Primary Care of the Psychiatric Mental Health Client II

The Neurobiology of Addiction Video Transcript

[MUSIC PLAYING]

I'm an addict. Drugs and alcohol nearly destroyed my life.

One of the things I've learned is that during my addiction I actually altered my brain chemistry.

Addiction is a cycle. My brain became dependent on the very chemicals which where destroying it.

Experts aren't sure why some people become addicts and others don't. They are discovering the ways in which drugs and alcohol affect our brain. The National Institute on Drug Abuse has called drug addiction a brain disease.

Diseases have a biological basis.

They have identifiable signs and symptoms, and a predictable course and outcome.

Diseases are not a matter of free will. There's no choice involved.

Chemical dependency is recognized as a disease by the American Medical Association, the American Psychological Association, and the World Health Organization.

In this video, we want to share with you some of the facts about chemical dependency.

Specifically, the way drugs and alcohol affect our brain chemistry, interfering with its normal function.

Everything we'll talk about in this program relates to the brain.

The nervous system is the body's main communication system, and the brain is the most centralized part of it and the part that controls all the rest, our perceptions, our attention. It controls memory, movement, and it also controls pleasure and pain.

Alcohol and other mood-altering drugs affect each function of the brain by interfering with the way it transmits and processes information. For example, if I prick my finger, I feel the pain instantly, or so it seems. But what actually happens is that the nerve cells at the tip of my finger send the message of the sensation up to my brain. I don't actually feel the sensation of pain until the message has reached my brain.

Messages like these travel along pathways made up of individual nerve cells called neurons. These cells are not connected, but separated by small gaps called synapses. The neurons talk to each other by releasing certain chemicals that act like messengers, traveling across the synapse.

These chemical messengers are called neurotransmitters, and each one has a distinct structure and message. What a neurotransmitter is released from a neuron, it attaches to a neighboring neuron at its receptor site. A neuron can only receive a neurotransmitter if its shape matches with the receptor site.

Alcohol and other mood-altering drugs disrupt the proper functioning of the brain.

They interfere with these pathways, affecting how the brain processes information.

Let's suppose my hand has been shot with Novocaine and is completely numb. I might hurt my finger, but never feel the pain. Novocaine stops the pain message from reaching my brain. That's because Novocaine stops the neurons from sending or receiving the message. Alcohol and other drugs alter the way the messages are sent or received in a similar way.

Every thought, mood, and emotion has a chemical basis. So every time you feel something, you sense something, every emotion that you feel, there's a chemical reaction occurring in the brain. And what alcohol and drugs do is alter this chemical symphony. They may produce a feeling that the individual likes, but there's a substantial price they pay for it as a result of this disruption of the chemical symphony.

One of the mysteries about addiction has been, how can it be that drugs of abuse, which are really different in their actions and their effects, cause this same phenomenon— addiction? And now we find through many, many studies that all drugs of abuse act on a part of the brain called the VTA, or ventral tegmental area.

Now, the VTA is a part of the brain that contains dopamine, which is a neurotransmitter that's associated with movement, but also with emotional response and pleasure. The VTA a is part of what we call the reward pathway. Now, when the reward pathway is naturally stimulated, it produces a sense of well-being and pleasure.

What drugs and alcohol do is overstimulate the reward pathway. This produces the high, and it also disrupts natural brain functioning, often with damaging results.

Most drugs that people abuse fall into five general categories. Opioids, sedatives—

Stimulants, psychedelics, cannabinoids.

All of these drugs have several things in common. Their principal action is in the brain. Since they primarily affect the central nervous system, they're referred to as CNS drugs.

They are able to cross the blood-brain barrier that usually protects the brain from foreign substances.

They all act by stimulating, depressing, or imitating neurotransmitters that are native to the brain.

They all create some sort of euphoria and they lower inhibitions. To the user, this tends to be the most attractive quality of psychoactive drugs.

[MUSIC PLAYING]

Opioids have two main effects— they block pain and they induce pleasure. Codeine, morphine and opium are all opioids derived from the opium poppy. Other opioids include heroin, methadone, Vicodin, OxyContin and Demerol.

All opioids act on what we call endorphin receptors.

Endorphins is a collective term for the natural pain suppressing chemicals that are found in our brains. Opioids have a chemical structure that's similar to endorphins, and as a result, they're able to occupy the same receptor sites. This means that opioids activate our natural pain-reducing system, but they do so much more intensely.

The activation of endorphin receptors by opioids results in stimulation of the reward system, and the combined effect on endorphins and dopamine makes the use of these drugs very pleasurable.

People who become addicted to opioids are subject to the classic symptoms of physical dependence.

Increased tolerance. With continued use, we need more of the drug to achieve the same effect.

And the onset of physical withdrawal when that drug is taken away. There was progressively more acute pain. The symptoms are like a severe case of the flu.

Opioid withdrawal is very uncomfortable and addicts will go to great lengths to avoid. This combination of seeking intense pleasure and avoiding intense pain makes letting go of heroin or painkillers very challenging.

