Choice or Disease?
What is the Choice Argument?
Addiction can't be a disease because taking a drug is a behavior and all behavior stems from choices.
How does one eradicate the symptoms associated with disease?
Attacking the defect eradicates the symptoms
What does the frontal cortex do?
Where choice is conceived and where attachment is formed; where moral and spiritual meanings are associated with a thing
What are genes?
Some people are more genetically predisposed to addiction- genes interact with the environment to make one more or less susceptible to addiction.
What is memory?
Glutamate locks drug in memory after exposure to pleasure-the brain remembers experience and this yields cues leading to motivation to use; "drug hyper-memory"
What is the choice argument supported by?
The knowledge that threatening an addict with death if they make the choice to use will make them decide not to use.
What happened after addiction was forsaken as a disease?
Addict cases were handed over to the criminal justice system.
What does the midbrain do?
-doesn't think or weigh choices
-tells us to do things that are pleasurable
-with addiction midbrain exerts more influence over the frontal cortex that the cortex exerts over the midbrain (a person who is without addiction/substance use disorder, the cortex exerts more influence over the midbrain)
Low vs high responders associated with genetics
High responders take longer to get drunk and are thus more vulnerable to becoming dependent.
What is stress?
Leads to relapse because stress is constantly being utilized to push dopamine back down to pleasure threshold until pleasure set point gets raised. Only drugs can reach the new pleasure threshold and choice and ability to distinguish pleasure is eliminated.
What does the movie conclude about whether addiction is a disease or a choice?
Addiction is a "disease of choice."
Are attitudes toward whether addiction is a disease or are attitudes not changing on this?
Yes, with the advent of neuroscience and its ability to identify defects within the addict brain, addiction is slowly started to be accepted as a disease.
What have mice studies on addiction revealed?
How survival instincts of the midbrain become associated with drug use so as to make the 2 indistinguishable.
What is Anhedonia?
Won't get pleasure from normal pleasure you got before.
What is hypofrontality?
When choice is eliminated, brain develops "craving" in order to protect pathways to drug use because the brain thinks it needs the drug for survival.
Craving is involuntary.
What is the disease argument?
Poor decisions made by addicts are symptoms of the disease, not signs of intrinsic badness or a moral failing.
2 areas of the brain that are important to addiction
Frontal Cortex and the midbrain
What happens to the brain's pleasure sense when hijacked by drugs?
The brain can't distinguish between pleasure
What do drugs do to to the brain with regard to the reward system in the brain?
What is recovery?
The brain state isn't permanent-coping skills can be strengthened and abstinence maintained to bring hypo- frontality to resolution.
Where did the disease model come from?
"Germ Theory"
An organ gets defect, symptoms arise
Causal Chain...organ, defect, symptoms
Addict trains brain to think
Drugs =
Survival
What is pleasure construct?
Involves involuntary memory-made up of genes, reward and memory
What is the dopamine hypotheses?
Susceptibility to one drug means susceptibility to all: cross-addiction
What is reward?
Release of chemical dopamine-tells brain when reward is salient or especially good and then tells it to remember that reward because it thinks it's good/better for survival.