Advances in science make it clear that addiction is a disease. Educating people about that reality helps combat the stigma associated with this disorder. It may begin with a choice – but we don’t blame people with colon cancer for opting for steak over the vegan menu. Once biology takes control, individuals need to fight their own bodies to find recovery.
How does that first drink or drug use become a life-altering crisis? Here’s the science behind how addiction hijacks our hierarchy of needs.
How Addiction Changes Your Brain
Drugs and alcohol structurally alter your brain chemistry, making it increasingly challenging to make the right choices the more the patient uses their substance. They attach to various receptor sites in your brain, altering levels of vital neurotransmitters that influence decision-making and behavior.
Substance abuse primarily impacts three primary regions: your dopamine receptors, GABA and glutamate receptors, and your HPA axis.
Dopamine is your brain’s pleasure chemical. The right amount pushes you toward behaviors that make you feel rewarded and happy. In non-addicted individuals, activities like attending a birthday party or feeling the springtime sun against their skin after a long winter prompt the release of this neurotransmitter.
Trouble arises when drug and alcohol molecules bind to your brain’s dopamine receptors. It creates the pleasurable sensation associated with use. However, it also numbs these regions, making them less able to feel joy through ordinary activities. Anhedonia makes the individual crave that one last thing that makes them feel good, fueling addictive behavior.
Here’s where our society fails at providing people with the structural support necessary for health. Prolonged stress, such as the kind suffered by people living in poverty with ever-present threats of violence and homelessness, also produces anhedonia by destroying your dopamine receptors.
However, instead of helping the indigent, we blame them for their plight, even though many poor people work. The one relief these individuals can get that restores some feeling of pleasure in their lives comes from a bottle or needle. Given the U.S.’s profit-based health care system, the people who need treatment the most often find themselves with no options. They retreat to their substance of choice, fueling deaths of despair from overdoses.
Anhedonia also explains why addiction is so hard to break. While your brain eventually recovers somewhat, it takes time – during which the struggling individual might not feel joy in anything. In a desperate attempt to feel good just one more time, they revert to use, perpetuating the cycle.
2. GABA and Glutamate
GABA and glutamate are like the Janus twins of neurotransmitters. Glutamate is an excitatory neurotransmitter that spurs you into action. GABA has the opposite effect, acting like the brain’s natural valium to inhibit action and calm your system.
Drugs like alcohol alter levels of these neurochemicals. Alcohol binds to your GABA receptors, so you feel relaxed after taking a drink. Problems arise when your brain tries to maintain homeostasis, increasing glutamate levels to combat what it perceives as excess GABA. When you wake up with a hangover, the glutamate spike makes you feel anxious and edgy, even angry. What do you do to ease these feelings? You take another drink.
Another problem? Over time, alcohol desensitizes your GABA receptors, making it more difficult for you to relax naturally. The combination of your dopamine and GABA receptors chanting in unison, “give us more, give us more,” proves too much temptation for many to resist, especially if they’re stressed or fatigued.
3. The HPA Axis
Your hypothalamus-pituitary-adrenal axis modulates your body’s fight-or-flight response. When your brain perceives a possible threat, it releases a flood of neurochemicals that prompt your adrenal glands to release adrenaline and cortisol. Adrenaline fades, but cortisol remains if your stress levels don’t decrease, keeping you on edge.
This mechanism explains why people with trauma histories often self-medicate with drugs and alcohol. These substances calm their overactive HPA axis, which otherwise sends out danger signals constantly. It’s exhausting to feel like you live in a war zone all the time, and substance use offers a temporary ceasefire.
Unfortunately, these individuals often lack the positive support network they need. For example, if they live in an abusive household, they may leave inpatient detox only to return to the same environment that caused their overwhelming stress load. It’s like unleashing a toddler in a toy store unsupervised and asking them not to touch anything.
What Is the Hierarchy of Needs?
Maslow’s hierarchy of needs starts with physiological realities at the base – food and shelter, followed closely by safety. Individuals can only meet higher-order needs like love and belonging, self-esteem, and self-actualization once they have the basic requirements for life.
Once you understand the neurobiology of addiction, it becomes easier to see how addiction hijacks this hierarchy. Someone with a substance use disorder isn’t thinking about how going to jail for stealing a bottle of Jack Daniels will impact their self-esteem or ability to hold onto the job they love. They’re focused on fixing a very real physiological problem: easing the screaming suffering in their brain that it seems only one thing will fix.
Recovering from substance use disorder requires intensive support. First of all, you need to meet the patient’s basic needs – perhaps the biggest problem in a highly individualistic society that demands everyone take care of themselves. Is it possible to get or stay clean when you’re facing potential homelessness and all the associated horrors of the street? Yes – but it’s akin to climbing Mt. Everest without a Sherpa guide or even a rope and carabiners.
Education helps patients understand how their biology drives their addiction. Doing so can also free them from the toxic shame of feeling like their disorder is all their fault. Shame complicates addiction, making the individual more likely to self-isolate in despair instead of seeking the positive social support they need to heal.
Finally, individuals need time and a genuine chance at a happy life free from substance use. Understanding the biological reality can keep them from using again as long as they have hope. If someone feels like nothing they do is enough – for instance, if they’re trapped in a low-wage job that doesn’t provide enough income to meet their basic needs – they can fall back into despair, becoming more likely to use again to ease uncomfortable feelings.
Does the Addicted Brain Ever Heal?
Fortunately, your brain will return to a healthy state in time, although it might not revert completely to its original condition, depending on the severity and length of your use. Unfortunately, there’s no way to determine how long the process will take. It varies by individual. Just like some people can bounce back from a tragedy like a natural disaster more quickly, people heal from addiction at various rates.
What’s essential is surrounding the individual with a substance use disorder with love and support. Inpatient interventions can allow users to safely detox and may be medically necessary if use reaches severe levels. For example, alcohol withdrawal can cause seizures, disruptions in the liver, heart, and brain functions, and even death.
It’s even more important to provide ongoing support once the person leaves inpatient care. They need a secure home and healthy food – the right nutrition helps their neurotransmitters return to normal more quickly. They also require meaning and purpose to avoid slipping back into old habits.
The German philosopher Fredrich Neitzche once wrote that he who has a “why” to live for could withstand almost any “how.” Helping patients reconnect with their hierarchy of needs provides a positive motivation to stay clean, not simply an edict not to use or else. What makes the person feel self-actualized? What activities boost their self-esteem? Encourage this exploration.
Addiction is, fortunately, a curable disease. However, it requires time, patience, and a loving, supportive environment, which many people sadly lack in modern American society.
Addiction Hijacks the Hierarchy of Needs – But It Is Possible to Claim Your Life Back
Addiction is a disease. It may begin with a choice, but it’s as real as cancer or diabetes once biology takes over. It causes just as many physical obstacles for people with substance use disorder to overcome.
Understanding how addiction hijacks our hierarchy of needs helps us see individuals struggling with substance use disorders not as weak or willful but rather brave soldiers who have fought an unwinnable war for far too long. As a society, we need to have the empathy to focus on providing necessary resources for healing so that all community members can thrive and actualize their full potential.