The Reward Pathway

 Amygadala

• The NA connects to the Amygadala.
• This part of the brain stores our memories and plays a major part in fear.
• This section is responsible for flight or fight.
• Those who suffer from PTSD or Anxiety Disorders have abnormal activity in this section of the brain.
• The pleasurable memories of drug use are stored in this part of the brain.
• It causes the addict to forget the negative consequences associated with chemical use which results in relapse.

Addiction is driven by pleasure and not by the relief of withdrawal. When I discovered this concept, I was really surprised especially with those addicted to opiates. I always thought it was about avoiding the painful effects of withdrawal.

• Pleasure is due to the release of dopamine.
• Seeking of pleasure in order to feel well vs. unwell.
• Those in rehab tend to increase cigarette smoking and eating because dopamine levels have dropped once the person stops the use of drugs and alcohol. Smoking and eating increase the dopamine levels.
• If addiction was all about the relief of withdrawal than detox would be enough treatment.
• 95% of those who leave treatment after detox and do not stay for rehab will relapse in the first year.

This is an important fact, I teach in the Addictive Brain class on Tuesday mornings. Many of the patients, I encounter think detox is enough only to discharge and return a short time later. My greatest challenge is getting insurance companies to recognize this fact. Most insurance companies want to fund detox and have the patient discharge to IOP (Intensive Outpatient). This sets a patient up for failure. Only after the patient fails in IOP will the insurance company consider rehab. This is a dangerous game to play when the life of a person is in the balance. The next drug run could be their last.