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.

Drug abuse statistics: American drug abuse and addiction

In looking up some numbers for a recent post I put up on TakePart, I uncovered some amazing addiction and drug abuse statistics (most from 2007, so they’re probably higher by now).

StatisticsAddiction statistics highlights:

  • Slightly more than half of Americans surveyed indicated that they are current drinkers (I thought it’d be higher) – Meaning there were about 126 million drinkers in the country. About 57.8 million had consumed more than 5 drinks in one sitting in the month prior to the survey.
  • It is estimated that more than 30 million people in the US meet criteria for some addictive disorder including drug addiction, sex addiction, gambling addiction, and food addiction (added from SAMHSA statistics about individual addictions)!!
  • More than 15 million of those are only dependent on alcohol!!
  • The next drug on the list is, you guessed it, marijuana with 3.9 million dependent individuals!!!
  • Of the more than 23 million individuals who needed drug treatment, only 10% sought help (2.4 million).
  • The most  staggering of all numbers – The cumulative estimated cost of addictive behavior (including overeating) in the United States = $500 Billion!!! Almost half of our current budget deficit!!!

I don’t know about you, but these numbers leave me a little in awe of just how big this problem really is. Given some of the other treatment-cost posts I’ve written (see here), I once again reiterate the notion that if we shifted our focus to drug-treatment, we’d save lives and money all at the same time.

Struggling with my addiction: Recovery, addiction, and the everyday stuff

I’ve written about my own struggles with my addiction on here numerous times. I’ve used crystal meth, ecstasy, cocaine, marijuana, alcohol, LSD, mushrooms, and more, though the first few were the ones that really got me.

After an extended career as a dealer and addict, I turned a new leaf and made a new life for myself. It took a couple of rehabs and a hefty jail sentence. Still the link between my addiction and my recovery is not always strong.

My notions regarding the strong relationship between addiction and personality factors like attention-problems, impulsivity, sensation-seeking, and others comes from both my research and my personal experience. I’ve seen the genetic, behavioral, and clinical manifestations; I’ve also lived it firsthand.

I’ve always been known for doing things I wasn’t supposed to and then feeling sorry for them (or not). It was true when I was 5, long before my first sip of alcohol. Sadly, I’m realizing it is still true now and will most likely be true forever.

I can’t keep anything organized in my head. I never could. I was the kid who lost his house keys 5 times a year, forgot about midterms and finals, let alone school assignments, and who could never remember birthdays, anniversaries, or other important dates and times. These days, I’ve learned to rely on my pda/phone to help me with at least some of those things and it’s made my life much easier. But the underlying problem remains.

The problem is that I’m still impulsive and I still do things I shouldn’t. It’s a constant struggle to pull myself back, a very conscious struggle most of the time. When I say that addiction can be treated, it doesn’t mean that it actually disappears, though for me, it has certainly taken a backseat. If anything, it was after getting sober that I realized my drug use was so tied up with sex that I most likely had developed a sex addiction as well.

I’m not sober now (I drink socially), but I’m very aware of my intoxication level when I drink and rarely let it get out of hand. I can count on one hand the number of times I’ve gotten actually drunk in the five years or so since I began the forbidden “AA experiment.” It works for me, though it might not be for everyone.

The point is that nowadays, I have too much going on in my life that I love to throw it all away over getting high. My fiance, my education, and my work are important to me. The thoughts are still there, but I don’t act on them. It took a lot of work to get here and I seriously hope that I never have to put that work in again, but recovery, addiction, and my everyday stuff can still be a struggle.

You have to build the life you want and do your best to make maintaining that life a priority. It’s not easy, but it can be done. Look here for an exercise that can help you figure out what that life should even look like.

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)

More CPDD Addiction research: Addiction, exercise, recovery!

Okay, this is probably the last addiction research update I will give focusing on the Reno conference. The rest of the stuff I learned will be incorporated into future posts.

I’ve written before about the relationship between exercise and recovery (see here) and I will surely write more since for me, it was a big part of the equation.

two separate studies at CPDD reaffirmed my belief that exercise can be a very useful tool in addiction recovery.

The first study, conducted in humans, examined the effect of incorporating an extensive exercise routine into a residential, as well as intensive outpatient, addiction treatment program. Their findings showed improved outcomes for participants in the short, as well as long run. These included length of sobriety, subjective assessment of well being, and more. In talking to the researcher, she seemed to believe that at least part of the effect was due to the relief of cravings achieved by allowing patients to focus on something that took effort, rather than simply sitting around.

The second, and to my mind even more interesting, study examined the effect of exercise on cocaine self-administration in rats. Researchers assigned half of their rats to a cage that had a running wheel while the others were assigned to a regular cage. the rats with the running wheel used the device to run an average of 12 kilometers a day! After a week of simply resting in their cages, when transferred to another cage for 2 hours a day, the rats who had the wheel in their cage took less than half as much cocaine as the rats who didn’t have a wheel. the “wheel-rats” were also found to run less after they began the cocaine portion of the experiment, but their cocaine-taking never got near that of the non-exercising rats. It seems that having the exercise did something to reduce the reinforcing power of cocaine.

I have a feeling that future research will show that these finding hold true for other drugs (like crystal meth, heroin, marijuana, cigarettes, and alcohol) and possibly even for behavioral addictions like food addiction, gambling, and sex addiction.

All in all, research seems to be supporting the notion that exercise can play a significant role in recovery from addiction. Whether it be for boredom relief or an actual internal change in the motivating power of drugs, it looks to me as if Addiction + Exercise = Recovery !

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: