Teens and drugs: Drug use statistics and treatment that works

Here are some drug use statistics:

  • Over 80% of teens engage in some form of deviant behavior (1).
  • Over 50% of high-school seniors admit to having used drugs (2).
  • Only 10%-15% of the population develop drug addiction problems related to their drug use (1).

The question is:

If the majority of teens experiment with drug use, and so few eventually develop drug addiction problems, should we be focusing on something other than stopping kids from trying drugs? Continue reading “Teens and drugs: Drug use statistics and treatment that works”

How does it all start? My thoughts on addiction causes and substance abuse

I was talking with a friend the other night, and he asked me my opinion about the line between addiction and normal behavior. He was wondering whether I think that everyone who looks at porn is a sex addict.

I don’t. (see some of our posts on sex addiction here)

Still, the conversation made me feel like writing something about my views on addiction causes. So here goes:

For the addicts who are still unaware, the line between normal- and addictive-behavior tends to blur again and again until it seems like more of faded smudge on their life. For those looking at addicts from the outside, the line normally seems so clear and so far away that they rarely believe it can be crossed back again.

I don’t personally believe that addiction per se is where things started for most people. By this I mean that no matter how hard we look, I believe that we will never find the elusive “addiction gene“, genes, or trigger.

Having been in the thick of it, I think that substance abuse is nothing but one possible outcome of set of circumstances, both biological and environmental, that lead some individuals down a particular path.

Impulsivity and other addiction causes

As I mentioned in earlier posts, addiction, at least to drugs (and I believe other addictions as well) is very closely related to a set of psychological conditions that have to do with impulse control problems.

I believe that individuals with increased impulsivity are simply more prone to putting themselves in situations that are inherently dangerous to their well-being. A simple example from non-drug related behavior might be one-night stands.

A typical person with no impulse control issues may hold off on sex if the only option was to have it unprotected. They may think to themselves “I need to stop, this could seriously affect the rest of my life.”

A person who has a reduced ability to control initial impulses may have the exact same thought and yet go through with the action, leaving them feeling remorseful and anxious the next day, but still having put themselves at risk.

This is a very common occurrence among sex-addicts. The thoughts are there, the knowledge is there, the ability to connect those to actions is seriously lacking. While some people make moral judgments about this fact, I’ve seen enough research that connects this problem to biological processes and genetics that I’m now resigned to the fact that at least on some level, the issue is physical and neurochemical.

Addiction help – Cures, treatment, and solutions

Still, I think the battle is far from lost. I strongly believe that education, informed by actual knowledge rather than misguided mythology, can put people in a better position to deal with the issues even if their source is outside of their control.

Even aside from pharmacological treatments (as in medications) that can help, there are endless ways to help people learn to be in better control of their actions once they are aware of their initial deficit. That is how AA and many other support groups function. People within them ask others about decisions they’re making BEFORE they act on them.

We know already that when it comes to drugs, the equation changes once the person starts using regularly and for long periods of time.

Chronic substance abuse further breaks down the brain’s ability to control impulses by reducing functioning specifically in the prefrontal-cortex; the part of the brain right behind your forehead which is thouught to be the center of the brain’s control tower.

The cycle seems too obvious: Impulse control difficulties leading to dangerous behavior which leads to further impulsivity issues and so on…

The treatment, like the progression of the condition itself, needs to be long. I don’t believe that any 30 day treatment program will be able to resolve a condition that took years to develop. Still, the issue of treatment will come up again here. This is enough for now…

Question of the day:
Do you have any insights from your own experiences as to how addiction develops?

Addiction-brain effects: Sex addiction, neurotransmitters, and being love addicted

***A disclaimer: Sex addiction is a relatively new concept in science. I haven’t been able to find much research on the subject, so much of what is being said here is my interpretation of the current literature on sexual responsivity in humans.***

sexI’ve already mentioned that scientists are beginning to consider behavioral addictions (like gambling and sex) as being similar to drug addiction. We’ve also covered sex addiction on the site quite a few times.

Since we’d covered the addiction-brain effects of some of the major drugs’ (see here for opiates, crystal meth, and cocaine), I thought it’s time to write about the possible science behind sex addiction.

