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NeuroView
Copyright © 2011 Elsevier Inc.. All rights reserved.
Neuron, Volume 69, Issue 4, 599-602, 24 February 2011
Nora D. Volkow1, , Ruben D. Baler1 and Rita Z. Goldstein2
1 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
2 Department of Medical Research, Center for Translational Neuroimaging, Brookhaven National Laboratory, Upton, NY 11973, USA
Summary
- Addiction co-opts the brain's neuronal circuits necessary for insight, reward, motivation, and social behaviors. This functional overlap results in addicted individuals making poor choices despite awareness of the negative consequences; it explains why previously rewarding life situations and the threat of judicial punishment cannot stop drug taking and why a medical rather than a criminal approach is more effective in curtailing addiction
Introduction
Substance use disorders (SUD) profoundly affect our society. Though the costs are usually translated in economic terms—approximately half a trillion dollars a year in the USA (ONDCP, 2004)—their impact is much more insidious, eroding the foundation of human relationships and the established social contract. Thus, it is not surprising that a significant portion of costs associated with SUD stems from costs associated with antisocial or criminal behavior and family services. The following letter excerpt (bold added for emphasis) painfully illustrates the devastation that SUD can bring upon individuals, their families, and society.As I sit to compose this plea I can't say with any amount of certainty that my son is alive. My son discovered narcotics at the age of 13. He experienced a severe orthopedic sports injury. There seems to be nothing that can induce him to stop for any appreciable length of time. I had him arrested May of 2006 for heroin possession and identity fraud, he stole 900 dollars from our checking account while I was in Connecticut burying my dad and his sister … tells me he cannot stop…. Our family is being destroyed … we have exhausted our savings and retirement. Everything seems so hopeless…
Research on the neuroscience of SUD has started to shed light on the ways in which chronic drug abuse changes the brain to cause the profound disruption we see in the behavior of an addicted person. This is because drugs of abuse impact many neuronal circuits that are crucial for proper functioning in social environments. These changes are long-lasting, persisting even after years of drug discontinuation, which has led to the recognition of addiction as a chronic and relapsing disease, as illustrated by another letter excerpt.I am a 42 year old male who has struggled with addiction to alcohol/drugs for almost two decades but I have also struggled with trying to find a way out of active addiction. My attempts have included about 15 stays at rehabilitation centers, numerous detoxification units, a stay at a long-term rehabilitation center, religion, philosophy, behavior modification and finally a 12 step program…. My life can be summed-up as a life of many failed attempts. Failed attempts in a lot of areas and I believe it is because I have not been able to stop abusing alcohol.
Addiction has a strong genetic component and both developmental stages (adolescents and young adults being at the highest risk for SUD) and environmental factors (e.g., exposure to stressful environments) play crucial roles in modulating the vulnerability for SUD in part through their influence on how the human brain works and responds and adapts to various types of stimuli (including drugs). Scientific insights into drug-induced impairments of specific brain circuits are beginning to answer many of the questions that had baffled us for so long, such as (1) why drugs can be so disruptive to social relationships, (2) why the social system used to deter behavior (e.g., the threats of incarceration or of loss of custody) does not work well in addicted subjects, (3) why social stressors (such as those that may be triggered by poverty) increase vulnerability for addictions, and (4) how to best harness the new information for the development of more effective prevention and treatment alternatives. Fundamental processes to addiction are the enhanced motivational drive for the drug and the weakening of control over this drive.
What's Important to Addicts: Placing Value in All the Wrong Places
People's ability to successfully identify, seek, and obtain what is important to them (but also avoid what's undesirable) at a particular point in time is crucial for their well-being. That which motivates us toward obtaining certain goals plays a key role in how successfully we navigate complex social environments. The sinister nature of addiction is that the very neurobiological systems underpinning this process become dysfunctional, hijacked by a user's drug (or drugs) of choice. From a biological perspective, this is believed to reflect the ability of chronic drug exposure to cause neuroadaptations in brain reward systems including the emergence of conditioned associations that link the rewarding experience from the drug to the multiple cues that surround it (Kalivas and Volkow, 2005).
