Fetal Alcohol Syndrome falls under the newly created a more correct umbrella term of Fetal Alcohol Spectrum Disorders (FASD).

As you may guess, FASD covers a wide range of symptoms and effects that may affect a baby born to a mother who drinks during pregnancy. The effects on the child can include learning disabilities, physical and mental impairments, and behavioral difficulties. The implications can be lifelong for the child.

FASD is the term now being used to cover the study Fetal Alcohol Syndrome, FAS and Fetal Alcohol Effects, FAE. Current estimates put the number of babies affected by this group of symptoms at approximately 40,000 per year. It is the single largest preventable birth defect. The method of prevention is for the mother not to consume alcohol during pregnancy.

Since the fetus and the mother share the same blood supply in alcohol enters the body through the blood system, when a pregnant woman drinks it is as if the baby is drinking also. Any amount of alcohol consumed by a pregnant woman is potentially harmful to the fetus. It does not matter what form the alcohol is in. Whether a person drinks wine, hard liquor, light beer, alcohol is alcohol.

No amount of alcohol can safely be consumed during pregnancy. This is a conservative and cautious approach. Since each person’s body metabolize alcohol in a different way in a different rate, it is difficult for researchers to make a categorical statement that any specific amount of alcohol will have any specific effect. But the fact remains if you do not want trouble without the hall don’t drink it. Not drinking alcohol will prevent FASD.

Ok, hear me out on this. All you scientists please resist the temptation to blow me out of the water. I am going to use simple concepts for complex processes.

Here is why addiction is tough to beat. For the purposes of this discussion, let’s say that dopamine is the “feel good” chemical in the brain. It occurs naturally in certain quantities. When we engage in pleasurable activities, the Dopamine is released and we feel good. But, these activities are actually deep seeded survival mechanisms.They exist in that part of the brain dealing with survival of the species.

For instance we need to eat to survive, and procreate or have sex to insure the survival of the species. Here is what the Dopamine release looks like for rats in a clinical trial.

When the rats were given food the Dopamine level increased about 160%. When they were allowed to have sex, the level went to 200%. The bottom of the graph is time to return to normal. So, on a primal level over many years the brain has ‘rewarded’ us for doing things to survive. We want to feel good again sooo….more food, more sex.

In the upper right is the Dopamine release for Amphetamine (Meth) 1050% increase, below that left is Nicotine225% increase, upper right is cocaine 350% increase, lower right is Morphine(opiate)., 200% increase.

In other words, we have tricked our brain into feeling astronomically better than we could naturally. The instinct part of the brain says an increase in Dopamine indicates the successful execution of a survival mechanism and wants more.

OK, before the scientists blow me out of the water, just think about it. The executive, thinking part of the brain says logically I know I shouldn’t use it makes no intellectual sense. We use. Why? Because the instinct for survival and the pleasure/reward system is far older and more powerful than our conscious thought.

Do me a favor and leave a comment on this post…thanks.

In Part 1 of this 2 part article we looked at some personality factors. In this, the conclusion, we will move to the biological factors of addiction.

I am pretty embarrassed to say this but I may have misled you on the title of the article. This second part is really more about the biology of addiction and the  the vie addiction is a brain disease, rather than inherited genetic traits. I hope you still find it a good read.

The work comes from an interview is an 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: 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: 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: There’s no natural high quite as high as a drug high?

Hyman: No, because the drugs really do trick the brain. Cocaine and amphetamine put more dopamine in key synapses over a longer period of time in this brain reward pathway than normal. And because they are so rewarding, because they tap right into a circuit that we have in our brains, whose job it is to say something like, “Yes, that was good. Let’s do it again and let’s remember exactly how we did it,” people will take these drugs again and again and again.

Moyers: His body is saying it wants more dopamine, he can’t get it, so he physically gets depressed.

Hyman: In effect, yes. But the addict doesn’t know that that’s what’s happening. What the addict knows, or thinks is correct, is, “I will feel better if I put myself back in this precise context where I felt good and use my drug.” This is the learning side of it, the emotional memory. It may not be true that taking the drug will make him feel better, but that’s what using the drug teaches him. And part of that memory is not only the emotion, but the whole context. The friends that they see when they are using drugs, the paraphernalia, the kind of room they are in or the kind of alley, all become attached to the ritual and the feelings of getting high. They become part of the brain’s “emotional memory.”

Moyers: That’s why AA talks about “people, places, and things.” Avoid the people you used with, avoid the places you used, and avoid the things associated with use like the pipe.

Hyman: That’s absolutely right. Remember, the dopamine in this brain reward circuit is still saying, “That was good, let’s do it again, and let’s remember exactly how we did it.” So there’s this emotional learning that goes on which is in many ways the longest lived change in the brain.

Moyers: Perhaps this is what we mean when we talk about indelible memories.

Hyman: I think that’s right. And one of the things that Alcoholics Anonymous says is that alcoholics are not recovered, they are recovering. I think they’re right because there are many things in the brain that make it likely that once addicted you’re at high risk of relapse and one of the most important is this indelible memory.

We know that when people are detoxified and then they’re back in a situation where they used to use drugs, they may experience certain feelings. In the case of the cocaine user, they might feel a little bit high. Which makes them want more. In the case of the heroin addict, some of them actually feel a little bit of withdrawal, and that makes them want the drug.

A common experience for ex-smokers is that they’ll have a festive meal and be reminded that they used to enjoy a cigarette at such times and they will feel waves of craving. These are cues which are awakening these powerful memories. When something is highly rewarding, we are likely to remember it vividly and also to remember the circumstances under which we encountered it. Even after years of abstinence, people may experience profound cravings and risk relapse if placed in the surroundings of their former drug use.

_________________________________________________

I know that I did not answer the question posed definitively. It is your job to take what you need and leave the rest. I, personally, find it fascinating that many of the old beliefs and posits of Alcoholics Anonymous written 70 years ago are now being validated by science. All the AA old timers had going for them was intimate knowledge, keen intuition and good powers of observation. To read this interview in its entirety go to :

Addiction, A Disease:Brain Biology Questions And Answers That Are Easily Understandable. Part 1 of 3

Addiction, A Disease:Brain Biology Questions And Answers That Are Easily Understandable. Part 2 of 3

Addiction, A Disease:Brain Biology Questions And Answers That Are Easily Understandable. Part 3 of 3

I was intrigued by the fact that for $399 you could spit in a cup, send it off in the mail, and have genetic testing done. There is an explosion of companies advertising these services on the Internet.

I began to wonder what the limits of genetic testing were. Could this genome testing predict mental illnesses, such as depression, drug addiction, and alcoholism?

What would parents do if they tested their baby and found out he was doomed to alcoholism or drug addiction? What if the tests could be done during pregnancy, before the baby was born? What are the ethical and moral implications?

What would you do…?

It seems that every year with disturbing regularity, the media jumps all over some new claim of having found the genetic marker for alcoholism or drug addiction, implying a ‘cure’ is at hand. Just as frequently, there is an announcement of “the Magic Pill” that will either cure addiction or allow people to continue to use with impunity.

Now We Have The Advent Of Genetic Testing

Genetic testing, for me,  raises two important questions:

1. Can the testing be predictive of mental health diseases?
2. Is there value in these tests being offered on the Internet?

Regarding the first question The National Institute Of Mental Health has this to say concerning the ability of genetic testing to predict mental health diseases:

Q. Can the new genome scans tell me what diseases I might get?

“A. To date, no gene variants are known that can predict with certainty whether or not someone will get a number of common diseases, including mental illnesses. Scientists haven’t yet discovered whether many of the gene variations that occur in humans are connected to specific diseases or how much they raise or lower the risk.”

Genetic tests for some rare diseases clearly tied to a specific, single gene, like cystic fibrosis, fragile X syndrome (a heritable cause of mental retardation), or sickle cell disease, give people definitive answers about their risk of getting these rare illnesses.”

Almost all mental health professionals would agree that a mental health illness is a combination of many risk factors, not just genetics. In fact there is controversy about genetics being involved at all.

Question #2. Is there value in these tests being offered on the Internet?

“People are always rushing to the market on the basis of one or two studies,” said Dr. Muin Khoury, director of the National Office of Public Health Genomics at the Centers for Disease Control and Prevention. “We have very little evidence that telling people their genetic information is going to make any difference.”

A report on msnbc states that “The proliferation of these tests (genetic) troubles many public health officials, medical ethicists and doctors. The tests receive almost no government oversight, even though many of them are being sold as tools for making serious medical decisions.

Health experts worry that many of these products are built on thin data and are preying on individuals’ deepest anxieties.”

John M. Grohol, Psy.D pulls no punches: “The first wave of companies is coming on the scene to peddle genetic tests that purport to help people see if they have genes associated with possible higher incidences of a particular disease or condition. Sound a little fishy? Well, given the complexity of genomics today, it is.

We consider all these kinds of genetic tests scams — elaborate tests draped in scientific mumbo-jumbo that provide little actionable information, or information that can’t already be readily obtained more easily and cheaply elsewhere.”

Family History Gives You Good Clues About Your Risk

Your family history is one of your best clues about your risk of developing many common illnesses, including mental disorders.

For example, bipolar disorder and schizophrenia tend to run in families. At this time, no type of genetic testing can tell you whether or not you will develop mental illnesses. Not enough is known about which gene variations contribute to them, or the degree to which other factors contribute.

For now, your family history may be your best indicator. For example, studies show that if you have a close relative with bipolar disorder, you have about a 10 percent chance of getting a mood disorder, such as bipolar disorder or depression.1

Now consider what the gene variations scientists have linked to mental disorders, so far, can tell you about your risk. Even the variations with the strongest ties raise the risk by only very small amounts. Knowing that you have one of these variations won’t tell you nearly as much about your risk as your family history can.

Family history also provides a good clue about your risk of rare diseases that can be detected through genetic testing. If one of these rare diseases, such as cystic fibrosis, runs in your family, your risk is likely very high.

If a disease runs in your family, your health-care provider can tell you if it’s the kind of illness that can be detected through genetic testing at this time.

Having looked at lot facts from reputable sources, and given the state of the art of genetic testing at this time, there is no way of predicting mental illness, such as addiction at this time. The question arising form the concept of genetic testing predicting mental illness is very disturbing, however.

What do you think? Please feel free to leave a comment.

Our friends around the net:

The High Cost of Alcoholism by Cheryl Lavin on Creators.com – A … – Cheryl Lavin Lifestyle Columns – The High Cost of Alcoholism.

Intentional Parenting Requires Courage, Vision, And Accountability – Ann Marier asked: Many parents may not be aware of what it takes to be an intentional parent. Of course, parenting is an ongoing process that teaches parents.

All About Parenting Blog Carnival: Birthdays! – And if you have a child with special needs – or your kids’ have friends or classmates with disabilitiies – you’ll want to read Terri Mauro’s compassionate take, “Birthday Party Trauma,” on About.com’s parenting special children site. …

Single Parenting: You Are Worthy – Single Parents – Families.com – A single parent due to divorce, your spirit is a little wounded at this point. You have been hurt in some form and your self-esteem is on the lower end of feeling good about yourself. Whatever the circumstances of your divorce you need …

Good parenting – Parents and the home environment are the most important factors in shaping a child’s wellbeing, writes Angela Sibson. In recent years the importance of parenting has moved up the public policy agenda, leading to a huge growth in …

The Thinking Mother: Parenting is Hard: A Story – I just had one of those moments where I’m reminded how hard parenting is. And how it seems that sometimes the hard parts seldom get discussed. These hard things are not the romantic notions of parenting that people often think about …

Modern Mommy Blog – Parenting in the 21st century » Mommy Tip of … – Parenting toddlers can be such a challenge and often times cause fights between you and your spouse. I know for me I thought we had this parenting thing all figured out and that we were on the same page with everything. …

When some one suffers an alcoholic blackout, he remains conscious for the whole time, but will not be able to recall what happened at the time of the alcohol blackout. It is as if events are never imprinted on the brain for recall. It can also be called loss of memory, but it occurs due to excessive consumption of alcohol and not as a result of some serious injury or accident.

