Grisel - Never enough: the Neuroscience and Experience of Addiction

I was twenty-two. Id been on the good end of a bad drug deal. In the wee hours of some morning late in 1985, behind a nameless restaurant in South Florida, a dealer gave me and a friend the wrong bag. I was the winner in this deal with substantially more drug than I was obliged to pass on to a friend of a friend somewhere in the Midwest.

Homeless at the time, my compatriot and I ended up checking into a cheap motel in Deerfield Beach. Predictably, we used the surplus along with what we owed. Toward the end of that binge, the stash mercifully depleted, both of us exhausted and on edge, my friend inexplicably announced that there would never be enough cocaine for us. While the prophecy struck me as true even in my overwhelmed state, I also knew it was irrelevant. As with every addict, my days of actually getting high were long past. My using was compulsive and aimed more at escaping reality than at getting off. Id banged my head against the wall long enough to realize that nothing new was going to happenexcept perhaps through the ultimate escape, death, which frankly didnt seem like that big a deal.

About six months later, through a series of circumstances rather than personal insight or strength of character, I was clean and sober for the first time in years, and therefore not quite so numb. I saw that I had a life-or-death choice. I could continue colluding with my mental illness as it inexorably consumed me, or I could find a different way to live.

In my experience, very few faced with those possibilities choose life, and I first went with the majority. The cost of abstinence seemed too high: Without drugs, what would there be to live for anyway? However, in a demonstration of tenacity almost diagnostic of an active addict, it dawned on me that I might be able to find another way. After all, I thought, Id come through many tight situations: bad deals in condemned buildings or police stations, with or without loaded guns, and miles from anything friendly or familiar. Aware now for the first time of the medical model of addiction, I figured that my disease was a biological problem that could be solved. I decided to cure addiction so I could somehow eliminate the problems caused by using.

With what may seem like exceptional fortitude to some, especially given that Id been kicked out of three schools by this time, I went on to get a Ph.D. in behavioral neuroscience and to become an expert in the neurobiology, chemistry, and genetics of addictive behavior. This accomplishment would seem almost unremarkable to most addicts, who know firsthand that there is nothing we would not do, no sacrifice too great, to be able to use. It ultimately took seven years to graduate from college, including about a year of dramatic change starting in a treatment center, plus another seven years of graduate school to earn that degree.

This book is a summary of what I have learned over the past twenty or so years as a researcher studying the neuroscience of addiction. Though Ive received grants from the National Institutes of Health and possess a controlled-substance license from the Drug Enforcement Administration (DEA), I regret to say that I havent solved the problem. I have, however, learned a lot about how people like me differ even before they pick up their first drug and about what addictive substances do to our brains. My hope is that sharing this information might help loved ones, caregivers, and crafters of public policy make more informed choices. Perhaps this understanding may even help the afflicted ones themselves, because its quite clear to me that the solution isnt coming in a pill.

Addiction today is epidemic and catastrophic. If we are not victims ourselves, we all know someone struggling with a merciless compulsion to remodel experience by altering brain function. The personal and social consequences of this widespread and relentless urge are almost too large to grasp. In the United States, about 16 percent of the population twelve and older meet criteria for a substance use disorder, and about a quarter of all deaths are attributed to excessive drug use. Each day, ten thousand people around the globe die as a result of substance abuse. Along this path to the grave is a breathtaking series of losses: of hope, dignity, relationships, money, generativity, family and societal structure, and community resources.

Worldwide, addiction may be the most formidable health problem, affecting about one in every five people over the age of fourteen. In purely financial terms, it costs more than five times as much as AIDS and twice as much as cancer. In the United States, this means that close to 10 percent of all health-care expenditures go toward prevention, diagnosis, and treatment of people suffering from addictive diseases, and the statistics are similarly frightening in most other Western cultures. Despite all this money and effort, successful recovery is no more likely than it was fifty years ago.

There are two primary reasons for the incredibly broad, deep, and persistent costs of drug addiction. First, excessive use is remarkably common, cutting across geographic, economic, ethnic, and gender lines with little variation. It is also highly resistant to treatment. Although reliable estimates are hard to come by, most experts agree that no more than 10 percent of substance abusers can manage to stay clean for any appreciable time. As far as illnesses go, this rate is almost singularly low: one has about twice as good a chance of surviving brain cancer.