Always stay mindful – My different experience with recovery, addiction, and crystal meth

One of the main features of addiction is, unfortunately, how insidious it is.
Given everything I’ve been learning in the past 12 years about drugs, their abuse, and the people involved, I feel right in saying that most people don’t realize how far gone they are until it’s too late.

I consider myself fortunate in finding my way out of my crystal meth addiction, and I’ve met many others who’ve found their way as well. Still, I realize constantly that you can’t be too vigilant or too aware in watching out for inroads back to disaster.

My Experiment

methAs I’d said before, I began drinking again after 3 years of staying completely sober. My decision to leave typical recovery was made after talking with my parents and loved ones and making sure that they understood what this meant. I made sure that if I began reverting back to my old way of being lazy, aloof, and disrespectful, they would step in and send me right back to rehab.

This was my way of running the famous AA experiment and for me, it’s been working for the past 5 years or so.

But, I am always aware of how intoxicated I am and it is rare nowadays that I let myself get to the point of the loss of control. I have this constant voice in my head now that monitors how drunk I feel. I DO leave unfinished glasses of wine at dinners at times, and I do my best to make wise choices before going out so that I don’t make dumb ones later (like driving under the influence).

How I stay grounded

Still, most of my awareness about my addiction and what it means comes from my constant work in the area. Working with people who are in the throws of their disease keeps me in touch with how far I’ve gone and how much I don’t want to go back. I now know much more about the risks and about what I’d be doing to myself were I to take them. I don’t want to kill additional neurons, and I sure as hell don’t want to go through 2 more years of hell trying to put my life in order. I’ve never tried speed again since the day I quit in 2002 because I can’t say that I’m sure of what would happen next, and I don’t want to find out in case it’s bad…

This is why I believe that education is one of our best weapons in the battle against addiction.

My most valuable help

Lastly, I feel like one of the most important ingredients in all of this is having people you can trust and confide in. I don’t have many of those, but there are a few, and my family is always there, and I share everything with them.

For me, it was the moment I chose to be forthcoming with my family and hide nothing from them that has healed years of tension, mistrust and fighting, and I never want to go back .

This however means that they too have to be open. We now laugh when I say things like “I wish I could do some speed now to get me through all this work I have,” but I assure you, no one was laughing 5 years ago…

A word of caution

DefeatedMy sponsor in AA “went out” (meaning he started using again) a few months ago after being prescribed pain medication for surgery. Many in AA would point to the fact that he should have never been prescribed those pills in the first place. Everything I’ve learned about the brain indicates that automatic relapse is only likely when using one’s “drug of choice“. I say it was the dissolution of his marriage and his trust that having been sober for 12 years he could do no wrong that got him in trouble.

The moral:

Be open, accepting, and loving. Let those around you say things that make you uncomfortable without too much judgment so that they feel safe in coming back to you, and if they ask for help, know how to give it to them. No matter how happy people are to finally quit drugs (or another addiction), the feeling of defeat when they realize they now have to learn to live without their crutch can be enormous. This is where the help is most important.

Question of the day:
Do you have a story about the support you found necessary for your own recovery or the recovery of someone close to you?

Drug use norms and expectations: Obsessions and compulsions in our society.

teensI used to always say, back in my using days, that speed (methamphetamine) was The American drug. Why? Meth makes its users sharper, more alert, and more focused, and it allowed me to spend entire nights up studying like I’d never been able to study before.

Unfortunately, like many other aspects of The American Dream, speed will also leave you spent before you know it, leaving the memories of those productive, focused, days far behind with little hope of coming back.

We live in a society that celebrates excess, be it in celebration or dedication to work, success, and achievement. Is it any wonder then that so many Americans turn whichever way they can to gain the edge that they feel they’re lacking when they compare themselves to those around them?

I read recently that many executives now keep a supply of medications like Adderall, Ritalin, and other attention deficit cures around for times when they need that extra push to stay up late and work.

We are skirting a dangerous line by putting out the message that everyone should be the best though of course, with no cheating… or at least no getting caught.

Teens are now using more and more prescription drugs while reducing, or at least not increasing, their use of many illicit, or illegal substances. How is this crisis we’re experiencing with our teens any different than the recent steroid stories exploding the mythic innocence of every American sport?

One of the things I want to inform my readers about in writing this blog is the process of addiction and the ways in which its development is often not under the control of the users, at least not the users likely to eventually develop into addicts. But, there’s also a different issue, the one having to do with what it is about our society that makes Americans so much more likely to turn to these substances in the first place???

It is estimated that more than a third (110 Million to be exact) of American have used at least one drug at some point in their lives. I don’t necessarily think that there is anything wrong per se with recreational drug use given the relatively low rates of addiction that develop from it. However, I think that drug use, even recreational use, that is meant to solve a problem or that is done as a normal part of life, is more likely to become problematic.