The sexual activity cycle

Scientists have divided human sexual interaction into 4 stages:

  1. Desire – Represents a person’s current level of interest in sex. It is characterized by sexual fantasies and a desire to have sex.
  2. Arousal – Includes a subjective sense of sexual pleasure accompanied by a physiological response in the form of genital vasocongestion, leading to penile erection in men and vulva/clitoral engorgement and vaginal lubrication in women.
  3. Orgasm – Involves both central processes in the brain and extensive peripheral effects. Orgasm is experienced by the peaking of sexual pleasure, release of sexual tension, rhythmic contraction of the perineal muscles and pelvic reproductive organs, and cardiovascular and respiratory changes.
  4. Resolution – The final stage of the normal sexual response cycle. There is a sense of release of tension, well being, and return of the body to its resting state.

After sexSex addicts don’t seem to have a problem with stage 3, and resolution is more like the end of sexual behavior. So we will focus the rest of our attention on the other stages 1 and 2.

Sex and neurotransmitters

While sex doesn’t involve the ingestion of substances, each of the above cycles does involve the release of many of the neurotransmitters we’ve already discussed (dopamine, serotonin, etc.).

In fact, there seem to be three major area in the brain that are activated during sex:

  1. The Medial Preoptic Area (MPOA) – This is one of the areas where all the sensory inputs to the brain converge. This. This area is crucial for the initiation of sexual response – the move from desire to arousal. It is mostly the release of dopamine within this area that supports sexual responding. Animals with lesions here can’t  mount or thrust.
  2. Paravantricular  (male) or ventromedial hypothalamus – These area are responsible for non-contact sexual responses. Dopamine is once again the main activating agent here.
  3. The mesolimbic system – Important for the motivation towards anything “good” this system is also very involved in motivation for sex, a big part of the desire and arousal stages. As with drugs, it is the release of dopamine with this system that increases the motivation for sex.

We haven’t discussed the first two area much, and from my understanding, their functioning is relatively specific to sexual response. However, we’ve certainly mentioned the mesolimbic system. This is the same system involved in the brain’s processing of opiates, cocaine, methamphetamine, and essentially all other drugs. It is also the system in charge of food motivation.

As you can see, dopamine is an activating neurotransmitter for sexual response. Serotonin on the other hand, plays an inhibitory role in sex. Through its activity on a number of brain area, serotonin reduces desire, arousal, as well as the ability to orgasm. The increase of overall brain-serotonin levels is one of the main reasons for reduced sexual responsivity in individuals who are taking SSRI antidepressants.

What about sex addiction?!

Aside from a few specific authors (like P. Carnes), scientists still find themselves struggling with whether or not behavioral addictions should be considered similar to drug and alcohol addiction or whether they are examples of compulsive, or impulsive, behaviors. I personally believe that these all share more common features than we may yet realize.

Nevertheless, for addicts, the subjective experience of a substance, or behavioral, addiction is similar. It is an inability  to control a behavior in the face of repeated negative consequences that is often accompanied by a need for more and a reduced sensitivity to the act.

Given my recent reading on the brain processes involved in normal human sexual response, I’ve developed my own early theory about sex addiction:

Given that many of the same neurotransmitters are involved in the regulation of sex, it is my belief that sexual addicts or those experiencing sexual compulsions, fall into one of two categories that probably overlap to some extent:

  1. Individuals who have reduced inhibitory capacity (like those with impulse control disorder, ADD, or ADHD for example). These individuals find themselves acting out relatively impulsive behaviors that others without such dysfunction seem to effortlessly control. Given what we know about impulse control disorders, it is no wonder that these individuals often find themselves engaging in more than one such behavior, including drug, sex, and other poossibly addictive activities.
  2. Those who’ve had sex paired with a strong neurological response – Given the important role of dopamine in all rewarding activities (what scientists call appetitive response), it is very possible that two or more rewarding experiences that are linked may increase the brain’s response to any of the individual rewards.

neurons that fire togetherLet me explain the last point: In neuroscience, there’s the concept that Neurons that fire together wire together,” which is to say that events that happen at the same time, if they are strong enough, may form their own neural networks. If something strongly negative (like violence) happens in conjunction with sex, the experience might lower sex responsivity. However, if a strongly rewarding event happens at the same time, the link might serve to enhance response for both future sexual experiences and the linked event.  The people in the first group are likely to often fall into this category due to their use of psychoactive substances. Drugs release huge amounts of dopamine, which may then become linked with sexual response, making sex seeking as strong as drug seeking.

So that’s my take, for now, on sex addiction. Like other addictions, it has to do with the exposure to a very rewarding event that in a subset of individuals ends up developing an exaggerated response or an inability to control it. Since feeling of love and intimacy can often be just as rewarding, people often refer to themselves as love addicted, and not sex addicted.

