Why people develop a drug of choice

This is the last installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.


representation of addiction

Drugs and compulsive behaviors are used to cope with a variety of problems.

Drug of choice can say a lot about a person or what they’re coping with. People choose drugs that will best help them cope with underlying problems. Sometimes these problems include severe mental illness. Addiction can occur when drugs or compulsive behaviors are relied upon for alleviation from multiple or serious problems.

Alcohol is often sought out by those who have a hard time expressing themselves, especially if coupled with social anxiety. It makes you feel loose and carefree by releasing GABA and suppressing glutamate in the brain. The soothing and disinhibiting effects are also helpful to people in emotional pain, such as someone suffering from grief.  Sometimes people with trauma histories turn to alcohol to soothe their psychic wounds. People with schizophrenia sometimes use alcohol to quiet auditory hallucinations.

Amphetamines give you a rush of pleasure and boost energy and focus by altering norepinephrine and dopamine in the brain. They may be sought out by someone who is depressed and has been unable to feel pleasure for some time. Improved focus may be sought after by someone with ADHD. Anti-psychotic medication can have dulling and flattening side effects and sometimes people with schizophrenia seek out the alertness and energy of stimulants. Nicotine is used by 95% of people with schizophrenia because of its ability to increase concentration and focus.

Opiates may help someone who is feeling irritable, stressed, or moody by blocking endorphin receptor sites in the brain and increasing feelings of euphoria. People who have experienced trauma or are in significant emotional pain may also turn to opiates to help soothe and forget their painful memories. Traumatized people may also turn to dissociatives for their ability to induce out of body experiences.

Hallucinogens and ecstasy create a sense of connection and feelings of warmth and empathy by altering serotonin and norepinephrine receptor sites.  Someone with anxiety or an inability to feel pleasure may turn to these drugs for comfort.

Recreational and pharmaceutical drugs work on the same systems in the brain. So if your drug use is an attempt to self-medicate an underlying problem, speaking to a trained professional can help you find healthier alternatives to cope.

Photo credit: Marrinc

 

Neurotransmitters and Addiction

This is the fourth installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.


Drugs act on neurotransmitters to increase, decrease, or alter their release or reuptake.

Drugs act on neurotransmitters to increase, decrease, or alter their release or reuptake.

In the previous installment of this series, we learned that dopamine is responsible for feelings of pleasure and euphoria, but it has other functions as well. And dopamine isn’t the only chemical messenger in the brain.

Dopamine is just one of dozens of neurotransmitters. It is the most well known chemical messenger and is responsible for feelings of pleasure, coordination of movement, and logical thinking. It is responsible for “the rush” one feels when they use a recreational drug and it also influences the addictive potential of a drug. It is released when we do things that are important for survival, like sleeping, eating, and having sex. Dopamine sends the message “That feels good! Do it again!”

Norepinephine is one of the brain’s natural stimulants. It is responsible for increased alertness and focus and is involved with learning and memory processes. Norepinephrine is also involved in the fight or flight response. It signals the release of adrenaline in your body to prepare you for survival in the face of imminent danger. It sends the message “Fight!” or “Run!”

GABA (gamma-aminobutyric acid) is the brain’s Valium. It relaxes the brain by suppressing overexcitement or hyperactivity, while allowing us to remain alert and focused. Low levels of GABA are associated with anxiety and seizure.

Glutamate stimulates various activities throughout the brain. We don’t know much about how it is involved in mood regulation.

Serotonin plays several complex roles in the brain. It is involved in regulating mood, sleep, appetite, and sex drive. Low levels of serotonin are associated with aggression, irritability, and depression. Serotonin is also responsible for hallucinations and regulating other neurotransmitters.

Endorphins are the brain’s natural opiates. They influence the perception and control of physical and emotional pain. In addition to pain relief, they are responsible for feelings of well-being, happiness, and euphoria.

Drugs act on these messenger chemicals to increase, decrease, or alter their release or reuptake. Our brain is wired to recognize these chemicals and accept their messages. The difference is that drugs relay the message better, faster, and in a much more intense way. Research shows us that life experiences affect the development of the brain, including how neurotransmitters work. For example, someone who has experienced trauma may find it difficult to feel pleasure or regulate their mood due to low levels of dopamine and serotonin. This may cause them to turn to externally supplied chemicals to balance the levels of neurotransmitters in their brain.

