One of the newest fads in the field of psychiatry and neuroscience in general is the notion that addictions to various substances or behaviors are in some manner biologically “caused.” This is usually an argument based upon the connection of activation of the reward circuitry of the brain with the substance or behavior. Aside from the basic logical truth that this confuses a simple correlation with potential cause and effect, it also assumes that individuals with no addictions have minimal activity within the reward circuitry.

I would have to imagine that if I sit down and enjoy a favorite food and truly savor it, that the reward circuitry of my brain in in some manner mediating this experience. However, my enjoyment of the food does not necessarily lead to out of control eating or addiction.

The errors of the deeply biological explanation ignore the basic realities of experience that patients and friends clearly describe when they change their behavior in pretty profound ways. As an example, a patient I evaluated described ceasing the use of tobacco, one of the more biologically addictive substances on the planet. She said that at the moment her grandchild was born, she had in instant revelation that if she didn’t stop smoking she would never see her grandchild graduate high school. She ceased a several decade history of smoking in an instant. She reported that there had been a few carvings which she ignored and then she knew herself to be a non-smoker.

What changed? How could this addiction disappear in a moment?

The biological answer can only be that a rapid change occurred in her association cortex, which altered the meaning and neural networks related to the behavior of smoking. Even if the desire for the substance is mediated by the reward system, it seems that the connection with the reward system can be instantly disconnected by a transformation of the meaning of the behavior.

Brings to mind the people, places, and things comments of the 12-step groups. All things related to the association network of neurons.

This simple question of how an addiction can be broken really opens a phenomenal series of questions about who we are, how we change, and what layers of the self regulate thoughts and behavior.