Sources:

1) A. G., Resnick, & M. H. Ithman (2008). The Human Sexual Response Cycle: Psychotropic Side Effects and Treatment Strategies. Psychiatric Annals, 38, pp. 267-280.

2) E. M. Hull, D. S. Lorrain, J. Du, L. Matuszewich, L. A. Lumley, S. K. Putnam, J. Moses (1999) Hormone-neurotransmitter interactions in the control of sexual behavior. Behavioral Brain Research, 105, 105-116.

Addiction causes – Learned self regulation and its possible benefits for drug use problems

In the first part of this little series on addiction cause and self-regulation I talked about some of the genetic influence on impulsivity that have been shown to also be related to drug use.

In this next part, I want to drive home some recent ideas regarding learning related to self-regulation.

It’s no secret that diagnoses like ADD and ADHD have been seen with much greater frequency in the last decade or so. Slight variations on the same theme, both of these disorders have to do with a person’s (usually a child) inability to appropriately control their impulses and behave appropriately.

The debate about the sources of the large increase in these diagnoses is still ongoing. Some think that they are nothing but an inflated push for pharmaceutical treatment by those who stand to profit from the sale of Adderall, Ritalin, and the likes.

However, if you talk to the parents of the children being diagnosed with these disorders, they’ll be the first to tell you that even though they can’t put their fingers on it, something’s up with their kids…

Tin Can PhoneA recent educational program in New Jersey (at the Geraldyn O. Foster Early Childhood Center) tries to instill in children the concept of internal regulation by making pretend play rules explicit. Children talk to their teachers before embarking on their next imaginary adventure in order to lay out everybody’s role. The idea is that by the generation of internal rules, the children become more aware of how social rules regarding behavior are dependent on their specific role in a given environment.

The creators of the program believe that children’s play in the recent past has become more and more structured. They believe that video-games, explicit toys, and constant oversight have reduced children’s ability to take on roles and depend on their own mind for the rules of behavior.

Adele Diamond, a researcher at the University of British Columbia, has found that children in the program performed much better (up to 35% better) than other children in tests of executive function. It should be noted that the program doesn’t claim, and hasn’t been shown to, get rid of attention-deficit problems in kids that have been diagnosed. Rather overall cognitive function for kids in the program seems improved.

More research on this program is ongoing, but the initial results seem to indicate that educational and developmental aspects of a child’s life can impact their ability to have internal oversight. This is obviously promising and upsetting all at once.

No parent intentionally places their child at a disadvantage, but it seems that the most recent trends of “electronic babysitting” we’ve become so accustomed to may in fact be impacting children in unintended, discouraging ways.

The connection to addiction again has to do with general impulse control problems. Less executive control leaves children generally more vulnerable to behaviors that can be detrimental to their future. As I’d mentioned in one of my earlier posts, most of the negative impact of drug use on the lives of users is not related to long term addictive use. Instead, it is the acute (as in quick and short lasting) negative impact of things like unintended pregnancy, motor accidents, and legal troubles and arrest, that end up impacting adolescent drug users.

Maybe by making our children better able to control their actions, we can protect them from a host of possible problems, including drug use…

Question of the day:
How much of your childhood was spent in relatively free play and how much of it was structured?
How, if at all, do you feel that these different activities have affected the kind of self-control you can, or can’t exert?

Addiction causes – Genetic variability related to attention, impulsivity, and drug use.

It will probably come as no surprise to at least most of you that addiction is closely linked to problems of self-regulation (like ADD and ADHD). This is one of the main reasons that professionals view addiction as a disease, and not a choice.

This post is pretty advanced, but it should leave you knowing a lot more about the relationship between attention, self-regulation, impulsivity, and addiction. Also, when I use the term “Addiction causes” I have to stress that the link to date has been one of association, NOT causation. We don’t truly know what causes addiction.

What is self-regulation?

Self-regulation is the ability to control one’s actions in ways that are appropriate to specific situations. Having to do with the most advanced aspects of cognition, self-regulation is considered to be the prime example of human executive functioning. It’s this aspect of thought and brain function that is thought to truly separate humans from other animals.

Being this important for our functioning, you can probably imagine how complex and interactive the brain systems that control executive functioning are. You’d be right.

These systems, centered in the Prefrontal Cortex (PFC), the part of the brain nestled right behind your forehead, are connected to essentially every other brain system, including vision, hearing, motor control, emotion, etc. It’s the PFC that controls these systems and tells the brain what brain impulses should actually be acted on.