The two most popular kinds of alcohol blackouts researched are:

1. Unconsciousness, up to some extent or not completely.

These tend to occur when lower levels of alcohol are taken. When talking to people you may forget names, or you may suddenly forget what you were talking about. During the time of intoxication these will somewhat interfere with memory formation. People can sometimes remember the missing pieces if they are prompted or reminded of the context of conversation or situation.

2. Full or total blackouts

Although seemingly not in his normal state, someone with a complete alcohol blackout is physically and mentally able to perform actions.
During this kind of blackout, a person is still conscious – but is unable to remember what has occurred during the time of his blackout, he will not remember anything what so ever. Attempts to bring about or trigger memories will not succeed. Apparently the ability to transfer and imprint memory of the storage of the present and short term to the long term is blocked.

How blackouts are caused by alcohol and drugs:

In the majority of cases, blackouts happen due to someone going on a drinking binge, which is, consuming a large quantity of liquor in just a short period of time. Age and sex should be taken into account, women being less able to metabolize alcohol making them more susceptible to its effect A woman’s’ tendency to black out more easily probably results from differences in how men and women metabolize alcohol. Females also may be more susceptible than males to milder forms of alcohol-induced memory impairments, even when men and women consume comparable amounts of alcohol.

The dangers of experiencing blackouts:

Surveys have shown that college students who have had blackouts discovered only later after they had already been involved in a number of high risk activities. Some examples include: engaging in sex without protection, driving under the influence of alcohol, or committing vandalism and other similar offenses. Patients that have a tendency to black out most likely have poor decision-making skills and have little impulse control during these episodes.

Tips for safe drinking and how to stop or manage blackouts:

Totally eliminating drinking from your life is the only sure way to avoid having an alcoholic blackout or memory problems. One undetermined issue on alcohol blackouts is that it’s number of times and triggering situations can not be predicted.

The brain damage from long term marijuana use is chronicled in this 2 minute video.

“This study shows long-term, heavy cannabis use causes significant brain injury, memory loss, difficulties learning new information, and psychotic symptoms, such as delusions of persecution, paranoia, delusions of mind-reading, and bizarre social behaviors in even non-vulnerable users.”

Data Show Anatomical Brain Abnormalities from Marijuana Use.

In the human brain, the hippocampus is associated with the regulation of emotion and memory, while the amygdala controls fear and aggression. Recently a study was conducted by Dr. Murat Yücel and associates from the ORYGEN Research Centre and the Neuropsychiatry Centre at the University of Melbourne in order to determine whether long-term heavy cannabis use is associated with gross anatomical abnormalities in two cannabinoid receptor–rich regions of the brain, the hippocampus and the amygdala.

In the study, Yucel’s team did high-resolution MRIs on 15 men who smoked more than five joints a day for more than 10 years with no history of poly-drug abuse. They compared those with scans of 16 men who did not use marijuana. In addition, all the men took verbal memory tests and were examined for symptoms of psychiatric disorders.

Results indicated that the hippocampus of marijuana users was 12 percent smaller, and that the amygdala of marijuana users was 7.1 percent smaller than among nonusers. Cannabis use also was associated with sub-threshold symptoms of psychotic disorders. Lead researcher Murat Yücel said, “This study shows long-term, heavy cannabis use causes significant brain injury, memory loss, difficulties learning new information, and psychotic symptoms, such as delusions of persecution, paranoia, delusions of mind-reading, and bizarre social behaviors in even non-vulnerable users.”

“The more marijuana was used, the more these individuals were likely to show reduced brain volumes in the hippocampus and amygdala, as well as being more likely to develop symptoms of psychotic disorders and to have significant memory impairment.” “There is ongoing controversy concerning the long-term effects of cannabis on the brain,” the authors write. “These findings challenge the widespread perception of cannabis as having limited or no neuroanatomical sequelae. Although modest use may not lead to significant neurotoxic effects, these results suggest that heavy daily use might indeed be toxic to human brain tissue.

Further prospective, longitudinal research is required to determine the degree and mechanisms of long-term cannabis-related harm and the time course of neuronal recovery after abstinence.” Author Affiliations: ORYGEN Research Centre (Drs Yücel, Whittle, and Lubman) and Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health (Drs Yücel, Whittle, Fornito, and Pantelis), Melbourne, Australia; School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia (Dr Solowij and Ms Respondek); and Schizophrenia Research Institute, Sydney, Australia (Dr Solowij). All text and images from Fair Use.

Regional Brain Abnormalities Associated With Long-term Heavy Cannabis Use. Murat Yücel, PhD, MAPS; Nadia Solowij, PhD; Colleen Respondek, BSc; Sarah Whittle, PhD; Alex Fornito, PhD; Christos Pantelis, MD, MRCPsych, FRANZCP; Dan I. Lubman, MB ChB, PhD, FRANZCP; General Psychiatry. 2008;65(6):694-701.

Moyers: So while the rational brain has said “never again,” the emotional brain circumvents it?

Hyman: That’s right.

Moyers: So which part of the brain ultimately determines our behavior?

Hyman: Well, it’s both really, but this emotional brain has an awful lot to say about our behavioral priorities. As I said, emotional circuits are survival circuits. And when they get literally perverted by drugs, they still have an awful lot to say about what we should do first and what we should think about. Just consider the behavior of an alcoholic or a drug addict. First of all, many long term alcoholics stop enjoying alcohol, either because of tolerance or physical illness, so they’re not even getting pleasure from it anymore. And they may recognize that they have wrecked their family life. Their job is in question, or it’s gone. They’ve lost their social status, and yet they keep drinking. How is it possible for people to do that? What I would say is that the critical circuit in the brain, which is involved in setting our behavioral priorities, has been usurped by the drug. The long term interest of the person — rationality — is barely audible in the calculations of a drug-impaired brain.

Moyers: It’s no longer driving the assigning of value, the creation of motivation?

Hyman: Right. And we can sit here and talk about it, but it’s actually people’s stories that really take your breath away. I mean, when you hear the story of a woman ignoring or even selling her children to get more crack cocaine, it’s easy to say this must be a bad person, but that’s not necessarily the case. This is someone whose behavior has been totally usurped by drugs, whose ability to set priorities has been totally deranged by drugs.

Moyers: Is this why you call addiction a disease of the brain?

