Reduce HIV Transmission – Shooting up, clean needles, and addiction treatment

Co-authored by: Jamie Felzer

We’ve talked often on this  site about many of the negative things that often come along with heavy drug use. We’ve not yet talked about any of the factors that make injection drug use even worse. Users inject cocaine, crystal meth, and heroin, or any combination of these.

Shooting up and disease

In addition to all of the other, addiction-relevant, factors we’ve talked about on here, injection drug use brings about the worry of blood borne pathogens, especially HIV and Hepatitis C.  While it may not always be easy to find clean needles or worry about cleaning a needle between uses there are steps that can be taken to reduce the risk of transmission.

1. Get Tested!!  HIV/AIDS testing is available all over the world, often for free.   Having another STD or illness can easily kill someone with AIDS. Know your status!

President Obama just finalized a plan to revoke the 22 year travel ban on those living with HIV/AIDS.  This will significantly reduce the stigma of HIV/AIDS and should bring about more testing centers and education.  See this video to hear Obama.

2. While it may not always be easy, take great care to try to check the needle for visible signs of blood before injecting. If you think the needle may have been used before, clean it with bleach or another disinfectant.

3. Utilize the free clinics around your town that give out free, clean needles.  They are there to help you!!  Use these addiction support centers for clean needles and other equipment (like the bleach I mentioned earlier).

4. Talk about it! Regardless of where you may live, the group of people you hang out, studies have shown that talking about this subject matter increases awareness and can decrease chance of infections.  Being informed is your most important tool. For more info check out AIDS Global Information or AIDS Action.

5. Get help! Treatment options are widely available and they serve as a very effective method for reducing risky behaviors.  We can offer you placement help if you’re in southern California, but even if not SAMHSA has a relatively good addiction treatment locator – Check it out.

Citation:

CAPS Fact Sheet: What are IDU HIV Prevention Needs?

Drug use memories and relapse: Can medication provide addiction help?

About a year ago, while sitting in a lecture on learning and memory, the idea that certain drugs can affect the emotional responses to memory long after the memory itself has been formed came up. As someone interested in addiction research, the implication for treatment immediately came up in my head:

Could we reduce the effect of triggers by giving people a pill?

In one word – Yes! But, the answer is not, in fact, that simple. Even in the studies already done in PTSD patients, the memories have to be re-triggered and the drug given at exactly the right time to be effective. In fact, in humans, some of the best work has been done in PTSD patients immediately after the traumatic event.

Addiction help through relapse prevention

Still, a recent study in animals suggests that the theory is sound. By interfering with the activity of a neurotransmitter important in the formation of memories, researchers were able to stop animals trained to self-administer cocaine from doing so. The animals, which had been trained to push a lever for cocaine when a light went on, reduced, or even stopped responding after a single dose of a substance that blocked memory formation. Essentially, the researchers prevented the animals from relapse. Again, this only worked if the drug was given while the light (as in the drug-trigger) was presented at the same time.

More recent studies, using repeated doses of the drug propranolol, have been shown to have an even more promising effect. Check out my coverage of that research here.

Given the powerful role of triggers in relapse, this avenue of research has some promising possibilities for future treatment of drug addiction.

Proteins and cocaine: Addiction is a disease, not a question of morality.

While there are some people who still argue about whether drug addiction is a disease or a condition that results from the moral failing of an individual, most of the scientific community has long agreed that there are at least some influences on it that are far beyond a person’s control.

I’ve mentioned the genetic influences that have been shown to be associated with a risk for addiction before (look here). However, most of the research I’ve been involved in myself recently has more to do with the way that trying drugs changes your brain in ways that make it more likely that you’ll try them again.

Along these lines, a recently published study has shown that very specific molecular targets can have a huge impact on the probability that addicts will keep going after drugs. The molecules studied were common targets of cocaine that are altered after long-term use of coke.

