A Tale of Two Brains

Is Addiction a Disease?

Dr. Ellis discusses how understanding alcoholism as a disease defuses shame, blame, and guilt, and how the family can begin to view the loved one not as a bad person who needs to be shunned or censured, but as a sick person who needs to be treated.

The brain is a combination of wondrous complexity, fragile balances, and remarkable resiliency. It performs truly incredible tasks, it can get sick, and it can heal. That's good to know when we're talking about alcoholism. The alcoholic can heal.

Any brief web-site review of the science behind addiction will be incomplete.

My task here is not to present an academic review but to try to illustrate some complex ideas in a simple manner.

For the purpose of understanding addiction we begin with two main parts of the brain, the midbrain, and the prefrontal cortex. The midbrain is one of the more primal areas of the brain. The process of reward, pleasure, and emotional processing begins here but involves many other areas. It is reflexive and sub-conscious. It is part of the survival matrix, telling us to eat, mate, fight, and flee.

The prefrontal cortex is a rather recent development in the brain, appearing to rapidly expand in primates about half a million years ago. It is the part of the brain with all of the folds. This area of the brain makes us human in the highest sense. It is where wisdom originates. In this area we weigh decisions, anticipate consequences, love others, and have spiritual experiences, etc. In the prefrontal cortex, we make decisions.

In a normal functioning brain, the prefrontal cortex executes choices and serves as a governor to more primal drives. Thus we do not seek to have sex, or eat, or fight all of the time. The midbrain serves its purpose of providing survival drives and indicating when an experience is pleasurable. The prefrontal cortex makes the final decision as to how these drives are fulfilled.

In addiction, this delicate balance is destroyed.