Why the addiction-brain connection has to be part of the addiction treatment picture

Dr. Dodes recent article, apparently trying to blow up the myth of addiction as a neurophysiological disorder, sounded persuasive, although its underpinning was oversimplified and it’s understanding of the brain-science involved in addiction, and other associated mental health disorders, was lacking. Hopefully, by presenting a more complete picture of the evidence for a brain-aspect to addiction, I can un-bias the discussion somewhat. I, for one, don’t believe that neuroscience will ever be the only factor important in addiction – an individual’s environment, social influences, and other factors will always end up playing important parts as well – still, I think that to dismiss all of the evidence for biological factors at play in the development of addiction is foolhardy. Especially when there’s so much of it that was glossed over in Dr. Dodes’ introduction.

Pleasure center activation is only part of the picture in addiction

Firstly, supporters of the notion that addiction is, at least partly, an outcome of specific brain function point not only to pleasure center activation, but also to a whole host of findings showing genetic variability that is either protective from, or a risk factor for, dependence on drugs and likely also behavioral addiction like eating disorders, compulsive gambling, and maybe sex addiction as well (you can start out looking up ALDH2-2 variability and alcoholism and cocaine addiction, DRD4 and stimulant addiction, and many more).

While it is true that all those who consume addictive substance activate the brain similarly, there are considerable differences in the specific of that activation in reaction to drugs. Some release more dopamine while others have more “active” versions of specific important receptors; neurotransmitter recycling is quick in some, but not all, and drug metabolism is different in different individuals in ways that have been shown to be important not just for addiction risk, but also for the probability of treatment success. Just look at the nicotine and CPY26 literature for an example. It’s right there.

Additionally an entire body of literature exists that shows differential activation, as well as structural differences, between addicts and non-addicts in regions as varied as the OFC, PFC, Insula, and more. This is not to mention a slew of evidence that shows different behavioral test performance on risk-taking, impulsivity, and delay-discounting, all personality variables highly associated with addiction. If one simply ignore all of this evidence, it may be easy to believe that there is no biological explanation for these phenomena, but that’s just wrong.

To say that mesolimbic activation (what the good doctor called “pleasure centers”) is the only evidence for physiological factors in addiction is dismissive at best.

Drug addiction develops in only some drug users

The notion that not everyone who takes drugs becomes addicted is nothing close to evidence against a brain explanation for addiction. Everyone’s motor–cortex, striatum, and substantia nigra (the areas of the brain responsible for movement) activate in the same way during movement, but only a small group ends up suffering from Parkinson’s or Huntington’s disorders. One fact does not preclude the other but instead may specifically point to the fact the group which develops the disorder has somewhat different neurological functioning. Researchers aren’t concerned with explaining why all individuals can become addicted to drugs, but rather why that small subgroup develops compulsive behavior. A short reading of the literature makes that fact pretty clear. Additionally, while Dr. Dodes’ claims otherwise, imaging technology HAS produced evidence explaining this “mystery”, including differences in the ways addicted smokers respond to smoking-related triggers, and an increased dopamine response in cocaine addicts to cues, and well as to cocaine.

As mentioned in the motor disorder section above, ingestion of chemicals is not at all necessary for brain disorders to occur or indeed develop later in life. Dr. Dodes example of shifting addiction could be used as evidence for an underlying neurological difference just as well as it would serve to make his point… Or even better. If there’s a faulty basic mechanism attached to rewarding behaviors, it doesn’t really matter what the behavior is, does it? Sex addiction, gambling, and more can all be explained using a similar mechanism, though drugs of abuse may just have a more direct impact. I know, I’ve written about them all.

The Vietnam vet heroin story used by Dr. Dodes as evidence that emotional, rather than physiological, factors are responsible for addiction actually fits right in line with the notion of predisposition and underlying differences, and I’m surprised to hear a physician point to group differences as an indicator of no neurobiological basis. Indeed, when it comes to the emotional reactivity associated with drug associated cues, normal learning literature, as well as drug-specific learning research, has revealed over and over that drug-related stimuli activate brain regions associated with drug reward in the same way that natural-reward predictors do for things like food and sex. Once again, these facts are part of the basic understanding of the neuroscience of learning, with or without drug abuse involvement.

My own dissertation work shows that it is very likely that only a subsection of those exposed to nicotine will develop abnormal learning patterns associated with that drug. However, among those, learning about drug-related stimuli (as in “triggers”) continues in an exaggerated manner long after the other “normal” animals have stopped learning. That sort of difference can lead to a seriously problematic behavioral-selection problem whereby drug-related stimuli are attended to, and pursued, more so than other,  non-drug-related ones. If that sounds familiar, it should, since drug users continuously pursue drug-associated activities and exposures in a way that seems irrational to the rest of the world. It just might be due to such a mechanism and others like it.