The same functional impairments that make the reward pathways of an addicted individual more responsive to the abused drug and its associated cues (Volkow et al., 2009) also reduce their sensitivity to previously effective natural nondrug reinforcers, such as spending time with friends or family. The intrinsically high rewarding properties of drugs of abuse combined with their relatively weak potential for satiety (Acquas and Di Chiara, 1992) trigger neuroadaptations that ultimately make drug searching and consumption the main motivational drive for addicted individuals. As a result, in addicted subjects, the reward value of the drug of abuse and its associated cues is enhanced, whereas that of other reinforcers is markedly decreased (Volkow et al., 2003) (Figure 1). Ultimately, this leads to a cycle of drug abuse that is difficult to break free of, even when an addict may truly want to become drug-free, resulting in the typical pattern of drug relapse so often seen in addicted individuals.
Furthermore, while the value that an addicted individual places on drug reward becomes unsustainably exaggerated, the potential impact of deleterious consequences (e.g., familial dislocation, becoming the target of drug-related violence, or incarceration) becomes progressively devalued. The establishment of such a severe imbalance in how an addicted individual attributes value to both rewarding and aversive situations and stimuli has a profound and negative impact on the individual's social competence. Their behaviors are now governed by the uncontrollable overvaluing of the drug and by a growing insensitivity to the deterrent value of potential punishments. The problem is further compounded by the tendency of many substance abusers, more so than nonusers, to routinely choose immediate rewards over delayed gratification (e.g., choose $20 dollars now rather than wait 1 week in order to get double that amount). This inability to appropriately weigh delayed rewards can be devastating to an addicted person who may be willing to sacrifice future gains or incur major losses in exchange for instant gratification. An individual in this situation may not think twice about the risk of losing his or her parole tomorrow in order to chase the high from the drug now.
This knowledge helps explain why the prevailing social system that dangles some future threat of imprisonment over an addict's head does not work well in deterring immediate substance abuse-related behaviors in addicted subjects. It also highlights the need to provide addicted individuals with alternative reinforcers as a strategy both for the prevention of SUD as well as its treatment.
When Both Steering and Braking Systems Fail: Cognitive Function and Impulse Control Derailed
For many years, studies of addiction focused on the role of brain reward circuitry (Weiss and Koob, 2001). However, imaging studies have provided consistent evidence for the involvement of the brain's cognitive system as well (i.e., prefrontal cortex [PFC]) in the addiction process (Volkow and Fowler, 2000). Both preclinical and clinical studies have explored the complex role that disrupted cognitive processing plays in the addiction cycle. In addition to the involvement of the PFC in classical cognitive operations, more recent work has also revealed that the PFC plays a crucial role in social cognition (Forbes and Grafman, 2010), which is necessary for proper social integration. For example, damage to ventral areas of this brain region can interfere with the ability of a person to accurately distinguish right from wrong in a socially acceptable manner, which can lead to socially inappropriate behaviors (Koenigs et al., 2007). Because the functions of these brain regions are also impaired in addicted individuals, this could explain an addict's inability to accurately steer their behaviors in appropriate directions despite having access to the required knowledge.
Behavioral inhibition is fundamental to the success of social intercourse, which is critically dependent on a person's ability to control impulsive behaviors whenever this is needed. It is therefore interesting to note that impaired impulse behavior, which is also dependent on the PFC, is another key symptom of addictive individuals. For most people, the combination of biological (e.g., individual-level characteristics) and environmental (e.g., culture, laws, religion) factors build up a sufficiently robust mechanism to inhibit or at least help manage internally or externally generated temptations. But the system is not fail-safe and some individuals at one extreme of the impulsivity distribution curve, as is the case in addiction, are the constant victims of very powerful, unstoppable urges. By perturbing the function of the PFC, the addiction process degrades the very substrates that enable an individual to exert free will. There is no doubt that the impaired function of neuronal systems involved in social behaviors in addicted individuals contributes to the stigma associated with SUD.
Social Stressors and Addiction
Lingering economic uncertainty, social dislocation, isolation, inequalities, and the ubiquitous threat of global terrorism are just a few examples of modern life's steady diet of stressful stimuli that could exacerbate the risk of mental illness including SUD. Stress systems greatly contribute to the addiction cycle of drug craving and withdrawal, pushing the addicted individual toward compulsive drug taking (Koob and Zorrilla, 2010). Indeed, epidemiological studies have shown a direct dose-dependent relationship between the number and type of adverse childhood experiences (ACE) and early initiation of drug use (Dube et al., 2003). Such ACEs appear to explain at least half of the risk for SUD later in life.
Of particular interest for neuroscience research has been the role of social stressors in SUD. For example, in nonhuman primates stressful alterations in an animal's social environment disrupted their expression of dopamine D2 receptors (D2R) in striatum and increased their subsequent propensity for drug use (Morgan et al., 2002). Similarly, imaging studies in humans have documented an inverse relationship between social status and striatal D2R expression (Martinez et al., 2010). This is relevant because both preclinical and clinical studies have shown that low striatal D2R expression is associated with impulsivity and propensity for compulsive drug use. Indeed, one of the most replicated findings from imaging studies of addiction is that of reduced striatal D2R levels (Volkow et al., 2009). Hence, one possible mechanism through which social stressors might enhance the risk for drug use could involve the downregulation of striatal dopamine signaling.
Social stressors have also been shown to have a deleterious impact on the developmental processes that connect the PFC with the limbic brain (including the amygdala, which processes emotions and stress reactivity) and that are indispensable for the establishment of cognitive control of emotions and desires. For example, children reared in an orphanage showed a delayed connectivity in these pathways that was proportional to the years they spent at that institution (Behen et al., 2009).
The fact that stressful stimuli and environments can exert such negative and long-lasting effects on the formation and function of the brain substrates responsible for protecting us against drug abuse and addiction (among others) should make us pause and rethink our prevention strategies. For example, should we consider how the enhanced stress of having an incarcerated parent may affect the risk for drug use in the children of incarcerated drug abusers or consider the neurobiological consequences of incarceration in the drug abuser and how this will affect their ability to recover once released into their communities?
Implications for Treatment and Social Policy
As we've discussed above, addiction involves persistent drug-induced adaptations in the brain systems responsible for controlling behaviors that are necessary for proper integration into complex social systems. Hence, therapeutic interventions should take this into consideration and create incentives for the substance abusers to engage and stay in treatment including strategies that help strengthen social ties with family and community. Social interactions are powerful reinforcers that can provide the addicted individual with alternatives to help counteract the perceived high-reward value of drugs.
An important consequence of the long-term brain adaptations is that most addicted patients will require a long period of treatment, during which relapse is likely to occur, which should be considered a predictable setback and not a failure of the treatment. This also explains why the best treatment outcomes are reported by programs that offer continuity of care for a 5-year period (McLellan et al., 2008). In addition, chronic drug abuse has recently been recognized to be associated with impaired self-awareness (including interoceptive or bodily awareness), which manifests as compromised recognition of disease severity and/or the need for treatment, but that has frequently been interpreted as denial (Goldstein et al., 2009). This in turn contributes to the low rates of treatment initiation and high-dropout rates.
According to the 2010 National Survey on Drug Use and Health (NSDUH) (SAMHSA, 2010), in 2009, 22.5 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem, but only 2.6 million received treatment at a specialty facility. This means that 20.9 million persons who needed treatment did not get it. The reason for such high undertreatment rates is instructive: the vast majority of addicts did not even perceive a need for treatment and among those who did admit needing treatment over half either didn't make any effort to seek it or were unable to procure it. The persistence of such a vast SUD treatment gap—the result of a combination of inadequate infrastructure and lack of interest—is a great concern because it continues in spite of the availability of effective interventions.