The interesting thing is that the research found that deactivating each of these targets produced completely different effects:

Animals that had the GluR1 receptor subunit turned off were unable to stop themselves from searching for cocaine in a spot where it used to be long after normal mice gave up. I don’t know about you, but that sounds more than a little relevant for addiction given what I know, and have experienced. We’ve been studying this sort of stuff for a while, but the fact that a single molecule can make an animal pursue drugs in a way that is completely irrational is amazing!

Animals that had the NR1 receptor subunit turned off experienced a different effect. While normal mice relapse to drug use when they experience a drug after a long break, the NR1 deficient mice just wouldn’t go back to their addictive behavior when they got a little sample. Again, the implications for relapse preventions are promising to say the least.

In short, while some people may think there’s still a reason to argue whether people with addiction should simply be left to god’s mercy, ongoing work is showing us that we can uncover specific molecular mechanisms that may one day allow us to combat addiction with much more success. I for one welcome that.

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.

Give me SUGAR!!!! And a little food addiction on the side…

sugarSo while we’re sitting here talking about drug addiction, quite a bit of research in the last few years has looked into food, and specifically high-sugar-content foods, as a possibly addictive substance (food addiction).

The focus started when the new head of NIDA (The National Institute on Drug Abuse), Dr. Nora Volkow, who’s been doing research on obesity, took her seat a few years back. Since then, there have been quite a few papers showing that when given foods (or water) high in sugar content, animals develop behavioral patterns that are very similar to drug addiction.

This makes sense from an evolutionary stand point, since sugar gives our bodies carbs, which supply energy for our daily activities. However, it’s probably no secret that 50,000 (or even 1000) years ago, people weren’t consuming foods with refined sugars crammed into them (refined sugars have only been around for about 250 years). Back then, people needed all the energy they could get their hands on.

Unfortunately for us, evolution doesn’t move as quickly as our industrial and technological advances, which means we now get more of the high energy foods more easily, all while moving less and therefore putting out less energy.

The result? Atkins diets and the likes recommending low carb intake, which in actuality, should probably read “sufficient carb intake.”

A very recent paper has shown that even artificial sweeteners (specifically saccharin, see citation), may be able to induce these types of behaviors. In fact, saccharin sweetened water (and also sugar sweetened water) was chosen over cocaine, even for animals that already liked cocaine, and even when they were offered more and more cocaine!!! How’s that for amazing?!

What does this mean for food addiction?

Well for one thing, it means that if we want to battle the obesity problem in this country, we need to re-examine the availability of these high-sugar, high-calorie foods. But, it may also mean that low calorie foods that are artificially sweetened may soon be shown to be as bad for us…

I’m telling you, by the end of all of this, we’ll learn that growing your own vegetables and fruits is the only way to stay healthy. Come to think of it, even then, I know at least one person who may be addicted to fruits…

Question of the day:
Does your experience with high-sugar foods lead you to agree or disagree with these research findings???

Citation:
Magalie Lenoir., Fuschia Serre., Lauriane Cantin, Serge H. Ahmed (2007). Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698.

Clubs, drugs, and dancing – Crystal meth, and club drug use

Anyone involved with the dance/rave/club culture knows that drugs often go hand in hand with music and dancing. Club drugs, as well as alcohol and drug abuse, are often rampant in the social groups full of excited club goers. Previous academic studies supported this notion but could not distinguish if the drug use took place inside the clubs/venues or whether people consumed before going out.

A recent study seems to support the latter explanation (drugs consumed before the club); at least for all drugs aside from crystal meth.

Club Dancing

In this study experimenters tested patrons as they entered and exited the club. Approximately ¼ of the attendees tested positive for some sort of drug when they entered as well as when they exited the club. There was not a significant difference in percentage of those that entered with drugs already in their system than those who exited with drug use. This supports the conclusion that no significant amount of drug use took place inside the club (excluding alcohol).

But this wasn’t true for all drugs. Cocaine and marijuana usage was the same at entrance and exit but positive crystal meth tests nearly doubled from entrance to exit.

Frighteningly enough 16% of the patrons exited the club with a BAC greater than .08%. Many of the people who were taking drugs also consumed alcohol which poses an even greater threat since the interactions between drugs and alcohol can cause severe reactions as well as a more severely impaired judgment.

