Addiction to ExcessAddiction to Excess

Definition of addiction has Definition of addiction has shifted from substance abuse shifted from substance abuse to to any any compulsive behavior.compulsive behavior.

Parameters of addictionParameters of addiction

HarmHarm CompulsionCompulsion Loss of controlLoss of control Continuation despite Continuation despite

negative consequencesnegative consequences

Other considerationsOther considerations

People choose the drug depending People choose the drug depending on their needs at that time. Needs on their needs at that time. Needs shift.shift.

Even healthy behaviors can Even healthy behaviors can transform into compulsions.transform into compulsions.

Risk factors for dependencyRisk factors for dependency

Genetics account for 40% - 60% of Genetics account for 40% - 60% of one’s vulnerability to addictionone’s vulnerability to addiction

Scope of addictionScope of addiction

A A syndrome approachsyndrome approach to addiction pushes us to addiction pushes us to look at the reward to look at the reward center in the brain, as center in the brain, as well as the natural well as the natural rewards of life rewards of life experiences. experiences.

People get hooked on all kinds People get hooked on all kinds of behaviors/ substancesof behaviors/ substances

Chocolate (phenethylamine- the chemical Chocolate (phenethylamine- the chemical of love!)of love!)

WorkWork Endorphins produced by running – also Endorphins produced by running – also

called the “keys to paradise”called the “keys to paradise” Computer & online games- online users Computer & online games- online users

have grown from 500K to 700+million in have grown from 500K to 700+million in 20+ years20+ years– 5.9% - 13% show some disturbed behavior 5.9% - 13% show some disturbed behavior

related to this activityrelated to this activity

Addictive personality traitsAddictive personality traits

Impulsive, rule-breakingImpulsive, rule-breaking Non-conformistNon-conformist Depressed or antisocialDepressed or antisocial Acting out as children, Acting out as children,

delinquent as adolescentsdelinquent as adolescents Family breakdownsFamily breakdowns Poor expectations for the future/ selfPoor expectations for the future/ self Shared group of usersShared group of users

There is a relationship between There is a relationship between personality & drug of choicepersonality & drug of choice

Narcotics/ heroin users-Narcotics/ heroin users- use passive use passive withdrawal/ reduced sensory stimulation to withdrawal/ reduced sensory stimulation to copecope

Amphetamine users-Amphetamine users- tend to distract with tend to distract with physical/ intellectual activitiesphysical/ intellectual activities

Hallucinogen users-Hallucinogen users- use fantasy, use fantasy, daydreaming to reduce tensiondaydreaming to reduce tension

Not only does the user first get a respite from Not only does the user first get a respite from tension, s/he also feels enhanced self-worth tension, s/he also feels enhanced self-worth due to having the ability to self-soothe due to having the ability to self-soothe – This may be in sharp contrast to how much control This may be in sharp contrast to how much control

the person feels in the rest of his lifethe person feels in the rest of his life– We like being in control- of somethingWe like being in control- of something

Coping stylesCoping styles

Satiation-Satiation- shutting down bad feelings by shutting down bad feelings by reducing stimulation from the world- like a baby reducing stimulation from the world- like a baby sucking his thumbsucking his thumb– Food, TV, Xanax, barbiturates, opiatesFood, TV, Xanax, barbiturates, opiates

Arousal- Arousal- seek to feel active & in control of the seek to feel active & in control of the environment & others- like a toddler trying new environment & others- like a toddler trying new things without regard for risk. The fear is things without regard for risk. The fear is helplessness/ vulnerabilityhelplessness/ vulnerability– Crime, boasting, gambling, risk taking, stimulantsCrime, boasting, gambling, risk taking, stimulants

Fantasy-Fantasy- trying to overcome fears through trying to overcome fears through feeling one with the universe, fantasies of powerfeeling one with the universe, fantasies of power– LSD, Ecstasy, mushrooms, romance, religious LSD, Ecstasy, mushrooms, romance, religious

fanaticismfanaticism

Wickler’s 2-stage modelWickler’s 2-stage model

Acquisition phaseAcquisition phase– Novice begins because of the “high” Novice begins because of the “high” – Environment becomes associated- triggersEnvironment becomes associated- triggers– Body adapts to drug and reduces responseBody adapts to drug and reduces response– User attempts to chase the original highUser attempts to chase the original high

Maintenance phaseMaintenance phase– Use is no longer affording pleasureUse is no longer affording pleasure– Use is necessary to feel “normal”Use is necessary to feel “normal”– Progress into loss of control, family, Progress into loss of control, family,

moneymoney

Why is this process so Why is this process so dependable?dependable?

Substances/ behaviors offer immediate, brief Substances/ behaviors offer immediate, brief relief as dopamine is released to the brain’s relief as dopamine is released to the brain’s reward center- reward center- euphoriaeuphoria– All the aspects of the setting become associated to All the aspects of the setting become associated to

the rush- setting up a the rush- setting up a conditioned desireconditioned desire The high is always followed by a low- depending The high is always followed by a low- depending

on how low it is, people may be driven to use the on how low it is, people may be driven to use the “hair of the dog that bit you” to moderate the “hair of the dog that bit you” to moderate the low.low.

The brain tries to control the process by reducing The brain tries to control the process by reducing the effect- and the user tries to overcome the the effect- and the user tries to overcome the brain by using more or different drugs.brain by using more or different drugs.

The crashThe crash

The maintenance phaseThe maintenance phase

As the body adapts to extra sources As the body adapts to extra sources of dopamine the drug no longer gives of dopamine the drug no longer gives a sense of pleasure.a sense of pleasure.

Now the behavior is used to avoid the Now the behavior is used to avoid the misery produced when the drug is no misery produced when the drug is no longer present- longer present- withdrawalwithdrawal

Unfortunately this is not a painless Unfortunately this is not a painless process, as there are social costs- loss process, as there are social costs- loss of jobs, relationships, arrest, of jobs, relationships, arrest, malnutritionmalnutrition

Addictive statesAddictive states

The reward system is in the The reward system is in the limbic systemlimbic system– Addict seems to be trying to compensate for a Addict seems to be trying to compensate for a

lowered response to dopamine with activities/ lowered response to dopamine with activities/ drugsdrugs

– Opioid receptor blockers reduce one’s intake of Opioid receptor blockers reduce one’s intake of sweets- sweets no longer satisfy (these are the sweets- sweets no longer satisfy (these are the same receptors for heroin, morphine)same receptors for heroin, morphine)

The The cerebral cortexcerebral cortex monitors content- monitors content- how linked to reality the user ishow linked to reality the user is– Right hemisphere- fantasyRight hemisphere- fantasy– Left hemisphere- risk taking, workLeft hemisphere- risk taking, work

Limbic hijackingLimbic hijacking

The limbic system- moderates our The limbic system- moderates our behavior & keeps us safe behavior & keeps us safe– It can be usurped by a steady pattern of It can be usurped by a steady pattern of

pushing the envelope, protected by pushing the envelope, protected by denialdenial Politicians like Eliot Spitzer, Pres. Clinton Politicians like Eliot Spitzer, Pres. Clinton

(brought down by sexual promiscuity) (brought down by sexual promiscuity) have have personality patternspersonality patterns of narcissism, of narcissism, sensation-seeking, needs for power/controlsensation-seeking, needs for power/control

The cerebral cortex (inhibits dangerous The cerebral cortex (inhibits dangerous behaviors) is behaviors) is desensitizeddesensitized by success in by success in the face of danger until it can no longer the face of danger until it can no longer exert power over the cravingsexert power over the cravings

So we are all at riskSo we are all at risk Many things combine to push us into behaviors Many things combine to push us into behaviors

that can put us at risk.that can put us at risk. The first time we stumble onto that magic The first time we stumble onto that magic

behavior/substance we can fall into the abyssbehavior/substance we can fall into the abyss We all have areas of insecurity, so if we find a drug We all have areas of insecurity, so if we find a drug

that manages that beautifully, we may cast off our that manages that beautifully, we may cast off our inhibitionsinhibitions

If that behavior is shared by friends in our youth, If that behavior is shared by friends in our youth, we may conform to our detrimentwe may conform to our detriment– ChannelizationChannelization occurs when we get an identity related occurs when we get an identity related

to the behaviorto the behavior– Identity development with friends includes dress, Identity development with friends includes dress,

language, behaviorlanguage, behavior If we develop a deviant role identity, it becomes If we develop a deviant role identity, it becomes

more difficult to change the trajectorymore difficult to change the trajectory

Horizontal conformityHorizontal conformity Once stigmatism occurs (X) it is Once stigmatism occurs (X) it is

extremely hard to move out of the extremely hard to move out of the lifelife

The brain is where euphoria The brain is where euphoria beginsbegins

Hughes and Kosterlitz (1974) Hughes and Kosterlitz (1974) discovered discovered enkephalinsenkephalins- endorphins - endorphins that are pain-killing molecules the that are pain-killing molecules the brain produces.brain produces.

