Drug addiction is as dark as the inside of a wolf. This chronic relapsing disorder is characterized by maladaptive learning about drugs and predictive cues that leads to compulsive drug seeking. The crucial goal of addiction treatment is to correct maladaptive behaviors and minimize relapse events without disrupting normal reward-seeking behaviors (like finding food and water). Because drugs hijack endogenous reward circuitry to elicit their rewarding and reinforcing effects, this proves difficult.
Enhanced activation of substance specific reward and reinforcement pathways, such as the dopamine system, can lead to remodeling of neural circuits as well as changes in synaptic connectivity that increase rewarding-seeking connections while decreasing plasticity, or the ability to reform healthy decision making circuits. Accordingly, individuals put enormous amounts of disproportionate effort into working to obtain drug at the expense of other adaptive behaviors. Thus, the inability to update information and extinguish maladaptive behavioral responses forms the basis of pathological drug seeking that often underlies relapse.
Relapse can happen, and it hits like a sack full of hammers. All of that detailed, scientific characterization of the neurological basis of addiction can be daunting. But what I’ve bore witness to at Riverbank fills me with hope – courageous men picking up the tools to change those maladaptive behaviors. It’s infectious and inspiring to be surrounded by those so determined to change their lives for the long term. All of elements are there, now it’s time to write the novel. That’s how this storyteller sees it, anyway.