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.

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 does it all start? My thoughts on addiction causes and substance abuse

I was talking with a friend the other night, and he asked me my opinion about the line between addiction and normal behavior. He was wondering whether I think that everyone who looks at porn is a sex addict.

I don’t. (see some of our posts on sex addiction here)

Still, the conversation made me feel like writing something about my views on addiction causes. So here goes:

For the addicts who are still unaware, the line between normal- and addictive-behavior tends to blur again and again until it seems like more of faded smudge on their life. For those looking at addicts from the outside, the line normally seems so clear and so far away that they rarely believe it can be crossed back again.

I don’t personally believe that addiction per se is where things started for most people. By this I mean that no matter how hard we look, I believe that we will never find the elusive “addiction gene“, genes, or trigger.

Having been in the thick of it, I think that substance abuse is nothing but one possible outcome of set of circumstances, both biological and environmental, that lead some individuals down a particular path.

Impulsivity and other addiction causes

As I mentioned in earlier posts, addiction, at least to drugs (and I believe other addictions as well) is very closely related to a set of psychological conditions that have to do with impulse control problems.

I believe that individuals with increased impulsivity are simply more prone to putting themselves in situations that are inherently dangerous to their well-being. A simple example from non-drug related behavior might be one-night stands.

A typical person with no impulse control issues may hold off on sex if the only option was to have it unprotected. They may think to themselves “I need to stop, this could seriously affect the rest of my life.”

A person who has a reduced ability to control initial impulses may have the exact same thought and yet go through with the action, leaving them feeling remorseful and anxious the next day, but still having put themselves at risk.

This is a very common occurrence among sex-addicts. The thoughts are there, the knowledge is there, the ability to connect those to actions is seriously lacking. While some people make moral judgments about this fact, I’ve seen enough research that connects this problem to biological processes and genetics that I’m now resigned to the fact that at least on some level, the issue is physical and neurochemical.

Addiction help – Cures, treatment, and solutions

Still, I think the battle is far from lost. I strongly believe that education, informed by actual knowledge rather than misguided mythology, can put people in a better position to deal with the issues even if their source is outside of their control.

Even aside from pharmacological treatments (as in medications) that can help, there are endless ways to help people learn to be in better control of their actions once they are aware of their initial deficit. That is how AA and many other support groups function. People within them ask others about decisions they’re making BEFORE they act on them.

We know already that when it comes to drugs, the equation changes once the person starts using regularly and for long periods of time.

Chronic substance abuse further breaks down the brain’s ability to control impulses by reducing functioning specifically in the prefrontal-cortex; the part of the brain right behind your forehead which is thouught to be the center of the brain’s control tower.

The cycle seems too obvious: Impulse control difficulties leading to dangerous behavior which leads to further impulsivity issues and so on…

The treatment, like the progression of the condition itself, needs to be long. I don’t believe that any 30 day treatment program will be able to resolve a condition that took years to develop. Still, the issue of treatment will come up again here. This is enough for now…

Question of the day:
Do you have any insights from your own experiences as to how addiction develops?

How can I overcome all this sugar??? The dilemma of food addiction

I’ve been asked by several people about the impact of sugar addiction and the possible ways for overcoming it.More cake please

The dilema of food addiction

Food addiction is especially difficult to fight because unlike drug addiction, you can’t simply stop eating, regardless of your willpower. This means that a person addicted to highly sweetened foods needs to figure out a way to continue eating without indulging in their favorite foods. This is a bit like telling an alcoholic they can only drink beer but not liquer, or telling a cocaine addict they can only smoke a little bit of crack every day…

My sugar addiction story

While there is very little research that I’m aware of regarding food addiction, I can share with you my story.

I’ve always been a huge fan of sugar. I love chocolate, soda, and ice-cream, and anything else that is loaded with sugar.
The soda habit I made myself quit a few years ago when I was trying to lose some weight and had started working out. I was very determined and when I realized just how many calories are in each can of soda, I told myself that I needed to reduce how much of it I drank. At the time, I would easily have 3-4 cans per day, and while I wasn’t able to completely cut soda out, I went down to 1 or less every day pretty quickly. My trick at the time was to remind myself that all that work I just did at the gym would easily be erased by having a single can of coke (my weakness).
Still, I was eating a lot of other stuff that was pretty bad for me, mostly without even realizing it.

It was only last year, possibly because of reading the article I’d talked about in my post about sugar addiction that I started really looking at what I was eating. It didn’t hurt that my girlfriend at the time was a health nut. I’d heard about the evils of High fructose corn syrup (HFC) before, but after reading the research, I realized that the stuff is perfectly engineered to make my body crave more and more sugar.

I’d already kicked drug use years ago; I wasn’t about to let sugar control me now…

When I started reading the labels of products, I was amazed. HFC is in almost everything!!! I was discovering that the bread I was eating, some of the deli meets I was putting on it, and nearly every drink I was having included the stuff. Without ever realizing, and with the wonderful help of the food manufacturing sector, I had become essentially dependent on this stuff. There is research that indicates that the make-up of HFC, which is a bit different than that of natural sugars, may contribute to obesity and cardiovascular disease. This evidence is not conclusive as of yet, but again, there’s also research that foods loaded with sweeteners in general can cause consumption patterns very similar to addiction.

My addiction advice

Thankfully, the are products who don’t contain HFC, and I’ve been doing my best over the last year to replace my old food choices with those.
Just to be clear, I still consume more sugar that I probably should. However, I feel that by removing this highly sweetened chemical from my diet, I am essentially allowing my body to now process the more natural sugars I’m consuming. In the long run, I’m hoping that this switch will work to reduce my overall dependence on sugar.

So, my advice, given the fact that we all need to continue eating:

Don’t try to remove sugar from your diet, especially because the artifical sweeteners have themselves been shown to produce consumption patterns that are unhealthy (at least in animals for now). Instead, start becoming aware of what you are putting in your body and reducing the consumption of sugar that way.

Most natural unprocessed sugar products have lower sucrose and fructose concentrations simply because they are not as heavily processed to remove impurities. Switching at least some of your consumption to these types of sugar will reduce at least some of your sugar intake without leaving you feeling like you had to make any major changes.

Goals are good as well. If you’re eating like I used to, you put 2-3 spoons of sugar in your coffee every morning; try reducing the amount of sugar you’re adding to foods by a small percentage (like 10-15%). Such a reduction won’t massively alter the taste of your foods but will get you on your way…

Question of the day:
Would you like to share your story of overcoming, or struggling with, addiction to sugary foods?
I’m sure all the readers will benefit from hearing others’ stories.

Addiction causes – Learned self regulation and its possible benefits for drug use problems

In the first part of this little series on addiction cause and self-regulation I talked about some of the genetic influence on impulsivity that have been shown to also be related to drug use.

In this next part, I want to drive home some recent ideas regarding learning related to self-regulation.

It’s no secret that diagnoses like ADD and ADHD have been seen with much greater frequency in the last decade or so. Slight variations on the same theme, both of these disorders have to do with a person’s (usually a child) inability to appropriately control their impulses and behave appropriately.

The debate about the sources of the large increase in these diagnoses is still ongoing. Some think that they are nothing but an inflated push for pharmaceutical treatment by those who stand to profit from the sale of Adderall, Ritalin, and the likes.

However, if you talk to the parents of the children being diagnosed with these disorders, they’ll be the first to tell you that even though they can’t put their fingers on it, something’s up with their kids…

Tin Can PhoneA recent educational program in New Jersey (at the Geraldyn O. Foster Early Childhood Center) tries to instill in children the concept of internal regulation by making pretend play rules explicit. Children talk to their teachers before embarking on their next imaginary adventure in order to lay out everybody’s role. The idea is that by the generation of internal rules, the children become more aware of how social rules regarding behavior are dependent on their specific role in a given environment.

The creators of the program believe that children’s play in the recent past has become more and more structured. They believe that video-games, explicit toys, and constant oversight have reduced children’s ability to take on roles and depend on their own mind for the rules of behavior.

Adele Diamond, a researcher at the University of British Columbia, has found that children in the program performed much better (up to 35% better) than other children in tests of executive function. It should be noted that the program doesn’t claim, and hasn’t been shown to, get rid of attention-deficit problems in kids that have been diagnosed. Rather overall cognitive function for kids in the program seems improved.

More research on this program is ongoing, but the initial results seem to indicate that educational and developmental aspects of a child’s life can impact their ability to have internal oversight. This is obviously promising and upsetting all at once.

No parent intentionally places their child at a disadvantage, but it seems that the most recent trends of “electronic babysitting” we’ve become so accustomed to may in fact be impacting children in unintended, discouraging ways.

The connection to addiction again has to do with general impulse control problems. Less executive control leaves children generally more vulnerable to behaviors that can be detrimental to their future. As I’d mentioned in one of my earlier posts, most of the negative impact of drug use on the lives of users is not related to long term addictive use. Instead, it is the acute (as in quick and short lasting) negative impact of things like unintended pregnancy, motor accidents, and legal troubles and arrest, that end up impacting adolescent drug users.

