The bad news keeps coming. These drug-based alterations to the brain and all the associations made don’t go away when drug use stops; they’re just “not used.” They may fade somewhat but they endure, and will still be there should the individual sample the drug again, no matter how long they’ve abstained. This is why relapse is so easy, and such a big problem.
Exactly how people end up becoming regular drug takers varies massively. Maybe they live in bleak deprived areas where the only relief from the realities of life is from drugs. They might have an undiagnosed mental disorder and end up “self-medicating” by trying drugs to alleviate the problems they experience every day. There is even believed to be a genetic component to drug use, possibly due to some people having a less-developed or underpowered impulse-control region of the brain.25 Everyone has that part of them that, when offered the opportunity to try a new experience, says, “What’s the worst that could happen?” Sadly, some people lack that other part of the brain that explains in exquisite detail exactly what could happen. This accounts for why many people can safely dabble with drugs and walk away unchanged, while others are ensnared from the first hit onwards.
Regardless of the cause or initial decisions that led to it, addiction is recognized by professionals as a condition to be treated rather than a failing to be criticized or condemned. Excessive drug use causes the brain to undergo startling changes, many of which contradict each other. Drugs seem to turn the brain against itself in some prolonged war of attrition, where our lives are the battleground. This is a terrible thing to do to yourself, but drugs make it so that you don’t care.
This is your brain on drugs. It is pretty hard to convey all this with eggs, admittedly.
Reality is overrated anyway
(Hallucinations, delusions and what the brain does to cause them)
One of the most common occurrences in mental health problems is psychosis, where someone’s ability to tell what’s real or not is compromised. The most common expressions of this are hallucinations (perceiving something that isn’t actually there) and delusions (unquestionably believing something that is demonstrably not true), along with other behavioral and thought disruptions. The idea of these things happening can be deeply unsettling; losing your very grasp on reality itself, how are you supposed to deal with that?
Worryingly, the neurological systems handling something as integral as the ability to grasp reality are disturbingly vulnerable. Everything covered in this chapter so far—depression, drugs and alcohol, stress and nervous breakdowns—can end up triggering hallucinations and delusions in the overtaxed brain. There are also many other things that trigger them, like dementia, Parkinson’s disease, bipolar disorder, lack of sleep, brain tumors, HIV, syphilis, Lyme disease, multiple sclerosis, abnormally low blood sugar, alcohol, cannabis, amphetamines, ketamine, cocaine, and more. Some conditions are so synonymous with psychosis they’re known as “psychotic disorders,” the most well known of which is schizophrenia. To clarify, schizophrenia isn’t about split personalities; the “schism” for which it is named is more between the individual and reality.
While psychosis often results in the sensation of being touched when you’re not being, or tasting or smelling things that aren’t there, the most common are aural hallucinations, aka “hearing voices.” There are several classes of this type of hallucination.
There are first-person auditory hallucinations (“hearing” your own thoughts, as if they’re spoken by someone else), second person (hearing a separate voice talking to you) and third person (hearing one or more voices talking about you, providing a running commentary of what you’re doing). The voices can be male or female, familiar or unfamiliar, friendly or critical. If the latter is the case (which it usually is), they are “derogatory” hallucinations. The nature of hallucinations can help diagnosis; for instance, persistent derogatory third-person hallucinations are a reliable indicator of schizophrenia.26
How does this happen? It’s tricky to study hallucinations, because you’d need people to hallucinate on cue in the lab. Hallucinations are generally unpredictable, and if someone could switch them on and off at will, they wouldn’t be a problem. Nevertheless, there have been numerous studies, focusing largely on the auditory hallucinations experienced by those with schizophrenia, which tend to be very persistent.
The most common theory of how hallucinations occur focuses on the complex processes the brain uses to differentiate between neurological activity generated by the outside world, and activity we generate internally. Our brains are always chattering away, thinking, musing, worrying and so on. This all produces (or is produced by) activity within the brain.
The brain is usually quite capable of separating internal from external activity (that produced by sensory information), like keeping received and sent emails in separate folders. The theory is that hallucinations occur when this ability is compromised. If you’ve ever accidentally lumped all your emails together in the same folder you’ll know how confusing this can be, so imagine doing that with your brain functions.
So the brain loses track of what’s internal and what’s external activity, and the brain isn’t good with such things. This was demonstrated in Chapter 5, which discussed how blindfolded people struggle to tell the difference between apples and potatoes when eating them. That’s the brain functioning “normally.” In the case of hallucinations, the systems that separate internal and external activity are (metaphorically) blindfolded. So people end up perceiving internal monologue as an actual person speaking, as internal musings and hearing spoken words activates the auditory cortex and associated language-processing areas. Indeed, a number of studies have shown that persistent third-person hallucinations correspond with reduced volumes of gray matter in these areas.27 Gray matter does all the processing, so this suggests reduced ability to distinguish between internally and externally generated activity.