And impulses is a great word for it. Given how complex the system is, there are many things that can affect its function. There are genetic factors, some that have to do with early development, and others that are affected by behavior, including the ingestion of drugs.

In this post, I would like to focus on the genetic influences, later on, I’ll talk about the developmental influences and the effects of drugs and other behavior on these systems.

Genetic influences on executive function:

There are a host of genes that affect different aspects of executive function. Some of these, like those impacting genes related to DAT, DRD4, and COMT functioning, have an effect on dopamine function that has been correlated with personality traits like sensation seeking and impulsivity.

Hyperactivity

As I’d mentioned earlier, these personality traits themselves, and the genes that affect them, have been found to be associated with addiction as well as several other conditions and syndromes that are related (such as ADD and ADHD).

Just to be clear, we all have these genes, but there are different version of them (called alleles). Some of these versions are more common than others, and some are associated with the conditions I mentioned earlier.

For instance: There are 2 versions of the COMT gene. This gene codes for a chemical in the brain that breaks down DA (this breakdown is important for brain function as I’d mentioned in an earlier post). One of these versions (named MET) breaks dopamine more slowly while the other (VAL) breaks it down quickly. The VAL allele actually breaks the dopamine down so fast that it interferes with dopamine’s ability to properly get its message across. That’s why this allele has been linked to attention and impulsivity issues. Each of these alleles has a 50% prevalence in society, which means that 1 out of 2 people have the VAL allele. Obviously its effect is not enormous, but along with many other factors, it has a significant impact on dopamine functioning.

Similar issues come up with one of the versions of the DRD4 gene, which codes for a specific type of dopamine receptor; and with the DAT gene, which codes for the DAT transporter I talked about in the cocaine post mentioned earlier.

Again, while the effects of each of these genetic variants is small, these can add up along with other genetic influences and environmental factors (especially during early development) to overall affect a person’s ability to control impulses.

Obviously, those who have a more difficult time controlling their impulses would have a more difficult time making appropriate choices. These difficulties can lead some to be more likely to start behaviors that are detrimental, including the use of drugs. The drugs themselves can then further exacerbate the problem (as we’ll see in a future post), and can do other things to make users more likely to keep using them.

In short, while genes don’t make people use drugs, they can definitely make it more likely for certain people to engage in risky behavior, including trying drugs in the first place…

Question of the day:
Did any of the people you know who have developed drug use/abuse problem show problems with impulsivity before their drug use?

Struggling with my addiction: Recovery, addiction, and the everyday stuff

I’ve written about my own struggles with my addiction on here numerous times. I’ve used crystal meth, ecstasy, cocaine, marijuana, alcohol, LSD, mushrooms, and more, though the first few were the ones that really got me.

After an extended career as a dealer and addict, I turned a new leaf and made a new life for myself. It took a couple of rehabs and a hefty jail sentence. Still the link between my addiction and my recovery is not always strong.

My notions regarding the strong relationship between addiction and personality factors like attention-problems, impulsivity, sensation-seeking, and others comes from both my research and my personal experience. I’ve seen the genetic, behavioral, and clinical manifestations; I’ve also lived it firsthand.

I’ve always been known for doing things I wasn’t supposed to and then feeling sorry for them (or not). It was true when I was 5, long before my first sip of alcohol. Sadly, I’m realizing it is still true now and will most likely be true forever.

I can’t keep anything organized in my head. I never could. I was the kid who lost his house keys 5 times a year, forgot about midterms and finals, let alone school assignments, and who could never remember birthdays, anniversaries, or other important dates and times. These days, I’ve learned to rely on my pda/phone to help me with at least some of those things and it’s made my life much easier. But the underlying problem remains.

The problem is that I’m still impulsive and I still do things I shouldn’t. It’s a constant struggle to pull myself back, a very conscious struggle most of the time. When I say that addiction can be treated, it doesn’t mean that it actually disappears, though for me, it has certainly taken a backseat. If anything, it was after getting sober that I realized my drug use was so tied up with sex that I most likely had developed a sex addiction as well.

I’m not sober now (I drink socially), but I’m very aware of my intoxication level when I drink and rarely let it get out of hand. I can count on one hand the number of times I’ve gotten actually drunk in the five years or so since I began the forbidden “AA experiment.” It works for me, though it might not be for everyone.

The point is that nowadays, I have too much going on in my life that I love to throw it all away over getting high. My fiance, my education, and my work are important to me. The thoughts are still there, but I don’t act on them. It took a lot of work to get here and I seriously hope that I never have to put that work in again, but recovery, addiction, and my everyday stuff can still be a struggle.