The next, and final, installment of this series will explain why some people turn to recreational drugs in an attempt to balance the chemical messengers of the brain.

Photo credit: Life Mental Health

This is your brain on drugs. For real.

This is the third installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.


This is not your brain on drugs. These are burnt eggs.

This is not your brain on drugs. These are burnt eggs.

Addiction is scary. It has caused pain in many people’s lives and has cost families and governments trillions of dollars to treat and prevent. It’s no surprise that social service agencies want to educate the general population about the harms of addiction. You may have seen this public service announcement comparing the addicted brain to fried eggs. The image is powerful, yes, but it is not educational. This is what actually happens in your brain when you take drugs.

Neurons generate messages that travel between cells in the brain.

Neurons generate messages that travel between cells in the brain.

Above is an image of a neuron. Our brain is filled with billions of these nerve cells and fibers. They contain genetic information and also serve as messengers. They transmit information through fibers from one cell to another via electrical charges. Neurons generate messenger chemicals, or neurotransmitters, to transmit information from cell to cell. The electrical charge travels through the dendrites, cell body (or soma), axon, and terminal bud down to the synapse, the gap between neurons where the magic happens. Neurotransmitters live in the terminal bud of neurons. An electrical charge comes through the neuron and releases the messenger chemicals. The chemicals then float across the synapse and attach to the neighboring cell for a short amount of time in a process called neurotransmission. Once the message has been relayed, they return to their home cell. This process is called reuptake. For example, if you were to burn your hand on the stove, nerve cells in your muscles would send a message to the neurons in your brain saying, “Ouch!” Your brain sends a message back down to the muscles in your arm to pull your hand back. At the same time, the message from your burning hand also alerts your brain to release endorphins, the brain’s natural pain reliever. The endorphins do their job and relieve the pain long enough so you can think to run cold water over your hand. Once the message has been communicated, the endorphins return to their home cell until the next electrical charge commands them to be released.

 

THIS is your brain on drugs.

THIS is your brain on drugs.

Above we have a close up of the synapse, the gap between neurons, and what happens when cocaine is present in the brain. The red arrows show the process of reuptake. The neurotransmitter dopamine has been released into the synapse to send a message to the neighboring cell. Once dopamine has completed its task, it attempts to go back home, but cocaine is blocking the way. Since dopamine can’t go back home it goes back to doing it’s job, binding to the neighboring cell. Dopamine’s loitering, so to speak, is what causes feelings of intense pleasure and euphoria.

Dopamine is only one of dozens of neurotransmitters in the brain. In the next installment, we identify the major neurotransmitters involved with drug use.

Photo credits: burnt eggs by incredibledictu, neuron, and neurotransmission by NIH

 

The Neurocircuitry of Addiction

Drugs and compulsive behaviors have an impact on the reward center of the brain.

Drugs and compulsive behaviors have an impact on the reward center of the brain.

This is the second installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.


Addiction causes changes to brain structures that regulate pleasure, motivation, and decision making. Depending on the type of drug abused and the length of the abuse, these changes can be permanent. Other factors, such as pre-existing abnormalities in brain structure (like depression, schizophrenia, or ADHD) can also make the effects of drug misuse irreversible. The primary brain structures affected by drug use and compulsive behaviors are the ventral tegmental area (VTA), the nucleus accumbens, and the prefrontal cortex.

This is your brain

The VTA is the birthplace of dopamine, a chemical that signals the brain about pleasure. It is involved in cognition, motivation, intense feelings of love, addiction, and psychiatric disorders like schizophrenia and ADHD.

The nucleus accumbens (NA) is the reward and pleasure center of the brain. It sends the chemical messenger of pleasure, dopamine, to various areas of the brain, depending on the message. Permanent changes occur to this brain structure with repeated drug use. These changes explain drug tolerance (needing to take more drugs to feel high) and drug withdrawal (physical and psychological discomfort when drug use stops abruptly). The NA is also involved in fear, aggression, laughter, impulsivity, and learning.

The prefrontal cortex (PFC) is the part of the brain that separates us from other animals. It is involved in executive functioning, complex brain functions that  include differentiating from good and bad or same and different, future consequences, predicting expectations based on actions, working towards a goal, and suppressing urges that might be deemed socially unacceptable. In the brain of addicted individuals, the PFC is thought to be involved in anticipation of the drug, motivation to seek out the drug, craving, automatic responses to emotions, and reduced self-control.  Once a person becomes addicted, their attention narrows to focus on drug-related cues over all other reinforcers, impulsivity increases, and basic emotions become unregulated.

