Dr. Mel Pohl is the Chief Medical Officer at the Las Vegas Recovery Center. Using his personal experience with addiction, along with his medical training and professional experience, Dr. Mel will help you see that change is possible. Whether you're addicted to substances, like drugs or alcohol, or to behaviors, like gambling or sex, the effect on the brain and body is quite similar - as is the recovery process. Learn why you have cravings, how to change, and what to do to find long-term peace and happiness.


The Basics


Addiction is a chronic, progressive, treatable, and potentially fatal brain disease. The brain is in charge of essentially everything we do, say, think, remember, decide, all of our actions and sensations. The brain is divided into several parts – the two areas of focus for this discussion are the frontal lobe (thoughts and executive function) and the midbrain (reptile brain), which contains the limbic system (survival functions and emotions).


In defining addiction, we need to recognize certain symptoms and characteristics. Craving is one symptom of addiction and is defined as having the desire for the drug or behavior when it is absent. Tolerance occurs when your body acclimates to the substance with chronic use, and the substance has less effect on you despite an increase in dose (this is the condition when you can “hold your liquor” without appearing intoxicated). Blackouts occur if you are tolerant to alcohol. These are periods of total or partial memory loss while intoxicated. 


Physical Dependence occurs when the body has changed so much after regular use of the substance, that it is not normal without the substance and you will experience withdrawal (the opposite effect of the drug). These symptoms also occur with behavioral or process addictions. For example, a gambler may lose track of time and place for hours and have difficulty recalling what has happened. Spending amounts or time spent with pornography may increase over time, though the effects become blunted as with tolerance. Stopping behaviors or use of substances will leave you feeling awful for a period of time due to withdrawal.


The most common reasons people use substances and create addictive behaviors are either to feel good (reward) or to escape from feeling bad (relief). Everyone wants to feel good and avoid bad feelings – that’s human nature. What happens in the brain, with addiction, is that the addictive behavior causes you to feel so good, and brings so much relief, that you pursue these “improved states” despite bad things happening and at the expense of your well-being. The drug works so well that it develops survival salience, which means that your brain thinks and feels like it needs the drug to survive – even more than food, water, sleep or sex.


Loss of control is a key symptom that occurs for the addicted person, essentially because of this brain short-circuit. So, basically, you can’t have “just one beer” or simply “smoke a joint” or “place a sports bet” or "look at one pornographic image." If you start, the destructive process begins again. 

Does cutting back work to treat addiction? Sadly, not very well because of this loss of controlphenomenon. Optimal treatment is abstinence from all mood-altering drugs and behaviors.


The other defining characteristic of addiction is continued use despite consequences. In other words, you continue to use even though your job is on the line, your relationship is damaged, your finances are wrecked and your self esteem is down at the bottom of a deep dark well.


Please answer the following questions in your notes below:


  1. What are the reasons that you use substances? To get high? To escape? Both?
  2. If you endorsed using to escape, then what do you want to escape from?
  3. How do you respond when you have a craving? A common response might be "I drink" or "I use" or "I act out." 
  4. Can you find some alternatives? For example, call someone, go for a walk, say a prayer – or ask for help in another way…
  5. What are some of the consequences you have experienced as a result of using substances or behaviors?


Meet Your Host:


Dr. Mel Pohl is a family practitioner and Chief Medical Officer of the Las Vegas Recovery Center, where he developed the Chronic Pain Recovery Program. Dr. Mel is certified by the American Board of Addiction Medicine and is the Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine. He is the author of The Pain Antidote - Stop Suffering from Chronic Pain, Avoid Addiction to Painkillers, and Reclaim Your Life.




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