You have to build the life you want and do your best to make maintaining that life a priority. It’s not easy, but it can be done. Look here for an exercise that can help you figure out what that life should even look like.

Addiction brain effects : Opiate addiction – Heroin, oxycontin and more

Okay, we’ve talked about crystal meth and cocaine and how they affect the brain during drug use. As I mentioned, both cocaine and meth interfere with the way the brain stores and cleans up important neurotransmitters, including, most importantly, Dopamine and Norepinephrine.

opiates-morphine & heroinThe class of drugs known as opiates, which includes morphine, heroin, codeine, and all their derivatives (including oxycontin), acts on the brain in a completely different manner. Since our goal at All About Addiction is to explain drug use and abuse as comprehensively as possible, let’s turn our attention to this opiate addiction next.

Heroin, morphine, oxycontin, vicodin and other opiates

While cocaine and crystal meth work by disrupting the normal functioning of molecules responsible for cleaning up released neurotransmitters, opiates work by activating actual receptors that naturally occuring neurotransmitters activate. Substance like this are known as agonists; they perform the same action (identically as, to a lesser, or greater extent) as a substance the body already manufactures.

In the case of morphine, heroin, and most other opiates, the most important receptors activated are knownOpiate Receptors as µ-opioid receptors. Activation of the µ-opioid receptors is associated with analgesia (suppression of pain), sedation, and euphoria, which makes sense given the relaxing, pleasure inducing effects of opiates.

Natural opioids (also called endogenous opioids), which include endorphins, are used by the body to relieve pain and increase relaxation, especially during periods of extreme stress. These are the chemicals that make sure we can function during accidents, like after breaking our leg…

Opioids and dopamine

Opioids also increase the amount of dopamine in the brain indirectly. As I mentioned in the earlier posts, dopamine is thought to be the reward indicator in the brain. Unlike crystal meth and cocaine, heroin and its relatives increase the activity of dopamine neurons by releasing the hold that other neurons (that use GABA) have on them. Think of this as the release of pressure on a hose spraying water on a lawn. When the pipe is pinched, only so much water can get through, but once the clasp is released, water can flow in greater quantity; this is essentially what opiates do.

Heroin addiction and long term opiate use

Like I said before, this doesn’t sound so bad, does it? All we’re talking about here is the increasing of the functioning of system that already exists in the brain. The problem isn’t so much in the process, the problem starts when this system gets activated for long periods of time.

HeroinHeroin addicts, and other frequent users of opiates complain about the extreme discomfort they feel when they stop using the drugs. This discomfort has been described as the worse case of the flu you could imagine. Doesn’t sound too appealing, does it? In fact, withdrawal symptoms associated with stopping opiate use are at least one of the main reasons many users return to the drug after trying to clean up. This in addition to all the other effects of the drug on the brain to make wanting to stop so much harder.

The reason for the pains and aches? Given the overactivation of its pain suppression system, the body not only reduces its own supply of opioids, but it also turns up the sensitivity on its pain receptors. Heroin users notice this as an increase in tolerance, but they compensate for it by simply using more. However, when they stop, they’re left with a body unable to suppress its own, hyper sensitive pain system. The results are more than uncomfortable, they’re simply excruciating…

Another common complaint of addicts is diarrhea. This, again, is simply the reversal of the constipation caused earlier by heroin’s actions on opioid receptors that are present in the peripheral system (outside the central nervous system).

I’ve heard addicts speak online about the slow recovery from opiate addiction and I want to dispell a myth here:

Opiates DO NOT stay in your system for weeks or months – The drug itself is gone from the body within days. The reason for the continued suffering is the slow adjustment of your brain and body back to the way things were before the drugs. Think of how long the tolerance took to develop… Now play the tape back in reverse. That’s what happening to you. You can help relieve the pain, but know that if you use anything in the opiate family, you’re making the process last much longer…

So, in summary: As usual, the actions of opiates on the body and brain are not all the severe, extreme, or inappropriate. Opiates are still used in medicine for pain suppression, not only because they work, but because the potential for abuse when used in this way are minimal to non-existent. However, as with all drugs, continued, chronic, abusive use of opiates will change the way your body functions in ways that will produce the exact opposite effects of those users like so much. This leaves people not only with possible addiction problems, but also with a terrifyingly uncomfortable return back to normal functioning.

Addiction help

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