About Addiction: Your brain, smoking, alcohol and drugs

Some new, different areas of addiction and some old favorites.  Read on to learn more!

Check out this USA Today story about President Obama’s public health fight and goals of reducing drug usage.  He said prevention and education are really what we need.

Your Brain and Addiction

Science Daily: A genetic variant of a receptor in the brain’s reward circuitry plays an important role in determining whether the neurotransmitter dopamine is released in the brain following alcohol intake.

Health Day: Children who experience psychological disorders such as depression and substance abuse appear to be headed for a financially depressed adulthood.

Science Daily: This article investigates separate and joint effects of alcohol and tobacco on the nucleus accumbens. A new study has found that alcohol abuse elevated the expression of a distinct set of genes in the NAC and VTA while nicotine blunted this effect in the VTA.

Alcohol

APP: This article talks about a new study on alcohol use of teens. The Partnership for a Drug Free America found in a study released in March an 11 percent increase among students in grades 9-12 who reported drinking alcohol in the past month, up to 39 percent in 2009, or 6.5 million students.

Science Daily: This article suggests that frequent alcohol use is linked to faster HIV disease progression. According to the article, HIV disease tends to progress at a faster rate in infected individuals who consume two or more alcoholic drinks a day.

Associated Press: This is a link to a short text which states that the World Health Organization endorsed a global strategy to reduce alcohol abuse. This text calls alcohol use one of the leading causes of sickness and death.

Smoking

Physorg.com: In a new study was found that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population.

Cesar Fax: This  states that cigarette excise tax increased in fifteen states in 2009. Four states have not increased cigarette taxes in more than a decade.

Other Drugs

Reuters: Prescription drug use of US children has risen. Children were the leading growth demographic for the pharmaceutical industry in 2009, with the increase of prescription drug use among youngsters nearly four times higher than in the overall population.

Medical News Today: There are significant changes in substance use treatment admissions patterns that have occurred over the past decade. The co-abuse of alcohol and drugs has declined gradually yet significantly.

Gambling it all away? The connection between gambling and drug addiction

Screaming in the last 10 seconds of a football game, the score is neck and neck, and your team has the ball on the 20 yard line. Needless to say your heart is beating like crazy in anticipation to see the outcome. Would it be beating any harder if you had money riding on the outcome? A recent study has shown that when it comes to gambling, the excitatory aspects are heightened when there is something to be won, no matter what game you’re playing, or the outcome (1).

Gambling’s more exciting when there’s money on the line

Recent work by researchers at SUNY Albany, discovered that in the last 30 seconds of a horse race and the following 30 seconds after the completion of a race, heart rate (HR) rises significantly more in individuals who think they will personally benefit from the race. The HR of those who lost money still rises after learning the outcome of the race—surprisingly just as much as those who won money. So whether you win or lose money in the race, your heart rate still goes up, which may provide a signal from the body that drives the continuation of gambling behavior.

Seems strange right? Win or lose, as long as you bet money on the game your body is going to become more excited about it. Still, when questioned afterwards, individual’s rated their experience as more exciting only if they won money. That, in fact, was the only difference between the men and women in the study. Women rated their subjective excitement higher even for lower winning rates (in this study $2, and $7), whereas men only said they were excited for the highest amount ($15).

How does gambling become addictive?

You become addicted to drugs because of chemicals that change your body and brain in specific ways that make you want more (see a past post here). Gambling doesn’t involve putting chemicals in your body, so how can you become addicted to it?
When you gamble, actual changes occur in your brain, just as they occur with drugs. Though gambling may not put chemicals in your body directly, it does affect the same class of chemicals that become altered by the intake of drugs. It all goes back to the reward pathway in the brain and neurotransmitters like dopamine, adrenaline, and noradrenaline. Whether a good experience or a bad one, the effect on the brain can apparently get some people to the point where they lose control over their betting, win or lose.

The question is: Why can’t you just play the same games without getting in debt?

