About Addiction: non-addictive pills, internet addiction, marijuana and alcohol

You want to know more about addiction and we want to tell you, so here is this week’s wrap up of exciting news (well, some of it. ) A lot of news about addiction comes up every week and we want you to be informed!

The End of Opioid Addiction?According to a joint international study by the University of Adelaide and the University of Colorado, published in the Journal of Neuroscience, the scientists have discovered an essential receptor in the brain that can cause opioid addiction, and there is a drug that can block this receptor without interfering with pain relief! The drug is called (+)-naloxone and it works by binding to the specific receptors in the immune system that ordinarily trigger the drug’s addictive properties and preventing the opioids from interacting with them, thus reducing the body’s addictive response to the opioid drug. This new drug is a variant of the drug naloxone, which has been used for many years to treat overdoses. However, this study is the first clear link to its effect on preventing addiction. According to the leaders of the study, clinical trials may even begin within the next 18 months!

Scientists discover internet-addiction gene?Internet addiction is defined as someone who obsessively thinks about the internet and whose sense of well-being is negatively impacted if they can not get access to the internet. According to the findings of German scientists, published in the September issue of Journal of Addiction Medicine, problematic users more often carried a variation of the CHRNA4 gene, which is typically linked to nicotine addiction. While this receptor in the brain has been known to be essential in nicotine addiction, this is the first neurological link to internet addiction that has been discovered. The study’s lead author, Christian Montag, acknowledged that more large-scale studies need to be done to further examine this connection between internet addiction and the CHRNA4 gene, however he insists that there is enough clear evidence to support a genetic predisposition to internet addiction.

Your childhood’s effect on your adult life It has long been accepted that traumatic experiences in one’s childhood can have long-lasting effects on a person well into their adult life. According to new research at Cambridge University, suffering a traumatic experience in childhood may increase one’s risk of drug addiction. The compulsivity and impulsiveness linked to addicts are also found in people as a result of a traumatic childhood. While having a traumatic experience in one’s childhood does not mean they will automatically become an addict, just as not having a traumatic experience does not make one immune to addiction, coming from this kind of background does make one more at-risk of becoming an addict.

Is Marijuana Addictive?There has long been a debate on whether or not marijuana is an addictive drug. Recently, it has been ranked number one on a list of the top five most commonly abused prescription drugs used by post-50 year olds. According to a 2011 report from The National Survey on Drug Use and Health, 3 million adults older than 50 have illegally used the drug and “out of 4.8 million older adults who used illicit drugs, marijuana use was more common than non-medical use of prescription medicines among the 50-to-59 age range.” All of this evidence leads to a need to differentiate between addiction and dependency. In this article, Robert DuPont, M.D. and Laurel Dewey debate the addictiveness of marijuana by arguing their point of view. As evidence of its addictiveness, DuPont points out that, since 2000, admission for treatment of marijuana abuse ranks higher than that of heroin, methamphetamine, cocaine and prescription painkillers. Of 7.1 million people with dependence or abuse of drugs other than alcohol or tobacco in 2010, 4.5 million had marijuana dependence. That’s 63 percent of everyone with illicit drug dependence or abuse! Contrarily, Dewey uses many personal experiences to show her side of the argument. She points to a 1974 study, conducted at Virginia Commonwealth University, that proved that the cannabinoids in the marijuana plant shrunk cancerous tumors and killed cancer cells, leaving healthy cells alone. She adds that, in the thousand years of its use, no one has ever died of marijuana use. Both authors use much more evidence for their side, which you can read about by clicking the link above. Read both views and form your own opinion!

Alcohol and Drug Use in SchoolsWith kids going back to school across the country, there have been many different studies on alcohol and drug use amongst the youth. In a survey led by SAFE Inc. (Substance Abuse Free Environment), there were mixed results. While the number of students who have tried alcohol has actually decreased, marijuana and amphetamine use have both increased. The survey targeted eight-, tenth-, and twelfth-graders, and showed that those tenth-graders who reported using alcohol in the last month dropped from 31 percent in 2010 to just 22.7 percent this year. It also decreased slightly in the eight- and twelfth-graders. Of the troubling findings, the most troubling may have been the increase in prescription stimulant abuse, such as Adderall and Ritalin. The most dramatic increase was among twelfth-graders, more than doubling from 3.8 to 8.5 percent. Marijuana use also showed increase both in the last month and in lifetime use amongst eighth- and twelfth-graders, although there was a slight drop by tenth-graders. 