Since most patrons entered with drugs already in their system, it seems reasonable to suggest that these clubs do attract drug users. Most people who entered without drug use did not take drugs during the course of their stay at the club. However the usage of methamphetamines while in the club definitely needs to be looked into further, as the effects of taking that inside the club in addition to drinking can cause many problems (legal and health wise) for both the patron and the owners.

Co-authored by: Jamie Felzer

Citation:

Miller, Holden, Johnson, Holder, Voas, Keagy (2009) Biological Markers of Drug Use in the Club Setting. Journal of Studies on Drugs and Alcohol. Vol 70 (9)

The brain-addiction connection: Cocaine, dopamine, and more

Okay, so we’ve covered how the brain’s neurons communicate with one another normally; now let’s learn about how drugs mess things up to produce their specific effects. Since the brain-addiction relationship is different for different drugs, we’ll do this one by one, starting with cocaine:

Cocaine

One of the most commonly abused drugs, cocaine interrupts a molecule in the brain that’s responsible for clearing away the dopamine that is released during normal functioning (it’s called DAT). Like I’d said before, neurons talk to each other by releasing these neurotransmitter molecules to transmit impulses from one to another.

Imagine for a second that every time you spoke, the sound of your voice would continue on, reverberating endlessly. By the time each of us would be done uttering our first sentence, the world would be a mess of unintelligible sounds, echoing forever. This wouldn’t make for a very effective way of communicating.

Sound loses energy as it travels through air, eventually having so little energy that it no longer moves enough air to be audible. This keeps each word distinct and meaningful. In the brain, the individual messages between neurons are similarly kept distinct up by a number of processes.

These include dissipation, chemical breakdown, and reuptake.

Let’s learn more about these processes

Dissipation is a process similar to the story with air and sound, as the molecules move around, their concentration gets lower, and they become less likely to activate anything.

Chemical breakdown does is exactly what it sounds like, chemicals breaking the neurotransmitters down so they can no longer activate anything.

Reuptake is a more complicated process of recycling. Instead of letting all those precious chemicals go to waste, the brain recycles them so they can be used again later. Cocaine blocks the molecule that makes this reuptake process (for dopamine) possible. It’s a small molecule that carries the cocaine back into the cell that released it. Cocaine wedges itself in place of the dopamine (see picture below) and therefore deactivates it.

Dopamine Transport Molecule

What does cocaine’s action result in?

The result is that since it can’t be as efficiently cleaned up, dopamine ends up hanging around the brain for longer than it’s supposed to. Because dopamine is one of the brain’s main “pleasure”, or “positive” signaling molecules, users of cocaine feel better than they would otherwise as a result of this extra dopamine.

This doesn’t sound like such a bad thing, does it? Reuptake is a small price to pay for feeling a high that is almost “naturally produced” (some of the brain’s own dopamine hanging around for longer than it should). The problem is, that like in anything else, for every action, there’s a reaction…

What happens when cocaine in taken for a long time?

Faced with increasing amounts of dopamine, the brain starts adjusting in these ways:

  • It starts out by producing and releasing less dopamine, because as far as it’s concerned, the balance has been interrupted.
  • The number of receptors available to bind with dopamine is also reduced.
  • Next, it starts turning up brain systems that are supposed to counteract the actions of dopamine in order to once again, adjust for the increased levels.

Overall, these are some of the reasons for the “come down” or, after effects of a heavy night of cocaine use.

Over time, many of these changes become long lasting, resulting in a whole set of undesirable effects for the user, including withdrawal, mood problems, as well as some serious problems with thinking and control over behavior.

Not to be ignored are the effects that cocaine use, and the good feelings it initially brings along, have on motivation and normal reward functioning and learning in the brain; but we’ll get to that in another lesson…

Question of the day:
Does the above explanation of how cocaine works help you make sense of the effects it has? Could you see how these effects would possibly bring about addictive, rather than recreational, use?