Betting money creates a heightened excitement by the release of the reward-related neurotransmitters. That feeling of reward becomes associated with all the other surrounding stimuli (i.e. bright lights and sounds of casinos or screaming fans) and Bam! Here comes trouble (see my post about cravings here). As long as the gambling is sometimes paired with an actual win, the arousal from the situation as a whole (even while losing) will continue to create the desired effect. In fact, inconsistent rewarding, and especially the kind that can’t be predicted, produces the strongest, hardest to shake kind of learning. This is why casinos program slot machines (their biggest gambling money maker) to win one out of every five draws o average – it keeps people coming back for more. Every one of those unexpected wins pushes up dopamine levels in the brain making it more likely that you’ll go back for more…

Sound familiar?

Citation:

Wulfert, Franco, Williams, Roland, and Hatley Maxson (2008). The Role of Money in the Excitement of Gambling. Psychology of Addictive Behaviors, 22, 380-390.

Crystal meth withdrawal – It’s not like heroin, but don’t expect it to be easy

Heroin, or opiate, withdrawal symptoms is the gold standard of addiction withdrawal. Imagine the worst flu of your life, multiply it by 1000, and then imagine knowing that taking a hit of this stuff will make it all better. Think sweats, fever, shaking, diarrhea, and vomiting. Think excruciating pain throughout as your pain sensors get turned back on after being blocked for way too long. Now you have an abstract idea of the hell and it’s no wonder why heroin withdrawal has become the one every other withdrawal is judged against.

Crystal meth withdrawal

Withdrawing from crystal meth use is nothing like opiate withdrawal and there’s no reason that the withdrawal symptoms should be. Opiates play a significant role in pain modulation and opioid receptors are present in peripheral systems in the body, which is the reason for the stomach aches, nausea, and diarrhea. Dopamine receptors just don’t play those roles in the body and brain, so withdrawal shouldn’t be expected to have the same effect.

But dopamine is still a very important neurotransmitter and quitting a drug  that has driven up dopamine release for a long time should be expected to leave behind some pain, and it does.

One of the important functions of dopamine is in signaling reward activity. When a dopamine spike happens in a specific area of the brain (called the NAc), it signifies that whatever is happening at that moment is “surprisingly” good. The parentheses are there to remind you that the brain doesn’t really get surprised, but the dopamine spike is like a reward signal detector, when it goes up, good things are happening.

Well guess what? During crystal meth withdrawal, when a crystal-meth user stops using meth, the levels of dopamine in the brain go down. To make matters worse, the long-term meth use has caused a decrease in the number of dopamine receptors available which means there’s not only less dopamine, but fewer receptors to activate. It’s not a surprise than that people who quit meth find themselves in a state of anhedonia, or an inability to feel pleasure. Once again, unlike the heroin withdrawal symptoms, anhedonia doesn’t make you throw up and sweat, but it’s a pretty horrible state to be in. Things that bring a smile to a normal person’s face just don’t work on most crystal-meth addicts who are new to recovery. As if that wasn’t bad enough, it can take as long as two years of staying clean for the dopamine function of an ex meth-addict to look anything like a normal person’s.

This anhedonia state can often lead to relapse in newly recovered addicts who are simply too depressed to go on living without a drug that they know can bring back a sense of normalcy to their life. The use of crystal-meth causes the sought-after spike in dopamine levels that helps relieve that anhedonic state.

When it comes to more physiological sort of withdrawal symptoms, the meth addict doesn’t have it that bad, I guess. After an extended period of sleep deprivation and appetite suppression that are some of the most predictable effect of meth, the average addict will do little more than sleep and eat for the first week, or even two, after quitting the drug. Many addicts experience substantial weight gain during this period as their metabolism slows and their caloric intake increases greatly. Like everything else, this too shall pass. With time, most addicts’ metabolism return to pre-use levels and their appetite catches up and returns to normal as well. Still, there’s no doubt that a little exercise can help many addicts in early recovery steer their bodies back on track.

There’s some research being talked about around the UCLA circles to see if detoxification from meth may help people do better in treatment for meth addiction by reducing the impact of their withdrawal. Detox before addiction treatment is an accepted fact in opiate and benzodiazepine addiction, but because of the supposedly “light” nature of crystal meth withdrawal, it’s been ignored. Hopefully by now, you realize that was a mistake.

