Brain Inflammation in Addiction & Alcoholism

(Note: the research articles used in preparing this article are referenced at the bottom of this page).

A big part of the puzzle of figuring out addiction and how best to prevent and treat it lies in the question "why do some people become addicted but some don't?" About 14% of people who drink or try using drugs become addicted, but most don't. So, what is it about those 14% that makes them become addicted?

What makes the question more puzzling is that many people who have all the risk factors for addiction (such as family history of addiction, a traumatic upbringing, socioeconomic disadvantage, high life stressors, mental health issues, and so on) can drink or use drugs and never become addicted, while there are people with few or no risk factors who do become addicted.

Fortunately, we've come a long way in understanding the addicted brain. When I was in medical school in the 90s, I can only recall 2 hours of lectures on addiction in my ten years in medical training. I finished my medical training and went into practice with the belief that alcoholics and addicts were bad people who wake up every day and make bad decisions all over again. Boy, did I get a surprise when I ended up there myself!

We know that there is something going on in the brain, because the vast majority of people who become addicted remain susceptible to relapse with even one "slip-up" for the rest of their lives. I know of many cases where people who have not used or drank for a number of years (even more than 20 years) have relapsed right back to where they were after one drink or one hit (see "When is Someone Cured From Alcoholism / Addiction?" )

Well, thankfully, in the past 15 years or so, science has learned a lot about what makes someone susceptible to addiction. There is no one thing, it's a combination of factors, and they are not all definitive. For example, most people are aware that addiction is very much a genetic thing. However, it's not a matter of whether or not you have the "addiction gene." There is no such gene. Rather, there are dozens (probably hundreds) of genes that have some effect on whether or not you are likely to develop addiction. As well, whether or not your kids will be susceptible to addiction because you are an addict is not straightforward (see "Is There an Addiction/Alcoholism Gene?").

Once someone has developed an addiction to drugs or alcohol (or gambling, food, etc.) there are a number of brain processes that become highly distorted and take over normal brain function. This results in the highly self-destructive, and odd behaviors that seem to make us a whole different person when we are in the throws of active addiction. These brain functions and the behaviors they cause (our psychology) are the subject of many of the articles on this website, and are fully explained in my book.

A great deal of recent research has uncovered yet another brain-related change that is at work in creating and propagating addiction. It turns out that alcohol and other drugs of abuse activate the immune system in the brain to cause inflammation, which in turn contributes to various aspects of brain function and behavior related to addiction. This isn't just simple inflammation from the presence of the drug; rather, alcohol and other drugs alter the very genetics of the brain's immune system, perhaps forever.

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This substance-induced brain inflammation (neuroimmune activation) has a far-reaching impact brain function and dysfunction involving more than just addiction: it's also involved in the development of neurodegenerative diseases (such as Alzheimer's disease and Parkinson's disease), and psychiatric disorders. As scary as that sounds, these new discoveries offer new opportunities and a framework for exploring and understanding addiction. It may lead to therapies for addiction.

This substance-induced brain inflammation appears to be the driving factor in brain damage caused by frequent alcohol use, and likely other drugs of abuse as well. As such, there is preliminary research into mice, looking into whether the anti-inflammatory medication indomethacin blocks the obsessive drive for drug use, and whether it prevents and perhaps treats the brain damage from drug and alcohol use. Again, this research is very preliminary, and is not yet being tried in humans, so please don't jump the gun by taking indomethacin.

So, how exactly does brain inflammation cause us to become addicted and stay addicted? Well, researchers have figured that out. In my article "The Brain in Addiction and Alcoholism," I explain how brain pathways develop in addiction that establish the behavior patterns and obsessive need for our drug of abuse, and that these pathways can be re-activated even many years into recovery. The neuroimmune inflammation affects the connections (synaptic connections) between brain cells (neurons) which is likely related to the new "addiction" pathways that occur between brain cell connections. So the inflammation facilitates the formation of these addiction pathways.

As would be expected, this dysfunctional brain inflammation can wreak havoc in the developing brain (i.e. anyone under age 25). The toxicity of the substance of abuse and the abnormal inflammation kill brain cells, disrupt the development of new brain cells, and disrupt the developing brain as it tries to form the connections it needs to grow and learn. Of course, the younger the person, the more damage it can cause to the developing brain. So, exposure to drugs or alcohol to the baby in the uterus is especially harmful. As well, this substance-induced inflammation in the developing brain is likely to cause behavioral disorders and psychiatric disorders as well, since the brain inflammation is associated with those conditions.

Interestingly, human studies of alcoholics show a positive correlation between alcohol craving and the level of brain inflammation, suggesting that activation of the brain's immune system may increase alcohol craving and consumption. Since this inflammation appears after binge-drinking or frequent drinking, it is likely that this inflammation plays a huge role in deciding if a person will become addicted to alcohol. The same effect is seen with other drugs of abuse: opiates (heroin, morphine, oxycodone, codeine, etc.), stimulants (cocaine, crystal meth, etc.), and marijuana.

These brain effects seem to be particularly pronounced in cocaine use, and seem to play a big role in the behavior and compulsive use associated with that drug. Very preliminary research has identified some compounds that seem to reduce this effect, leading to the possibility of a future treatment option for cocaine addiction.

In a previous article I discussed the very close ties between addiction and mental health disorders, especially depression and anxiety, as well as bipolar disorder, psychotic disorders, etc. (See "The Link Between Mental Health and Alcoholism/Addiction"). This link is based on genetics, as well as risk factors such as life situation. Now we know that this brain inflammation is another link between the two, and why they tend to occur in close association.

In the end, this is a relatively new discovery, and much research will follow. It should allow us to understand addiction and why some people become addicted while others don't. As well, further research could provide novel drug targets for the treatment of addiction. However, it is my personal and professional belief that there will never be a cure-all pill for addiction. When people are in the throws of addiction they are much more than physically sick; they are messed up in the mind and spirit as well, and those things must be addressed to enable a long and healthy recovery. In my own case, simply removing the drugs and alcohol would not have made me a well person. I had to address all the mental and spiritual (NOT religious) carnage that was left over after years of addiction.

There are a few articles on this website that explain how to do this, and the nature of all that mental and spiritual carnage. See "Why Do They Call Addiction/Alcoholism a Spiritual Sickness?", "I'm Overwhelmed!", "Getting Around Past Traumas" and "Craving Cessation."

References:

Crews, F. T., & Vetreno, R. P. (2014). Neuroimmune basis of alcoholic brain damage. International review of neurobiology, 118, 315-57.

Cui, C., Shurtleff, D., & Harris, R. A. (2014). Neuroimmune mechanisms of alcohol and drug addiction. International review of neurobiology, 118, 1-12.

Ferrer-Pérez, C., Martinez, T. E., Montagud-Romero, S., Ballestín, R., Reguilón, M. D., Miñarro, J., & Rodríguez-Arias, M. (2018). Indomethacin blocks the increased conditioned rewarding effects of cocaine induced by repeated social defeat. PloS one, 13(12), e0209291. doi:10.1371/journal.pone.0209291

Nennig, S.E., & Schank, J.R. (2017). The Role of NFkB in Drug Addiction: Beyond Inflammation, Alcohol and Alcoholism, 52(2), 172–179.