In the next installment, we’ll dive even deeper into the brain to look at the role drugs have in neurotransmission.

Photo credit: Lydia Kibiuk and BrainFacts.org

The Neurobiology of Addiction

Brain_Broccoli_by_faiizeThis is the first installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.


Addiction is a biopsychosocial phenomenon that affects over 20 million people in the United States. The factors that cause addiction are not yet well understood, with some arguing that it is a disease and others suggesting it’s more complicated than that.

But we can identify some predictors for addiction and we do understand the impact it has on the brain.

This five part series will primarily focus on current understanding about the brain structures and neurotransmitters involved in addiction. We’ll also look at the interaction specific drugs have with neurotransmitters in the brain and how this accounts for preferences in drug selection. We’ll start with an overview of addiction theories then dive into the neurocircuitry and neurobiology of addiction. We’ll conclude by looking at the effect of drugs on neurotransmitters in the brain and discuss why one develops a drug of choice.

Theories of addiction

Although we don’t fully understand addiction, there are lots of theories that attempt to explain it. The most popular one is the disease model. It explains that addiction has a biological origin that causes changes in the brain. This model also accounts for the heredity of addiction, or genetic predisposition. Studies of twins who have been separated at birth show that they are likely to develop addictions, despite growing up in different home environments.

You may have also heard addiction described as a hijacker of the reward center of the brain. Brain imaging studies show that overuse of drugs or compulsive behaviors “hijack” the reward system and can lead to changes in the brain that make it difficult to experience pleasure as one did before.

Then there’s the self-medication hypothesis. It posits that people use drugs to help them cope with physical and/or emotional pain. It helps explain why people turn to specific drugs or compulsive behaviors to help them deal with things like depression, chronic pain, trauma, or grief.

But the best way to explain addiction is as a biopsychosocial phenomenon. We know that addiction has a biological component. It causes temporary and permanent changes in the brain and body. We also know there is a psychological component: an inability to cope with distressing emotions. The social component of addiction is related to peer culture, as they influence what you use, how you use it, or how (not) to deal with your emotions.

In the question about nature versus nurture, the answer might just be nature and nurture. Drugs affect us biologically and we may even be genetically predisposed to those effects. Your parents, family, friends, or lovers may have modeled addictive behaviors or inability to cope with emotions in a healthy manner.

The next installment of this series will focus on the neurocircuitry of addiction.

Photo credit: Faiize

 

Is internet addiction real?

If internet use interferes with one’s life and ability to function, internet addiction or compulsive internet use may be a concern.

Internet Addiction

Although there is debate in the academic world about the authenticity of internet addiction there is no dispute that, for some people, excessive internet use can cause distress, strife, and disruption in their ability to function. Internet addiction is somewhat of a misnomer and compulsive internet use seems to capture the nature of the disorder more accurately. It’s compulsive because use of the internet acts as a substitute for an unmet lifestyle need. For example, someone who suffers from depression or anxiety may turn to the fantasy world of the internet to escape those uncomfortable emotions. Obviously this is also true of drug addictions, and although a recent study shows differences in the brain anatomy of excessive internet users, the results are inconclusive.

The Center for Internet Addictions proposes  the following diagnostic criteria for internet addiction for users who have experienced four or more of the following symptoms in the last month:

  • Feeling preoccupied with the Internet or online services and thinking about it while off line
  • Feeling a need to spend more and more time online to achieve satisfaction
  • Inability to control online use
  • Feeling restless or irritable when attempting to cut down or stop online use
  • Going online to escape problems or relieve feelings such as helplessness, guilt, anxiety or depression
  • Lying to family members or friends to conceal how often and how long you stay online
  • Risking the loss of a significant relationship, job, or educational or career opportunity because of online use
  • Continuing use even after spending too much money on online fees
  • Going through withdrawal when offline, displaying symptoms such as increased depression, moodiness, or irritability
  • Staying online longer than originally intended

Compulsive internet use can take on several forms:

  • cybersex & pornography
  • online relationships
  • gaming
  • compulsive shopping

Regardless of the biological underpinnings of excessive internet use, it is clear that people experience distress and disruption to their lives when they compulsively turn to the internet for relief. If you think your internet usage is compulsive, contact a mental health professional for an evaluation. It is highly likely that you are using the internet to cope with an underlying issue.

