Addiction Recovery Basics

Undoubtedly a keystone interview on addiction and the biology of the brain. These are easy to understand Q and A’s, perhaps the best of its kind on brain addiction biology.

When I first read that there was a biological explanation for addiction and my behavior, I remember thinking “Thank goodness, I’m not crazy”.

The following is the edited transcript of an interview by Bill Moyers with Steven Hyman, M.D., on the brain and its role in addiction. Hyman directed the National Institute of Mental Health. Portions of this interview appear in the CLOSE TO HOME series.

Moyers: You’ve said in the past that we have to stop thinking about the brain as an impenetrable black box, a bag of chemicals that we can never comprehend. How should we consider it?

Hyman: We now have the tools to begin to understand how the brain works. There’s a great deal we still don’t know, but what we’re finding is really remarkable. As we learn to understand the brain, we’re going to increasingly understand how we as human beings work. How we learn and also how we get sick. How we get mental illnesses, including addictions.

Looking at the brain as a black box separates us from our brains, in essence. It leads to this kind of thinking which separates body and mind. And we have to understand how things go wrong in the brain, if we’re going to understand how things go wrong in our mental life and our behavior.

Moyers: You’ve also referred to the brain as a universe. What do you mean by that?

Hyman: The brain is the most complex structure we’ve discovered. It has a hundred billion cells, but by itself that fact isn’t particularly remarkable. Unlike other organs in the body, however, those hundred billion cells are made up of thousands of distinct cell types. Different kinds of cells with different shapes and different chemical natures. And those cells communicate with each other in a marvelously precise, but marvelously complex, network of intercommunication. And they communicate using more than a hundred different chemicals.

Moyers: Chemicals which in a way are the equivalent of our words, our language?

Hyman: Yes, that’s a good way of putting it. The only thing is that the brain has different ways of decoding each word or each chemical. And the decoders are called receptors. So for a chemical that people have probably heard about like serotonin — which has been in the news because many modern anti-depressants work on it — there are at least fifteen different kinds of receptors or decoders. Obviously that’s a very rich and complex signal. But besides the fact that the brain is so complex in its wiring and in its chemistry, in many ways the crowning complexity of the brain is that it changes. It changes with experience. Every time you learn something your brain is physically changed. There’s this old idea that the brain is some kind of hardware and thoughts, for example, might be considered software running on it. But that’s not quite right.

Because literally the physical nature of the brain itself is changed by experience. By drugs, by chemicals, by all kinds of things.

Moyers: On the plane earlier, I saw an ad for a long distance phone call company. And I make a lot of long distance calls from the road. Over time I’ve come to punch in their number automatically, without thinking. My brain changed to learn that?

Hyman: Absolutely. How else could it be? How is that you could take a random fact that you’ve come across somewhere in your world and carry it with you for days or weeks or years, maybe for a lifetime? Memory is not written in the clouds or on some ghostly material. It literally is recorded by changes in the brain. What’s happened is that some of the specialized connections between nerve cells, called synapses, have been altered.

To store a memory, some synapses have a stronger connection. Maybe more chemical signal is being transmitted across that synapse. Others perhaps have a weaker connection. But there is a literal, physical change in your brain for every memory.

Moyers: What are things like the PET scan and other brain imaging techniques doing for your research?

Hyman: Modern noninvasive neuro-imaging, PET scans, MRIs are very important. They’re allowing us to see the living, thinking, feeling, human brain at work. In the past, there were certain experiments that could only be done on animals. But there are lots of things we can’t ask a rodent or a monkey because they can’t describe their subjective experiences. These techniques allow us to take what we’ve learned from animal models and look at what happens in the human brain. What happens when we experience fear? What happens when we formulate a sentence or remember something? And I have to tell you it is really with a certain amount of awe that I experience some of the results that we’re getting.

Moyers: Can you look at these PET scans, these images, and see this communication taking place?

Hyman: Yes. We can image desire in the brain.

Moyers: And see the receptors all engaged in this lively conversation?

Hyman: Well, I’m afraid we can’t quite do that yet. Because things in the brain are so small. Inside our heads we have maybe a quadrillion synapses. A number that is hard to even imagine. And looking from the outside even with these wonderful tools we can’t literally see individual synapses or even small assemblies of cells. What we see are many cells working together. And that’s why we have to go back and forth between human research and animal models where we can use much finer methods, to see what’s happening at the synaptic level.

Moyers: What’s the most important thing we’re learning about addiction from brain research?

Hyman: Well, one very important insight is the recognition that in vulnerable individuals, the disease of addiction is produced by chronic administration of the drugs themselves. Drugs of abuse appear to commandeer circuits in the brain that are involved in the control of motivation, which means the addicted person’s will can be impaired.

Moyers: OK, now we’re back to addiction and the brain. So there’s solid evidence that alcohol, tobacco, cocaine, and heroin physically change the brain?

Hyman: There is incontrovertible evidence that these drugs physically change the brain. At all levels, beginning with molecular and chemical changes. In many cases we can actually see changes in the structure of synapses and in the shape of cells. Above all, what we’re seeing are the kinds of changes in the way nerve cells communicate with each other that would impact our subjective life and our behavior.

Moyers: You mean drugs change not only the physical size and shape of the cell but the psychological operation of the brain as well?

Hyman: Yes. The psychological operation of the brain — how we feel about ourselves, what we do — reflects the workings of networks of nerve cells. And these drugs change the way that these networks function. And therefore, they can change our behavior.

Moyers: Do these four main drugs all change the brain in the same way?

Hyman: There are some shared properties and some differences. The shared properties have to do with a particular brain pathway — sometimes called the reward circuitry — which is where all drugs of abuse, directly or indirectly, have their effect. This pathway is rather deep in the brain. It extends from a structure called the midbrain and sends projections of nerve cells (they are called axons) to a part of the brain called the nucleus accumbens. In Latin, that means “leaning nucleus,” and it’s named because of its shape. The nucleus accumbens is in an area involved in the processing of emotions. This circuit has to do with, among other things, learning what’s good for us. You see, learning that occurs in the presence of strong emotion is very different from trying to remember something that seems dry as dust. Let’s say a child touches a hot stove. Well, that child certainly doesn’t have to study or practice the idea that you don’t touch a hot stove twice. The child will learn in a profound way and carry that for the rest of his or her life.

Moyers: Mark Twain said that when a cat sits on a hot stove it won’t sit on that stove again.

Hyman: [CHUCKLES] That’s right.

Moyers: But neither will it sit on a cold stove.

Hyman: And the difference between the human and the cat is that we can learn about different contexts.

Moyers: So what happens when a child touches the hot stove?

Hyman: Well, part of the brain which is involved in emotion, in this case something called the amygdala, basically says, “Ouch. This is bad, we’re not going to do this again.” And the child has a subjective response to the hot stove, which is very negative: aversive, we call it. And all kinds of things are happening in the brain. Among them is something called emotional memory. The child is going to associate anything now that looks like a stove with a negative consequence. And the next time the child encounters a hot stove, the child is not going to have to say, “Hmm, now let me recall . . . did I do my homework? Do I or don’t I touch this?” Quite the contrary. The child may actually recoil. And anyone who’s suffered a terrible accident — we see this in post-traumatic stress disorder — can be reminded in a full-blooded way of the entire scene by just one cue. The entire emotional panoply, including changes in heart rate and all kinds of negative feelings, can be evoked. That’s on the negative side. We also have circuits, not quite as well understood, on the positive side. And these are the circuits that are used by drugs of abuse. In the 1950s in Canada, two scientists named James Olds and Peter Milner did a very crucial and famous experiment. They wanted to know whether there were areas of the brain which would respond positively to electrical stimulation, which would feel good when stimulated. So they put electrodes in the brains of rats. And there were levers for the rats to press which would let them stimulate themselves.

Not surprisingly, there were some locations where the rat treated the lever with a great deal of respect, as if perhaps it had caused something very painful. Most locations of the electrode were really quite neutral. The rodent would treat the lever as just another piece of furniture in its cage.

But there were a small number where the rodent would literally push the lever tens of thousands of times in succession until exhaustion supervened and the rat fell asleep. That electrical stimulation was apparently very pleasing, very exciting to the rat. Now, in the pop-psych literature, this area got called the pleasure center. It is the same evolutionarily very old meso-accumbens projection that I’ve been discussing. And the nucleus accumbens seems to have a particular role in telling us what might be pleasing, what might be good for us. What we want. What we desire.

Moyers: So the rat pushed the lever over and over because the stimulation was giving something of a “high?”

Hyman: Yes, it hit that spot which said, “That feels good, do it again and remember how to do it.” And we as humans have a spot like that as well.

Moyers: Drugs, alcohol, tobacco, all converge on that same brain region?

Hyman: Yes, they do. The brain communicates with chemicals, it uses chemicals as its “words” and those chemicals control the brain’s electrical activity. And what all the addictive drugs have in common is that they are mimics. They masquerade as natural chemicals in these reward circuits. Drugs like cocaine, for example, are like Trojan horses. In essence, what coke does is it gets into the apparatus that usually turns off the dopamine signal. And this apparatus recognizes that “Hey, this thing isn’t dopamine at all,” but it’s already blocked. So it can’t send the signal “no more dopamine” — it’s quite literally a Trojan horse.

Moyers: The cocaine tricks the brain into making dopamine more active?

Hyman: That’s exactly right. Now, let’s think about this brain reward circuit and what it might be doing. Say that you have discovered a delicious and wonderful new food. You don’t have to study this, you remember it right away and you remember it with pleasure and with indeed a certain amount of desire. When this memory is laid down, a certain amount of dopamine is probably released in this brain reward circuit, in this meso-accumbens circuit.

Moyers: So why doesn’t the brain get addicted to broccoli?

Hyman: The simple answer is that broccoli doesn’t have chemicals in it which short-circuit the system and provide abnormally elevated rewards. Because what people who use cocaine or amphetamine discover is that they can circumvent all of the work it normally takes to get some natural reward. I’ve talked about discovering the good taste of a new food. But imagine that you’ve just finished a marvelous documentary. And you feel a certain amount of pride and reward and you get a certain amount of dopamine for that.

To continue click on to Part 2

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