ADDICTION: Asking the right questions!

How much of the problem is nature and how much is nurture?Or is it a disease of the brain?

Why do we self-medicate?I have asked this question to over 1,000 offenders. The same reasons are given!• ‘want to fit in’• ‘I am different’• ‘I’m a freak’• ‘It makes me feel more confident’• ‘I’m boring when I’m sober.’• ‘I want to block out the past.’• ‘I want everything to feel OK.’• ‘I get bored.’• ‘Life is dull if I cannot drink.’• ‘I won’t have a social life without

alcohol.’• ‘It hurts too much to be sober.’• ‘Everyone drinks: I’ll be the odd

one out.’• ‘The pain inside my head is too

much to bear.’• ‘I came back from Iraq. I should

have died with my mates.’

What is normal brain development?‘The Scientist’: Feb 2nd 2014‘Pruning synapses, improves brain connections’.What is synaptic pruning?What happens if it doesn’t take place?

The normal brain has resident MICROGLIA [resident immune cells that engulf damaged cells.] Absence of microglia may contribute to autism/OCD. [Nature Neuroscience, Feb 3,2014.]

Three of our chief neurotransmitters, with which we are born, are –NORADRENALINEDOPAMINESEROTONINWithin normal people there is sometimes less of one of these. Only when the imbalance is greater, do we find the emergence of problems.

DSM 1V [DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS].

Within this manual, used by psychiatrists and mental health professionals, there are descriptions of multiple addictions, each tied to a specific substance or activity. The consensus is emerging that these may represent multiple expressions of a common underlying brain process. Addiction changes the brain, first by subverting the way it registers

pleasure, and then by corrupting other normal desires such as learning and motivation.

Stephen Melemis [Feb. 2014, refers to addiction as a disease of the wiring of the brain –www.Addictions and recovery.org]

Koob GF, describes addiction as ‘the hijacking of the brain’ 2012.

DEFINITION OF ADDICTION -Addiction is characterised by INABILITY to consistently ABSTAIN;Impairment in BEHAVIOURAL control;CRAVING; or increased hunger for drugs or rewarding experiences;DIMINISHED recognition of significant problems with one’s behaviour, and a dysfunctional EMOTIONAL response.

The addicted brain is one where the brain receptors become overwhelmed.

The closest concrete analogy is the National Grid being forced to shut down certain areas in order to meet demand – eg Dec 25th – multiple homes cooking Christmas dinner!

THE REWARD PATHWAY• The reward pathway has long

been known about in the terms of the dopamine neurotransmitter being in charge of pleasure. But, when drugs are used repeatedly, the dopaminergic pathway is damaged, and the brain responds to the ‘flooding’ by producing less dopamine or eliminating dopamine receptors. [In concrete terms, it is similar to turning down the volume on a loudspeaker when the noise becomes too loud].

New research shows the interplay between the regions of the brain!

• The site of action for addiction is the interplay between the frontal lobes and the nucleus accumbens, and the hippocampus, and the amygdala.

• The substances hijack the reward system and the individual compulsively pursues these rewards instead of natural rewards.

• Addictive drugs can release 2-10 times the amount of dopamine that natural rewards do!

• Feature of the addict: When do we want it? We want it now – and lots of it!

Armed with this knowledge, who is most likely to be affected?

• Genetic factors account for between 40% and 60% of those who become addicted.

• Children who have been exposed in utero to maternal alcohol consumption are highly pre-disposed to becoming addicted.

• Environmental influences and exposure to trauma interact with the person’s biology.

• Young people are ill- advised to partake in binge drinking, since the brain is not fully physiologically developed until age 24.

• Those with poor supports and under- developed resiliences as a result of poor nurture, will not have the coping mechanisms nor the adult listening ear to enable sound decisions.

• We often hear addicts say – ‘I want to block out the bad stuff’. The trouble is, that the brain cannot discriminate between good and bad – it blocks out and shuts down all emotions, resulting in an inability to function!

Why do different people select different drugs?

• Cocaine’s chemical formula mimics dopamine’s formula. Cocaine blocks the re-uptake of dopamine which then accumulates in the synapse to stimulate receptors further and cause the person to feel extremely good. [Tomkins and Sellers].The wanting more leads to powerful cravings – followed by repetitive use- and long-term damage to dopamine levels in brain.Other drugs that mimic dopamine are methamphetamine,dexedrine,ritalin and addererol [Kipper and Whitney].Less harmful mimics of dopamine are caffeine and sugar. An excess of dopamine in children can cause ADD and ADHD. FAS children can also end up with ADHD as a result of maternal alcohol consumption.

• Those people who have a lack of serotonin – the neurotransmitter responsible for moods and emotions, are most likely to self- medicate with with alcohol/heroin. Both of these drugs mimic serotonin – making the person feel better. Prozac – is a serotonin and noradrenalin re-uptake inhibitor. They block the re-uptake of serotonin and enable it to remain in the syntax where it can stimulate receptors. It is for this reason, that there are some addicts who will require very lengthy medical interventions to enable them to function ‘normally’.

• The structure of neurons can be changed permanently. This needs to be understood in order to create a programme of recovery for those who are seeking abstinence and maintenance of a drug free life.

• Noradrenaline keeps us informed of potential threats and is in charge of our flight/fight/freeze responses. An over abundance of noradrenaline leads to anxiety ; a massive amount leads to panic. High levels of noradrenaline over a sustained period result in sleep disorders and in complex mental health problems. In these cases, addicts will gravitate towards Valium/Xanax/Ativan/Marijuana/nicotine.

‘I am where I am, therefore, with God’s help, I will be the best I can be, and I will share my sobriety with anyone who wants help.’

‘When you hold onto the past with one hand and grab at the future with the other, you have nothing with which you can hold on to today.’

‘You cannot get ahead until you learn to be here.’

‘Our sickness is between our ears.’

‘Alcohol was my strength, then I learned it was my weakness.’

‘Each day I wake up and go through my long list of reasons for being grateful, and I know that I am truly rich.’

Tomorrow has gone…today is here…it is the present, and in its truest sense it is a gift!

• Recovery is more than stopping drug use – it is a return of the senses – a renewal of the mind and spirit – and an intense awareness of beauty.

• It is a recognition that we need to keep life simple. Respect ourselves, and others, and find a way to give back to those who are still struggling.