“You can’t get rid of addiction through willpower”

Every unhappy person is unhappy in his own way. Especially in modern reality, which offers ways to become unhappy for every taste: drugs, gambling, gluttony... But whatever the method of escaping reality, they all have a lot in common. They are treated by Ruslan Dmitrievich Ilyuk , scientific director of the Department of Therapy of Patients with Addictive Pathology at the St. Petersburg Bekhterev Psychoneurological Research Institute.

Ruslan Ilyuk:

“Generally speaking, addiction consists of a compulsive need for a certain activity that a person cannot control.

There are three types of addictions. With chemicals, psychoactive substances become the object of addiction - alcohol, opiates, cannabis, cocaine, psychostimulants, and so on. Examples of non-chemical addictions are gambling addiction, gambling addiction, Internet addiction, gadget addiction, and so on - their subgroup is sometimes called technological. Finally, there are intermediate addictions of a mixed nature - such as addiction to food.

By the way, the usual addiction to coffee is also an addiction. Uncontrolled coffee consumption appears in the International Classification of Diseases (ICD), under F15, which lists disorders caused by the use of various stimulants.

— If addictions can concern anything, then is there any definite boundary between a normal, ordinary addiction and a painful one?

In this sense, addictions are divided into socially acceptable ones - such as “workaholism”, excessive addiction to creativity, extreme sports, spiritual practices - and socially dangerous ones, such as alcoholism, gambling or drug addiction. As a rule, these are the ones that have to be treated.

If we talk about diagnostic criteria, they are listed in the same ICD classifier - International Classification of Diseases, 10th revision. To diagnose addictions, several key symptoms are used, which must be observed within a month and repeated with reasonable regularity throughout the year.

The first symptom is craving, a very strong desire to take a substance or act. The second is the emergence of tolerance, addiction, which leads to the need to constantly increase the dose to achieve the same desired effect. The third symptom is a violation of control - over taking a substance, over gambling, over time spent on the Internet... Finally, one of the most important manifestations is withdrawal syndrome. This is a set of physical and mental disorders that develop in patients with addiction some time after stopping taking a psychoactive substance. Withdrawal syndrome also exists with non-chemical addictions, although its manifestations are not so pronounced.

— How characteristic of our time are technological addictions, such as Internet addiction, that did not exist in the past?

Some of them have been known for quite a long time, although many, indeed, have appeared only in recent years. Let’s say that the craving for playing slot machines became evident in Russia only in the 1990s. Internet addiction spreads with the advent and spread of the Internet - in fact, it has become quite common since the year 2000.

Nowadays, the Internet is developing very dynamically, so this is where the newest forms of addiction arise. They can develop in people who are overly immersed in games, in communication through social networks, in virtual sex... In the end, so-called web surfing can also cause addiction. This is an aimless journey through the Internet, constantly searching for information, watching videos, and so on, which takes a lot of time. A person can be so absorbed by it that his mental and physical health and his socialization will suffer.

— As we understand, addictions can be very different. Do they all have a common physiological nature?

I gave a presentation on this very topic at one of the recent conferences. Its title was: “Chemical and non-chemical addictions. General mechanisms, general phenomenology and general approaches to therapy.”

In fact, any addiction, regardless of its object, arises from a certain combination of biological, psychological and social factors. What is important is the accessibility of the object of addiction, and a certain attitude of society towards it, and cultural tradition - in the end, and state policy, which can influence all this. But there are also biochemical mechanisms that are common to all types of addiction, both for alcoholism and for gambling addiction.

The fact is that in the limbic system of the human brain there is a so-called reward system. Water, food, sex and other factors are its natural stimulants: by receiving all this, we force the reward system to work and experience a feeling of pleasure. Evolutionarily, this mechanism is very ancient and important; it allows you to remember and consolidate beneficial forms of behavior. We naturally strive to ensure that the reward system works more often.

The essence of any addiction lies in the artificial stimulation of the reward system. This leads to very intense pleasant experiences, which the brain mistakenly perceives as a beneficial action: psychological dependence arises. At the same time, the metabolism of the nervous system, the number of receptors and the level of various neurotransmitters - substances involved in the transmission of signals between neurons - change, which leads to the formation of physical dependence.

