Program in Mt. Lebanon examines brain’s relationship to addiction

For most of us, thinking about how the human brain works leads to a big ball of confusion.
But researchers, if you’ll pardon the expression, are making headway.
“Now, I’m not saying we know everything, because we certainly don’t,” Eileen O’Toole admitted. “But there’s a big relationship here between what our addiction does to us and what our brain is going through.”
A doctor of nursing practice and family nurse practitioner, O’Toole has been studying that relationship in connection with her work at drug and alcohol treatment centers.

As featured speaker at the June 13 meeting of the Coalition for Leadership, Education and Advocacy for Recovery, held at St. Paul’s Episcopal Church in Mt. Lebanon, she discussed how understanding addiction as it relates to the brain can influence treatment and change the perception of the disease.
O’Toole, who serves on CLEAR’s steering committee, said that a recent key discovery involves the behavior of dopamine, the substance that helps control the brain’s reward and pleasure centers.
Researchers had established it as primarily affecting the limbic system of the brain, “the one that makes us want to use,” she said. “And then it also, which nobody knew before, goes to the prefrontal cortex, which inhibits our ability to say, ‘I’m not going to use today.'”
Her reference was to the section of the brain that takes care of such functions as making decisions and using logic, and one that is not fully developed until a person is in his or her mid-20s.
“When I do my assessments, I would say that 95 percent of the people I’m interviewing started using drugs at the ages of 12 to 14,” she reported, noting at that point in life: “They have no prefrontal cortex to say, ‘Oh, I shouldn’t be doing this. This isn’t a good idea.’ They are just ruled by the amygdala” – part of the limbic system – “which tells them to continue using these drugs.”
Brain development is indicative of the changes that the main organ of the central nervous system routinely undergoes, “based on the things that go on in our lives and our environment. Not only does it change from the chemicals, it also changes from adverse childhood experiences. It also changes from mental illness,” O’Toole explained. “If we look for the cause of addiction only in the chemicals, we may miss all these connections that we need to have.”
As such, she contended, the key to successful treatment and recovery is addressing what she called the “trifecta” of contributing to relapse: substance use, mental disorders and early trauma.
“Unresolved trauma can absolutely lead to addiction,” she said, citing various types of abuse and other life-altering experiences. “They have calculated that as high of 80 percent of drug use involves some trauma in our childhood.”
On top of that, she reported that half the children ages 8 to 15 who have mental illness receive no treatment, and their solution often is to self-medicate.
“We have to connect it with their lifestyle,” she said. “We have to connect it with their mental illness. We have to connect it with all the stressors.”
No matter when addiction starts, recovery is likely to be a lifelong pursuit, as O’Toole can testify. She is candid in talking about her own battles with alcoholism and recently celebrated her 28th year of sobriety.
“It was a beautiful day,” she told the St. Paul’s audience. “I walked out on the patio and thought, wouldn’t a glass of Chablis be nice? I don’t have any idea where that thought came from. I don’t even know that I drank Chablis. But that’s the thought that went through my mind.”
Yes, her brain still was trying to lead her astray after all those years. And so her message to those with similar struggles:
“We have to stay without our drug for a long time before the pathway that has been carved by our addictions – using every day, every day, every day – is gone.”
For more information about CLEAR, visit www.facingaddiction.org/partner/clear-coalition-for-leadership-education-advocacy-for-recovery.