Teen learning exaggerates rewards – Bad decisions and brain development

Teens tend to make some seriously stupid decision (including teen drinking and driving), at least when compared to younger kids and older adults. We’ve all heard that brain development during that part of life plays a role in this but the question is: What exactly about brain development makes teens more risky?

There are a number of options – 1) Teens could have less control over all aspects of their behavior as their prefrontal cortex finishes developing, 2) Teens may be over-sensitive to rewards, putting too much emphasis on the positive value of stimuli they’re exposed to, or 3) Teens might just be less sensitive to the negative consequences of their action, which lets them take risks others just wouldn’t.

A somewhat recent study coming out of UCLA (and I just have to congratulate my colleague Jessica Cohen for getting a 1st author Nature paper!) suggests that at least to some extent, oversensitivity to positive reward-signals may be the answer and brain development has a lot to do with it. Continue reading “Teen learning exaggerates rewards – Bad decisions and brain development”

Gambling on marijuana use makes for bad decisions

I just can’t seem to stay away from the marijuana debate, even given the recent defeat of Proposition 19 that aimed to legalize marijuana in California. This article is a short one, but speaks to some of the cognitive issues associated with marijuana use.

A study (see here) conducted by a Wake Forest University team (Including Doctor Linda Porrino) found that habitual marijuana smokers (those who smoked an average of twice a day for seven years) may be bad at detecting negative outcomes.

The experiment used fMRI scanning technology to examine the brain activity of smokers and controls during the Iowa Gambling Task, which uses four decks of cards. Two of the decks yield large, infrequent, rewards as well as losses. The other two decks yield small, more frequent rewards, and less losses. The first two are considered the “bad” decks, and the latter two the “good” decks, because selecting from the small-gain, small-loss, decks will result in more gain overall. The task is considered a pretty good, if complex, measure of risk-taking, decision making, and loss-discounting.

Marijuana users lose money while controls gainThe take-home result from the study: Not only did marijuana smokers take longer to learn how to maximize their rewards, but their decision-making brain regions seemed to show lower overall responding during the task, meaning they were less active while performing the decisions. And as you can see from the graph on the left, while the controls were able to achieve overall gains, the same was not true for the long-term marijuana users even after 100 repetitions. It seems that marijuana smokers’ brains were not as efficient at detecting losses and responding to them. Maybe that’s why marijuana users are the first to claim that marijuana use has no negative outcomes associated with it…

As usual, it is important to note that since the participants in the study were not randomly assigned to long-term marijuana smoking, it’s impossible to know if these deficits are specifically caused by marijuana use or if they were pre-existing. Nevertheless, these results strongly suggest that individuals who engage in long-term use of marijuana are cognitively distinct from those who don’t. I think that plays into the argument that marijuana legalization would not increase use, because if that’s actually true, then there’s something different about individuals who choose to smoke weed and it is not the legal status that matters. I suspect that in actuality, people who currently choose to smoke marijuana long-term are in fact distinct, in some ways, from some of the people who would take up smoking the stuff if it became legal.

Citation:

Christopher T. Whitlowa, Anthony Liguoria, L. Brooke Livengooda, Stephanie L. Harta, Becky J. Mussat-Whitlowb, Corey M. Lamborna, Paul J. Laurientic and Linda J. Porrino (2004). Long-term heavy marijuana users make costly decisions on a gambling task. Drug and Alcohol Dependence, 76, 107-111.

Tips for consistent boundaries and better addiction outcomes

People close to addicts (mothers, wives, brothers, and such) often find themselves struggling when trying to decide how to treat the substance abuser. They feel betrayed when the addictive behavior is displayed, but are lost when it comes to what they can do. For example, a mother with an alcoholic husband may feel that it’s unfair to withhold a father’s love from her child, even if he did get drunk when he promised he would not. She doesn’t want to punish her boy for his father’s behavior.

Consistent boundaries are important for the substance abuser

When teaching people how to behave, one of the worse things to do is to provide inconsistent feedback. It’s true for babies, hell, it’s true for dogs, and it’s certainly true for addicts. The basic principles of learning research tell us that rewarding good behavior while not rewarding (or even punishing) bad behavior is the best method to affect change. Being inconsistent will make the substance abuser more likely to repeat their offensive behavior than rewarding them for it all the time! It’s called a random reinforcement schedule and is the best method to teach a simple behavior and the hardest one to unlearn. Even mice in an experiment are more likely to repeat an action if they know that they’ll get rewarded for it once in a while and can’t predict when that reward will come. Consistent boundaries let people know what to expect in return for their actions.