[MUSIC PLAYING]

Sedatives are central nervous system depressants. They can be used medically to reduce anxiety, induce sleep, or control convulsions or seizures.

These depressants include barbiturates and benzodiazepines, such as Valium, Xanax and Rohypnol.

Another sedative is GHB, which has potent, alcohol-like effects. But the most commonly used sedative is alcohol.

Sedatives act by binding to receptors in the brain for Gamma-Aminobutyric acid or GABA. GABA is the major inhibitory neurotransmitter in the brain. It's rather like the brakes on a car, keeping things slowed down, in control, and on course.

When sedatives activate GABA receptors, it's like pushing on the brake a little harder. This can reduce anxiety, panic, or fear, and so is can serve valid medical purposes. However, there is a high potential for abuse with these drugs, especially for those who seek to self-medicate.

If you focus just on, what drug has the most damaging effect, clearly, it's alcohol. Alcohol impacts on every organ in the body and it produces the widest spread damage of any drug that we have.

Alcohol has the potential to cause more organ damage than other so-called harder drugs.

Damage to the liver, pancreas, digestive system, heart, muscles, and brain are all seen with alcoholism.

Alcohol can also cause fetal alcohol syndrome in the fetuses of pregnant women, causing permanent brain damage and developmental disabilities in the child.

Alcohol withdrawal can be more dangerous and life-threatening than withdraw from any other drug. Taking away alcohol from GABA receptors that have adjusted to heavy abuse can be like removing the brakes from a car, allowing it to accelerate out of control. This new over stimulation of the neurons is what can cause seizures.

Other sedatives, such as anti-anxiety medications like Valium or Xanax, act on GABA receptors in much the same way that alcohol does.

There's no little flag in the brain that says, legal drugs go to this receptor, illegal drugs go to that receptor. Once the drugs get in the brain, they go to the same receptor system. So although the prescription drugs prescribed by the doctor may be beneficial, they can also produce addiction and disrupt that internal chemical symphony just like street drugs. And addiction-prone people have to be particularly careful.

Sedatives can be highly addictive, resulting in tolerance and withdrawal symptoms similar to those experienced by opioid addicts.

Mixing different sedatives or mixing them with alcohol can lead to overdose or death.

Stimulants include cocaine, amphetamines, caffeine, and nicotine.

Ephedra is another stimulant most commonly found in over-the-counter diet aids and stay awake pills. Illegal stimulants like cocaine, especially the smokeable form, crack, and methamphetamine are highly addictive.

Cocaine and methamphetamine alter neurotransmitters that regulate physical functions in the body, such as heart rate and blood pressure, as well as our emotions.

The high experienced by the stimulant user is caused by the release of the neurotransmitters dopamine and norepinephrine.

Dopamine is released naturally when we have a good meal, when we're happy, during sex, and at other times. It affects our moods, our energy levels, and our feelings of pleasure. When dopamine is released in natural doses it affects the nearby cells. It's then taken back up into the cells that released it.

Cocaine molecules block the gates to the neurons so that the neurotransmitter can't get back inside. We call this blocking the reuptake of the neurotransmitter. Dopamine keeps floating around in the synapse and stimulating the cells.

Norepinephrine is another neurotransmitter similar to dopamine, but it's involved in basic functions like blood pressure and heart rate. Stimulants also block the reuptake of norepinephrine, which mimics the body's natural fight or flight stress response and increases blood pressure and heart rate.

It also produces an alteration in the electrical rhythm of the brain that can produce stimulant-induced seizures, an alteration in electrical rhythm of the heart, which can produce an arrhythmia of the heart, including cardiac arrest, even death. The stimulatory neurotransmitter release produces a big increase in blood pressure, which can result in stroke. So the desire to have the euphoria from the stimulants can produce some very severe medical damage.

Stimulants can be as addictive as opioids and sedatives. Because of the way they act on the brain, they can create rapid tolerance.

There tends to be of repeated cycle of binge use in which the drugs are used to the point of depleting the natural chemicals in the brain.

This brings on a down, or crash phase, after which the brain replenishes dopamine and norepinephrine levels. With chronic binging, the brain cannot produce enough chemicals to replace what is lost. Low levels of dopamine and norepinephrine in brain cells cause feelings of depression and lack of energy.

The user craves more cocaine or methamphetamine and the cycle starts all over again.

Another stimulant that's equally addictive is nicotine. Although nicotine provides a less intense rush or high than coke or meth, nicotine is particularly hard on the mind and body.

Both our muscles and our brains have receptors that accept nicotine. After extended use, these receptors are programmed to receive more nicotine in what is called an anticipatory response. This leads to an intense craving for more nicotine. Quitting is extremely difficult because of this reconditioning nicotine does to our brain.

Nicotine and smoking are responsible for over 400,000 deaths a year in the United States alone. Cancers, heart disease, emphysema, pneumonia, influenza, and other nicotine and smoking-related diseases cause more deaths worldwide than all other drug-related deaths combined.

