Drugs Do Not Cause Addiction
Addiction, it has touched most lives in some way either directly or indirectly. We start learning about addiction in elementary school. In the 80’s the tag line was “say no to drugs”, these days children go through the D.A.R.E. program to learn about substance abuse and addiction. When you hear the word addiction most people think of cocaine, heroin, opioids, maybe cigarettes, alcohol and gambling. However, this is a very abbreviated list of substances that are associated with addiction. A more complete list would include shopping, internet, gaming, social media, food (sugar, high fructose corn syrup, and carbohydrates), and smartphones. Often the words addiction and substance abuse are used interchangeably, but I would like to suggest they are entirely different. People can be addicted to non-substance items, such as being the center of attention and power. We have all heard the saying “he/she is on a power trip”, quite literally power causes the same reaction in the brain as cocaine. I just wanted to address the fact that not all addiction is substance abuse, because I think that is a big misconception. If I’m being completely honest, I think most everything we think we know about addiction is a big misconception.
Recently the dentist I work with introduced me to Dr. Howard Wetsman, not personally through the internet. I began to research Dr. Wetsman’s work and it changed the way I viewed addiction. I hope through writing this I can do the same for you. Most of the information I will share here will be based on Dr. Wetsman’s work with additional peer reviewed studies. Dr. Howard Wetsman is an addiction psychiatrist he has been researching and treating addiction for the past 25 years, his goal is to end addiction in the next 30 years. I want to help him achieve his goal, by spreading as much information as possible on addiction and how we have missed the mark for years on the proper treatment and diagnosis for addiction.
Is addiction a disease or a choice? I asked this exact question to some dear friends of mine, that I know have directly been affected by addiction. I received mixed answers, several said it was a choice that turned into a disease, while others felt it was an untreated mental illness that caused addiction. I want you to forget for just a moment everything you think you know about addiction. Prepare to learn about addiction and the science associated with addiction in a different way than ever before. I hope it leaves you with a better understanding and new outlook on the addiction crisis plaguing the United States.
According to the American Society of Addiction Medicine addiction is defined as a primary chronic disease of the brain reward, motivation, memory, and related circuitry.  Let’s break that down a little more. The brain is comprised of many parts. If a person were to choose to abuse a substance or non-substance, that decision would be made in the cortex of the brain. The cortex of the brain is highly evolved, it assists in making decisions. When you are choosing what to have for dinner tonight, you are utilizing your cortex. You think with the cortex and you are completely aware of the conscious decisions you are making. The cortex is not where addiction is in the brain. That means addiction is not a choice. 
The midbrain is part of the brain all mammals possess, it is the reward center. This is the part of the brain where addiction occurs. Addiction is a midbrain disease. In the midbrain you will find a group of cells called the ventral tegmental area. Attached to the ventral tegmental area is an arm called the axon. The ventral tegmental area makes and uses a chemical called dopamine to send signals to another group of cells called nucleus accumbens. When you have enough dopamine in the nucleus accumbens, the nucleus accumbens sends a signal to the cortex (remember we discussed the cortex above) telling your brain “everything is fine”, this enables you to use the cortex/thinking part of your brain. However, when we don’t have enough dopamine, things are completely different. Your brain starts sending survival signals, telling you to focus on what is happening right now, not what is happening or going to happen in the future. When you do not have enough dopamine, the future is not on your radar. Your brains focus is to fix the problem at hand, which is a lack of dopamine. Low dopamine creates certain behaviors to fix the lack of dopamine. Low dopamine at the nucleus accumbens is the cause of certain telltale behaviors in people with addiction. We have all experienced this feeling at some point in our lives. A perfect example is when you are “hangry”, you know that feeling of irritability, discontentment, and restlessness you feel when you are really hungry, all you can think about is getting something to eat. Sometimes it doesn’t matter what it is, you will eat anything to help you feel better and satisfied. Well, people with low dopamine feel this way all day, every day. 