¿Es real la adicción a internet?

Para leer este y otros de mis artículos en español visite articulando.com.uy

Photo credit: Federico Morando

Drug Tolerance Explained

toleranceOur brain thrives on novelty and dopamine helps us store information about novel situations.  We know that dopamine is released when we receive a reward, but it is also involved in noting unexpected rewards. If you get more juice than you anticipated, your brain releases dopamine and sends it to the anterior cingulate in your frontal cortex, a brain region responsible for anticipating rewards and making decisions. Get less juice than you anticipated and, again, your brain will encode the information, but this time, by sending less dopamine to the anterior cingulate. If you get the same amount of juice you expected, no dopamine is released. This mechanism enables us to recognize patterns and learn which behaviors lead to risk versus reward.

How does this translate into drug and behavioral tolerance? When you use cocaine for the first time, your brain registers it as a pleasurable experience. After using it a few more times, you might notice that you don’t experience the same level of euphoria as before. That’s because the experience has lost novelty and your brain has learned to recognize the pattern. In other words, dopamine isn’t released since there isn’t anything novel about the experience. Tolerance is born. In order to achieve euphoria from cocaine, you must now use more.

The same process occurs with compulsive behaviors. The first few times you shoplift (and don’t get caught) you experience relief and pleasure, but with subsequent trials you notice a decrease in the euphoria you experience. So, you start shoplifting more frequently.

NoteThere are many neurobiological mechanisms at play in addiction and compulsive behaviors and the role of dopamine in addiction and tolerance is just one facet of a complex biopsychosocial phenomenon.

Substance Abuse Treatment Options: Getting Help

substance abuse treatmentCounseling? Rehab? Support groups? How does one know where to start when it comes to choosing a substance abuse treatment program?

First, you’ll want to get a formal assessment from a licensed professional to determine which treatment option is appropriate for you. Some substance abuse treatment options to consider are support groups, inpatient, and outpatient treatment.

AA, NA and other 12 Step programs

Support groups led by peers that focus on helping a person abstain from substances or behaviors.
Pros:  offer additional support and can be a good place to find additional resources and information, free, many locations, various meeting dates and times
Cons: Abstinence is the only treatment goal option, lack of clinically trained support staff, religious undertones, little to no treatment for underlying psychological issues

Inpatient substance abuse treatment

Patients are required to stay in a facility for a pre-determined amount of time varying from 15 to 90 days or more.
Pros: safe, contained environment, trained professional staff, 24/7 support, sometimes the facilities are relaxing and luxurious, intensive treatment, various modalities including individual therapy, group therapy, expressive arts
Cons: expensive (plus you’ll have to take time off work), limited contact with outside support system, intensive treatment, there may be limited availability in your area

Outpatient substance abuse treatment

Patients attend treatment once or several times per week and address underlying issues plus addiction.
Pros: individualized treatment,  local, clinically trained professionals, choice of abstinence or moderation, various modalities to choose from including individual therapy, group therapy, partial hospitalization or intensive outpatient
Cons: some treatment options may be expensive, may not be enough support or treatment for your needs, availability may be limited in your area

A partial hospitalization program involves daily treatment for 6 to 8 hours per day for one to two weeks. This is a good substance abuse treatment option for those who cannot afford inpatient treatment but would like intensive therapy or who live far away from an outpatient treatment program that specializes in the care they need. Intensive outpatient treatment (IOP) involves daily treatment for 1 to 2 hours per day and can last up to several months. This option works well for those who need substance abuse treatment more than once per week or who have time commitments that prohibit them from seeking more intensive treatment. IOP can even be done in the evening after work.

 

Some people will need to go through medical drug detoxification before starting substance abuse treatment and in some cases it may be a prerequisite for admittance into a program. If you are dependent on a substance, (especially alcohol, opiates or benzodiazepines) it is advisable to detox under medical supervision to avoid complications and discomfort from withdrawals.

Never stop using alcohol or benzodiazepines (Xanax, Klonopin, Valium, Ativan) cold turkey! The withdrawal effects can be severe and life threatening. It is necessary that you detox from these substances under medical care if you have been using them daily and at high dosages.