Thinking straight might help: Modafinil in early recovery from crystal meth addiction

I’ve mentioned before that I believe medications can be a very helpful tool in early recovery, especially for specific individuals who need help getting over the initial, most difficult, period (look here).

If you take a look at my first post about meth and its effects on the brain, you’ll read that crystal meth use can negatively affect the function of a neurotransmitter called dopamine. One of the dopamine’s important roles in the brain has to do with impulse inhibition and control over behavior.

The role of impulse control in early recovery trouble

With a reduced capacity for behavioral control, it’s no surprise that people in early recovery find it especially hard to resist urges to use again. When you consider that it’s already been shown that addicts are more likely to have impulse control problems, like ADD/ADHD, the role of impulsivity becomes even more important for understanding addictions. Having less control over a preoccupation that results in obsessive-thoughts and compulsive-actions means that slips, or relapses, are an almost expected outcome.

If we could only figure out how to give people better control over their impulses, we’d possibly better equip them to prevent their own relapses.

ADHD medication for crystal meth addiction help

Well, a number of drugs used for ADHD have been researched as possible aids for addicts, and it seems like Modafinil (marketed as Provigil) may help with exactly the cognitive deficits that seem to trip meth (and cocaine) addicts in early recovery up. In fact, the results seem to be strong enough to warrant the initiation of some larger scale investigations. This, along with previous findings that reported relatively low abuse-potential for modafinil suggest that this may indeed prove to be a useful medication.

No one is saying that this is the pill that will cure addiction, or even that a pill like that is going to be found. But hopefully, along with other medications (like Bupropion), the number of tools in the proverbial toolbox of addiction specialists will continue to increase, allowing them to better treat a larger proportion of those suffering from addiction.

Citations:

Jasinski, D. R & Kovacevic-Ristanovic, R. (2000). Evaluation of the Abuse Liability of Modafinil and Other Drugs for Excessive Daytime Sleepiness Associated with Narcolepsy. Clinical Neuropharmacology, 23, 149-156.

Ling, W., Rawson R., & Shoptaw, S. (2007). Management of methamphetamine abuse and dependence. Current Psychiatry Reports, 8, 345-354.

Addiction causes – Drug addiction as a chronic disease makes sense

The stigma of addiction is alive and well. Whether you believe in the disease model or not, it seems that people’s judgments regarding what it means to be an addict are well entrenched.

I’d like to work on that a bit.

Why is addiction a disease?

In numerous posts on this site I’ve addressed issues like genetic predisposition and the effects of drugs on the brain that impair addicts’ ability to control their choices. A disease is commonly defined as “A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.” (See Answers.com) I don’t think there’s a question regarding whether or not addiction involves a pathology of a body part, namely the brain.

It would definitely be easier if we could all just say that addiction is the product of bad choices. Nevertheless, all the science I’ve seen points to the fact that addicts have impaired decision making to begin with that is only made worse by the drugs they take in.

A comparison with Diabetes

diabetesFor some reason, this still leaves a lot of people seeing addicts as the only ones to blame. I’d like to try a different approach:

We’ve all heard of type 2 diabetes. It’s the kind people aren’t born with, but rather are develop later in life. Most cases are the result of an over exposure of the body to sugars that breaks down its ability to produce insulin, leading to the disease. There are an estimated 15 million people in the U.S. who have type 2 diabetes. They make up 90% of diagnosed diabetes cases.

I think that type 2 diabetes is a disease that can help many reformulate the way they think about addiction.

Patients with adult onset diabetes likely have genetically reduced insulin receptor functionality and possibly other factors that increase their likelihood of developing the condition. They also likely consume more sugars than people who don’t develop type 2 diabetes, though the exact causes are still uncertain. Nevertheless, with early detection, the disease progress can certainly be slowed and perhaps even halted. As the disease progresses, the body’s response to sugar is altered, eventually resulting in what looks like a severe alergy to sugars. However, once developed, type 2 diabetes patients often require similar treatment courses, including medication, exercise, and dietary changes that patients with type 1 diabetes (the type present early on in life). At this point, simply cutting back will no longer do.