Hyman: This is exactly why I call addiction a disease of the brain. What happens is, in the vulnerable brain — not everyone who experiments with drugs is going to get addicted — in the vulnerable brain, if you use drugs at a high enough dose, frequently enough, and for long enough, you literally change the way the brain works, you change the way nerve cells communicate in such a way that you develop this compulsive, out-of-control use despite knowing that all kinds of terrible things can happen to you, and despite even experiencing many of those things.

Moyers: Do you have any hope that we might be able to identify the vulnerable person early enough to intervene?

Hyman: I think that we’re going to be able to identify vulnerability, and then it’s a different question as to how we intervene. For alcohol, I think it’s pretty clear that those people who have the early-onset, severest forms of alcoholism are genetically predisposed.

Moyers: But even when we say it’s genetic, there’s still more to say, isn’t there? My brother became addicted to cigarettes. He died very early because of his addiction. But I never felt addicted to tobacco.

Hyman: Well, you might not have shared all of the same genes, but what you’re saying is actually quite important. Which is that for things as complicated as behavior we don’t have any situation that I know of where genes have all of the say. Where we have total genetic determinism. Rather, for behavior what we have is a complex dance of genes and environment building a brain as we develop, creating us as we experience the world, and as we behave. It’s a very complicated dance that we’re only just starting to unravel. But I don’t think that we are ever going to find a piece of DNA that will make someone an alcoholic 100% of the time. Rather, what we’re going to find are pieces of DNA that are part of the instructions for building a brain. These instructions are read out in the context of our environment. Starting before we’re born, in utero, and continuing well after we’re born. And in combination with many other genes, we emerge as people with certain traits that the genes give us a bias toward. For reasons that we don’t yet understand, some genes create a risk of alcoholism — in some young men a risk that may be as much as tenfold greater than in people who don’t have those genes.

Moyers: What’s your response to someone who says to you, “Sure, Doc, I’d like to quit, but my DNA won’t let me?”

Hyman: That question gets to the heart of the controversy over the disease model. We know that addiction looks every bit like a disease. But the problem is that the disease model can be misinterpreted. An addict could retort, as you suggest, “Gee, I’d like to say no, Doc, but I’m just a helpless tool of my DNA.” But the disease model doesn’t mean that we can’t ask people to be responsible for themselves. Because the brain doesn’t have only one pathway. It has this remarkable complexity of myriad circuits and trillions and maybe quadrillions of synapses.

Moyers: It’s a universe.

Hyman: Yes, and it divides up tasks — it’s redundant, if you will. So while part of the brain may be perverted by the drug, and one set of circuits may be really out of whack, there are other circuits at work. People who are addicted still remain engageable. Other parts of their brain are still working. Now, it’s not easy to engage them. And it’s not easy because in addiction, literally, the organ of compliance, the part of the brain that’s involved in setting behavioral priorities, is affected.

Moyers: Well, if the brain has been compromised by the drugs, and if the desire to use has become a commanding motivation, is that person capable of responsible choices? Is the addict still a moral agent, capable of free choice?

Hyman: I believe that the addict is still a moral agent, but his ability or her ability to exercise free choice is very much compromised. And I believe it is the job of the family, the employer, the doctor, the community, to serve almost as a prosthesis.

Moyers: Explain that.

Hyman: Everyone around the addict needs to work together to bolster what’s good and capable in the patient. To prop up his motivation to change and help this addicted person to recover. People need help to counter the intense desire for another drink or “hit.”

Moyers: I see so many mothers and fathers and sisters and brothers and friends and employers get so angry and frustrated at somebody they love or care about who just won’t stop. The addict seems to willfully disregard all of our efforts to help.

Hyman: Well, yes, in the beginning picking up a drink is a voluntary act, but we have to look past that and ask about the motivation. The addicted person is not able to select his or her motives. The part of the brain that is selecting behavioral priorities is compromised. So the motor behavior, picking up a drink, seeking drugs, smoking cocaine is really the downstream expression of something that’s broken, which is this whole set of motivations. We can’t see them — from the outside, an alcoholic taking a drink looks like anyone else engaged in that behavior. But what’s happening in his head is different. The important thing for us to remember is just how hard it is for the addicted person to stop. And how much support they need in order to be able to stop. Take heart patients. We don’t blame them for having heart disease, but we ask them to follow a certain diet, to exercise, to comply with medication regimes. So it is with the addicted person — we shouldn’t blame them for the disease, but we should treat them as having responsibility for their recovery. One critical difference between addiction and heart disease is that the substance — illicit drugs or alcohol or nicotine — can markedly diminish the ability of the patient to follow through on medical advice. So the patient’s family, friends, employers, etc., must shore up whatever strengths the patient has in order to help him stop. We have to help addicts get treatment, and support them in staying with it.

Moyers: So even though drugs have changed the brain, it can be changed back?

Hyman: I don’t think that you can have your brain back just the way it was, but I certainly believe recovery is possible. There are some changes in your brain that may be irreversible, especially the kinds of emotional memories that we talked about, they may really be indelible. But people who have a stroke are able to recover by using other parts of their brain which weren’t affected. It seems extreme, but you might think of someone who is addicted almost as if they’ve had a peculiar kind of stroke, which affects their motivation and self-will.

Moyers: What can we expect from the addict?

Hyman: Well, my experience as a clinician is that many addicts are just not ready to give it up. Drugs are too important. They still are experiencing mostly positive consequences from using. But eventually, people very often get into a position where the negative consequences of their addiction begin to outweigh the positive.

Moyers: They hit bottom, in the language of AA.

Hyman: Yes. Now, some of these people actually stop by themselves. It’s really quite remarkable. But many people, perhaps most, need treatment. And when you address somebody like this, often you’re met initially with anger or denial. After all, what you’re saying is, “I’m going to ask you to give up the central thing in your life. That thing without which you think you can’t go on.” So it’s not surprising that people don’t say, “Sure, Doc, fine. Where’s the nearest treatment program?” You have to be persistent. And non-judgmental. I think what you really have to do is sit with the addicted person and face the problem together and say, well, “How about the traffic accident you caused? How about this abnormal liver test? What are we going to do about it?” You start to engage the person, but recognize that it might well take time before he or she quits entirely.

Moyers: If I were your patient, and I relapsed once, you would not consider our relationship a failure?