Tips for better addiction outcomes

So before you go any further, decide on what behaviors you want to reinforce and make them clear – Not going to happy hour with coworkers, not hanging out with that friend who always ends up mysteriously getting some coke, or any other such behavior that seems to keep creeping up in your particular situation. Then make sure that you have a little list of “rewards” – they can be as simple as quality time with the kid, a nice dinner, or spending money for your kid. By having the list ahead of time, it’ll be easier to stay consistent, knowing what to withhold and what to use as rewards (depending on the behavior).

Addicts should never be rewarded with things they want after failing to deliver on their promises of staying clean. No matter the manipulation, the rules must stand. I’m not necessarily a big supporter of punishment, since it can often put additional stress on a relationship, but rewarding bad behavior should not be an option. This way, the hope is that the substance abuser will change their behavior even if their own willingness to change isn’t quite there, out of their need for the rewards that are being withheld. Slowly, they should begin producing more of the desired sort of behaviors.

This isn’t exactly like tough love (which normally includes punishment), but it’s not far from it either. Obviously, this falls under the category of “easier said than done.” Still, as difficult as it may be, as in raising a child, changing the behavior of a substance abuser requires consistency and perseverance. If a good dose of basic training can help, I say why not give it a try, even if it feels a little bit like training your favorite pet.

Good luck!

Obesity, drug addiction, and dopamine

Eating junk-food can be addictive, and apparently, it causes brain changes that look eerily similar to drug addiction. That’s the message not only from the rapidly fattening waistlines of Americans everywhere, but also from the Johnson and Kenny labs at the Scripps Institute.

Food and drug addiction

The idea that obesity is caused by a compulsive pattern of eating, and that there could be a similarity between such compulsive eating and drug addiction isn’t super new. In fact, Dr. Volkow from NIDA seemed to make research into this association her goal when taking  the helm of the addiction research kingdom.

When you think about it, the notion isn’t far-fetched: Drug addicts continue to take drugs, in increasing amounts, even though they’d often like to stop (at some point) and in the face of negative consequences and the common loss of other important life functions (like family, work, etc.). Obese individuals are quite the same, eating more and more food regardless of their desire to adopt a healthier diet and in-spite of ridicule, low self-esteem, and decreased functioning that often accompanies extreme weight gain.

The research by Johnson and Kenny examined whether exposure to the kind of high-fat, super high-calorie foods that floods the junk-food market are responsible for creating food-addicts in a similar way to drugs that alter the brain in ways that make stopping more difficult.

Dopamine, reward, and junk-food

The study took three groups of rats and gave them either the regular chow diet lab animals are used to or the worse kind of birthday party food: bacon, sausage, cheesecake, pound cake, frosting and chocolate. You can imagine the party going on in the rat cages that got to eat that! Of the two groups that got to eat the crazy-fat food, one had unlimited access while the other got to binge for only one hour a day.

The bottom line: Only the rats that got unlimited access to the fat-party food developed compulsive eating habits that resulted in roughly twice the weight gain of the other two groups and the ability to continue eating even in the face of signals for punishment (a light that they were trained to associate with shocks).

When the researchers looked deeper, they found that the brains of these rats suffered a significant reduction in the density of a specific kind of dopamine receptor (D2) in a brain part known as the striatum, the same kind of reduction common in drug addicted people and obese individuals. This receptor type is often thought to be important for regulation of impulses, both physical and otherwise. It therefore makes sense that losing this type of function would cause uncontrollable eating or drug taking.

Are drug- and food-addictions the same?

While this research isn’t saying that compulsive eating, or obesity, are the same as drug addiction, it does strongly suggest that there are common mechanisms in both. More importantly, it reveals a common process that unfolds when over-exposure to the reward, in this case food, occurs. This tells us that there can likely be common pathways to these different addictive disorders, though whether any specific person ended up a food- or drug-addict because of this kind of process is still an open question. I wonder if we’ll see something like this with sex addiction soon…

Citation:

Johnson and Kenny (2010) Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nature neuroscience, 13, 635-641.

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.

Triggers and relapse, a craving connection for addicts

I’ve already written about one reason why cravings make quitting difficult (find it here). However, cravings and triggers are not just abstract concepts; they are well known, important players in addiction research and I think they deserve some more attention.

What are triggers?

A trigger can be thought of as anything that brings back thoughts, feelings, and memories that have to do with addiction (like a computer reminding a sex addict of porn). In addiction research, these are often simply called cues. The word comes from learning research in which a reward (or punishment) is paired with something (the cue).