Maybe by making our children better able to control their actions, we can protect them from a host of possible problems, including drug use…

Question of the day:
How much of your childhood was spent in relatively free play and how much of it was structured?
How, if at all, do you feel that these different activities have affected the kind of self-control you can, or can’t exert?

Addiction causes – Genetic variability related to attention, impulsivity, and drug use.

It will probably come as no surprise to at least most of you that addiction is closely linked to problems of self-regulation (like ADD and ADHD). This is one of the main reasons that professionals view addiction as a disease, and not a choice.

This post is pretty advanced, but it should leave you knowing a lot more about the relationship between attention, self-regulation, impulsivity, and addiction. Also, when I use the term “Addiction causes” I have to stress that the link to date has been one of association, NOT causation. We don’t truly know what causes addiction.

What is self-regulation?

Self-regulation is the ability to control one’s actions in ways that are appropriate to specific situations. Having to do with the most advanced aspects of cognition, self-regulation is considered to be the prime example of human executive functioning. It’s this aspect of thought and brain function that is thought to truly separate humans from other animals.

Being this important for our functioning, you can probably imagine how complex and interactive the brain systems that control executive functioning are. You’d be right.

These systems, centered in the Prefrontal Cortex (PFC), the part of the brain nestled right behind your forehead, are connected to essentially every other brain system, including vision, hearing, motor control, emotion, etc. It’s the PFC that controls these systems and tells the brain what brain impulses should actually be acted on.

And impulses is a great word for it. Given how complex the system is, there are many things that can affect its function. There are genetic factors, some that have to do with early development, and others that are affected by behavior, including the ingestion of drugs.

In this post, I would like to focus on the genetic influences, later on, I’ll talk about the developmental influences and the effects of drugs and other behavior on these systems.

Genetic influences on executive function:

There are a host of genes that affect different aspects of executive function. Some of these, like those impacting genes related to DAT, DRD4, and COMT functioning, have an effect on dopamine function that has been correlated with personality traits like sensation seeking and impulsivity.

Hyperactivity

As I’d mentioned earlier, these personality traits themselves, and the genes that affect them, have been found to be associated with addiction as well as several other conditions and syndromes that are related (such as ADD and ADHD).

Just to be clear, we all have these genes, but there are different version of them (called alleles). Some of these versions are more common than others, and some are associated with the conditions I mentioned earlier.

For instance: There are 2 versions of the COMT gene. This gene codes for a chemical in the brain that breaks down DA (this breakdown is important for brain function as I’d mentioned in an earlier post). One of these versions (named MET) breaks dopamine more slowly while the other (VAL) breaks it down quickly. The VAL allele actually breaks the dopamine down so fast that it interferes with dopamine’s ability to properly get its message across. That’s why this allele has been linked to attention and impulsivity issues. Each of these alleles has a 50% prevalence in society, which means that 1 out of 2 people have the VAL allele. Obviously its effect is not enormous, but along with many other factors, it has a significant impact on dopamine functioning.

Similar issues come up with one of the versions of the DRD4 gene, which codes for a specific type of dopamine receptor; and with the DAT gene, which codes for the DAT transporter I talked about in the cocaine post mentioned earlier.

Again, while the effects of each of these genetic variants is small, these can add up along with other genetic influences and environmental factors (especially during early development) to overall affect a person’s ability to control impulses.

Obviously, those who have a more difficult time controlling their impulses would have a more difficult time making appropriate choices. These difficulties can lead some to be more likely to start behaviors that are detrimental, including the use of drugs. The drugs themselves can then further exacerbate the problem (as we’ll see in a future post), and can do other things to make users more likely to keep using them.

In short, while genes don’t make people use drugs, they can definitely make it more likely for certain people to engage in risky behavior, including trying drugs in the first place…

Question of the day:
Did any of the people you know who have developed drug use/abuse problem show problems with impulsivity before their drug use?

About addiction: Exercise, stigma, marijuana, and friendhip.

Here we are again. I’ve been slacking on this, but check out the new crop of great articles about addiction. As usual, if you press the title of this post, you’ll be rewarded with our relevant posts!!!

MSNBC: Exercise may help prevent substance abuse – Here’s an article that reports on some of the findings I’d recently talked about here.

Addiction Inbox: Treating addicts like human beings – About the stigma and shame associated with addiction.

Addiction tomorrow: Marijuana – a gateway drug?

Addiction recovery basic: Friendship in recovery – Having social support and friends is important, especially when trying to make huge changes in lifestyle like quitting an addiction.