The disconnect that exists between treatment needs and access is even more apparent in the context of criminal justice system populations. The fact is that most prisoners (80%–85%) who could benefit from drug abuse treatment do not receive it (Mumola and Karberg, 2006). This is a missed opportunity because integrating treatment into the criminal justice system would enable us to provide treatment to individuals who otherwise would neither seek nor receive it, and it has been shown to improve medical outcomes and reduce recidivism particularly when maintained throughout the critical postrelease period (Chandler et al., 2009). This is because returning to a neighborhood awash with so many drug-associated cues can trigger powerful cravings and relapse to compulsive drug-seeking behaviors. This is further compounded by the systemic difficulties and stressors these individuals face when reintegrating into society, including that of finding a job while under the shadow of a criminal record. This is vividly illustrated by the following letter.I am writing as the mother of a crack addict. My daughter has been an addict for 12 years. She is the mother of 4 children all of which she has lost parental rights to. She has been in prison most of the 12 years, and had many programs, doing well in what was offered during incarceration. When she is released from prison, she is always hopeful for success.… She is immediately faced with 4 major challenges: getting a place to live, finding a job, transportation, and obtaining continuing recovery treatment…. Now she just got [out] of jail 3 weeks ago, went through what I just described above, and went back on the streets. She was broke and shoplifting, and now will go back to jail, do the program for probably the 10th time, and be released again the same way. There are many like my daughter, so addicted they will end up dead.
Forward-Looking Agenda
I wonder how many times my son has left in him. Is there any hope for the alcoholic/addict who has reached bottoms so deep and so dark that it is hard to imagine that there is any place left to go? That there is anything left to lose. When there are no more resources, no money, no free treatment options that are available during the unending crisis—what then? When a bright, educated man can no longer work because of his addiction, where do we turn? I ask because I have done everything and I have done nothing and neither strategy has worked.
Social isolation is not only a marker but a well-recognized risk factor of physical and mental illness (Karelina and DeVries, 2011). Yet, by most accounts, stigmatization and/or incarceration have been society's prevailing responses to addicted individuals. Such stigmatization impedes the search for treatment and further isolates addicted individuals and their families.
The ideas expressed here could be easily construed as advocating a sort of moral relativism at the expense of individual responsibility. Yet nothing could be farther from the truth. We merely state the fact that addiction is a brain disorder that impacts the very same circuits that enable self-monitoring and complex social functioning. Granted, our understanding of the brain systems whose function or dysfunction shape subjective value and decision-making and how drugs affect them is still incomplete. Nonetheless, the recognition that social stressors such as stigma and isolation can further impair the function of neuronal systems necessary for an addicted person's recovery highlights the need to treat addiction as a disease rather than as a criminal behavior.
Acknowledgments
The authors wish to recognize and thank the anonymous relatives and addicted individuals who, in their search for an answer to their problem, wrote the poignant letters.
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Read More....
By Shari Roan, Los Angeles Times
February 23, 2011, 10:48 a.m.
Drug addictions plague about 22.5 million Americans, according to recent statistics. But promising scientific research may one day begin to whittle away at that number, say scientists writing in a special issue of the journal Neuron published Wednesday. The issue is devoted to addiction and details many of the latest theories about substance abuse prevention and treatment. Included in the journal (online access is free for this issue) are papers on opioid prescriptions for chronic pain and the risks involved; how drugs might be used for cognitive enhancement and how obesity is linked to other addictions. Don't miss the essay by Dr. Nora Volkow, director of the National Institute on Drug Abuse. There's also a podcast of her speaking on the subject. Volkow describes how addiction rewires the human brain's reward systems to impair normal thinking and behavior. "People's ability to successfully identify, seek, and obtain what is important to them (but also avoid what's undesirable) at a particular point in time is crucial for their well-being. That which motivates us toward obtaining certain goals plays a key role in how successfully we navigate complex social environments. The sinister nature of addiction is that the very neurobiological systems underpinning this process become dysfunctional, hijacked by a user's drug (or drugs) of choice," she writes. More recent research, however, indicates that addiction targets more than the reward system of the brain. Imaging studies show that the brain's cognitive systems in the prefrontal cortex area are disrupted by drug addiction. "For example, damage to ventral areas of this brain region can interfere with the ability of a person to accurately distinguish right from wrong in a socially acceptable manner, which can lead to socially inappropriate behaviors. . . Because the functions of these brain regions are also impaired in addicted individuals, this could explain an addict's inability to accurately steer their behaviors in appropriate directions despite having access to the required knowledge," she writes.
The Montreal Gazette
January 16, 2011
By HANNAH HOAG, Special to the Montreal Gazette
The brain arrives shortly after lunch.
It rests on the lab bench, in a Styrofoam box plastered with “Urgent Delivery” and “Fragile” stickers, while two research assistants prepare the dissection laboratory. One has tuned a small radio to a classical station. The sounds of bassoons and strings waft into the room. The opus is an allegro – upbeat and quick.
The technicians glide around the room with practised coordination. They are cloaked in knee-length blue plastic aprons, sleeves tucked into latex gloves. They tape absorbent mats to the bench tops and lay out scalpels and forceps.
Josée Prud’homme adjusts her face mask and eye shield, and nods to her colleague, Maâmar Bouchouka.
Bouchouka lifts the red biohazard bag from the box and slices it open with a scalpel.
“We’re starting. It’s 13:21,” he says.
He pats the brain down with paper cloths and sets it on a white cutting board. It slouches a bit. The tissue has started to break down. The brain is pink and a little shiny. Dark red blood vessels snake through the deep wrinkles and folds of the cerebral cortex, like rivers through weathered canyons.
It’s the brain of someone who took his life over the weekend, and was donated to the Quebec Brain Bank shortly thereafter.
“It’s very emotional, each time we receive a brain at the bank. We don’t get used to death,” says Prud’homme.
For 90 minutes, Bouchouka and Prud’homme will remove and freeze the brain’s key structures. They’ll separate the two hemispheres, preserving one in a rectangular clear plastic container filled with a formaldehyde solution, and cutting the other into one-centimetre-thick slices flash-frozen for storage at minus 80 degrees Celsius.
Now named S-252, this brain has become a critical resource for scientists interested in the biological and environmental underpinnings of mental illness.
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Natural News
Friday, December 31, 2010 by: Ethan A. Huff, staff writer
The rate of prescription drug use among children and teens continues to rise, with a new report from Medco Health Solutions Inc. saying that at least a quarter of all U.S. children are now regularly taking pharmaceutical drugs. And according to the report, many of these drugs were originally intended for adults, and carry with them unknown side effects for long-term use in young people.
The Wall Street Journal (WSJ) reports that in addition to taking drugs for conditions like attention-deficit hyperactivity disorder (ADHD) and asthma, children are now taking things like sleeping pills, diabetes drugs and even statin drugs, which are typically only prescribed for adults. The report cites an eight-year-old boy, for example, who has been taking blood pressure medications since he was a baby.
Dr. Danny Benjamin, a professor of pediatrics at Duke University, admitted to the WSJ that prescribing chronic medications to children is a serious problem. "We know we're making errors in dosing and safety," he said, noting also that parents must do more to question the safety of medicines their doctors prescribe.
Experts worry that the increasing prevalence of children on prescription drugs is causing these young people serious harm, and that parents should instead seek out dietary and lifestyle changes for their children. But because many doctors continue to dole out the drugs like candy, despite known dangers, many parents just accept them for their children without giving it a second thought.
Centre Daily Times
By Karlene Shugars
October 2010
Last month was National Alcohol and Drug Addiction Recovery Month. President Obama called upon citizens to “express support for those living healthy, productive lives in long term recovery ... applaud those working to help struggling Americans break the cycle of abuse and encourage those in need to seek help.”
The initiative was established 21 years ago to raise public awareness of the treatable disease of addiction and to educate communities about addiction treatment and recovery.
Scientists have gathered irrefutable evidence that ad diction is a disease which can be treated. Still, an overwhelming number of people continue to regard addiction as a moral weakness or character flaw.
While we exist within a culture that promotes substance use, we continue to brand and shame those who are unable to drink “normally” or use certain medications as prescribed. Even more disparaged are those who use illegal drugs and consequently find themselves labeled “offender” and “junkie.”