Hyman: Absolutely not.

Moyers: If I relapsed a second time?

Hyman: I would not consider it a failure. But if you keep relapsing and we sit here and talk about your alcoholism at every session and you do nothing to get treatment, then we’re not doing something right. It would be easy for me to say that you’re so sick that I can’t help you. It would be easy for me to say, “I’ve done my job because I’ve issued a stern warning.” But what we really have to do when somebody either doesn’t get treatment or keeps relapsing is to ask, “What am I not mobilizing to get this person into treatment?” Maybe I have to get the family and the employer involved. Maybe I need to approach you differently. This disease is a terrible enemy once it is dug in.

Moyers: Do you think we will ever eliminate the desire people have to try drugs?

Hyman: No, I don’t think so. I think that part of our humanity is that many people are curious about transcending themselves. People are curious about new experiences. Some people are suffering and looking for ways of feeling better. And people will experiment with drugs. In a healthy society we can help people avoid the most dangerous drugs and we can help people get well if they become hooked.

Moyers: If addiction is about learning, why doesn’t the addict learn that withdrawal in certain cases is so painful, so abominable, so awful that the brain says, “I don’t want to go through that again, so I won’t use.”

Hyman: One of the really striking things about human beings is that we have a lot of trouble thinking about long-term risk. We are very short-term creatures indeed. Also, you see, withdrawal is very painful, but it’s not actually associated with the drug. What’s associated with the drug is pleasure and relief. The withdrawal syndrome is occurring in isolation and without the drug. Indeed, it is accompanied by intense craving for the drug. So the withdrawal does not in any way extinguish or do away with the impulse, the craving, the desire for drugs. Indeed, one of the important challenges to us as a species is how we can figure out ways of dealing with our inability to conform our behavior to our long-term best interest.

Read From the beginning Part 1

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

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.

Moyers: Till I read the review.

Hyman: Till you read the review, exactly. Then your amygdala (which codes fear and anger, amongst other things) starts firing.

Moyers: [LAUGHS]

Hyman: Basically the drug abuser finds that these drugs, at least initially, give them a kind of euphoria. A kind of self confidence. A feeling that they can achieve only with extreme difficulty using natural stimuli.

Moyers: There’s no natural high quite as high as a drug high?

Hyman: No, because the drugs really do trick the brain. Cocaine and amphetamine put more dopamine in key synapses over a longer period of time in this brain reward pathway than normal. And because they are so rewarding, because they tap right into a circuit that we have in our brains, whose job it is to say something like, “Yes, that was good. Let’s do it again and let’s remember exactly how we did it,” people will take these drugs again and again and again.

Moyers: What about tobacco? I mean, a lot of times when children smoke that first cigarette they will cough and choke because they don’t like it. But they’ll have another cigarette and another. What’s going on there?

Hyman: With drugs that are harder to like at first, like tobacco, people teach each other to enjoy them. The peers of a child trying his first cigarette create an atmosphere where that act receives approbation, where toughing it out is respected and cool. And pretty soon they get over the initial irritation and cough. And soon after that, they find out they’re hooked.

Moyers: And are they hooked because nicotine has done for this pleasure pathway what the cocaine has done for the user?

Hyman: Yes, though maybe not as profoundly. All of the most addictive drugs, either directly like cocaine and amphetamine or indirectly, like nicotine, alcohol, opiates, cause release of dopamine in this brain reward pathway.

Moyers: And because the dopamine is released I have the impression that something really good is happening to me?

Hyman: Yes, and here’s the important thing. You have a subjective feeling of euphoria. You feel when you take these drugs that something really good is happening to you. You feel, as I’ve said, either high or in the case of cocaine and amphetamines, that you have great confidence. The world is bright. The problem is that these drugs are like a sledgehammer in the brain. While the person is feeling this euphoria, other things are happening. You see, our cells have all kinds of mechanisms to adapt to powerful environmental stimuli that they see as a stress. It’s called homeostasis, trying to keep functioning well under constantly changing environmental conditions.

Perhaps the best example I can give you is going to the gym and lifting weights. The first time you go, you strain your muscles, right? You have sore arms after you lift weights. But if you go back to the gym and lift very heavy weights, (think drug dose), you do it enough times a week (think frequency of drug administration), and you do it for long enough (think chronicity), what happens? A signal goes from these poor strained muscle membranes to the very nucleus of the cell, which contains the genetic material. And it says basically, “We’ve got to adapt, we’re under a lot of stress here.” And the muscle cell turns on the genes that make structural proteins and over time we get what a body builder considers a very positive adaptation — big muscles.

Moyers: The gene is saying, “Hey, guys, I need more protein.”

Hyman: Exactly, “Give me more protein.” Now let’s go to the drug addict’s brain. Here’s this poor synapse which has never seen so much dopamine for so long in its life, what is it going to do? The dopamine on the one hand may be helping the drug user feel euphoria, but at the same time, the receptor cell isn’t very happy. It’s stressed. What happens? First, it’s trying to decrease the efficacy of this dopamine signal so it won’t hit it so hard, and it’s saying “Enough, too much.” It sends signals to other cells to say, “Turn this off.” So adaptation occurs, and we see the clinical realities of this when somebody ends a cocaine binge. At that point, there might be less dopamine in the brain or the dopamine that’s there might be less effective than prior to drug use. So after a cocaine binge, the brain is physically changed — it’s adapted. But that adaptation, less dopamine now, means that the drug user feels bad. The drug user can’t feel pleasure. The drug user might feel depressed and is craving more drug.

Moyers: His body is saying it wants more dopamine, he can’t get it, so he physically gets depressed.

Hyman: In effect, yes. But the addict doesn’t know that that’s what’s happening. What the addict knows, or thinks is correct, is, “I will feel better if I put myself back in this precise context where I felt good and use my drug.” This is the learning side of it, the emotional memory. It may not be true that taking the drug will make him feel better, but that’s what using the drug teaches him. And part of that memory is not only the emotion, but the whole context. The friends that they see when they are using drugs, the paraphernalia, the kind of room they are in or the kind of alley, all become attached to the ritual and the feelings of getting high. They become part of the brain’s “emotional memory.”