This is not all that different from addiction.

Addicts are often born with a set of genetic and environmental factors that predispose them to impulsively engaging in and seeking out, risky, exciting activities. Moreover, the addict’s reaction to drugs is often different than that of non-addiction-prone individuals. For example, many stimulant abusers report a calming, rather than excitatory, effect of drugs like methamphetamine, cocaine, and the likes. That was certainly my experience back in my crystal meth days.

It is true that here the predisposition is more abstract, since it resides in brain activity patterns, but as I’ve said many times before, the brain is certainly a physical part of the body and should be treated as such. Like diabetic patients, once addicts begin using the drugs in large quantities and for extended periods, the drugs cause alterations in physical systems. Like diabetics, once these changes occur, they are certainly long lasting, if not permanent. Dopamine function in the brain of crystal meth abusers has been shown to take as many as 2 years to return to anything resembling non-user levels and we have no way of telling if the newly formed dopamine activity is at all related to what was previsouly there. Once the disease we know as addiction (or dependence) takes hold, there are specific recommended treatments that need to be followed. Simply cutting back will no longer do.

The bottom line?

Addiction fits the model of a disease as well as many other conditions. I have no doubt that people’s moral judgments get in the way sometimes and make it hard for them not to fully blame an addict for their trouble. I don’t doubt that addiction can only develop with the use of drugs, but if there are pre-existing conditions that make that use more likely, I think it need to be taken into consideration as well.

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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The brain addiction connection : Crystal meth, and our friend dopamine

We’ve talked about the general way in which neurons in the brain communicate with one another and then reviewed the ways in which cocaine messes some of the basic processes that the brain depends on.

It’s time to move on to another drug, and since the brain-addiction connection is similar for meth and cocaine, it seems the natural next step…

Methamphetamine (speed, ice, glass, crystal, meth)

Remember how we said that cocaine affects the way that dopamine is cleaned up after being released? Well, crystal meth also affects dopamine, but in a different way:

Instead of not allowing a molecule (DAT) to pull released dopamine back into the cell that released it, methamphetamine doesn’t allow the dopamine in a cell to be stored in the little packets that it’s supposed to be put away in. Like the DAT molecule, there’s another molecule that packages dopamine (and other neurotransmitters actually).

This molecule is called vesicular monoamine transporter (VMAT) because it puts a specific kind of neurotransmitter (called monoamines) into packets called vesicles.

You may be asking this right about now:

“If cocaine and crystal meth act in such similar way, why are their effects so different?”

That’s a very good question.

Even though these two ways of affecting dopamine seem very similar, they cause different changes in the levels of dopamine in the brain:

This flood is similar to the effect of crystal meth on the brain. By interrupting the way the brain packages dopamine, speed causes an unstoppable flood of this neurotransmitter.While cocaine doesn’t allow the neurons to take dopamine back up (reuptake), the brain has these small monitoring devices called autoreceptors. These receptors detect the levels of dopamine in the brain and adjust the output. When cocaine increases dopamine levels, these autoreceptors decrease the amount of dopamine being released.

The problem with crystal meth is that the dopamine can’t be packaged at all, which means that whether the autoreceptors tell the brain to turn down dopamine output, the fact that the dopamine won’t go into it’s packages means it just keep leaking out.

Imagine having a burst pipe and trying to stop the flood by turning down the faucet… not too helpful, right?!

So what you end up with is a long lasting flood of dopamine that the brain can’t do much about… You may have already figured it out, but this is one of the many reasons why crysal meth has become the new drug epidemic; it just does its job really really well!

Dopamine function in a non-drug-using, meth addict after quitting, and a meth addict after 1 year of staying cleanThe long lasting effects on the brain are similar to those of cocaine, but can be even more devestating. Meth is very neurotoxic meaning that at high levels, it can actually kill neurons by over exciting them. In fact, for both cocaine and methamphetamine, but especially for meth, it can take a very long time (a year or more) for dopamine function to look like anything close to a non-user’s brain (look for the decrease in red in the middle figure showing less overall activity in this area).

Check out this video about meth’s effects: