Since the 1980s, Nancy Reagan’s “Just Say No” campaign may have done almost as much to stigmatize addiction as the substances themselves, according to a Butler Memorial Hospital official.

According to Ruthane Durso, director of therapeutic and social work services at Butler Memorial Hospital, “Just Say No” seems logical at a glance.

“If there’s something that’s hurting your life, hurting your family, your career, you wouldn’t do that,” she said. “Who in their right mind does that?”

But addiction is anything but logical, Durso said.

“It’s not logical, because there are biological and brain changes as a result of chemical use, and so that alters the logic components,” Durso said.

Addiction, she said, is a disease.

Genetic predisposition to addiction, paired with these biological and chemical changes in the brain, make addiction anything but a choice according to Durso.

“So, No. 1, the body and brain is looking for that substance — it wants it, it needs it,” she said. “So the body is going through processes that it wants to have that experience, that chemical.”

These biochemical changes are so fundamental, Durso said, that just thinking about or preparing to use an addictive substance can trigger priming processes for those affected.

“That’s why when people are getting sober we teach them a lot about changing people, places and things,” she said. “Because, if I’m around people and places that I associate with using, there’s brain chemistry taking place that’s preparing me to use.”

Additionally, she said the altered logic of someone addicted to substances affects their thinking processes.

“I can say to you, ‘If you get three DUIs or you’re using IV heroin, that’s probably a problem,’ and you may say to me, ‘Well, heck, yeah, that would be a problem,” she said. “But to someone in the throes of addiction, it’s not that black and white, their thinking becomes altered, so their perceptions of that reality aren’t entirely accurate.”

According to Durso, people with addictions become experts at justifying behavior and circumstances as anything other than addiction.

“Because addiction is a disease, it almost has a self-preservation component to it,” she said. “So the mind is protecting the use because the body wants it, the brain wants it, so now my thinking and my logic is going to help protect that craving and that desire.”

The combined cognitive and biochemical realities of addiction require a multifaceted approach to overcome, according to Durso, not something as simple as saying, ‘no.’

“There’s, again, this whole biochemical and psychological thinking component that has taken place,” she said, “and so all of that has to be unraveled and explored and understood.”

Dr. C. Thomas Brophy, medical director at the Gaiser Center, agreed, saying addiction begins in one of the most primal parts of our brain.

“Addiction arises from the limbic system,” he said. “Now, traditionally, the limbic system drives us toward our most basic needs. It’s sort of like your ‘caveman brain,’ driving you toward food, water, sex, shelter, safety.”

Satisfying our most basic needs, Brophy said, then frees the brain to access its more logical, lucid functions.

“We’re free to use our prefrontal cortex, we’re free to use that front part of our brain,” he said. “It’s that smart part of our brain that helps us think about long-term consequences and planning for the future.”

Without satisfying the limbic system, according to Brophy, the brain remains in a form of limbo.

“When those limbic system needs are not being met, the sole focus of the brain is how to acquire that thing,” he said. “And that’s where addictive substances are working, in the limbic system.”

Using MRI, Brophy said it was possible to chart this as addictive substances interact with the brain.

“They all go to the limbic system, and for someone to sit down and say that they don’t want to do drugs anymore, in that moment, they’re using their prefrontal cortex,” he said. “But for them to continue to not pick up drugs, that would be the equivalent to somebody who’s never touched drugs in their life going for three or four days without water.”

For those addicted to substances, Brophy said it can feel like being “on autopilot.”

“So when you tell somebody, ‘Just say no,’ if they’re in a state of chemical balance, they’re going to use the prefrontal cortex and say, ‘Yes, I am going to say no, of course I’m going to say no,’” he said. “But then whenever that limbic system’s needs aren’t getting met, they’re going to pick up that substance again.”

According to Durso, Alcoholics Anonymous has an unofficial slogan to summarize these concerns.

“’I don’t have a drinking problem, I have a thinking problem,’” she quoted.

From there, according to Durso, help comes in small steps.

“My best recommendation to folks is, if somebody thinks they have a problem, they can always start with family and friends to get feedback to see if they do think there might be a problem,” she said.

From there, Durso recommended contacting a professional therapist, Independent Health System, the Ellen O’Brien Gaiser Center or the CARE Center with Southwestern Pennsylvania Human Services.

“Reach out and make an appointment to have an evaluation or to talk through those concerns,” she said, “as well as options.”

Treatment, Durso said, can vary from person to person.

“There’s some people that may need a detoxification and inpatient care,” she said. “Other people may just need some outpatient counseling or an intensive outpatient program where they do some initial more frequent sessions and get more education and things like that.”

These treatment plans can range from counseling to medically assisted treatment, according to Durso, but a fundamental key to their effectiveness is understanding.

“Addiction is not a character disorder, it’s not a personality deficit,” she said. “It’s a medical problem that has to have a treatment plan, whatever that may be.”

Durso emphasized that addiction did not represent a failure in judgment.

“If this is the only sentence that they can hold onto or hear, it’s that addiction has nothing to do with moral character,” she said.

And she reminded those facing addiction that they are never alone.

“They have a disease process that’s happening, and there are tons of treatment options to help them,” Durso said. “It all just starts with a conversation.”