The 4 Stroke Model of Addiction

Introduction

Our default understanding  is that addictive drugs are addictive. That is, you could become addicted to taking heroin, but the chances of you ever becoming addicted to vitamin C are slim to none. Some things have potential for being addictive while others don’t. But if you are a bit curious or if you actually need information about addiction works, this is quite inadequate. Question becomes how and why addictive drugs are addictive. The default understanding on this level is still that addictive drugs are addictive because of their chemical properties and their impact on the human brain. But while this explanation initially have some attractive features, it is not a closed case as many would have you believe. You can find a detailed critique of this understanding elsewhere on this site.

But all this raises the question: How else can we understand addiction? Are there any scientific alternatives to the patophysiological (chemistry based) model of addiction?

The four stroke model of addiction is a detailed map of the main phases in the self perpetuating progression of addiction. It details how addiction gets stronger while you don’t see it as in your long term interest.  The model covers in detail how and why stress promotes bad decisions, how bad decisions promote impaired physiology, how impaired physiology promotes stress vulnerability and how the whole closed loop will drive addictive behavior without relying only on the physiological effect of any involved addictive drugs.

The Four Stroke Model of Addiction describes addiction as a “vicious circle”. Specifically addiction is described as based on four phases that in a cyclic pattern enhance the influence of each other. These are:
 
  1. Stress reactions and changes to the state of your brain that favors short term strategies
  2. Drugtaking or other short term coping strategies
  3. Changes to the personal environment which are consequences of short term coping strategies
  4. Stress exposure, including stress exposure due to changes in personal environment
The structure of short term strategies is that they are based on fear of and avoidance of risk, danger, pain or problems that are proximate in time, while turning a blind eye to risk, danger, pain and problems that are somewhat more distant in time. Put more simply, all short term strategies have that in common that they focus on the near future while ignoring the distant future and what problems might be created further down the line by present actions. This structure is due to the evolutionary primacy of survival: There is no benefit of long term gains that you are not alive to enjoy. Because all long term benefits are contingent upon short term survival, any threat to short term survival can be dealt with at a cost to long term benefits, with no real loss relative to the non-survival alternative.
In other words: Evolution through survival and procreation favors a shift towards being short term focused as soon as there is any real danger to your survival, however small. The organ in the human body that is optimized for detecting threats to our survival is the brain, located in the bone structure just above your neck. It uses a combination of inate sensitivities towards biological relevant threats (clifside, spiders, rats, snakes) and learned signals of danger. These combine to define a set of stimuli that will change the state of the brain and elicit a set of hormonal responses collectively know as the stress response cascade, the so called flight-or-flight response. This starts with danger detection in the brain, that elicits a cascade of hormonal changes (one hormone stimulating the release of the next in a number of steps). This cascade will affect a number of physiological changes that seem to have in common a prioritizing danger avoidance at the cost of long term health and other benefits:
The imunesystem is compromised
Reproductive system is depressed
Rational thinking is compromized
Instinctive reactions are promoted
Accelerated heart rate
Activated sweat glands
Blood flow is diverted to the muscles
Pupils are dilated
Reduced saliva flow and digestive functions
Release of energy stores (glycogen released as glucose)
Release of hormones, such as adrenaline
Inhibited bladder and excretory functions
These changes all seem to favor the avoidance of danger in the present and immediate future at the cost of long term health and well being. This short term focus is what makes stress exposure unhealthy and makes work related stress a threat to your long term health.
We have know about the health costs of stress exposure for about 100 year as Walter B. Canon first wrote about the fight-or-flight response in 1915. But the focus has been on the health issues that it entails. How for instance stress hormones can damage your short term memory because the hippocampus in the limbic brain is damaged by high levels of the stress hormone cortisol. Or how cortisol can lead to overweight due to changes in  the function of the hypothalamic-pituitary-adrenal gland axis.
Less attention has been given to the fact that the stress response is one big physiological funneling of all efforts toward the immediate future and might explain why people seem to care so little about their long term prospects if they are under a bit of stress. When you consider how stress and danger promotes a shorter time horizon it does not make much sense to scare smokers with pictures of tarred lungs if you want them to adjust their behavior for long term benefits.
The tendency has been towards explaining a lack of long term planing and long term execution with a lack of understanding or even a lack of information. Why some people feel inspired to seek out the last few remaining people who don’t fully understand that smoking is a health hazard or what they intend to do for them is not really clear to me. But a somewhat lacking understanding of the dynamics of risk and stress and how the time horizon is shortened under stress might explain a lot of wasted efforts of this variety.
The same could be said about the people and programs that seek to nudge people towards a healthier lifestyle, more exercise and less junk food. Armed with statistics they point out how people with shorter educations are less likely to lead a healthy lifestyle. They then act as if lack of education is the problem and that information geared towards the uneducated is the solution. The abject arrogance of this approach is perfectly matched by the lack of desired effect. Apparently most ordinary people are just too uneducated to learn from well meaning health snobs. Or it could be that stress promotes a short termed disregard for both long term benefits of both education and of healthy eating. And a healthy disregard for health conscious cocks.

The four stroke model of addiction is a detailed map of the main phases in the self perpetuating progression of addiction. It details how addiction gets stronger while you don’t see it as in your long term interest.

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