What Is Neuroplasticity?

As we grow from children into adults our brains are continually changing. Through each new or repeated experience, connections are formed in the brain that influence how we understand and engage with ourselves and the world around us. The brain was once believed to be a static, unchanging organ once it reaches maturity in our mid-twenties. Now, it is understood that the structure of the brain can change throughout the lifespan, based on our thoughts, behaviours, and experiences.1 This is because the brain is neuroplastic. Neuroplasticity means that neural pathways in the brain can grow stronger or weaker, depending on how much we reinforce them.
In the journal Annals of Anatomy, neuroplasticity is broadly defined as the brain’s ‘ability to make adaptive changes related to the structure and function of the nervous system’.2 It is further defined in Frontiers in Psychology as ‘the brain’s ability to modify, change, and adapt both structure and function throughout life and in response to experience.’3

“Our brains renew themselves throughout life to an extent previously thought not possible.” – Michael S. Gazzaniga

Thanks to neuroplasticity, we can learn new skills, new languages, solve problems, and even improve our physical fitness. In this way, neuroplasticity is highly advantageous. However, it is not always beneficial. If we repeatedly engage in unhealthy behaviours, then our brains become accustomed to those behaviours and their chemical and emotional outcomes.
‘Neurons that fire together, wires together’4 is the concept behind neuroplasticity. This refers to the chemical messages that get sent to, from, and around the brain and nervous system. The more the same type of neural pathway is used, the stronger it gets.
For example, we might have a distressing thought or feeling that leads us to engage in avoidant behaviour such as substance use. If we keep using drugs to mask that thought or feeling, neural pathways form in the brain that associate that thought/feeling with a drive to use drugs. Thus, anytime the thought comes up, we will be driven to use. This is a common precursor for addiction.

Neuroplasticity and Drug Use

There are many reasons why a person chooses to first use drugs. We might first use drugs out of curiosity, peer pressure, or due to stress. On first use, exposure to the drug releases large amounts of dopamine in the brain.
Dopamine is a neurotransmitter (chemical messenger) that is strongly associated with the brain’s reward system.5 It is released when we engage in biologically rewarding behaviours, like eating, exercise, or sex.
Dopamine release is pleasurable. The desire for more dopamine motivates us to act. In this way, it promotes our survival.
SAMHSA explains that when we use drugs, dopamine gets released in abnormally large amounts.6 The amount of dopamine is usually not possible for the brain to achieve on its own. Thus, when we repeatedly use drugs and keep releasing dopamine in large amounts, the brain becomes accustomed to this means of release and drives us to keep taking the drug.
The brain has learned that using a particular substance will lead to a dopamine release. Over time, the association between drug use and reward grows stronger. In time, the brain’s dopamine receptors decline in numbers – this is a physical change and an example of neuroplasticity7. This means that users will feel the effects of dopamine less, and so will require increasing amounts of the substance.
Those of us who have been through traumatic experiences, particularly in early childhood through experiences such as neglect or abuse, may be more vulnerable to developing a substance addiction than those who have not suffered from trauma.
“Hardwired fear-based memories often lead to avoidance behaviours that can hold you back from living your life to the fullest.”8 – Christopher Bergland
Trauma impacts our mental and emotional health to a significant degree. When such a person uses drugs, they might notice a sense of relief from the difficult or disturbing thoughts and feelings that have remained with them since their exposure to trauma.
This relief itself is pleasurable, as it can make the person feel ‘normal’ – something they might not feel very often. However, the relief gained from using drugs is temporary. The effects soon wear off, and those difficult thoughts and feelings eventually resurface.
According to Charles P. O’Brien, MD, PhD, in Dialogues in Clinical Neuroscience, ‘compulsive drug-taking behaviour develops in vulnerable individuals who ingest substances that activate the reward system.’9
Through repeated drug use, the trauma survivor is likely to go on to develop an addiction. The relief and dopamine release are rewarding, and motivate us to keep using the drug. ‘Addiction is a disease of neuroplasticity’10, claims O’Brien.

