Biology, environment, or psychology? Which is most important in addiction?

I get asked this question a lot, both by people who are fully committed to the biological (or brain) model of addiction and ones who thinks it’s crap and that it’s all about psychology, experience, and motivation.

The thing is that it is absolutely impossible to separate the influence of the brain, environment, and psychology since they all intertwine and interact to deliver the final condition… I was reading an article about marketing in the new Internet age yesterday and it included a joke that I thought was relevant, so I’ll steal it. Instead of focusing on addiction, this joke centered on the question of which part of the body is most important? Maybe it’ll do a good job of explaining why asking the question of which of the above is most important is to some extent useless.

So – The brain, blood, lungs, and Legs were all fighting each other on the question of which of them was most important in the human body. Along came the anus and argued for its own place as The King of all that is human. The first four all laughed in its face, thinking the idea that the anus is King a funny joke. In protest, the anus shut down, a little upset at being made fun of. Three days later the rest of the body sent a notice that the anus has won the debate and begged it to get back to business.

You see, the brain runs the body, upon which it relies for everything and together those two interact with the environment in ways that alter them both. Then you place thousands and millions of people together in the environment and they interact to create a psychological reality that affects everything else that’s already there. It’s completely impossible to separate the parts sice they all rely on each other and are affected by the others.

This is why behavioral interventions, medical interventions, and environmental conditions have all been shown to affect the probability of addiction developing and of addiction ceasing. They all contribute so they all have the power to affect it, though the mix is probably different in different people based on their own experiences, biology, etc…

Make sense?

Physical addiction or psychological addiction – Is there a real difference?

This is another one of the basic questions I get regarding addiction.

It seems that people think about physical addiction and psychological addiction as somehow separate processes. I think this distinction makes no sense. Even if people really meant what they were saying, the brain is undoubtedly part of the body, and therefore, psychological addictions are also physical.

The “Physical Addiction” Vs. “Psychological Addiction” truth

blackboardWhat people are really referring to when they make this comparison is the distinction between physical withdrawal symptoms and the addictive process in the brain. There’s no doubt that some substances, like alcohol, opiates, and the likes, leave long term users with horrible withdrawal symptoms that are terrible to watch, and even worse to go through. In fact, early addiction theories asserted that it was this horrible withdrawal syndrome that made people go back to drugs. This was called the Tolerance-withdrawal addiction theory.

The Tolerance-withdrawal addiction theory fell apart when addictions to substances that didn’t display such withdrawal effects became obvious (like cocaine addiction), and when getting people through the difficult withdrawal proved insufficient to cure their addiction (naltrexone was thought to be the magic cure once upon a time).

In one of my previous posts about marijuana addiction, a reader suggested that since marijuana does not produce horrible withdrawal symptoms, it can not be physically addictive. While withdrawal from marijuana, cocaine, methamphetamine, nicotine, and numerous other drugs does not result in the stereotypical “opiate-withdrawal-flu-like-syndrome,” there is no doubt that real withdrawal from these substances exists for long term users and it sucks: Fatigue, depression, anxiety, sleep disturbances, and trouble eating are only some of the symptoms that tend to show up.

Withdrawal – The real physical addiction

Withdrawal symptoms occur because the body is attempting to counteract the stoppage of drug ingestion. Just like tolerance builds as the body adjusts to chronic drug use, withdrawal occurs as the body reacts to its cessation.

As crystal meth increases the amount of dopamine present in the brain, the body reacts by producing less dopamine and getting rid of dopamine receptors. When a user stops putting meth in their body, the low production of dopamine must increase and additional receptors must be inserted. Like tolerance, the process of withdrawal, even past the initial, obvious, symptoms, is a long and complicated one. For crystal meth addicts, the initially low levels of dopamine result in what is known as anhedonia, or an almost complete lack of pleasure in anything. There’s no mystery as to why: Dopamine is one of the major “pleasure” neurotransmitters. No dopamine, no pleasure.

The process of addiction in the brain

So, if we’re going to try to dissect which drugs cause what effects on the body, it’s important that we understand the underlying causes for those effects and that we use the proper language. Withdrawal, tolerance, and addiction are different, though obviously related topics. Their interplay is key for understanding the addiction process, but their more subtle points can often be lost on those observing addicts unless they are well trained.

As I’d mentioned in earlier posts, our current best notions about addiction are that the process involves some obvious physical and psychological processes and some much more subtle effects on learning that are still being studied. A study I’m currently conducting is meant to test whether drugs interfere with some of the most basic learning processes that are meant to limit the amount of control that rewards have over behavior. Such fine distinctions are no doubt the result of the ways in which drugs alter the neurochemical reactions that take place in our brain. Such basic changes can not possibly be seen as any less important than physical withdrawal symptoms.