Internet addiction – Epidemic or fad?

By Adi Jaffe, Ph.D., and Yalda Uhls, MA, MBA

1 in 3 people consider the Internet to be as important as air, water, food and shelter. Given how intensely people feel about this technology, is it any wonder that some psychologists are convinced that Internet addiction is a real pathology?  True, claiming that people are as dependent on the Internet as they are on air, food, or water is obviously a non-starter; it’s pretty clear that the actual role of technology is far less compulsory in terms of human survival.

But does this kind of dependence, compulsory or otherwise, qualify as an addiction?

While the DSM only currently recognizes specific dependence on substances as an addiction, it is apparent that a subset of people who overuse the Internet and digital media tools also display behaviors exhibited by substance abusers.  In the last decade, as the problem became more widely acknowledged, a few psychological measures have been developed to identify Internet addiction. While none of these are perfect, certain measures are becoming more accepted in the field (like Young’s Internet Addiction Test).  Using these scales, studies have identified correlates of Internet addiction and found that ADHD, depression, social phobia and hostility were all linked to excessive Internet use, a pattern reminiscent of correlates of alcohol and drug addictions as well.

The internet is just a tool, why should people who overuse it be considered addicts?

Some of the most compelling evidence comes from Asia.  In Korea, a country where technology is deeply enmeshed in the culture and Internet cafes abound, Internet addiction is considered one of the country’s most serious problems.  In the last decade, many people have died after marathon sessions of playing online video games, presumably from exhaustion and lack of nutrition, as they ignored their basic needs so they could continue to play a game. It’s a bit reminiscent of animal studies in which rats with electrodes implanted in their dopamine “pleasure centers” forgo food for lever presses to their own demise.  China has struggled with similar issues and in 2007 the country restricted game use to less than three hours a day (it’s important to note that there’s some loose consensus that more than 38 hours of recreational internet use a week is problematic).  In Korea, where they may be ahead of the curve in terms of dealing with the issue, more than 1,000 counselors have been trained in the treatment of Internet addiction and nearly 200 hospitals enlisted in the effort.  Moreover, preventive measures were recently introduced in schools and free Internet rescue camps are offered throughout the country.

In America, current estimates are that a child between the ages of 8-18 uses digital media nearly eight hours a day, while extreme users spend up to 12 hours a day with media, every day of the week.  Children are spending more time with screens than with their parents or at school; are we doing enough to protect vulnerable children from developing an addiction to the Internet?  No laws currently exist to protect children from excessive internet use. Doesn’t society have a responsibility to protect children, in the way we attempt to protect them from drugs and alcohol? If so, what would such protection look like and how would it be enforced?

You might be asking yourself whether people are actually addicted to the Internet itself or whether the Internet is simply a tool where other more basic pathologies, such as poor impulse control or social phobias, or fetishes are played out?

In the case of certain online behaviors, it may be simple to define the behavior as problematic because similar behavior offline has long been established as socially unacceptable when performed to excess.  For example, well established addictive behaviors such as gambling or sexual activity are easily played out online.   Even respected public leaders such as former congressman Anthony Weiner admit they have problems that are beyond their own control and that they need professional treatment.  In case you haven’t heard about Weiner, he was the Congressman who resigned after being exposed for texting sexually explicit photos of himself to constituents he had never met. Sounds like something an ignorant teenager might do right?  So when does this kind of behavior cross the threshold to compulsion or addiction when performed repeatedly?

Examples such as Weiners’ may be relatively easy to identify as a problematic compulsion but when online behavior is sanctioned by society as in the case of sending non-sexual texts, emails, or surfing the Internet for hours on end, it is more difficult to determine exactly when the line between normal and dysfunctional is crossed. Indeed, when one considers the “crackberry” nickname given to certain smart phones, a direct comparison to addiction seems relevant. Nevertheless, those who constantly check emails at the dinner table, on vacations, and while driving, are often extremely successful executives whose business culture demands this level of connectedness.  Indeed, some schools even promote the use of digital media as an exciting learning tool; for example, the curriculum for one elementary school in New York is designed entirely around video games. Given the potential for harmful behavior, how do we reconcile overuse of the Internet when our culture often validates and supports its use?

With all of these difficult issues still to be resolved, the answer to the question of whether or not Internet addiction is the same as substance abuse is obviously not yet, and may never be, crystal clear.  However, according to everything we know right now, there’s no question that for at least a subset of Internet users, online life can become disruptive to normal functioning. The question is how to minimize that sort of risk as our society becomes more and more globally dependent on technology.

