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

 

Circumcision of the brain?

opiate addiction

Photo by Domiriel

Physicians in China performed brain surgeries to treat opiate addiction by destroying the nucleus accumbens, the pleasure center of the brain. The procedure is called stereotactic ablation of the nucleus accumbens, which means brain tissue is burned away. Although the procedure was banned in 2004, surgeries continued in the name of research.

The hope was that by destroying the part of our brain responsible for pleasure associated with drug use (among other things) the desire for using drugs would diminish. Results published in World Neurosurgery last October showed that 5 years after the surgery, 53% of participants had relapsed and were addicted to opiates again. In addition, 21% of participants experienced memory deficits and 18% experienced loss of motivation. These side effects are permanent due to the irreversible nature of the treatment. Read more about this controversial surgery here.

It is clear that addiction has devastating effects, but how far are we willing to go to treat it? Is it fair to ask addicts to potentially sacrifice pleasure and motivation to kick their habit? Some of the participants of this study were as young as 19 years old and had been addicted to heroin for 3 years. Granted, this research was conducted in China, a place where the death penalty is considered a suitable intervention for addiction. Is it ethical to have moral standards influence scientific research? Where do we draw the line?

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.