Moyers: That’s why AA talks about “people, places, and things.” Avoid the people you used with, avoid the places you used, and avoid the things associated with use like the pipe.

Hyman: That’s absolutely right. Remember, the dopamine in this brain reward circuit is still saying, “That was good, let’s do it again, and let’s remember exactly how we did it.” So there’s this emotional learning that goes on which is in many ways the longest lived change in the brain.

Moyers: Perhaps this is what we mean when we talk about indelible memories.

Hyman: I think that’s right. And one of the things that Alcoholics Anonymous says is that alcoholics are not recovered, they are recovering. I think they’re right because there are many things in the brain that make it likely that once addicted you’re at high risk of relapse and one of the most important is this indelible memory. We know that when people are detoxified and then they’re back in a situation where they used to use drugs, they may experience certain feelings. In the case of the cocaine user, they might feel a little bit high. Which makes them want more. In the case of the heroin addict, some of them actually feel a little bit of withdrawal, and that makes them want the drug. A common experience for ex-smokers is that they’ll have a festive meal and be reminded that they used to enjoy a cigarette at such times and they will feel waves of craving. These are cues which are awakening these powerful memories. When something is highly rewarding, we are likely to remember it vividly and also to remember the circumstances under which we encountered it. Even after years of abstinence, people may experience profound cravings and risk relapse if placed in the surroundings of their former drug use.

Moyers: You’ve referred to the reward circuit as part of the “old brain.” What do you mean, the “old brain,” and why might we have a reward region in the first place?

Hyman: Well, the idea of an older part of the brain really comes from study of comparative neuroanatomy that looks at lizards and evolutionary older mammals and compares them to primates and humans. And what we see is a very developed neocortex in humans, which is the outer layer of our brain and has been linked with reasoning. Our cerebral cortex appeared relatively recently in evolution. But some of the emotional circuits in the brain have been around for a much longer time. That’s why they have gotten the moniker “the lizard brain,” because of their evolutionary history. But it’s unfair to equate all of our emotions with lizards because after all, they do a lot of good things for us as well. What makes us fundamentally human is not thinking alone or emotion alone but a combination of the two. In fact, what makes us different from computers is certainly emotion. And some of the highest human feelings like love or altruism are human, as well as fear or anger or pain which we share with lizards. It’s the interweaving of emotion and cognition that allows us to make any decision that we make in life. The important thing is that we have dedicated circuits in the brain which are involved in emotion. I mean, imagine the world without emotion. All meaning would drain out of it — it would just be a world of cold facts. The world comes to us instead, full of rich meaning. Things have a valence. They make us happy or sad. Some things are fearsome, some things are enjoyable, some make us curious. Some are edible. And the emotional part of our brain is making appraisals. It’s saying this can hurt us, this is good for us. And in making those appraisals, the emotional parts of our brain start all kinds of downstream reactions. The emotion of fear, for example, starts our hearts racing.

Moyers: But what does this have to do with that old lizard brain? Why would the lizard have eveloped a brain that would assign priorities of value?

Hyman: Well, probably not so that it could write philosophical texts about value. The circuit most likely developed to control behavior quickly. At the simplest level, any animal needs to be able to judge what to avoid and what to approach. It needs to evaluate situations and react to them immediately. It can’t be sitting there thinking, “Hmmm. Is this food or is this something that will eat me?” It has to react as soon as a threat is spotted, otherwise it won’t live very long.

Emotions really are circuits in our brain that allow us to survive. Now this is speculation, but just imagine some of the roles for this reward circuit in evolution. Without something to make sex appealing, nature’s experiment with sexual reproduction would have been a great failure. We would have been perhaps budding like yeast or something, with no need for a sexual partner or the sex act. And while that sounds kind of silly, the fact is there has to be something extremely compelling about reproduction in order to get the job done because, as any parent knows, the process of having a child is not always easy. If sex gave no pleasure, or you didn’t remember or desire that pleasure, you wouldn’t reproduce yourself. But also, evolution couldn’t hardwire every possible response into our brains. We’re going to encounter all kinds of new and unexpected situations in our world. And so this reward circuit has to be able to learn. And when it’s something like a new food that’s good for us, or something that is healing or useful, then we’ve learned about something that’s going to be adaptive.

Moyers: Let me make sure I understand this. In terms of survival, the more relevant something is to survival, the more likely we are to remember it?

Hyman: That’s very well put. The more relevant something is to our survival, the more likely we are to remember it. Again, let’s contrast having to study some dry as dust material in the classroom, where you have to rehearse and rehearse to remember it, and compare that with something that’s really emotionally charged. You just don’t forget your first love, but most of us forget the Pythagorean theorem. The other thing which is very important is that key parts of memory are not necessarily conscious. They are memories that get us to control behavior — that motivate us, if you will. So, for example, if you encounter something that has hurt you badly in the past — let’s imagine you have been bitten by a snake once, and you’re now hiking along and you find yourself in just the kind of country where you were bitten before — before you even realize it, you might find that your heart is racing, that your palms are sweaty, and that you’re vigilant and ready to escape. I think the important point here is that emotion paints the world with meaning. Emotion says this is important, that is dangerous, this is good. And it paints the experience in such a way that our conscious minds may be involved but all kinds of unconscious processes are also involved.

I think some of the stigma of addiction results from a misunderstanding of these unconscious processes. Because the illness is largely invisible, but also because when people look inside themselves, they don’t realize they can’t see everything that motivates their own behavior. We don’t recognize, for example, that when I reach over to point my finger at you, all kinds of things have happened in the background of my brain. It calculated a trajectory, it stabilized my shoulder girdle, it told certain muscles to fire up so many hundred milliseconds and opposing muscles to fire up so many hundred milliseconds. If I had to calculate the trajectory and do the fine tuning as I approach my target, I don’t think I would be very successful in pointing at you; in fact, I might well hit you instead. And it’s the same thing with emotional processing. Lots of things which we aren’t wholly aware of are going on in the background, telling us about the emotional valence of the world. For the addicted person, it’s saying, “You know, you better get another drink now because we’re running out here and the world’s getting pretty bleak.” Addicts aren’t willfully choosing those background thoughts and feelings and drives, and non-addicted people don’t have to contend with them.