For instance, in Pavlov‘s classic experiment, a dog heard a bell ring right before it would get served its daily portion of meat. The dog quickly learned to associate the bell with food, and would begin salivating as soon as the bell would ring, even before the food was presented. In this case, the bell was the cue, and food the reward it was paired with.

The story in drug addiction is similar. I’m sure many of you can relate to the overwhelming memories and emotions that seem to come out of nowhere when you hear music you used to get high to or pass a street where you used to buy drugs (or sex). Each of those examples is a trigger that is simply bringing about a similar reaction to Pavlov’s dog’s salivation. Seeing these things, or hearing them, creates an immediate response to the reward that it was paired with, the drug!

Triggers, cravings, drugs, and relapse

As if matters needed to be made worse, triggers not only bring about responses that make you think about the drug. In fact, over and over in learning and addiction research, it’s been shown that triggers actually bring back drug seeking, and drug wanting, behavior. As soon as a cue (or trigger) is presented, both animals and humans who have been exposed to drugs for an extended period of time, will go right back to the activity that used to bring them drugs even after months of being without it. In fact, their levels of drug seeking will bounce back as if no time has passed. Sound familiar?!

Given these findings, is it any wonder that cravings bring about relapse in so many addicts who are trying to quit? If simply thinking about, or hearing, something that was always tied to drugs can bring about such a strong response, what is an addict to do?

Is there a solution for addicts??

For now, the simplest way to break the trigger-response connection is simply repeated exposure without the reward. As bizarre as this may seem, staying away from the triggers can make their ability to bring back the old drug-behavior stronger. Obviously, this isn’t something that should be undertaken lightly. I’m currently working on putting together a drug treatment system that specifically addresses these issues so that with help, users can eventually release the hold that triggers have over them.

In the meantime, be honest with those around you, and if you’re seeing a therapist, or a good case manager, tell them about your triggers so that you can hopefully start talking about them, and re-triggering them in a safe environment. As always, feel free to email me with any questions you might have.

How can you offer addiction help?

The question that seems to be on everybody’s mind (except perhaps that of the addict), is:

SO HOW CAN I HELP ?!?!?

– One of the first things you must do if you want to help someone with an addiction is to educate yourself. Obviously, you are already beginning the process by reading blogs like this along with, hopefully, finding other resources online. The National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) have some great information that will no doubt be useful!

– While you’ll learn a lot throughout this process, don’t expect that the addict will be as excited about your learning as you may be. You are learning so that you understand what addiction entails. Remember that addiction is a disease of the brain and that the drugs, or alcohol, have a grip on your loved one that is more than simply moral. There are actual changes in neurological (brain) circuits that are caused by heavy drug use and that affect the user’s ability to quit (look for my educational posts on drug addiction).

Behavior is guided by rewards and punishments. This is something that we’ve learned over and over in psychological research. While it may seem difficult, decide on what you’re willing to accept and what you aren’t, and stick by those rules. I don’t necessarily believe in the punishment idea in this context because it can seriously strain relationships. However, if you go the the mostly-reward-route, make sure that you only reward behavior that is healthy, like decisions not to use. If “using behavior” is sometimes rewarded (like when you feel really bad for the user), the mixed message will make it much harder to change the behavior later.

– I also don’t necessarily believe in the al-anon method of detachment. My own story would have turned out very differently had my family not been there to catch me when I had my last, huge, fall. If you choose to detach though, decide for yourself if this is a temporary solution or if you want to do so permanently. Drug users are great manipulators and if you think that a night of “I’m not talking to you,” may be enough, you are sorely mistaken…

Intervention Hell

– When it comes to interventions, everyone always thinks of the stereotypical kind now immortalized in the A&E television show. That sort of intervention is known as th Johnson Institute method. Nevertheless, it’s far from the only one and has actually been shown to be marginally effective. Remember that any attempt to alter behavior is considered an intervention. The act of rewarding positive decisions I’d mentioned above would alter behavior in ways that are slower, but most likely more long lasting, all while introducing less strain on the relationship, at least in the short run. Another type of technique that I prefer when it comes to getting resistant addicts into treatment is called Motivational Interviewing. Make sure to ask anyone you approach for treatment whether they use this technique. It’s been shown to greatly improve addicts’ own motivation to enter treatment and when they want it themselves they’re more likely to benefit from it.

As always, if you have specific questions, please feel free to contact me.

Be strong, and most importantly, don’t blame yourself for what’s going on, but be aware of your role in the relationship and know what you can change about your part.

Good Luck!