A note about harm reduction and abstinence: Harm reduction is at the core of all substance abuse treatment programs – abstinence based and moderation management. Harm is reduced by abstaining from the problematic behavior or through reducing negative consequences associated with it.

This is your brain on dopamine

Dopamine_PathwaysDopamine is a neurotransmitter responsible for movement, pleasure, motivation, and cognitive processes, such as learning. For the purposes of understanding its role in addiction, let’s concentrate on pleasure and motivation.

Whenever we do something that propagates the advancement of our species, dopamine is released in order to motivate repetition of the action. When we sleep, eat, and have sex dopamine is released in our brain and the message is, “That was great, do it again!” We also release dopamine whenever we find something pleasurable. Be it 18th century poetry, heroin, or Radiohead, our brain will release dopamine to encode the stimulus as something that brings us pleasure.

Dopamine not only serves to categorize the good things we encounter in life, it also programs our pre-frontal cortex (the part of the brain involved in judgement and decision making) to alert us when the pleasurable stimulus is available. If your brain cells could talk, it might sound something like, “OMG! There’s a flyer on that lamppost for a Radiohead concert. Go look at it!” In other words, we become hyperaware of opportunities for engaging in behaviors that bring us pleasure. In fact, a study on people with alcoholism found they were more likely to spot alcoholic beverages in a busy photograph than people who don’t have problems with alcohol.

When we consume substances, it makes us feel good because our brains release dopamine, but drugs elicit a higher amount of dopamine release than is necessary. This is part of what causes experiences of euphoria and feeling high. Sometimes the amount of dopamine released is so great, the chemicals in our brain become unbalanced and we may experience hangover or withdrawal. In time, our brain regains chemical equilibrium. However, if one abuses substances, the brain may develop a tolerance (meaning the person needs to use greater amounts to get high) or dependence on the substance as a source of dopamine. If one becomes dependent on a drug, it may take some time for the brain to regain equilibrium and the person may experience extreme physical discomfort and emotional distress when they aren’t using. The period of re-calibration depends on the amount, type, and frequency of the drug used. It’s always a good idea to be under medical supervision and receive support from friends, family, and a mental health professional if you’re dependent on a drug and want to stop or decrease your use.

The mechanism of tolerance is also evident in impulse control disorders, such as sex addiction, kleptomania, and compulsive gambling. Although it doesn’t appear that persons with an impulse control disorder undergo the same intensity of withdrawal that persons addicted to substances experience, there can certainly be a period of re-calibration of dopamine receptors during which a person feels irritable and agitated after stopping a behavior.

Based on the information presented here, it appears that we are all hard-wired to become addicts and you may be asking yourself, “If this is true, why do some people become addicted and others don’t?” This is a really good question and the answer is “We don’t really know.” We can predict the likelihood of someone becoming an addict based on factors such as first age of substance use and family history of addiction, and we know that a lack of social support and coping strategies (especially when coupled with mental illness) can also lead to addiction, but there is no conclusive answer to date.

The best ways to prevent addiction are to educate yourself about the substances you use (or to abstain from substance use altogether) and to be mindful about the choices you make. If you have a mental illness, ensuring that you are getting appropriate treatment and maintaining social support are good preventative measures.

The Truth About Addiction

addiction

Addiction is not a character flaw and it most definitely is not a choice.

Addiction is a biopsychosocial phenomenon that results in negative consequences and feelings of shame and guilt. Biological, psychological, and social factors culminate into a dependent relationship to a substance or compulsive behavior as a means of coping with distressing emotional, psychological, and environmental states.

More specifically, addiction is characterized by several criteria:

  1. the inability to resist an urge to consume a substance or engage in a behavior that is harmful
  2. an increase in tension or arousal before the act, followed by gratification and relief
  3. a noticeable  increase in amount and frequency of the act in order to achieve the desired effect (e.g. pleasure or escape)
  4. over-investment of resources, such as time and money, to engage in the act
The  emotions associated with addiction are one of the most notable elements. Shame, guilt and powerlessness are hallmarks of addiction and often lead to feelings of self-loathing and isolation. Individuals suffering from addiction are often misunderstood by their families and loved ones, causing them to lie and keep secrets.

This website offers information about addiction, drugs, and compulsive behaviors, including the latest news and research. Resources for people with an addiction and their loved ones can also be found here.

 

Informing yourself can be the first step in gaining power over your addiction.