AddictionAddiction is defined as self-induced is defined as self-induced changes in neurotransmission that changes in neurotransmission that result in behavior problems:result in behavior problems:– Personal responsibilityPersonal responsibility– Biochemical effectsBiochemical effects– Social reactionsSocial reactions

The brain is a computer as well The brain is a computer as well as a chemical factoryas a chemical factory

Its 100 billion cells can store more information Its 100 billion cells can store more information than all the libraries of the worldthan all the libraries of the world

Each cell has 3 parts: dendrite, soma, axon (there Each cell has 3 parts: dendrite, soma, axon (there may be 10K dendrites per cell)may be 10K dendrites per cell)

All the quadrillion connections are separated by a All the quadrillion connections are separated by a synapse, so the neural message is sent by way of synapse, so the neural message is sent by way of neurotransmitters dumped into the synapse to neurotransmitters dumped into the synapse to stimulate the following cell chemicallystimulate the following cell chemically

This occurs not by entering the following cell, but This occurs not by entering the following cell, but by chemically turning the key of the receptors on by chemically turning the key of the receptors on that cell.that cell.

These neurotransmitters can be mimicked by These neurotransmitters can be mimicked by substances.substances.

Structure of a neuronStructure of a neuron

Synaptic transmissionSynaptic transmission

So why would we get hooked So why would we get hooked on a drug if it does the same on a drug if it does the same thing as a neurotransmitter?thing as a neurotransmitter?

Stimulant drugs increase the amount of Stimulant drugs increase the amount of neurotransmitter emitted in 2 ways:neurotransmitter emitted in 2 ways:– Amphetamines- increase the rate of release of the Amphetamines- increase the rate of release of the

neurotransmitterneurotransmitter– Cocaine- prevent reuptake of the neurotransmitter, Cocaine- prevent reuptake of the neurotransmitter,

allowing for longer & more intense firingallowing for longer & more intense firing Increases of norepinephrine also signal the Increases of norepinephrine also signal the

hypothalamus to dump cortisol which hypothalamus to dump cortisol which decreases sensitivity to paindecreases sensitivity to pain– So people on Ecstasy can dance until their feet So people on Ecstasy can dance until their feet

bleedbleed

Hypothalamic-pituitary-adrenal Hypothalamic-pituitary-adrenal axis (HPA)axis (HPA)

Because it also involves the glands, it canBecause it also involves the glands, it can– speed the heart ratespeed the heart rate– bringing in oxygen/ nutrientsbringing in oxygen/ nutrients– increase strengthincrease strength– decrease reaction time (and to some degree decrease reaction time (and to some degree

short-circuit the inhibiting frontal lobes)short-circuit the inhibiting frontal lobes) This occurs very fast, allowing us to This occurs very fast, allowing us to

escape from danger, but it also keeps us escape from danger, but it also keeps us keyed up for a long while as the hormones keyed up for a long while as the hormones dissipate (resulting in the crash after use)dissipate (resulting in the crash after use)

HomeostasisHomeostasis“staying the same”“staying the same”

HormonesHormones– EstrogenEstrogen– TestosteroneTestosterone– Growth hormoneGrowth hormone– Insulin Insulin

NeurotransmittersNeurotransmitters– Acetylcholine, norepinephrine, Acetylcholine, norepinephrine,

dopamine, serotonin, GABA, dopamine, serotonin, GABA, endorphinsendorphins

Glands dump hormones in the Glands dump hormones in the blood streamblood stream

Central Nervous SystemCentral Nervous System

SomaticSomatic AutonomicAutonomic

– SympatheticSympathetic– ParasympatheticParasympathetic

A few notes on A few notes on neurotransmission:neurotransmission:

The neurotransmitter hits the The neurotransmitter hits the receptor sites & opens these cells receptor sites & opens these cells doors to allow ions/ charged particles doors to allow ions/ charged particles (potassium, sodium, chloride) to pass (potassium, sodium, chloride) to pass throughthrough

This alters the electrical nature of the This alters the electrical nature of the receiving cell- depolarizes it as receiving cell- depolarizes it as positive ions enter to produce an positive ions enter to produce an action potentialaction potential

Action PotentialAction Potential

Psychoactive drugs can fill Psychoactive drugs can fill receptor sites and prevent receptor sites and prevent

normal chemical transmissionsnormal chemical transmissions

Other drugs prevent reuptake Other drugs prevent reuptake of the neurotransmittersof the neurotransmitters

Drugs can operate in a variety of ways, but Drugs can operate in a variety of ways, but the ultimate result is the brain tries to the ultimate result is the brain tries to moderate the euphoria.moderate the euphoria.

The brain The brain reduces its responsereduces its response to artificial to artificial chemicals, reassuring addiction as the user chemicals, reassuring addiction as the user tries to reproduce the original high.tries to reproduce the original high.

When When brain chemistry is alteredbrain chemistry is altered, the brain , the brain can no longer produce “normal” by itself.can no longer produce “normal” by itself.

Now drug use is essential to feel “normal”.Now drug use is essential to feel “normal”. Now the user experiences Now the user experiences “withdrawal”.“withdrawal”.