Some important points about science in Dr. Dodes’ article

One very true fact about mental health pointed out by Dr. Dodes is that diseases like schizophrenia, which used to be explained simply as demon possession and evidence of witchcraft can now be, to a large extent, explained by the study of behavioral neuroscience and cognition. The same is true for bipolar disorder, depression, ADHD, and a host of other such conditions. In fact, the study of psychology has only been able to rely on technological advances that allow us to “see” brain function for a few short decades, leading to incredible advances in the field that I think will continue. The thinking that no such advances have, or will continue to be, made in the study of addiction is, in my opinion short sighted.

As I mentioned above, I don’t for a second think that the entire explanation for drug abuse and addiction will come from neurophysiological evidence. The doctor points out that “If we could take a more accurate image of addiction in the brain, it would encompass much of the history and many of the events that make us who we are.” I agree that we need to advance our technology as well as expand our understanding, but I think that to discount neuroscientific explanations completely is a big mistake.

Addiction stigma – Making addiction recovery, and addiction treatment entry, even harder

When people think about drug addicts, they often bring-up the negative stereotypical hippie, or homeless, image that movies, television, and much of our daily experience has left us with. Its usually not a successful business man, doctor, or lawyer that comes to mind.

This is an issue because many addicts attempt to disassociate themselves from this negative stigma, often resorting to denial of their drug problem or secrecy coping,  and not seeking the addiction treatment they need.

The truth is that addicts are found in every socioeconomic class and within every ethnic group and gender. On this site we have talked about doctors with addictions, the reality of behavioral addictions, and the science behind the compulsive behavior that addicts are so well known for. We have attempted to destroy myths about addictions, by informing our readers about the neuroscience of addiction, and allowing people “to come out” about their addictions. By doing this we hope to encourage openness about addictions, and not allow stigma to get in in the way of recovery.

Addiction stigma hurts addiction treatment success

The center for Addictions and Substance Abuse Technologies, at The University of Nevada, did a study on the affects of stigmatization on 197 drug users. The findings indicated that there is a direct correlation between the degree to which drug users are perceived negatively (stigmatized) and whether or not they overcome their addiction. The study suggested that addicts become more dependent on the substance they use because of the stigma (actual or perceived).

Researchers looked at six questions regarding stigmatization which were:

  1. To what degree do drug users experience stigma?
  2. Were the metrics of stigmatization conceptually distinct?
  3. Is the perceived stigma related to the number of previous addiction treatment episodes?
  4. How does secrecy as a coping strategy affect drug users?
  5. Do intravenous drug users have higher levels of perceived stigma than non-intravenous users?
  6. Do people with current contact with the legal system report higher levels of stigma?

The study found that there are varying degrees of stigmatization and that the most prevalent stigmas were; drug users felt that people treated them differently after finding out about their drug use (60%), felt that others were afraid of them when finding out about their drug use (46%), felt some of their family gave up on them after finding out about their substance use (45%),  felt that some of their friends rejected them after finding out about their substance use (38%), and felt that employers paid them a lower wages after finding out about their substance use (14%). My own personal experience certainly supports the first three findings – I have encountered people who stopped talking to me after finding out about my drug addiction past, and during my addiction there were long stretches of time during which my family completely gave up on the possibility that I would ever recover. At the time I simply shrugged these things off and pretended like they didn’t matter, but they certainly didn’t give me a good reason to stop using drugs.

The results of the study indicated that the measures of stigma are conceptually unique. These measures included Internalized shame Perceived stigma, and stigma-related rejection, all of which were correlated with one another to some extent.

Users with a higher number of addiction treatment episodes also engendered higher levels of stigma and had a more difficult time succeeding in treatment. These results  support earlier findings (Sirey et al. 2001) that showed that users with higher levels of perceived stigma were more likely to prematurely discontinue treatment, confirming that stigmatized drug users are not likely to seek addiction treatment and are more likely to relapse after starting treatment.

Addicts have a sense of shame associated with seeking treatment for their problem

The current addiction treatment system has produced a seeming paradox within the mind of the struggling addict – By owning up to their addictions, addicts reduce the invisibility of the problem, helping others claim back their lives from the secrecy of substance abuse and behavioral addictions. Unfortunately, that process takes far longer than the stigma the confessing addict has to immediately confront.

The study showed that secrecy coping is associated with lower quality of life because of the drug user’s inability to openly discuss their addiction. Subjects  that dealt with their addiction alone had poorer mental health, decreasing their chances of recover due to the stigma of addiction. Much like with many other chronic mental, and physical, conditions, the stigma attached to addiction, and addiction treatment seeking, can often lead to poorer outcomes in the long run and less successful treatment development due to low participation rates in the kind of groundbreaking research necessary. By reducing the shame associated with confessing to an addiction, society could drive forward the advancement of addiction treatment, helping us treat addiction like we treat cancer, parkinson’s disease, and many other chronic diseases.

