What does it mean in our society to say something in the brain is cortical? Well, while not exactly correct in a neurological sense, we usually mean that it is conscious, that it is deliberate, that it is subject to the will. Let's look at what we mean by cortical and deliberate.

I have in front of me a glass. I reach my hand out and grasp the glass and lift it off the table. I did it. You watched it. It was obvious to you that I wanted to do it. It was a clear conscious behavior. And in court you'd testify that I deliberately raised the glass off the table.

But why did I do it?

We could assume a lot of things. We could assume that I wanted to hurl the glass at you. We could assume I wanted to move the glass somewhere else. We could assume I wanted to wash the glass. 

Imagine for a minute that picking up a glass was illegal or even just frowned upon by society. Imagine that in the Glass Control act of 2018 it became illegal to lift a glass. Well, you saw me pick it up. You saw it was a deliberate act. And that's what we need in our society to say someone is guilty of something, that it was a deliberate act. 

If we substitute taking a drug for lifting a glass, there really isn't much difference. If I had a drug in front of me and you saw me take it, you'd see that there are a series of motor functions I did in a sequential fashion. I picked up the drug, brought it to my mouth, put it in my mouth, and swallowed. Don't worry, that was fish oil. 

What we see when we look at addiction is a series of deliberate actions. After all, we decided not to put cocaine up our nose, so that guy that did it must have decided deliberately to do it. So on the face of it, it is clear that addiction is deliberate. Addiction is cortical. And so we've always assumed. Let's go back to that glass.

What if I'm thirsty. I mean really, really thirsty. In fact I haven't had anything to drink all day, and I gave blood, and just mowed the lawn. I mean, I'm dehydrated. And I sit down here and here's this glass. We've all been really thirsty. When you are really thirsty, how much deliberate thought do you put into picking up a glass of water that's in front of you? Not much. It's pretty automatic. 

Now imagine I'm that thirsty, and you tell me that what's in the water (lead, PCBs, some other carcinogen) will kill me in 40 years? Remember last time we talked about who in their right mind would do something that will kill them? Well, here's the answer. Someone who's midbrain is telling him that he'll die a lot sooner if he didn't do it.

When we feel great thirst or great hunger, our bodies are designed to keep us alive. There's a survival drive mechanism that's inherent in all mammals, and it isn't cortical. I mean, it wouldn't be much good if you had to think about it. Drives are automatic. They drive us. That's the point. When I'm that thirsty, the midbrain, the part below the context, the part we don't have conscious contact with, is sending out a signal that things are not well. It drives an urgency to fix the situation. We aren't driven to trust others and ask for help. We aren't driven to look up the best long term solution on google. We are driven to do now, by ourselves, what is the fastest solution to the immediate survival threat, even if it's dangerous in the long term. 

So last time we asked, "Who in their right mind would keep drinking if he knew it would kill him in time?" One obvious answer is someone who felt that he'd die sooner if he didn't drink. And who would would feel that way? Someone who had a sub-cortical drive to drink. And so we get our clue to where to start the sequence of addiction treatment, not with the cortex and conscious thought, but with the subcortical drive structures of the midbrain. Next time we'll look more in depth at the biology of that system and how we get started.