The brain has billions of neurons, which connect via neural pathways. As children develop and learn, their brains create and change these pathways, a process known as neuroplasticity, with relative ease. At approximately age twenty-five, the brain has developed the majority of its neural pathways; its plasticity is significantly reduced.
The brain uses neural pathways as efficiently as possible, allowing repetitive tasks to become “automatic” or habitual. The frequent use of the same circuits embeds them deeper into the brain, making it more difficult to alter their routes. Imagine dragging a scissors’ blade across cardboard along the same line over and over; the groove gets more pronounced. Fortunately, the brain is more flexible than cardboard. Although adults need more time and effort to change neural pathways than a child does, adults can change their brains.
Changing the adult brain is essential for individuals who engage in addictive behaviors. Even in a high-tech society, humans still behave on the pleasure-reward system our early ancestors used for survival. The brain releases dopamine, the “feel-good” neurotransmitter when an action, event, or emotion is satisfying or pleasurable. To get more of that good feeling, humans repeat that stimulating action or thought.
Alcohol and drugs affect the brain’s neurotransmitters and neural pathways. At the same time, the brain strives to maintain balance. As a result, when drugs and alcohol change the brain’s chemistry, the brain adapts. For example, the brain will reduce the production of dopamine if a drug artificially recreates the effects of dopamine. Once the adaptation becomes the norm, the brain will want to “correct” an imbalance when the drug is no longer present by taking the drug again. Over time, substance use disorder (SUD) changes both the brain’s structure and how it functions.
This changing of the neural circuits is possible because of the brain’s neuroplasticity. The brain’s plasticity is impressive and necessary for making positive changes; unfortunately, it can also adapt to form unhealthy habits, associations, and addictions. As the National Geographic article “The Addicted Brain” states, “Addiction remodels neural circuits to assign supreme value to cocaine or heroin or gin, at the expense of other interests such as health, work, family, or life itself.” The longer the addiction continues, the more deeply ingrained it becomes, changing neural pathways and making recovery more difficult.
Areas of the Brain Affected By Substance Use
While alcohol and drugs affect the entire brain, some regions are more involved with SUD than others. The National Institute on Drug Abuse (NIDA) explains the effects of drugs on the brain in the article “Drugs, Brains, and Behavior: The Science of Addiction,” which focuses on the overstimulation of three key brain areas: the basal ganglia, the extended amygdala, and the pre-frontal cortex.
- The basal ganglia, associated with the brain’s reward system, recognizes pleasurable activities such as enjoying a good meal or having fun with friends. When overstimulated by drug use, though, it loses sensitivity to natural neurotransmitters, such as dopamine. With continued drug use, drugs become the only stimulus that activates this reward center.
- The extended amygdala is associated with negative emotions such as stress, anxiety, and irritability. These are symptoms a person experiences when a substance leaves the bloodstream. To avoid the negative symptoms of withdrawal, individuals often take more drugs, creating a feedback loop.
- The pre-frontal cortex is the area of the brain that governs decision making, logic, problem-solving, self-control, and impulse control. When this area of the brain is affected by drugs, confusion and poor decisions dominate the cognitive process.
Several drugs, including alcohol, affect the cerebellum. The cerebellum assists with muscle control and coordination, which is why people who have had too many drinks may stumble and weave when they walk.
Excessive drinking also shrinks the grey and white matter of the cortex, slowing cell growth and development. The dura, the protective layers over the brain, also shrinks due to dehydration.
The loss of minerals and nutrients due to binge drinking, defined by the Centers for Disease Control and Prevention (CDC) as more than four drinks for women and five for men, can impair brain functioning, even after there’s no alcohol remaining in the bloodstream. Fortunately, abstaining from alcohol for one week has shown improvement in the volume of grey matter cells. However, the white matter and other areas of the brain continue recovering months after the last drink.
Substances like cocaine reduce blood flow to the brain, according to Substance Abuse Treatment: Group Therapy on the National Center for Biotechnology Information. Once in recovery, the blood flow may take months to return to normal or near-normal levels. For those who use cocaine, the frontal lobe still shows signs of recovery 4 to 6 months after the last use.
What Do Brain Scans of Addicted People Show?
Though addiction can display itself in many different ways, from physical changes to behavioral responses, brain imaging and scans can also find signs of addiction in the brain itself.
Researchers who study how addiction changes the brain have found clear markers of addiction within brain chemistry and structure. Using technology like magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, medical professionals can see inside the inner workings of the brain, both with an addictive state and without.
These scans show us that several different regions and pathways within the brain are affected by addiction. From an increase in neurotransmitters like dopamine to reduced or increased activity in particular brain regions, addiction has a direct impact on the brain’s structure, functioning, and health.
- A 2009 study published in the journal Neuropharmacology used PET scans to show the flow of dopamine to different regions of the brain in individuals who misused drugs. When researchers followed the dopamine through the brain, they found that dopamine levels were lower in parts of the brain that controlled repetitive or risk-taking behavior and decision making. Dopamine also affected areas of the brain that associated drug-taking with pleasure and stimulation, making it more likely the individual would take drugs again.