Moyers: Are those background thoughts predetermined?

Hyman: Well, with reproduction, for example, the desire is very much hardwired. Witness all of the hard work that people have to do in order to avoid sexual desire when in certain religions they decide they’re going to be celibate. It takes a great act of will to overcome, in this case, these very hardwired desires that evolution, interested as it was in reproductive success, put into us.

Moyers: What do you mean, “hardwired”?

Hyman: Certain responses in our brain, like sexual desire, develop through pre-existing genetic programs which we are born with. We may experience aspects of sex and find them good or rewarding or disappointing or what have you, but we are born to find sex pleasurable. If people were designed to avoid sex, there wouldn’t be too many of us around, would there? But because the world is complicated and unpredictable, nature could not have built in a list of everything that was going to be good, of everything that could hurt us, of everything we ought to be afraid of. And so these emotional circuits have some built in functions, but perhaps the most important thing they do for us in our lives is, they learn. But there can be a danger here because in many ways emotional circuits take our higher processing out of the loop. They literally cut it out, by bypassing those pathways and — crucially for our understanding of addiction — push our behavior before we’ve really had time to look rationally at all its implications. And so when you’ve learned to like a drug, you find you’re already going after it before you’ve thought about it. If you talk to an alcoholic or a drug addict, they will tell you they often wake up in the morning and they say “I’m not going to use today. Right. In fact, I’m never going to use again.” And then they go out in the world and they see their drinking buddies and the sight of them taps into these emotional memories. The voice of reason, of conscious control, becomes a rather small voice in competition with this intense emotional sense of craving and need.

Moyers: So while the rational brain has said “never again,” the emotional brain circumvents it?

Hyman: That’s right.

Click here to go back to Part 1

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

Scientists know that addictive drugs can mess with the brain’s circuitry and hijack its reward systems, but a July 31 rat study in the journal Neuron shows that psychological factors may be more instrumental in causing these changes than a drug’s chemical effects are. Cocaine use triggers long-lasting cellular memories in the brain, the study found–but only if the user consumes the drug voluntarily.

A team led by Billy Chen and Antonello Bonci, both at the University of California, San Francisco, trained three groups of rats to press levers that delivered cocaine, food or sugar. The researchers injected cocaine into a fourth group. When they examined the rats’ brain tissue, they found an increase in synaptic strength within the reward center in those rats that had self-administered sugar, food or cocaine. These cellular memories were short-lived in the sugar and food groups, but in rats that had self-administered cocaine they persisted for up to three months after consumption had stopped. Most interestingly, the brains of rats that had consumed cocaine involuntarily did not show such imprints.

[More]

Chemo brain is an emerging topic that relates to memory loss or cognitive dysfunction in those that have under gone chemotherapy for cancer. Is chemo brain relevant to addiction recovery?

Post-chemotherapy cognitive impairment (also known as chemotherapy-induced cognitive dysfunction, chemo brain or chemo fog) describes the cognitive impairment that can result from chemotherapy treatment.

Approximately 20-30% of people who undergo chemotherapy experience some level of post-chemotherapy cognitive impairment. The phenomenon first came to light because of the large number of breast cancer survivors who complained of changes in memory, fluency, and other cognitive abilities that impeded their ability to function as they had pre-chemotherapy.

The concept of chemo brain is not a well known one in the addiction recovery field.  My interest was sparked because I am a cancer survivor, having gone through extensive chemotherapy within the last 2 years and am also in long-term addiction recovery.

The Mayo Clinic states that “Chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur after cancer treatment. Chemo brain can also be called chemo fog, cognitive changes or cognitive dysfunction.

Though chemo brain is a widely used term, it’s misleading. It’s not yet clear that chemotherapy is the cause of concentration and memory problems in cancer survivors. And many cancer survivors with memory problems still score well on cognitive tests, leaving doctors wondering whether chemo brain really exists.

Despite the many questions, it’s clear that the memory problems commonly called chemo brain can be a frustrating and debilitating side effect of cancer and its treatment. More study is needed to understand this condition.” They furher list these symptoms:

Signs and symptoms of chemo brain may include:

Being unusually disorganized
Confusion
Difficulty concentrating
Difficulty finding the right word
Difficulty learning new skills
Difficulty multitasking
Fatigue
Feeling of mental fogginess
Short attention span
Short-term memory problems
Taking longer than usual to complete routine tasks
Trouble with verbal memory, such as remembering a conversation
Trouble with visual memory, such as recalling an image or list of words

 
Signs and symptoms of cognitive or memory problems vary from person to person and are typically temporary, often subsiding within two years of completion of cancer treatment.

Ralph E. Jones states in Know a Client’s Cancer Treatment History published in Addiction Professional:

“Addiction professionals can and should be involved along with neuropsychologists in assessment of problems relative to brain function, and develop with the patient strategies toward memory recovery and improvement, such as memory aids and the strengthening of cognitive skills. Counselors also can assist the patient in working through emotional distress.

Counselors and others performing substance abuse evaluations and assessments should include questions such as: Have you ever had cancer? Have you received chemotherapy as a treatment? If so, how long ago and how many treatments? What symptoms did you have during your chemotherapy? Have there been any persistent symptoms since your treatment? When a patient presents with cognitive complaints, the problems can be evaluated for intervention when an overall understanding exists of chemotherapy-related cognitive changes based on a conceptual model that continues to be informed through well-conceptualized and well-designed research.

For the individual undergoing chemotherapy at the time of treatment for addiction, it is imperative that the addiction professional know which drugs the client is being given in order to understand and treat symptoms that might overlap during addiction recovery.”

Many substances including alcohol, nicotine, and other drugs of abuse can have negative effects on the developing fetus because they are transferred to the fetus across the placenta.

For example, nicotine has been connected with premature birth and low birth weight as has the use of cocaine. Fetal Alcohol Syndrome is the most preventable cause of mental and physical birth defects in the United States. The solution is to not drink during pregnancy.  Here are some articles written on that topic: 

Dangers Of Drinking During Pregnancy: Facts on Fetal Alcohol Syndrome

Is It Safe To Drink When Pregnant?

Whether a baby’s health problems, if caused by a drug, will continue as the child grows, is not always known.