All in all, the only way to look at Addiction is as both a psychological addiction AND a physical addiction that are inextricably liked through our psyche’s presence in the brain, a physical part of the body. It may seem like a small thing, but this distinction makes many users feel as if their problem is less, or more, sever than that of other addicts. As far as I’m concerned, if you have a behavior that is making your life miserable and which you can’t seem to stop, it doesn’t matter if you’re throwing up during withdrawal or not. It’s an issue and you need help.

Black tar heroin – Pure Death

Back in the 70s, heroin was mostly filler, and the good stuff was 5% pure or so. Nowadays a new, more potent, version of the stuff is killing people all around the country with widely varying purities as high as 90%.

What makes black tar dangerous

When heroin was weak, shooting it was the best way to get high, which kept many people away from it. But this relatively new stuff (it’s been around California for a while), brought in from Mexico and known by the name Black Tar, is strong enough to make smoking, or snorting, it a viable option for a nice long high. It’s a much easier sell for the dealers too – no more ugly needles, they tell their customers you can “just smoke it like weed,” which is true until you get hooked.

Black Tar HeroinLike any other form of heroin, black tar will cause some serious changes in a user’s body and brain, messing with the body’s pain, digestion, and mood systems. The problem is that at these purity levels, the chance of a user overdosing are much higher too, and that’s where the body-count comes in.

The stuff is cheap, at least in relation to the old heroin that used to come in from the far-east, but the body count’s mounting and the problems only getting worse. Heroin overdose death rates have gone up at 20%-50% and they’re still going strong. Many of the people who are most concerned about this are hoping that heroin doesn’t bring about the same epidemic that crack did in the 80s.

Avoiding death by talking

As usual, I don’t believe in running away from a problem like this. Instead, this is exactly the kind of thing that education, information, and a good dose of harm reduction can fix. We need to make sure people know that the potency of this stuff can kill you. The only way to make sure that less people die from black-tar heroin is to let them know that they need to be careful with it because one mistake can mean death.

I’m hardly ever the “just say no” type and I think that in this situation, an approach like that will leave us in deeper and deeper trouble. The AP article I based this on talked about yearly seizures of heroin quadrupling to 86 kilograms across the U.S.-Mexico border last year. By comparison, cocaine seizures in 2008 totaled more than 8000 Kilos! I can tell you one thing, as someone with experience as a drug dealer, getting 86 kilos across the border isn’t that hard with the amount of Mexican corruption and “help” dealers can get. Where’s there’s money, there’s a way, and it seems that this heroin trend is offering up some money.

Calderon honoring dead in drug warIt’s that experience of mine that makes me believe we have to work towards understanding addiction and who develops it, and getting better at prevention, intervention, and treatment. Try as we might, solving this problem by the supply side isn’t going to work, I don’t care how hard Calderon is willing to fight.

Cravings – The all consuming experience of wanting something

In my studies of addiction, the concept of cravings comes up often. Researchers talk of “wanting” versus “liking” of drugs and of the idea that cravings are a programmed response to environmental signals that have been connected to drug use through experience.

What are cravings?

I agree with these descriptions and the idea that cravings are strong memories that are linked to the effect of drugs on the brain’s neurochemistry. The immense neurotransmitter release that is often brought on by the ingestion of drugs is responsible both for the experience and the lasting effects on learning. When it comes down to it, memories are really the brain re-experiencing an event, so it makes sense that reliving a drug, sex, or other past-compulsive experience would cause a serious emotional reaction.

But aside from all the research, I know very well what cravings feel like. I know the intoxication you feel the moment that memory hits you and your entire body tingles with anticipation. It’s as if your whole being is crying out saying “This is what we’ve been waiting for. Give it to me!!!” I never know to expect it, but when they hit, there’s no questioning – I know that a craving has just taken over me. It’s no wonder that people go out over these things, especially early on in recovery.

How to deal with cravings

I’m now at the point where no matter how strong the craving, I’m not about to throw everything I’ve worked for out the window for another hit. But still, it’s just so damn tempting.

When you have a craving, recognize it for what it is. You might as well enjoy the rush, it’s like a freebie you don’t get to control. By being scared of the feeling, you induce more anxiety and shame that may lead you to act out. Instead, recognize your lack of control over the craving, let the experience happen, and go on with your life.

If the experience is overwhelming, make sure there’s someone you can talk to about it (a therapist, partner, parent, or 12 step sponsor). As time passes your cravings will become less and less frequent, though without specific treatment, their intensity will likely not go away.

Cravings are a part os the reality of addiction – knowing what to do with them is a key to success.

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

If you need help finding treatment for your own, or a loved one’s addiction, make sure to give our Rehab-Finder a try: It’s the only evidence-based, scientifically created, tool for finding rehab anywhere in the United States!