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.

My Friend the sex addict part 2 – The ups and downs of sexaholics

As you may recall from an earlier post, a friend of mine, Brian, has been struggling to get some control over his sex addiction.

I had referred him to a number of clinics that treat sex-addiction specifically, and to Sex Addicts Anonymous (sometimes known as sexaholics anonymous) as a starting point. I’m not at all surprised that he hasn’t followed up with either of these for now, since his addiction has only recently become an issue he recognizes and though the costs are obvious, they’re not staggering, yet.

The concept of addiction to sex is relatively recent (see 1st citation, in 1991). Still, it’s relationship to substance-use and dependence in terms of predictors, determinants, and progression have been mentioned from the very beginning and are still being examined today.

The issue for most people here is the absence of any drug that’s being taken in, which makes them doubt the validity of looking at the two conditions as one.

In my earlier posts on the pharmacological actions of cocaine and meth, I talked about how it is that those drugs activate that neural systems that control rewards in ways that are unnatural. There is little doubt that the “help” provided by these chemicals makes the link between their initial use and later, compulsive use, easy to follow.

ProstitutionStill, repeated exposures to a rewarding stimulus (like sex) can themselves set up behaviors that seem reinforced, but that are maladaptive (as in bad for them). The search for internal reinforcement through repeated sexual encounters, pursuits, and preoccupation would be the pattern common to many sex addicts.

By consistently making them feel better (sexual release results in more dopamine in the brain as well), a pattern develops that may lead certain individuals to seek the reward whenever they need reinforcement. Once such a pattern develops, the road to compulsion, is not too long. This is especially true for those who already have low impulse control, for whatever reason, as I discussed earlier.

Brian’s issue is certainly his need for ego reinforcement, and his brain has learned that the attention of a woman provides that in bulk. The problem is, as I’d pointed earlier, that many areas of his life, including his ego when he ends up not keeping up with other responsibilities, end up being damaged in the process.

This sets up the all too familiar cycle of ups and down common to many addicts. To those who know him, the fact that Brian’s priorities are “screwed-up” is no secret.

Brian at least recognizes his pattern now and perhaps, if the roller-coaster ride become too extreme, he may decide that it really is time to do something about it. One thing is certain, he recognizes that he is likely a sex addict.

In the meantime, the age of the internet has provided immediate access to sexual content, which makes relapse all to easy for sex addicts. I recommend putting a lock on your own computer that is controlled by someone else if that is part of your sexual addiction. Having someone to talk to that you feel comfortable enough to share urges when they do come up can be of great help too. This is where 12-step groups come in handy for most people. It’s hard to talk to most people about things we find shameful unless they too have had the same problems…

Question of the day:
If sex-addiction is your problem, what have you found can help you in best resisting the compulsive urges?

Citation:

Schneider, J. P. (1991). How to recognize the signs of sexual addiction. Asking the right questions may uncover serious problems. Postgraduate Medicine – Sexual Addiction, VOL 90 (6).

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.

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 !