assessment and the physiology of addiction and mental health

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Addiction and Co-Occurring Disorders Part 2:

Physiology of Addiction and Mental Health Issues

Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUsPodcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery Author: Journey to Recovery (2015) & Happiness Isn’t Brain Surgery (2017)


Objectives Neurotransmitters Sex Hormones Thyroid Hormones Stress Hormones Physiology of Emotion and Motivation Physiology of Sleep Physiology of Eating Physiology of Stimulants Physiology of Depressants


Neurotransmitters--Inhibitory Serotonin

Broken down to make melatonin/sleep Bowel function Anxiety/Aggression Impulse control Depression? Pain control Sleep Alcohol impairs body’s ability to convert

tryptophan to serotonin…


Neurotransmitters--Inhibitory GABA

Sedative/depressive/anti-anxiety neurotransmitter

Improves concentration by filtering out “background noise”

Impulse control Glucose is necessary for the formation of GABA…

hypoglycemia can lead to a reduction in GABA


Neurotransmitters--Excitatory Glutamate

Glutamate is generally acknowledged to be the most important transmitter for normal brain function.

Excitatory Neurotransmitter Learning and Memory

Norepinepherine/Noradrenaline (Catecholamine) Increases arousal and alertness Promotes vigilance and focuses attention Enhances formation and retrieval of memory Restlessness and anxiety.


Neurotransmitters--Excitatory Dopamine (Catecholamine)

Broken down to make norepinehperine Motivation chemical (increased arousal and

pleasure) High levels of free dopamine in the brain

generally enhance mood and increase body movement (i.e., motor activity)

Too much dopamine may produce nervousness, irritability, aggressiveness, and paranoia


Stress/HPA-Axis In response to stress, the level of various

hormones changes. Reactions to stress are associated with enhanced

secretion of a number of hormones including glucocorticoids and catecholamines to increase mobilization of energy sources

The HPA-Axis is activated Cortisol (gluticocorticoid) is released Chatecholamines (i.e. adrenaline and dopamine) are

released Gonadotropins are suppressed


Sex Hormones Androgen/Testosterone

Concentration Mood (Irritability and depression) Increase in belly fat

Estrogen (Neurostimulant) Receptors are very abundant in the amygdala (emotion center) and

hypothalamus (autonomic nervous system/fight-flight-freeze) Estrogen increases serotonin receptor responsivity, increases the

number of serotonin receptors and enhances serotonin transport and uptake

High levels of estrogen associated with anxiety Low levels of estrogen associated with depression


Sex Hormones Progesterone

Imbalance in ratio with estrogen is implicated in mood disorders.

Referred to as the relaxation hormone Synthetic progesterone is associated with depression

Gonadotropins: Hormones synthesized and released by the anterior pituitary, and promote production of sex hormones

Oxytocin (bonding hormone): Can counteract cortisol and vice versa


Thyroid Hormones Thyroxine (T4) and Triiodothyronine (T3) Too much thyroid hormone speeds things up and too little

thyroid hormone slows things down The pituitary gland releases thyroid stimulating hormone to

get the thyroid to release T4 and T3 Majority of thyroid hormones produced by the thyroid are

T4, however T3 is the most active useable form The conversion of T4 to T3 is a critical element in this

puzzle. By testing TSH and T4 alone, doctors are assuming that our

bodies are properly converting the T4 to active T3.


Thyroid Hormones Cont… Over-activity

Anxiety - a feeling of nervousness, with butterflies, heart racing, trembling, irritability, sleep difficulties

Under-activity Depression - low mood and difficulty enjoying things, tearfulness, loss

of appetite and disturbed sleep Either over-activity or under-activity

Mood swings - snappiness or short-temper which people often call 'moodiness'

Sleeping difficulties What about other cognitive issues?

Difficulties with concentration Short-term memory lapses Lack of interest and mental alertness


More Thyroid… Serotonin and Thyroid Health

Hypothyroidism led to a significant decrease of responsiveness of the serotonin system.

Optimal thyroid function may be necessary for an optimal response to antidepressants

Hypothyroidism generally increases enzyme activities and GABA levels

Thyroid hormone plays a role in the output of dopamine (the precursor to norepinepherine our motivation chemical)


Stress Hormones Cortisol (Adrenals—Glucose)

Mental stress leads to chronic activation of the neuroendocrine systems.