While we often chastise people for not seeking help, we conveniently ignore the fact that acknowledging an addiction can cost individuals their jobs, jeopardize their health care coverage or even result in the loss of a child should one be de clared an “unfit parent” after acknowledging a chemical dependency problem. For many, shame has become the largest barrier to treatment.
So how do we rid society of the stigma surrounding addiction? We start with learning.
First, addiction is a disease of the brain. Almost all abused substances cause dopamine surges in the brain’s reward center. The ensuing sensation of intense euphoria motivates people to repeat the experience. However, these surges damage and eventually destroy the areas of the brain that govern our ability to make decisions and regulate im pulses; hence, in the latter stages of addiction, an individual may literally lack the ability to exert self-control.
Read more:
DNA - Daily News Analysis
Published: Thursday, Sep 9, 2010, 2:06 IST
By Divyesh Singh | Place: Mumbai | Agency: DNA
They will go to any length for a ‘fix’. Not sure what exactly the caterpillar was thinking when it instructed Alice (in Lewis Carrol's Alice in Wonderland) to have a bite of the mushroom, she grew and shrunk with each bite.
Surreal, yes, but perfectly normal in a bizarre universe populated by characters like the Mad Hatter and the March Hare. In the regular world, the experience would be termed hallucinogenic.
Such effects of some mushrooms in South American users has been well-documented as is that of cacti. But in a world fixated with the fix, people have gone much beyond mushrooms. From snake bites to tweaking chemicals in labs to abusing pain killers and cough syrups, the experiments have been a constant in the world of addicts and thrill-seekers.
The desperation of the human mind for forbidden pleasures is amazing, as is its flexibility for innovation. The good old cough syrup would not mean much to many, but some have turned these into potent vehicles for a ‘trip’.
Phensedyl and Corex, containing the highly addictive opium-based codeine phosphate, are the most abused. A rage among young addicts in the north-east a decade or so ago, it has spread across the country. Easily available over the counter and light on the pocket, its abuse has caught on in Mumbai too.
Use of opiads like Fortwin, an Analgesic, too, has been in vogue in the city. A combination of Fortwin and Diazepam (a benzodiazepine derivative drug, marketed as Vallium earlier) taken intravenously produces a dreamlike state and finally deep sleep. The abuse of prescription drugs is known to be common among doctors and paramedical staff. But the knowledge has spread. Even bored housewives are not loathe to experimenting with what is available to them around.
Those looking for prescription drugs come in the age group 14-60. A World Health Organisation estimate puts such abuse in alarming statistical perspective. Addiction to prescription drugs is 10 times more rampant than abuse of illegal drugs the world over, it says. Indian law prohibits the sale of drugs without a prescription, but that is hardly a deterrent.
The experimentation doesn’t stop here. Pain balm being used as bread spread is not a new phenomenon.
People also use syringes filled with distilled water. Injected directly into the nerve, it produces a hallucinogenic effect on the brain and the body. Among stationery products, the most abused is ink whitener solution, or diluter, which is inhaled by addicts by applying the liquid to a handkerchief or a piece of cloth. Addicts are known to misuse the solution used to make corrections on printed or written matter.
With the brain playing the role of laboratory, the only thing the law can do is to play the catch-up game.
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Thea Singer
Journalist, writing instructor at MIT
Posted: September 17, 2010
On my daughter's fourth birthday, a swim party in 2002, my youngest sister showed up late in an outfit befitting a weekend rager: ratty black jeans, a threadbare camisole and a long-sleeved voile blouse in dingy white.
"It's the closest thing I had to a bathing suit," she told me skittishly, before wandering off to smoke a Camel.
Then, she disappeared for two hours. She reappeared only when everyone had left, running to us across a field, so skinny her bones seemed to rattle.
Looking back, her choice of swimwear should have been another of the warning bells going off that year. There were the false teeth she'd gotten to replace her own because of a rare gum disease. The frequent, sudden naps -- in a chair, on my rug. The strange gifts -- used teleconferencing software for me, worn beige tap shoes for my daughter. The way she'd fought me -- bitterly, unrelentingly -- when I'd refused to let her take my bike out late one night for a spin.
