PS511 Unit 2 Neurobiology of Addiction Paper Example

Why the Pills Stopped Working but the Craving Did Not: A PS511 Unit 2 Paper Applying the Neurobiology of Addiction to One Client

[Student Name]

Purdue University Global

PS511: Chemical and Psychological Dependency Counseling

Unit 2 Neurobiology of Addiction Paper

[Instructor Name]

[Date]

The writer, the clinic, the client and every detail of the case are composite and illustrative; the sources cited are real.

The Question

In our second session, Mitch said something that puzzled me: "Those pills haven't felt good since about Christmas of the first year. I just can't be without them." If people use drugs because they feel good, why would someone keep using, and use more, after the pleasure has gone? This paper uses current neurobiological models of addiction to answer that question for Mitch and to show what the answer means for counseling.

The Three-Stage Model

Koob and Volkow (2016) lay out a loop of three phases, and they assign each phase its own group of brain structures. In the binge and intoxication stage, the drug's rewarding effects are driven largely by dopamine and opioid signaling in the basal ganglia, and cues paired with the drug, such as places, people and times of day, gain the power to trigger use. The second phase, withdrawal and negative affect, is where the pleasure machinery goes dull while the extended amygdala, a hub for stress chemistry, runs hot; quitting then feels like irritability, dread and gloom. In the third phase, preoccupation and anticipation, the frontal regions a person uses to plan ahead and say no lose ground, and wanting the drug crowds other thoughts out.

The authors argue that addiction moves over time from use driven mainly by reward to use driven mainly by relief, as the second stage takes over from the first. A person who began taking a drug because it felt good ends up taking it to stop feeling bad.

Mitch, Stage by Stage

Mitch's first month of oxycodone after surgery fits the first stage only partly. The pills eased pain and, Mitch admits, brought "a warm, floaty feeling" in the evenings. That feeling became tied to a routine: two pills with supper in the recliner, the television on. By the time the prescription ended, the recliner and the evening news had become cues.

The withdrawal and negative affect stage shows up clearly by the end of the first year. Mitch describes the hours before a dose as "the worst flu with the worst mood," with aching legs, sweating, anger at the kids and a sense that the back pain was worse than ever. Volkow et al. (2016) note that tolerance and withdrawal reflect changes in the brain's adaptation to the drug, and that the drop in reward sensitivity makes ordinary pleasures, like a fishing trip or a hockey game, feel flat. Mitch stopped going ice fishing that winter.

The pills had stopped adding pleasure and started subtracting misery, which is the turn from reward to relief in the model.

The preoccupation and anticipation stage appears in how Mitch planned his days. Mitch counted pills at the start of each shift, kept a mental map of which coworkers might have extras and felt panic when a supply ran short. Mitch knew the risk of driving a haul truck while sedated, said so clearly and still took a pill before a night shift. Frontal control that has lost ground helps explain how someone can understand a danger and still act against that understanding.

What the Model Does Not Explain

Heilig et al. (2021) defend the brain disease view against its critics but argue that it needs revising. They accept that social and environmental factors strongly influence who develops addiction and who recovers, and they argue for consilience, meaning that evidence from neuroscience, psychology and social science should be brought together rather than placed in competition. For Mitch, the brain model explains why stopping felt impossible, but it does not explain why Mitch kept the job secret, why the supply was so easy to find at the mine or why the nearest pain clinic was ninety minutes away. Those are psychological and social facts.

The authors also caution against reading the brain disease view as saying people with addiction have no choice. Mitch made choices throughout. The model explains why those choices became harder over time, not why they were impossible.

Implications for Counseling

Understanding the stages changes how I talk with Mitch and what we plan. First, because the withdrawal and negative affect stage is driving use now, the first goal is to relieve withdrawal safely, which means a medical evaluation for medication. Asking Mitch to outlast an overactive stress system on willpower alone would set Mitch up to fail.

Second, the cues from the first stage, the recliner, supper and evening television, need a plan. We agreed Mitch would move the recliner to the basement for a few months and take an evening walk with the dog after supper.

Third, because prefrontal control recovers slowly, early recovery should rely on structure rather than on in-the-moment decisions. Mitch will hand pay to his wife for the first months, and we will schedule sessions on the days after night shifts, when cravings are strongest.

Fourth, the flatness of ordinary pleasures will take time to lift. I explained this to Mitch so that a dull first month without pills would not be read as proof that recovery was not working.

Explaining the Model to the Client

When I described the three stages to Mitch in plain words, Mitch said it was the first explanation that made sense of feeling "hooked on something that didn't even feel good anymore." Psychoeducation about the brain can reduce shame, as long as it does not suggest the person is helpless. Mitch's wife came to the following session and asked whether the changes were permanent. I explained that the research shows many of them recover over months of abstinence, unevenly, and that this is part of why early recovery feels so hard and why the plan relies on structure while the brain recovers.

Limits

The neurobiological models come mostly from animal research and brain imaging studies of groups of people. They describe tendencies, not what is happening in any one person's brain. I cannot know which circuits have changed in Mitch, only that the history fits the pattern.

Conclusion

Mitch's puzzle, using more after the pleasure had gone, is what Koob and Volkow's three-stage model predicts: use that began for reward became use for relief, driven by stress circuits and weakened self-control. Heilig and colleagues remind us that the brain is only part of the picture. Together they point to a plan that treats withdrawal first, manages cues, builds structure while self-control recovers and prepares Mitch for a flat period early in recovery.

References

Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L., & Vanderschuren, L. J. M. J. (2021). Addiction as a brain disease revised: Why it still matters, and the need for consilience. Neuropsychopharmacology, 46(10), 1715-1723. https://doi.org/10.1038/s41386-020-00950-y

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773. https://doi.org/10.1016/S2215-0366(16)00104-8

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371. https://doi.org/10.1056/NEJMra1511480