Some theories of addiction specifically assert that “self-medication”, as in using a drug to alleviate problems, especially psychological problems, can be a major indication of likely addiction potential. The problem is that the unsupervised use of the drug often does little to help the initial difficulties, and if anything, makes things worse as the drug user becomes more involved in the illegal drug culture. I probably don’t need to tell many of you about the social withdrawal and added psychological stress that goes along with becoming, or living with, a drug user.

My point is that we need to change the way we think about drugs in general. Drugs can be useful for many specific medical and psychological benefits, and possibly even for their recreational benefit (think Van Gough, or The Doors). But, in order to make sure that those we care about most don’t abuse and misuse drugs, we need to move away from the current attitude that seems to drive children and teens towards irresponsible, ill-informed, and dangerous drug use. By educating kids, not scaring them away from, the things that are dangerous for them.

You wouldn’t dream of teaching a child to look both ways before crossing the street by yelling at them that they better not EVER dream of setting a foot on the road without looking left first, would you?!

We teach our kids everything we think they need to know about life in order to prepare them for what’s ahead. Why is it that when it comes to drugs (and often sex), we shy away from bringing the subject up and still expect them to be well prepared when a friend says “Hey, want to pop one of these pills with me?”

There will always be those who for one reason or another are more likely to develop a problem with drugs regardless of how well prepared they are. Genetic influences on things such as low impulse control and sensation-seeking are known and are probably closely linked to some bad decision making. But even these people will benefit from being better prepared and more educated about their own choices so that when the time comes, even if a problem develops, they can hopefully acknowledge it, and deal with it, in a more capable, informed way.

We need to stop turning away from a problem and thinking it will solve itself. It’s time for us to look for answers and not rely on solutions appearing magically. They most likely won’t…

Question of the day:
Do you think that enforcement (of drug laws) or treatment (of heavy drug users)is the more effective way of dealing with the drug problem?

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:

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?

The brain-addiction connection : Neurons and neurotransmitters

As I’d mentioned in an earlier post, while many people experiment with, or use, drugs at some point in their lives, only a small percentage (between 10%-15%) develop chronic drug abuse and dependence¬†problems. While some of the specifics of what makes one person more likely to move from recreational use to addiction are still being investigated and hotly debated, we do know quite a lot about what happens in the brain when drug are used.

Before I can go into the specifics of the brain-addiction connection…

We need a little background on the way the brain works:

The neuron

The brain is in essence a very complex network of interconnected fibers (neurons) and their maintenance and support structures. The brain contains about 10,000,000,000,000 (10 trillion) of these cells, and they each make many connections.

The left end of the neuron in the picture on the right is called the dendrite; this is the neuron’s main information receiving hub. The long part extending to the right is called an axon, and it ends in axon terminals that eventually connect to other neurons’ dendrites.

This is the basic way in which everything that happens in the brain is communicated, including our thoughts, feelings, movements, and memories!!! Dendrite to axon, to axon terminals, to dendrites, and back to step 1. How this transmission is achieved within the neuron is not necessary for this discussion; let’s just say that you should eat your bananas and make sure you always have some potassium, sodium, and calcium in your body…

How do the neurons talk to one another?

Neurotransmitters

What is important for us is the way these neurons transfer information across the gap between the axon terminals and their connecting dendrites. This is achieved by chemicals called neurotransmitters. There are quite a few of these, but the main ones we’re going to be concerned with are serotonin, adrenaline, GABA, and dopamine as these are some of the major players in drug addiction (especially dopamine).

When a neuron wants to send a signal to its neighbor, it releases packets of a neurotransmitter (most axon terminals release only one specific neurotransmitter), and these are received by specialized receptors at the dendrites of the receiving neuron. If enough neurotransmitter is released and enough receptors are activated, the signal starts again and the cycle continues…

Neurotrasnmitters and drug use

Most abused drugs disrupt some combination of factors within this mechanism to produce both the intended, and unintended, effects they are known for.

Alright, that’s probably enough to absorb for now, more on what specific drugs do to interrupt this process soon!

Question:
How many of you knew about the ways in which drugs affect the brain? Would you mind sharing the things you’ve learned and where you’d learned them?

Neuroscience updates!!!

Hey readers!

We’ve just passed the 6000 visitor mark and our readership is growing steadily. I want to thank everyone who regularly check the site and welcome those of you who are here for the first time.

I’m in DC right now, attending the annual meeting of the Society For Neuroscience (sfn.org). I have been learning about new exciting developments related to addiction for the past 4 days and can’t wait to share them with you.

Watch out for some great new stuff!!!

And the survey says…

Well then, it seems that the drug-use survey I created is telling me that my blog readers’ drug use falls right in line with the use patterns common in the country.

Most of the readers smoke cigarettes, with marijuana, alcohol, and cocaine close in tow. I didn’t expect the meth, ecstasy, and other drug counts to be so low (less than 10 for each of those), but I guess that’s why I created the survey!

So, I’ll be trying to write the posts with your use in mind, and I’ll be continuously monitoring the survey to see if anything changes…