If you think you might have a problem with the Internet, ask yourself the following questions – if you answer yes to more than 5 of these problems, you may need to seek treatment.

1. Do you often feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?
2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop your Internet use?
4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
5. Do you stay online longer than originally intended?
6. Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
7. Have you lied to family members, therapist, or others to conceal the extent of your involvement with the Internet?
8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

As with other compulsive or addictive behavioral patterns, the key to combating internet-addiction-like symptoms is to intervene early. Since many addicts start out using their respective drug/behavior of choice as a coping mechanism, realizing early on that unhealthy patterns of behavior are developing is crucial. If a child draws his or her self-esteem from retreat into the online world, it would be extremely helpful to find additional activities that could similarly boost confidence. If compulsive use patterns do develop, it is likely going to take a concerted effort to break them without bringing up serious resistance. Techniques such as Motivational Interviewing (MI) will likely prove as useful in this domain as they have with substance abuse and addiction – gentle guidance is often more effective than cornering a troubled individual and forcing them to act.

The good news? Internet withdrawal is not likely to cause much in terms of physiological withdrawal symptoms, so if cutting off access does become necessary, at least there’s no risk of going into shock, cardiac arrest, or DT-like symptoms. Still, expect that psychological withdrawal-like symptoms will be similar to those experienced with many drugs: Depression, anhedonia, anxiety, irritableness, sleep disturbances, and more are all likely to be part of the picture. If we’re talking about cutting off a child, expect screaming… lot’s of screaming.

 

For more information about technology and its effects on human development, visit Yalda T. Uhls’ website:  Inthedigitalage.com

 

Citations:

Cisco Survey on Internet, 2011: http://www.cisco.com/en/US/netsol/ns1120/index.html

American Psychiatric Association. (2008). Issues for DSM-V: Internet addiction.

Byun, S., Ruffini, C. R., Mills, J. E., Douglas, A. C., Niang, M., Stephchenkova, S., Lee, S. K., et al. (2009). Internet addiction: Metasynthesis of 1996-2006 quantitative research. Cyberpsychology and Behavior, 12(2), 203-207.

Christakis, D. A. (2010). Internet addiction: A 21st century epidemic? BMC Medicine, 8.

Young, K.S. (1998). Internet addiction: The emergence of a new clinical disorder. CyberPsychology & Behavior 1:237-244.

Child Pornography: Internet sex offenders

Co-authored by: Jamie Felzer

Child pornography on the web is becoming increasingly harder to track down because of advances in technology and sex offenders’ increasing creativity at masking their true identity.

According to recent research – People who look at child pornography can be generally separated into 4 groups:

1. those who are solely curious or acting impulsively

2. Those who take part in a fantasy only pornography

3. Direct victimization where the offenders take part in online pornography as a prelude to both contact and non contact sexual offenses

4. Commercial exploitation offenders who make or sell photos to make money

Often offenders show abnormal functioning in the motivational/emotional areas of the brain. This can make them more likely to suffer from problematic mood states (like depression, anxiety, etc.).  They also have problems in selecting appropriate actions, especially when related to impulsive behaviors.

Regardless of the mood they are in many sexual compulsives find themselves getting lost in the internet and use it as a way of escaping from reality and finding pleasure. These escapes can last many hours (8-10 hours is not unusual in many cases). The internet also tends to bring out the impulsive behaviors in those especially that may already have impulse control issues. This is due to the anonymous nature of online interactions.

These are some common beliefs often shared by people within this group:

a. Children can be seen as and used as sexual beings because they enjoy it. Sex isn’t harmful to children.

c. The adult offender is more important and worthy of pleasure.

d. The world itself is dangerous and predatory behavior is natural.

e. The world is uncontrollable and their predatory behaviors are due to uncontrollable factors

There are some basic differences between offenders who stay online and those who engage in direct victimization. About 25% internet offenders suffered sexual abuse themselves as children whereas about 36% of contact offenders suffered sexual abuse and more often they suffered at a younger age.  Also, internet only offenders were more likely to have partaken in heterosexual play prior to puberty while contact offenders more often engaged in homosexual play. As usual, these difference are correlational and don’t necessarily indicate a causal relationship.

Citation:

Elliot, Ian, Beech, Anthony. Understanding Online Child Pornography Use: Applying sexual offense theory to internet offenders. Aggression and Addiction. 14,3 May-June 2009 (180-193)

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.