Neuroplasticity and Addiction Recovery

In the same way that the brain’s neuroplasticity can result in addiction, it can also be used to help us recover. By understanding the nature of neuroplasticity and using evidence-based tools and techniques to encourage neural change, we can modify the behaviours that are associated with our addiction.
To recover from addiction using neuroplasticity, we must learn new, healthy behaviours. Drug misuse often arises out of learned behaviours. We might use drugs, or gamble, or avoid food, to help ourselves cope in the face of stress or difficult thoughts, feelings, and emotions. Recovery involves replacing these behaviours with healthier ways of dealing with and managing our feelings as they relate to our experiences.

Cognitive Behavioral Therapy and Neuroplasticity

One tool in particular, used effectively in various therapies, is Cognitive Behavioural Therapy (CBT).11 It is an intervention that is based on learning and the brain’s ability to adapt to new information and experiences. Integral to CBT is the ‘cognitive triangle’.12
The cognitive triangle is a model used in CBT that helps clients understand the strong link between their thoughts, feelings, and behaviours. A client might struggle with one thought in particular. The thought causes certain feelings to arise, feelings which may not yet be fully processed and cause distress or discomfort.
To mask, escape, or suppress this thought, the person might engage in a behaviour such as substance use. Substance use is not the only avoidant behaviour that a person can engage in. Anything that changes how we feel has the potential to be addictive. Some people binge on food, or avoid it altogether. Others engage in high-risk behaviour such as unprotected sex with unfamiliar partners, or self-harm.
CBT, and other therapies that utilise the brain’s neuroplastic abilities, help clients to heal by offering methods of coping and self-management that promote mind and body health. Over time, as new behaviours are learned and reinforced through experience, new neural pathways are formed and strengthened.

1 Kolb, Bryan, and Robbin Gibb. “Brain plasticity and behaviour in the developing brain.” Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Académie canadienne de psychiatrie de l’enfant et de l’adolescent vol. 20,4 (2011): 265-76.
2 Zilles K. Neuronal plasticity as an adaptive property of the central nervous system. Annals of Anatomy. 1992;174(5):383–391
3 Voss, Patrice et al. “Dynamic Brains And The Changing Rules Of Neuroplasticity: Implications For Learning And Recovery”. Frontiers In Psychology, vol 8, 2017. Frontiers Media SA, doi:10.3389/fpsyg.2017.01657. Accessed 18 Dec 2020.
4 Keysers, Christian, and Valeria Gazzola. “Hebbian learning and predictive mirror neurons for actions, sensations and emotions.” Philosophical transactions of the Royal Society of London. Series B, Biological sciences vol. 369,1644 20130175. 28 Apr. 2014, doi:10.1098/rstb.2013.0175
5 Arias-Carrión, Oscar et al. “Dopaminergic reward system: a short integrative review.” International archives of medicine vol. 3 24. 6 Oct. 2010, doi:10.1186/1755-7682-3-24
6 Center for Substance Abuse Treatment. Treatment for Stimulant Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 33.) Chapter 2—How Stimulants Affect the Brain and Behavior. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64328/
7 Volkow, N D et al. “Imaging dopamine’s role in drug abuse and addiction.” Neuropharmacology vol. 56 Suppl 1,Suppl 1 (2009): 3-8. doi:10.1016/j.neuropharm.2008.05.022
8 Bergland, Christopher. “How Do Neuroplasticity And Neurogenesis Rewire Your Brain?”. Psychology Today, 2017, https://www.psychologytoday.com/us/blog/the-athletes-way/201702/how-do-neuroplasticity-and-neurogenesis-rewire-your-brain. Accessed 18 Dec 2020.
9 O’ Brien, Charles P. “Neuroplasticity In Addictive Disorders”. Neurotoxicity And Neuroprotection, vol 11, no. 3, 2009, pp. 350-353. Servier International, doi:10.31887/dcns.2009.11.3/cpobrien. Accessed 18 Dec 2020.
10 O’ Brien, Charles P. “Neuroplasticity In Addictive Disorders”. Neurotoxicity And Neuroprotection, vol 11, no. 3, 2009, pp. 350-353. Servier International, doi:10.31887/dcns.2009.11.3/cpobrien. Accessed 18 Dec 2020.
11 Hofmann, Stefan G et al. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.” Cognitive therapy and research vol. 36,5 (2012): 427-440. doi:10.1007/s10608-012-9476-1
12 InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Cognitive behavioral therapy. 2013 Aug 7 [Updated 2016 Sep 8]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279297/

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