- A 2013 article published in JAMA Psychiatry noted that MRI scans could also show us how the brain responded to addictive triggers, helping researchers understand why people with substance use disorders relapsed after a period of sobriety. These scans showed that particular parts of the brain (especially areas that could stimulate cravings) were highly active in individuals with substance use disorders when exposed to triggers, making it more likely they would relapse.
- Other studies have found that a series of brain pathways are involved in many different addictive activities, from getting drunk to developing a chemical dependency to relapse. These pathways are particularly vulnerable to addictive substances and can become “rewired” to encourage individuals to continue consuming drugs.
Luckily, brain scans are not only used to detect abnormalities related to addiction. Researchers, doctors, and addiction treatment professionals can use brain scanning technology to identify areas of the brain that have been altered by addiction. From there, they can develop more customized treatment plans that directly support these affected areas of the brain.
In this way, while brain scans can show us the damage caused by addiction, they can also point us towards possible proactive solutions to help individuals recover and find effective treatments for ongoing addictive behaviors.
Can the Brain Heal Itself After Addiction?
The brain is a remarkable organ, capable of incredible breakthroughs and life-changing ideas and actions. Yet because of its delicate structure and chemistry, the brain is also highly vulnerable to addiction.
Fortunately, researchers have found that brains that have been harmed by addiction do have the potential to “unlearn” addictive behaviors, although the risk for addiction never magically disappears.
Researchers have studied several different ways that the brain has adjusted back to a “baseline” level during and after addiction treatment. A 2013 study published in the journal Psychology of Addictive Behaviors found that incorporating mindfulness and meditation into addiction treatment could lessen the risk of relapse. The study also indicates that brain pathways that can trigger relapse may be retrained by mindfulness practice.
Another study published in the Journal of Neuroscience found that individuals who chronically used methamphetamines had lower numbers of dopamine proteins than individuals who did not use the drug. As a result, methamphetamine users frequently suffered challenges with movement and memory and may have been at a higher risk for Parkinson’s disease. Researchers found that 12 months of recovery led to an increased number of dopamine proteins (in some cases, up to a 19% increase.) These findings suggest that the brain can begin to heal itself in the aftermath of drug use.
Additional research has also begun to uncover the structural changes that take place in the brain during addiction, which can help scientists and medical professionals to devise new treatment methods. One 2011 study published in the journal Alcoholism found that individuals who relapsed had less development in the brain reward system, an area of the brain that governs pleasure and reward responses, than individuals who did not relapse.
In addition to changes in the brain’s chemical processes and physical structure, addiction recovery can help individuals develop new behaviors and routines that can help “retrain” the brain to meet the new reality. Many reputable treatment programs use cognitive behavioral therapy (CBT) and other forms of therapy to help individuals learn how to create alternate routines and patterns of thinking that help the brain adjust.
Additionally, support from peers in recovery and trained clinicians can help individuals avoid the common relapse “triggers” in order to lessen their influence on the brain. These may include avoiding people, places, and situations associated with addictive behaviors, as well as finding new ways to manage disruptive or difficult emotions or life circumstances.
Helping the Brain Recover From Addiction
Research on the brain’s recovery is limited and still relatively new. Less than a century ago, scientists thought the mature brain stopped developing new cells; we now know the brain continues to create new cells and neural pathways. However, addiction recovery takes time, discipline, support, and patience. Before the brain can begin healing, the body must be clean of any residual substance. Detox can take several days to several weeks, depending on the substance and how long an individual has struggled with addiction.
The brain will start recovering the volume of lost grey matter within one week of the last drink with alcohol. Other areas of the brain and the white matter in the pre-frontal cortex take several months or longer to recover.
Rebuilding the neural pathways to reinforce healthier choices and habits depends on each individual’s circumstances. Opioids and cocaine are highly addictive, which makes them more challenging to re-configure deeply ingrained neural circuits. Additionally, the longer a substance is abused, the more solidified the neural pathway for that behavior becomes.
Most drugs change dopamine levels. Many variables determine whether or not the brain’s capacity to release and re-uptake dopamine will ever fully recover. In addition to the specific substance and length of use, dopamine recovery depends on a person’s age, genetics, mental health, and how many drugs were used simultaneously.
Many medical professionals suggest ninety days as a general estimate for dopamine recovery. However, the damage from drugs can last longer, requiring a year or longer for dopamine levels and brain cells to recover. Some drugs can permanently damage the receptors that re-absorb dopamine, preventing the brain from fully recovering.
The brain is a complex organ with billions of neurons firing messages to each other in order to maintain essential life functions, coordinate muscle movement, and learn new skills.
Neural pathways help build efficiency in repetitive tasks and behaviors, which is positive for habits like exercise, playing an instrument, or cooking a meal. However, this same efficiency can contribute to substance dependency and make it difficult to overcome.
Fortunately, the brain has robust neuroplasticity. It can rewire the neural pathways to overcome self-destructive habits and behaviors and create paths that lead to healthy and sober life choices. With the support of healthcare professionals, friends, and family, plus patience and focus, the body and brain can recover from addiction.
At StoneRidge Centers, we utilize a research-backed approach to helping patients understand, manage, and overcome substance abuse, starting with the brain. Call us to find out how we can help heal the damage caused by addiction and start the path to long term recovery.
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