringue pie using brown sugar and wholewheat flour. Needless to say, it wasn’t as good as the ‘real’ thing, but she soon got used to the taste – and rapidly gained five pounds.
Later that year she decided to take the bull by the horns and just stopped eating altogether. The bathroom scales kept her on course for four days; it was saying great things. When her mother pleaded with her to be more sensible, she got out the cottage cheese, took a few bites, then reached for the biscuits.
Diets came and went, each beginning with strong determination and ending in despair. She tried commercial programmes, liquid protein, diets of the stars, diets of her friends, hypnosis and fasting. For a time she felt invincible. The world was her apple and that apple would always be eaten raw, never again in a pie. Despite her unceasing hunger for sweets, each time she dieted she lost weight. And sometimes she kept it off for a period of time through vigilant self-deprivation and icy determination. Then the ice would melt and the sugar craving would win. She watched her weight come back as if it had a life of its own.
Each time the craving was stronger than before, and she was more irritable and more easily stressed. Each time the unfairness of her plight, the burden of never-ending hunger, and never-ending vigilance overwhelmed her. Sweets called her name and she would eventually answer, ‘I’m back.’ She would reach out to her old friend, always there to soothe and comfort her.

Now, many people will tell you that Irene was just not motivated. But why would she do the same thing over and over again unless she really wanted to free herself from her addiction to sugar? She had controlled it over 20 times for a period long enough to lose weight. Why would you do again what you had failed at 20 times previously unless you wanted it very badly? Some people will tell you that Irene just did not have any self-discipline. How many of us have the self-discipline to endure ongoing, unrelenting pain – with no relief in sight – without looking for some source of pain relief?
How our How to Quit programme can help

Let us be clear here that many addicted people do make it and find ways to remain free of their addiction. Many find a better life through practising the principles of Alcoholics Anonymous (AA), Nicotine Anonymous, Overeaters Anonymous, or Narcotics or Cocaine Anonymous. Thousands of ex-smokers or drinkers or drug addicts are living proof that recovery from addiction is possible.
Through their experience of addiction and recovery they find meaning and purpose, and are able o live a happy life. Sadly, this is a minority. Some people are able to stop with the help of a counsellor or counselling programme. As important as counselling is, the majority do not achieve abstinence on a long-term basis, and those who do, often experience ongoing abstinence symptoms. Most treatment is helpful in that it helps addicts cope with the craving and pain of abstinence, but it does not take it away.
This is the missing link

With our How to Quit programme this can change for you and you can avoid relapse. Even those who have already been able to quit their addiction and stay off with the help of a 12-step support group or treatment programme can reduce the severity of their abstinence symptoms and improve the quality of their life. With our programme you can quit and begin to feel your abstinence symptoms improve in a matter of days. Some addictions are more serious and more difficult to overcome than others, but all addictions – whether to illegal drugs, prescription drugs, alcohol, nicotine, caffeine or sugar – have in common a need for restoring the brain to optimal functioning. Wherever you are along the road to addiction, you will find our How to Quit programme provides the missing link: when you fix the brain, you will find quitting and staying free of the need for substances so much easier.
SUMMARY

 We use drugs to compensate for a lack of, or imbalance in, or dysfunction of, neurotransmitters.

 When the reward system of the brain is working properly it creates a sense of well-being and satisfaction. Craving, dependence and addiction occur when the reward system goes wrong.

 Many people born with the genetic predisposition to reward deficiency are also genetically predisposed to becoming addicted.

 The more you have of a mood-altering substance the more insensitive your brain becomes to your own neurotransmitters. This is called down-regulation – it makes you more tolerant to larger amounts.

 The more you consume the more your brain adapts to the presence of large quantities until you must use larger and larger quantities to get the same effect, causing more and more changes in the brain.

 As neurons in the brain adapt to larger and larger quantities, the brain becomes reliant upon the mood-altering substances and shuts down its own production of neurotransmitters.

 You now crave the substance and, if you don’t have it, you get withdrawal or abstinence symptoms.

 Any substance you crave, or any substance that make you feel good, is either promoting your ability to make or restore the balance of your neurotransmitters, or is mimicking the neurotransmitter, docking onto its receptor site. Now you’re hooked