There are three factors that contribute to the levels of dopamine available in your midbrain. These three factors are: dopamine release, dopamine receptors and time. Dopamine release is the amount of dopamine released from the ventral tegmental area. Dopamine receptors transfer the dopamine into the nucleus accumbens. Time refers to the amount of time the dopamine is available at the receptors, a malfunction in dopamine reuptake can lessen the amount of time dopamine is available. In summation, lack of dopamine released, lack of dopamine receptors, or dopamine reuptake too quickly are among some of the reasons people experience low dopamine. Malfunction in just one of these areas causes critically low dopamine. All these factors have a genetic cause, which means some people are born with a midbrain disease that predisposes them to addiction.  I’ve heard from the time I was very young that addiction can be hereditary. I never questioned it, but this information helps me to understand the science behind that statement.
Human genome research has advanced our understanding of many diseases. Mutations in certain genes have been linked to addiction. Studies have concluded there is evidence of a huge number of single nucleotide polymorphisms (a variation in a single base pair in a DNA sequence) associated with drug use.  Though there are many gene mutations being studied in association with addiction, I want to focus on methylenetetrahydrofolate reductase (MTHFR). The MTHFR gene is responsible for a chemical reaction that turns folate (vitamin B9) into methyl-folate.  The body cannot use folate until it is converted to methyl-folate. Methyl-folate is the only form of folic acid that can cross the blood-brain barrier. This is important because methyl-folate is responsible for the production of dopamine. If you have the MTHFR mutation, your body can not convert folic acid into methyl-folate, without methyl-folate your brain will not produce enough dopamine. If your brain does not produce enough dopamine, your midbrain is screaming to your cortex HELP!! This overrides cognitive thinking and causes people to seek out something to raise their dopamine level, such as chocolate, carbohydrates, a cocktail, cocaine or opioids.
I hope this helps explain why drugs do not cause addiction. Addiction is a midbrain disease that results in certain behaviors, like substance abuse. To add insult to injury, people suffering from a gene mutation (no fault of their own) are being incarcerated and sent to rehab centers that are focused on the substance and not the underlying issues. People that are spared a jail sentence in leu of rehab are often on probation and drug tested regularly, if they fail a drug test they are sent to jail. Just think of how ridiculous this kind of treatment would be for someone with cancer. The patient has treatment (chemo/radiation), they go into remission, go home happy to be with their families, go back regularly for a PET scan, then they have a relapse. If we treated this cancer patient like we treat patients with addiction, this cancer patient would now need to be quarantined because clearly, they chose to have a relapse. Has your head exploded yet, because it should! Just as a cancer patient would not choose to relapse an addict is not making that conscious decision either. Addiction is a chronic disease; no other chronic disease is treated in the same manner as addiction.
Addiction has been a problem for hundreds of years. We have yet to find a solid successful treatment for addiction. Genetic testing could prove to be just the piece of the puzzle we need to better understand and treat addiction. For example, if an addict has a MTHFR mutation, the way to help them is a simple supplement that can be found at your local pharmacy. The supplement l-methylfolate bypasses the need to break down folic acid and delivers methyl-folate to the brain and helps the brain produce dopamine. I am not suggesting anyone should go and buy this supplement, I’m suggesting you have a conversation with your doctor. As I mentioned before there are other contributing factors to addiction, this is just one that I focused on to show the great strides I believe we are making with addiction, as well as mental health in general.
I don’t know the answer to the addiction problem in the U.S., but I do know that we are closer to finding the help people need now than ever before. I will be following this topic closely, because I want to be at the celebration when Dr. Wetsman achieves his goal of ending addiction in American public life within the next 30 years.
1. American Society of Addiction Medicine. Retrieved from https://www.asam.org/resources/definition-of-addiction
2. Howard Wetsman, MD. Retrieved from https://youtu.be/K3-HeYL9Aqs
3. Howard Wetsman, MD. Retrieved from https://youtu.be/KWabTRPr91s
4. Howard Wetsman, MD Retrieved from https://www.youtube.com/watch?v=WZHG0Ttol4g
5. Buhler KM, Gine E, Echeverry-Alzate V, Calleja-Conde J, de Fonseca FR, Lopez-Moreno JA. Common Single Nucleotide Variants Underlying Drug Addiction: More Than a Decade of Research. Addict Biol. 2015 Sep; 20(5): 845-71. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25603899
6. U.S. National Library of Medicine. Retrieved from https://ghr.nlm.nih.gov/gene/MTHFR