I hope you guys got a lot out of the lecture on substance use disorder. We talk about the opioid crisis from the standpoint of the prescriber quite a bit – but we don’t have a lot of places in our curriculum where we actually talk about addiction itself.
I ask Dustin to come give this lecture every year so you can understand a bit about what the disease is like from the patient’s point of view. We’ve had a lot of great feedback on this lecture, and some students have even found it profoundly useful in their own lives. If you weren’t in lecture that day, I’d encourage you to watch the Mediasite presentation when you get a chance.
Another reason I want to talk about addiction is to dispel some of the myths around this disease. If we had more time, I’d love to talk about how recent (as in last couple years) research disproves some of these myths.
Why willpower doesn’t work
For example, a common misperception about addiction is that the addict simply lacks willpower or isn’t trying hard enough. But that isn’t true – and recent functional MRI studies are beginning to explain why.
As an addiction develops, the brain links three things together: a precipitating factor/ trigger (anxiety, for example), a behavior (such as drinking), and the result/reward (diminished anxiety). There’s an actual anatomic pathway in the brain called the reward pathway that lights up during this trigger/behavior/reward cycle.
The more times you go through the cycle, the stronger the neural connections in the reward pathway become. There’s a saying: “neurons that fire together wire together.” It’s kind of like a cross-country skiing trail: the more you use it, the deeper it becomes.
It turns out that as this reward pathway is growing stronger, the part of the brain that mediates logical thought (the prefrontal cortex) actually goes offline (becomes disconnected from the rest of the brain). This makes it all the more difficult to break the trigger -> behavior -> reward pathway. You may really want to quit that behavior, and you may even be alarmed by all the consequences that are piling up as a result of that behavior, but it feels like all the willpower in the world is no match for the power of the reward circuit in the brain.
You may have experienced a mild version of this if you’ve overindulged in something sugary, then felt like crap and said “never again” (and meant it!) – only to find yourself staring at an empty pint of Ben and Jerry’s while stressed out studying for an exam. What happened?!
Short answer questions
We won’t have test questions on this lecture because the material doesn’t really lend itself to multiple choice questions. Instead, I’ve posted a few short-answer questions (link below) for you to work through. I’ll read through them and add 10 points to your total course score for thoughtfully going through this exercise (if you miss something big I’ll let you know). The questions will be open until Sunday, October 13 (I’ll nag you if you haven’t finished the questions by then).
Your answers don’t need to be long or perfect – I’m just interested to hear what you think, and I want to give you the chance to ask any questions you may not have felt comfortable bringing up in lecture. I hope you came away from the lecture with a little deeper understanding about what substance use disorder is (and isn’t). I’d love to hear your thoughts and suggestions for this area of the course.