Two months after the party, I learned the reason for the get-up and behavior: My sister, then 42, had become addicted to methamphetamine. The shirt and long pants on that hot summer day were to cover the tracks from shooting up. And the lateness? Victim to the compulsive behavior that is one of meth's hallmarks, she'd been sidetracked diving into dumpsters to collect "treasures" on her way to see us.
What had driven this successful juvenile-defense attorney to turn to drugs? As she tells it, a big part was precisely that: the stress of winning cases--of keeping moms from having their parental rights terminated (one client's child died while in foster care). My sister, upended by the child's death, had "burned out."
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AIDS 2010
XVIII International AIDS Conference
Vienna, July 18 - 23
Mara Kardas-Nelson
Published: 27 July 2010
Two scientific lectures presented at the Eighteenth International AIDS Conference in Vienna last week, demonstrated that drug use in and of itself is linked to increased rates of HIV transmission, giving support for evidence that substitution therapy programmes could help to stem the HIV epidemic.
Currently, ten million injecting drug users (IDUs) are living with the virus worldwide. While needle sharing is a strong predictor of HIV seroconversion, non-injecting drug users also experience increased rates of transmission when compared to the general population. This is a result of drugs’ impact on brain chemistry and function, as they diminish inhibitory responses and therefore lead to riskier behaviour.
Nora Volkow of the US National Institute on Drug Abuse, or NIDA, noted, “the prevalence rates of substance abusers are in many instances equivalent whether they inject or don’t inject.”
Charles O’Brien from the University of Pennsylvania agreed, stating, “Even oral drugs greatly increase the risk of being… positive.” As such, combating HIV transmission among non-injecting drug users “is even more complex than addressing just injecting drug use, [in which] you only have to address contaminated equipment”, said Volkow.
Discussing alcohol, cocaine, heroin and methamphetamine use, Volkow noted that many drugs increase sexual desire and impulsivity while decreasing the function of the inhibitory and controlling systems of the brain, with acute and chronic drug use affecting the prefrontal cortex. Brain and behaviour changes can often last several years after use is discontinued.
Addiction is a “chronic disease”, said Volkow. People take the drug “not because the individual [wants to], but because they have lost their ability to control”.
According to O’Brien, the notion that drug addiction is a disease of the brain is not a novel concept. “We have very good evidence [that addiction] is governed in large measure by our genes. A lot of people who are addicts are not guilty of anything that the rest of us don’t do, like experimenting with drugs,” he said.
While “it should not be any surprise that sexual behaviours increase when intoxicated”, the pinpointing of changing brain behaviour and chemistry is a relatively new phenomenon, according to Volkow. Such data demonstrate “that you actually can very specifically identify the biochemical changes in the brain that lead us to understand the disruptive behaviour”, she explained.
In addition to increasing the risk of HIV transmission, some psychoactive drugs actually exacerbate the neurotoxic effects of HIV. Volkow explained that this “combination of two very different vectors… collide to disrupt [brain function] even further”.
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Your Neurotransmitter Levels and Emotional Health
Your emotional health is a combination of attitudes, personality, support systems, and your brain’s neurotransmitter levels. Positive attitudes and a healthy personality help us through life’s difficulties and a good support system of family and friends is also valuable during times of trouble. Despite having these resources, there are times when coping with our experiences and life events changes our neurotransmitter status. Like an overheated automobile, we begin to have difficulty operating properly.
We are all at-risk for changes in our brain’s chemistry. Mostly commonly, we will experience depression, anxiety, or stress reactions. As our neurotransmitters change, they bring with them additional symptoms, behaviors, and sensations that add to our on-going difficulties. Recognizing these changes is an important part of treatment and returning your life to normal and reducing our stress.
This discussion is offered to explain how the neurotransmitter system in the brain can create psychiatric conditions and mental health problems. It is hoped the discussion will provide information that will be of value to those who suspect their neurotransmitter system is creating problems.