Research does show that children born to mothers who used marijuana regularly during pregnancy may have trouble concentrating, even when older. Research continues to produce insights on the effects of drug abuse on the fetus.

All drugs of abuse target the brain’s reward system by flooding the circuit with dopamine.

Drugs are chemicals. They work in the brain by tapping into the brain’s communication system and interfering with the way nerve cells normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don’t activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.

Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels. The difference in effect can be described as the difference between someone whispering into your ear and someone shouting into a microphone.

How do drugs work in the brain to produce pleasure?

All drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The over stimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.

How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs?

 
Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.

Why are drugs more addictive than natural rewards?

When some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards do. In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors such as eating and sex. The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well.

Having a drug and alcohol craving can be a grave danger to your addiction recovery; do you know what to do when they strike? Read on for tips and tools that may save your recovery.

Drug and alcohol cravings will occur even when working a solid addiction recovery program, sure as the sun will rise tomorrow.

Having stopped drug and alcohol use, the frequency, intensity and duration of cravings differ from person to person. The bad news is they occur; the good news is that over time they generally lessen in frequency and duration.

The trick is to stay safe while riding out the wave. One way to view abstinence and sobriety is simply preparing for that moment when a craving occurs, nobody is watching, and nobody would know if you used, except you. What do you do? That is the moment of truth.

What follows are some tips and tools that may get you through that moment of danger. Not all tips work for all people, the trick is to find one that will work for you.
That being said, here are the tips:

1. Buy yourself some time, distract yourself, with exercise, work or cleaning, get busy. Put yourself in a safe place where drugs and alcohol are not available. Cravings pass with time.

2. Play the movie forward. Remember that we are never talking about ‘just one’. Once you pick up, control goes out the window.

3. Talk to someone. This is the purpose of building a social support network, utilize it. Go to a meeting, call your sponsor, best friend, relative or counselor. Talking it out with someone who really understands helps prevent a return to active addiction.

4. Pray or meditate. Ask for help in just getting through this. Use the Serenity Prayer. The point is to ask for help outside yourself.

5. Remember the pain and bad times, and the fact that you would be risking everything good that you have worked so hard for. Try focusing in the positive, not drinking or drugging and all the reasons you should not do it.

6. Go to a 12 step meeting, even if you have never gone before. They will listen, that’s what they do. Call information and ask for AA .

7. H.A.L.T. Hungry, angry, lonely, tired: if you are in any of these states, fix it. Eat, sleep, chill out, go visit someone.

8. Remember a craving will pass with time and when it is through, you come out the other side even stronger.

This was not, by any means, a complete list of relapse prevention strategies. There are many more detailed resources available:

Buprenorphine Drug Treatments: Trading One Bad Habit for Another – These “treatment” methods call for heroin addicts to be placed on a prescription drug of Methadone or OxyContin in order to lessen withdrawal and craving effects associated with abruptly stopping drug usage. …

Health, Questions About Alcohol Or Drug Addiction And Some Answers … – Drug addiction is a physical and mental condition characterized by habitual and uncontrollable drug intake, involving craving and seeking, even despite the negative consequences associated with drug use. Alcohol or drug addiction is …

Drug Addiction Medication May Erase Drug Cravings – When the rats pushed down on a lever, a small amount of the drug was dispensed. The more they pushed, the more the drug was given. After a few weeks of withdrawal (simulating detox and rehab), some of the rats were injected with the …

Addiction Brain Science – so We Can All Understand It! – Their need to satisfy the cravings becomes dominant in all behavior. It does not matter what drug they choose. Nothing will satisfy the overwhelming craving except their drug-of-choice. Meth users will not settle for heroin. …

by Bill Urell

Alcoholic blackouts can range from being mildly annoying to life threateningly dangerous. Do you know the facts? Read on to learn more about the alcohol blackout.

The occurrence of an alcohol blackout is unpredictable both in severity and in timing.

When an individual experiences an alcohol induced blackout, his consciousness remains throughout the period but will be unable to have complete recollection of what happened during that time. The events are never imprinted on the brain for recall. It’s amnesia in a way, but it’s caused by drug or alcohol abuse and not a traumatic or physically debilitating experience.

There are two types of alcohol induced blackouts commonly studied:

1. Fragmentary or partial blackouts. These tend to occur when lower levels of alcohol are taken. You might forget names or what you were talking about in the middle of a conversation. These partially interfere with memory formation during intoxication. People can sometimes remember the missing pieces if they are prompted or reminded of the context of conversation or situation.

2. Complete or en bloc, blackouts.

When a person has a complete alcohol blackout, he is still physically and mentally able to perform actions although he may seem not like his usual self. In this type of blackout, an individual is still conscious but will be unable to retain any memory of what happened during his blackout, what so ever. Prompting or reminders will not lead to recall the events. It appears that the ability to transfer and imprint memory from the present and short term to long term storage is blocked.

How alcohol and drugs can cause blackouts -

In most cases, blackouts are a result of

binge drinking, that is, consuming an excessive quantity of liquor in a brief period of time. This has been confirmed by a research conducted for the National Institute on Alcohol Abuse and Alcoholism which reports how large and especially rapid consumption of alcohol can produce partial or complete blackouts.

One researcher states “If recreational drugs were tools, alcohol would be a sledgehammer” alcohol produces detectable memory impairments beginning after just one or two drinks. As the dose increases, so does the magnitude of the memory impairments.”

Other things you should know about blackouts -

Age is a determining factor in how much alcohol you can safely consume. A woman’s tendency to black out more easily probably results from differences in how men and women metabolize alcohol. Females also may be more susceptible than males to milder forms of alcohol induced memory impairments, even when men and women consume comparable amounts of alcohol.

The dangers of experiencing blackouts -

Surveys have discovered that college students who had experienced alcoholic blackouts found out later on they had participated in various high-risk activities like engaging in sex without protection, driving under the influence of alcohol, or committing vandalism and other similar offenses.

People who experience blackouts may at that time have an impaired ability to decide and judge and possess minimal or no control at all over their impulses.

Tips for safe drinking and preventing and managing blackouts -

The only sure-fire method for not having a blackout or memory problems is to not drink. One puzzling aspect of blackouts is that the occurrence and consequences cannot be predicted.