Transcript
Addiction & the Brain
Communication in the Brain
Human behaviour and emotions are controlled by neurotransmitters that act as “keys” between neurons.
The amount of any given neurotransmitter in the brain’s circuits is precisely controlled by feedback mechanisms – like the way that a thermostat controls temperature.
Drugs are substances that disturb this delicate balance, because they have “passkeys” (chemicals) that let them open certain “locks” (receptors) located between the neurons.
The brain automatically adjusts to these substances from outside the body by producing fewer of its own natural “keys”.
It thereby achieves a new state of ‘balance’ that is maintained until the body starts to miss the external substance.
At that point, the person experiences a craving that will persist until the neurons that stopped producing get back to work.
There are over 100 identified neurotransmitters, and evidence suggests there are substantially more.
We know that despite
their many differences,
most abused substances affect the
dopamine and serotonin pathways
This reward circuit that is overstimulated by drugs uses a particular neurotransmitter called dopamine.
It is not surprising then to discover that practically all of the drugs that cause dependencies affect the amount of dopamine in the reward circuit.
Circuits Involved in Addiction
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How do drugs affect the brain?
Some substances imitate natural neurotransmitters and take their place on their receptors.
Morphine, for example, binds to the receptors for endorphin (a natural "morphine" produced by the brain).
Other substances increase the secretion of natural neurotransmitters. Cocaine, for example, mainly increases the amount of dopamine in the synapses, while ecstasy mainly increases the amount of serotonin.
Still other substances block a natural neurotransmitter. Alcohol, for example, blocks the NMDA receptors.
Dopamine is involved in many functions that are essential for survival such as attentiveness, motivation, learning, and memorization.
Most of all, dopamine is a key element in identifying natural rewards. Natural stimuli such as food and water cause us to engage in certain behaviours.
Unconscious memorization of signs associated with reward.
Not all drugs affect dopamine levels in the same way.
Serotonin plays an important part in the regulation of learning, mood, sleep, appetite and constriction of blood vessels
Low serotonin is connected to such psychological problems as depression, anxiety, seasonal affective disorder, and obsessive-compulsive disorder
Not all drugs affect serotonin levels in the same way.
Drugs and alcohol have an enormous effect on the brain.
Often misdiagnosed whilst in active addiction, and prescribed medication incorrectly as a result.
Only once drugs and alcohol are out of the system can accurate observation and diagnosis (if any) be made.
Medical Intervention
If misdiagnosis is suspected medication will be altered, reduced, or stopped to evaluate the person. Through this process it will become evident as to whether or not medication is necessary.
In the initial phase of treatment it may be necessary to use medication in order to stabilise brain function. Once this stability has been achieved and maintained for a period of time the medication will be reviewed and where necessary altered, reduced or stopped.
It is vital that this is done in consultation with a doctor, preferably a psychiatrist.
Psychiatric medication cannot be stopped at
once, altogether – this is very dangerous.
The necessity for, amount, and period of use of medication is dependent on the damage caused to the brain, and on any underlying factors that may be present (depression, bi-polar, etc.)
Anti-depressants
Fluoxetine (Prozac; Nuzak; Lilly Fluoxetine)
Sertraline (Zoloft; Serdep; Serlife)
Venlafaxine (Efexor; Venlor)
Citalopram (Cipramil; Cipralex; Lexamil)
Aimed at stabilising Serotonin levels.
Anti-psychotics
Risperidone (Risperdal)
Quetiapine (Seroquel; Serez)
Olanzapine (Zyprexa)
Aimed at stabilising Dopamine levels. Quetiapine has a sedative effect, and has been found to further help with anxiety.
Mood stabilisers
Lamotragine (Epitech; Lamictin)
Valproate (Epilim; Depakote)
Carbamazepine (Tegretol)
Topiramate (Topamax)
Aimed at stabilising fluctuating mood. Often used in conjunction with anti-depressant.
Anxiolytics
Benzodiazepines (Aimed at short-term relief of
severe and disabling anxiety). Highly addictive.
Diazepam (Valium)
Clonazepam (Rivotril)
Lorazepam (Ativan)
Clobazam (Urbanol)
Dual diagnoses/Co-morbidity
Addiction and coexisting psychiatric illness. E.g. Alcoholism and depression.
Includes amongst others, depression, mood
disorders, social phobias, personality disorders.
Addiction – primary; psychiatric illness – secondary
Psychiatric illness – primary; addiction secondary
Coexisting psychiatric illness must be treated alongside addiction – it cannot be treated before or after addiction treatment, and addiction cannot be treated before or after the coexisting illness.
Symptoms of one problem may mask or worsen the symptoms of the other.
If dealt with separately, and not concurrently, one problem will inevitably trigger the other.
Denial and acceptance
Motivation for change
Adherence to treatment and post-treatment plans
Lifestyle, psychological and emotional health, social abilities and interactions, spiritual life
Compliance with medication
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