The following is a discussion of neurotransmitters and current thoughts about how these neurochemicals are involved in psychiatric illness. Four neurotransmitters, out of over fifty, are well researched and known to be related to psychiatric conditions.
Dopamine: Parkinson’s Disease and ADHD to Smoking and Paranoia
Dopamine is a neurotransmitter linked to motor/movement disorders, ADHD, addictions, paranoia, and schizophrenia. Dopamine strongly influences both motor and thinking areas of the brain.
One type of Dopamine works in the brain movement and motor system. As this level of dopamine decreases below the “normal range” we begin to experience more motor and gross-movement problems. Very low levels of Dopamine in the motor areas of the brain are known to produce Parkinson’s Disease with symptoms such as:
- Muscle rigidity and stiffness
- Stooped/unstable posture
- Loss of balance and coordination
- Gait (walking pattern) disturbance
- Slow movements and difficulty with voluntary movements
- Small-step gait/walking
- Aches in muscles
- Tremors and shaking
- Fixed, mask-like facial expression
- Slow, monotone speech
- Impairment of fine-motor skills
- Falling when walking
- Impairment in cognitive/intellectual ability
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Physicians Practice
By Keith L. Martin | July 15, 2010
You may have an obligation to report a colleague who is impaired or incompetent, but it turns out most of you are reluctant to do so.
Why? Because physicians are “unprepared” to deal with it.
In a new study, published in the most recent edition of the Journal of the American Medical Association, of physicians who knew a colleague was unfit to perform medicine, only two-thirds reported this to the relevant authorities, leaving one-third who let it go unreported.
The authors of the research did ask those who shunned reporting impaired or incompetent colleagues why they chose to stay mum. Of those offering an answer, 19 percent said they thought someone else was taking care of the issue. Another 15 percent said they thought nothing would come of being a whistleblower and 12 percent feared some kind of retribution.
The study defined “impaired” and “incompetent” based on several factors, including drug addiction to those unaware of the latest ways to treat a patient’s condition.
The JAMA article notes that peer monitoring and reporting are “primary mechanisms” for identifying docs who cannot or should not perform medicine and 64 percent of the 2,938 eligible respondents (covering practices like family practice, internal medicine and pediatrics) agreed with their duty to respond. But only 69 percent reported being “prepared” to effectively deal with an impaired colleague and 64 percent to deal with an incompetent doc in their practice.
The authors recommend promoting further education on who to call and how to report at both practices and hospitals as a way to increase awareness.
The Star Online
Malaysia
May 17, 2010
TIGER Woods and Sandra Bullock’s ex-husband Jesse James are the latest names to wear the “sex addict” tag. They join a long line of celebrities like actors David Duchovny, Jude Law, Bill Murray, Charlie Sheen, Woody Harrelson and Tom Sizemore; British comedian/presenter Russell Brand; singer Eric Benet (former Mr Halle Berry) and Chelsea footballer Ashley Cole, to name just a few.
They probably overdosed on serotonin and endorphins, the brain’s feel-good chemicals released during sex.
Is there such a thing as sex addiction? Or could it be a convenient excuse for philandering husbands, Lotharios and porn purveyors, to justify their behaviour?
According to a Reuters report, “sex addiction” is still not recognised as an official diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
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The Cleveland Leader
February 16, 2010
According to the results of a new study conducted by researchers in the United States and Switzerland, popular anti-anxiety drugs such as Valium and Xanax have powerful "reward pathways" that can lead users to addiction.
Well-known medications in the benzodiazepine class of drugs, Valium and Xanax boost the action of a neurotransmitter in the brain, which then activates the gratification hormone known as dopamine. This is the same "reward pathway" that illegal drugs such as heroine activate.
Researchers believe that these findings, which were recently published in the journal "Nature", may help scientists develop a new generation of anti-anxiety drugs that would not be addictive. They hope to come up with similar drugs that bind to a different part of the brain while still offering the calming benefit of Valium without the addictive side effects.
Drug companies have tried to develop benzodiazepines that are not addictive, but to date their efforts have not been successful.
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