The brainThe brain

Cerebral cortexCerebral cortex Basal gangliaBasal ganglia HypothalamusHypothalamus Limbic systemLimbic system Midbrain, pons, Midbrain, pons,

medullamedulla Lower brain stemLower brain stem

Different drugs work on Different drugs work on different parts of the braindifferent parts of the brain

Most mood alterations involve Most mood alterations involve dopaminedopamine

Dopamine is most effective in the Dopamine is most effective in the pleasure center of the brain (in the pleasure center of the brain (in the limbic system)limbic system)

The pleasure center is the nucleus The pleasure center is the nucleus accumbensaccumbens

A reward cascade occurs when A reward cascade occurs when dopamine causes GABA to be dopamine causes GABA to be increased, producing relaxation, increased, producing relaxation, sense of well-beingsense of well-being

Many things increase Many things increase dopaminedopamine

SSRI drugs work SSRI drugs work to moderate to moderate depressed moods depressed moods in a legal way but in a legal way but they can still they can still become addictive become addictive

Brain Imaging Brain Imaging TechniquesTechniques

PET scans-Positron PET scans-Positron emission tomographyemission tomography

MRI scans- MRI scans- Magnetic resonance Magnetic resonance imagingimaging

MRI scan & PET scanMRI scan & PET scan

The reward cascadeThe reward cascade

Serotonin (5-HT) is produced from Serotonin (5-HT) is produced from tryptophan (an amino acid)tryptophan (an amino acid)

Serotonin triggers enkephalins (internal or Serotonin triggers enkephalins (internal or endogenous opiates) which are inhibitorsendogenous opiates) which are inhibitors– Enkephalins & endorphins- Enkephalins & endorphins- keys to paradisekeys to paradise

GABA (which is a general inhibitor) is GABA (which is a general inhibitor) is decreaseddecreased

This allows for more dopamine production This allows for more dopamine production in the reward center (nucleus accumbens)in the reward center (nucleus accumbens)

Stimulation can be Stimulation can be conditionedconditioned

Once you have had a pleasurable Once you have had a pleasurable experience, anything associated with it experience, anything associated with it can trigger increases in dopamine as can trigger increases in dopamine as an expectation of rewardan expectation of reward

This triggers drug-seeking activityThis triggers drug-seeking activity Many things can produce pleasure- Many things can produce pleasure-

– eating, hugging, smoking, risk-takingeating, hugging, smoking, risk-taking Different drugs have differing powers Different drugs have differing powers

to increase dopamine – dependence to increase dopamine – dependence potentialpotential

Dependence potential of Dependence potential of Psychoactive drugsPsychoactive drugs

Very high: Heroin/ crack cocaineVery high: Heroin/ crack cocaine High: Morphine/ OpiumHigh: Morphine/ Opium Moderate/high: Cocaine/ tobacco/ PCPModerate/high: Cocaine/ tobacco/ PCP Moderate: Valium/ Alcohol/ Moderate: Valium/ Alcohol/

amphetaminesamphetamines Moderate/low: Moderate/low:

Caffeine/Ecstasy/MarijuanaCaffeine/Ecstasy/Marijuana Low: KetamineLow: Ketamine Very low: LSD/ Mescaline/ PsilocybinVery low: LSD/ Mescaline/ Psilocybin

It’s not just the power of the It’s not just the power of the drug that produces addictiondrug that produces addiction

Genetically it’s also linked to reward Genetically it’s also linked to reward sensitivity of different peoplesensitivity of different people

Some people have less enzymes Some people have less enzymes necessary to convert dopamine – necessary to convert dopamine – they simply feel less pleasurethey simply feel less pleasure

They may compensate by using They may compensate by using dopamine-enhancing drugs- opiates, dopamine-enhancing drugs- opiates, cocaine, methcocaine, meth

Using drugs to combat drug Using drugs to combat drug abuseabuse

Opium & cocaine were used as cures Opium & cocaine were used as cures for alcoholism (!)for alcoholism (!)

Heroin introduced to control Heroin introduced to control morphine addiction/ then methadone morphine addiction/ then methadone used- also addictiveused- also addictive

Antabuse used to make an alcoholic Antabuse used to make an alcoholic sick if he continues to drink- but if sick if he continues to drink- but if you don’t take it, you can drinkyou don’t take it, you can drink

Drugs activate the reward Drugs activate the reward paths up to 20 times better paths up to 20 times better

than natural pleasuresthan natural pleasures Once drugs are introduced, normally Once drugs are introduced, normally

satisfying things hold no charm as satisfying things hold no charm as the brain tries to reduce reactivity- the brain tries to reduce reactivity- building tolerance to the drugbuilding tolerance to the drug

Brain of a 20 year old cocaine user Brain of a 20 year old cocaine user can look like that of a 60 y.o. can look like that of a 60 y.o. Parkinson’s patientParkinson’s patient

Coping stylesCoping styles

SatiationSatiationArousalArousalFantasyFantasy