Surprisingly the results from the study showed that the legal system does not increase the  level of stigmatization, yet subjects that used intravenous drugs felt a higher level of stigma.

Citations:

Sirey, J. A., Bruce, M. L., Alxopoulos, G. S., Perlick, D., Raue, P., Friedman, S. J., et al. (2001). Perceived stigma as a predictor oftreatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 158, 479−481.

Luoma J.B., Twohig M.P., Waltz T., Hayes S.C., Roget N., Padilla M., Fisher G. (2007) An investigation of stigma in individuals receiving treatment for substance abuse.

About Addiction: Drug use, Addiction Recovery, and smoking

We’re back with our weekly post about addiction news and research. We’ve got harm reduction in Australia, heroin ads that don’t work, the impact of drug abuse on children, and more. Get your 30 seconds of education for the day.

Using Drugs – Heroin, HIV, the law, and recovery

The Australian– There is a state approved heroin injecting room in Australia. The center opened to create a safer place for drug users to shoot heroin. 3500 individuals have overdosed on the premises without a single fatality, making for a very interesting way of combating drug addiction that would definitely fall under that harm-reduction model American hate so much!

Star Advertiser– When it comes to scaring individuals into not using drugs, specifically heroin, fear appeals do not seem to work in preventing future drug users. Fear appeals ads show drug users as violent, and often have missing teeth or skin problems. Apparently, audiences are smart enough to see these as not really representative of heroin users in general and they’re not buying it, making the ads useless in combating drug addiction.

Global Development– Eastern Europe and Central Asia have the fastest growth rate of HIV infection in the world (Russia accounts for between 60% and 70% of the epidemic). This may be due to sharing dirty needles when using drugs and the biggest problem is likely lack of prevention efforts for high risk groups.

Guardian– A senior police officer from Britain thinks that individuals should not be criminally prosecuted for possessing marijuana. By focusing less on drugs found among youth the police can focus on things they see as more important like hard core criminals. I’m sure our legalization friends will love this, although again, this isn’t legalization but decriminalization and parents will hate it.

Addiction Inbox– Meditation and exercise play a role in drug addiction recovery. Both methods apparently help to eliminate the panic and anxiety that plays a role in detoxification. Although it may not be the most popular method of recovery, we at A3 have already written about this and think you should give it a try!

Breaking the cycles–  A program called Partnership for a Drug Free America has five new drug programs in order to eliminate drug use among teens. These programs educate teens as well as their parents with a variety to drug information.

Smoking, pregnancy, and attitude

Science Daily- Women who smoke during pregnancy can hinder their children’s coordination and physical control (likely affecting boys more). Smoking during pregnancy can damage development in the fetal stage, so if you are expecting try not to light up (as our other post on pregnancy and smoking recommends).

Decoder– You are in for a good read on the changing attitudes of smoking. This blog gives an inside perspective on smoking and how it has evolved from the time it was considered “cool”.

Addiction’s impact on others

Philly Daily News- Addiction impacts not only the drug addict but their children as well. 15% of all children live in a household with an alcoholic and one in four children is exposed to a family member’s alcohol abuse or dependence. These children are often neglected when their parents are under the influence and that neglect can lead to some pretty terrible outcomes for the children themselves down the line.

Addiction Recovery– This is an excellent read on the importance of patience when it comes to addiction recovery. Rome wasn’t built in a day and neither will a drug addict’s wonderful new life. Recovery takes time so take a deep  breath and enjoy!

Making a difference one post at a time… Helping drug users

Hi everyone,

I’ve been wanting to do something to help drug users for a long time now, so instead of just thinking about it, I’ve decided to go ahead and give this a try.

I’m a doctoral student at UCLA working on my PhD in psychology. I’ve been studying issues related to drug-addiction, sex-addiction, and gambling-addiction for the past 6 years and am continuing on my quest to discover what I call “The pathway to addiction.”

The thing is that on the way I have been, and still am, gaining an amazing amount of knowledge that I think can benefit not only those struggling with drug use and addiction themselves, but also the family members, friends, and loved ones of those being affected by this disease, condition, or whatever each of you feels comfortable calling addiction. As far as I’m concerned, this should all be about somehow actually helping drug users.

I’ve had my own experiences with drug use and addiction, and so I don’t expect my writings to be devoid of subjective input that I feel I can contribute given my experience.

My goal here is to get what we, as scientists, know about addiction to the general public.

I want to do this because I feel that knowledge is a key ingredient not only in curing and fighting conditions (be they medical, academic, psychological, or otherwise), but also in simply being able to handle and accept things as they are more completely.

We tend to be more scared of things when we feel like we don’t understand them.
I’m not going to lie to you on here and I’ll have no problem revealing personal history and experience by they related to my drug use or other aspects of my life.

I want this to be a forum for people to ask honest questions, get honest answers, and be able to look to when they feel like they’re at a loss and need someone who understands. Making a difference takes work. I hope it works…