Dopamine, which is released by the reward system, is one of the key neurotransmitters and causes us pleasure. And if a dependent person has taken alcohol or injected a drug, dopamine is released, causing a feeling of pleasure and satisfaction. It's the same with gambling addiction. While playing, a person wins from time to time, albeit little by little. This repeatedly stimulates the release of dopamine and causes a state of joy close to euphoria. For a pathological gambler, the gaming cycle lasts on average up to eight hours, during which he receives a dose of dopamine every now and then. He feels how problems and depression recede, feels joy - all this is due precisely to the artificial stimulation of the dopaminergic system... And all this is only a temporary phenomenon.

- Can we say that the reward system, which helps the brain in the learning process, gives a false positive during addiction - and the brain “learns” addiction?

This model of addiction is called operant conditioning. In essence, this is the formation of a reflex through reinforcement with one’s own dopamine. Another model is based on imprinting, “imprinting”. Learning through imprinting is quite common in nature. It may not require repetition and can be caused by just one very intense impact, a strong psycho-emotional reaction associated with the first use of a substance, winning or cybersex. Such a vivid experience is “imprinted”, the reward system releases its neurotransmitters - and the person strives for an endless repetition of this experience.

— The first thing a person resorts to in order to break this vicious circle is his own willpower. How much can it help with addiction?

Willpower implies that a person is able to control his behavior. And with addiction, it is this area that suffers first—control is lost. Addiction is the result, among other things, of volitional violations, so getting rid of addiction through volitional efforts, “pulling yourself together and stopping” will not work.

- How then to get rid of it?

Treatment of addiction is a complex problem, starting with the fact that many patients generally deny the presence of the disease until complex consequences appear. In any case, you should first contact a specialist.

Integrative treatment is usually assumed: medication, therapy and social care. Psychopharmacological drugs are used that affect the metabolism of opiates, serotonin, dopamine and other neurotransmitters. Intensive psychotherapeutic influence is used, correction of human behavior and his environment is carried out. It is often necessary to combat the social isolation into which the patient finds himself as a result of addiction, to create in him a sense of responsibility towards himself and his environment, new motivation... Social therapy can play an important role, organizing patients into therapeutic communities like “Alcoholics Anonymous” or “ Anonymous Gamblers", where they learn to regulate their behavior among their own kind.

— How common are these diseases in our society?

If we talk about heroin addiction, we have about a million such patients. There are many more alcoholics, about 4-5 million. With the numbers of non-chemical addictions, everything is much more complicated; here we can only give very rough estimates, since such people themselves rarely seek help. The number of gambling addicts, according to various sources, ranges from 1.5-3% of the population.

In the same social and cultural conditions, approximately the same percentage of addicts is observed. In any society there is a certain proportion of people who have a tendency to become addicted.

- This suggests the genetic nature of addictions.

Of course, a certain role of heredity cannot be denied. If we take the same alcoholism, in half of the cases it occurs in people who have close relatives who are alcoholics. There were even studies where they studied twins, children of chronic alcoholics who grew up in different conditions - and the occurrence of addictions in them was the same in different environments.

A number of studies have shown that gambling addicts often had parents who were gambling addicts. Connections have been found between gambling addiction and certain genes, including those encoding dopamine receptors and the transporter of another “pleasure hormone,” serotonin.

The connection between addiction and personal psycho-emotional characteristics is very clearly manifested. There are certain traits that are characteristic of addicted people - emotional instability, impulsiveness, difficulties with social adaptation and communication, closedness, poor adaptability. This can also be inherited from parents to a certain extent.

— Does a child of an alcoholic have an increased chance of developing another addiction - say, drug addiction?

Of course. There are a lot of studies that have shown that children of alcoholics, in addition to understandable mental disorders, also develop, for example, drug addiction. Let’s imagine that such a person plays slot machines and receives a certain “charge of vivacity.” When these devices were closed, he switched to amphetamine, which gives a comparable effect. I ran out of money for amphetamine and switched to alcohol and some alcohol-containing energy drinks. So he jumps from one addiction to another, and we see three diseases and three diagnoses at once: a mental disorder of a depressive cycle, addiction to narcotic stimulants and alcohol."