Cortisol triggers a decrease in leptin and an increase in ghrelin, inducing increased appetite and food intake.

Affects the endocrine system, which produces all hormones, including

thyroid hormone (which regulates metabolism) insulin (which regulates blood sugar) sex hormones (estrogen, progesterone, and testosterone)

Affects the digestive system Affects the immune system Affects neurotransmitters, the brain chemicals that determine

energy, mood, mental clarity, focus, and sleep.


Stress Hormones Adrenaline Thyroxine (Thyroid—Fatty acids) Effects of Chronic Elevated Cortisol

Impaired cognitive performance Dampened thyroid function Blood sugar imbalances Sleep disruption Elevated blood pressure Lowered immune function Increased abdominal fat


Stress Hormones Cortisol—Chronically low levels

Brain fog, cloudy-headedness and mild depression Low thyroid function Blood sugar imbalances, such as hypoglycemia

(remember GABA??) Fatigue – especially morning and mid-afternoon fatigue Sleep disruption Low blood pressure Lowered immune function Inflammation


Physiology of Emotion In general

Stimulus received by peripheral nervous system Brain responds by triggering

Amygdala (emotion center)Hypothalamus assesses the need for fight or flightEmotional memory helps the brain determine the

types of neurochemicals to secrete and in what amounts

What happens if there is Too much chemical/hypersensitive receptorsToo little chemical/ insensitive receptors


Note All notations of excess and insufficiency are

relative to the proportions of all other hormones and neurotransmitters


Physiology of Emotion Anxiety/Irritability/Anger (threat response)

Serotonin insufficiency GABA insufficiency Norepinepherine excess Estrogen excess Testosterone excess Thyroid hormone excess


Physiology of Emotion Happiness/Excitement

Dopamine Norepinepherine Glutamate Serotonin (for balance)


Physiology of Emotion Depression

Serotonin insufficiency or excess Norepinepherine insufficiency Dopamine insufficiency Thyroid (T3) insufficiency Estrogen insufficiency or excess


Physiology of Depression A New England Journal of Medicine review on

Major Depression, stated: “… numerous studies of norepinephrine and

serotonin metabolites in plasma, urine, and cerebrospinal fluid as well as postmortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably.”


Physiology of Sleep Estrogen and progesterone modulate sleep—

too much estrogen can cause insomnia Sleep deficiency promotes elevated cortisol

and further disrupts ghrelin and leptin (elevated nor-epinpherine and Stress Response Hormones)

Sleep deficiency is related to a 30% reduction in thyroid hormone levels. (GABA, Serotonin)


Physiology of Eating Serotonin suppresses appetite and increases

with feeding Dopamine is associated with satiety Cortisol increases appetite Neurons involved in the regulation of feeding

are located mainly in the hypothalamus Ghrelin & Leptin regulate hunger and satiety


Physiology of Stimulants Stimulants

Set off the Stress Response SystemThyroid hormonesStress hormonesSuppression of sex hormonesExcitatory Neurotransmitters

Dopamine (pleasure/reward) Norepinepherine (focus/concentration)


Physiology of Depressants Increase GABA May increase serotonin (i.e. alcohol)


Summary There are a variety of neurotransmitters that are

implicated in moods. Sex, stress and thyroid hormones, among others

modulate the secretion and absorption (i.e. availability) of these neurotransmitters

Dysphoria is about having an imbalance. You may have too much X in relation to Y.

Sleep deprivation directly contributes to alterations in hormone and neurotransmitter levels

Excessive eating may be caused by high cortisol levels because the brain thinks it needs to store energy for the long fight


Summary Sex hormones also impact the availability of

serotonin One sex hormone, oxytocin, has been shown

to inhibit cortisol Dysphoric moods are caused by a

neurotransmitter imbalance. What causes that imbalance in each person varies greatly.

A cascade effect can happen when one “system” goes offline

Final Thoughts Chronic stress impairs sleep which causes imbalances in hormones

and neurotransmitters involved in Eating Sleeping Mood Attention Motivation Sex

Disruptions in nutrition can fail to provide the building blocks for the hormones and neurotransmitters

Sleep impairment is associated with Decreases in thyroid hormones Increases in cortisol levels Dysregulation of feeding hormones

Estrogen and Testosterone imbalances can cause depression or anxiety

Thyroid hormone imbalances cause depression or anxiety


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