The Cycle of Addiction
As mentioned in the previous section, addiction is a cycle that repeats itself in three stages:
- Binge/Intoxication
- Negative Affect/Withdrawal
- Preoccupation/Anticipation.
Repeated substance abuse changes the brain systems involved in reward, stress, decision-making, and impulse-control. These changes help explain why addiction is not a moral failure or simply a lack of willpower.
Scroll through each stage to see how it correlates to the brain.
Stage 1
Binge / Intoxication
Connected to the basal ganglia
- Reward: A person experiences the rewarding effects of the drug, such as euphoria, reduced anxiety, or smoother social interactions.
- Habit Formation: Repeated activation of the brain's reward circuit motivates continued drug use and reinforces habits and other drug related behaviors.
- Cravings: When the basal ganglia is repeatedly stimulated by drugs, it changes how a person responds to drug related cues, such as certain people, places, or images. These cues can trigger powerful urges to use.
Homeostasis and Tolerance Stage
The Brain Adapts
The brain works to maintain balance.
- Maintaining Balance:The brain naturally works to maintain a stable internal state, called homeostasis. When substance use repeatedly overstimulates the brain's reward system, the brain begins to adapt to counteract those effects.
- Reduced Reward: Over time, the reward system becomes less sensitive. The same amount of a drug may no longer produce the same pleasurable effects, and everyday activities may also feel less rewarding.
- Tolerance: This adaptation contributes to tolerance. A person may need more and more of a substance to feel the same pleasurable effects they used to feel with a smaller amount.
Stage 2
Negative Affect / Withdrawal
Connected to the extended amygdala
- Withdrawal: When someone with SUD stops using, they go through withdrawal symptoms that can be both physical and emotional: pain, illness, dysphoria, anxiety, and irritability.
- Changed Baseline: Because the brain has adapted to repeated drug use, everyday rewards may feel less pleasurable, while the brain's stress systems become more active.
- Seeking Relief: At this stage, the person no longer uses drugs for the “high”. Instead, they try to escape the negative feelings of withdrawal.
Stage 3
Preoccupation / Anticipation
Connected to the prefrontal cortex
- Drug Seeking: In this stage, a person becomes increasingly focused on when and how they will use the substance again. As tolerance develops, they may experience stronger urges to seek and use, even though it may no longer produce the same pleasurable effects.
- Impaired Self Control: This stage compromises how the prefrontal cortex operates, making it harder for the person to perform executive functions such as managing behavior, solving problems and controlling impulses.
Binge / Intoxication
Connected to the basal ganglia
- Reward: A person experiences the rewarding effects of the drug, such as euphoria, reduced anxiety, or smoother social interactions.
- Habit Formation: Repeated activation of the brain’s reward circuit motivates continued drug use and reinforces habits and other drug related behaviors.
- Cravings: When the basal ganglia is repeatedly stimulated by drugs, it changes how a person responds to drug related cues, such as certain people, places, or images. These cues can trigger powerful urges to use.
Negative Affect /Withdrawal
Connected to the extended amygdala
- Withdrawal: When someone with SUD stops using, they go through withdrawal symptoms that can be both physical and emotional: pain, illness, dysphoria, anxiety, and irritability.
- Reduced Reward: These symptoms can come from two sources:
- Reduced activation of the brain’s reward circuit makes it harder to experience pleasure in everyday life.
- Increased activation of the brain’s stress circuit can lead to anxiety, irritability, and unease.
- Seeking Relief: At this stage, the person no longer uses drugs for the “high”. Instead, they try to escape the negative feelings of withdrawal.
Preoccupation /Anticipation
Connected to the prefrontal cortex
- Drug Seeking: This stage happens when someone seeks drugs after they have been abstinent. They become preoccupied with how to get more, and look forward to using.
- Impaired Self Control: This stage compromises how the prefrontal cortex operates, making it harder for the person to perform executive functions.