[MUSIC PLAYING]

Psychedelics include LSD or acid, MDMA or ecstasy, PCP, ketamine, mescaline from the peyote cactus, and psilocybin, which is naturally produced in certain kinds of mushrooms.

Psychedelics work by stimulating certain serotonin receptors.

Serotonin is a neurotransmitter involved in multiple functions, including mood and perception. Psychedelics like LSD interact with one of the serotonin receptors, which we call the 2A receptor. We know that much. What we don't know is, why does that result in psychedelic effects?

One idea is that this 2A activity changes the way that sensory information reaches the brain. In other words, our perceptions are altered because the incoming information is different from what the brain expects.

Drugs like ecstasy work differently from LSD because they're made from methamphetamine. They combine the stimulant effect of methamphetamine, its influence on dopamine and norepinephrine, with the psychedelic effect on serotonin.

With psychedelic use, perceptions are so strongly altered that the user experiences sensory distortions, perceptual changes, even hallucinations. Sometimes these effects can return to the user long after the drug has left the body.

Inhalants are another group of drugs that are sometimes classified as psychedelics. People inhale glue, paint, gasoline, and other toxic fluids to experience a drunk, dizzy feeling. This feeling comes partly from inhalant's effects on the brain, which are similar to sedatives, and partly from their effects on the lungs.

Inhalants interfere with the body's oxygen supply, resulting in serious physical consequences. They cause more brain damage in a shorter time than any other drug, killing irreplaceable brain cells. They also affect other organ systems, including the heart, liver, and kidneys. Even a single use of inhalants can result in suffocation, seizures, or a heart attack.

Psychedelics are the least understood drugs of abuse. We don't know why their effects on serotonin result in perception changes. We know they produce tolerance if used frequently.

We know that addiction to them typically shows up as part of addiction to multiple drugs. But we don't know how damaging psychedelics, especially ecstasy, can be to our brains.

[MUSIC PLAYING]

Cannabinoids include marijuana, hashish and marinol. Because of their mildly hallucinogenic effects, they're often classified as psychedelics.

But since they also have some sedative and some pain-reducing properties we're dealing with them separately. Tetrahydrocannabinol, THC, is the main psychoactive ingredient in marijuana and other cannabinoids. THC resembles a naturally-occurring brain chemical and it has its own receptors in the brain. These receptors are located in areas that control pain, memory, and motor coordination. This helps to explain THC's pain-reducing and anti-nausea effects, as well as its negative effects on memory and coordination.

People often refuse to believe they can be addicted to marijuana, but as with alcohol, using standard diagnostic criteria THC can be considered addictive.

More commonly, we see addiction to multiple drugs, including THC.

THC is one of the drugs that remain in the brain for the longest time. But with continued abstinence, THC leaves the brain and normal function is slowly restored.

[MUSIC PLAYING]

As we said earlier, chemical dependency is a brain disease. Drugs and alcohol significantly alter brain and body chemistry. Their assault on the brain and the body makes us weaker and sicker over time.

Fortunately, we are capable of recovery. But just as with other chronic diseases such as diabetes and high blood pressure, lifestyle changes and treatment are essential to successful recovery.

When we stop using drugs and alcohol and make the effort to nourish ourselves properly, our brains begin the task of healing. The first stage of healing is withdrawal.

Withdrawal can bring about changes in memory, concentration, sleep—

Physical coordination, body temperature, blood pressure, heart rate—

Skin color, allergic responses, hunger, and the ability to handle stress.

Withdrawal from sedatives is the most dangerous, and can be fatal. When the body rebounds from chronic over-sedation, the result is intense over-stimulation. Blood pressure goes up, often to dangerous levels, and seizures become a risk.

Medication with benzodiazepines makes withdrawal from alcohol or other sedatives safer and less painful. We also use medications with opioid withdrawal. Although withdrawal from opioids like heroin is not life-threatening, it is extremely uncomfortable, and many addicts relapse if they're not treated with drugs like methadone or clonidine.

Stimulants and cannabinoids also have recognizable withdrawal syndromes, but they don't present the same kinds of risks and can be treated without medication. Usually a supportive environment is enough.

We used to seek pleasure and avoid pain by using alcohol and other drugs, but our body has its own natural rewards.

The longer we are sober, the more we understand that our brain can naturally produce the joy, tranquility, and creative energy we seek.

Addiction is always with us. Introducing drugs and alcohol back into our body only causes the disease to progress.

Understanding some of the medical aspects of addiction helps us understand why chemical dependency is called a disease. Sobriety is the best way to fight this disease, and that means taking better care of yourself.

We need to be aware of how we treat our mind and body. If you need medications in the future, ask your doctor about the effects they will have. Are they non-addictive?

The ongoing process of recovery isn't easy. We need time for our minds and bodies to heal. The good news is that we can, and do, recover.

Once we've made it through withdrawal, only time, continued abstinence, and self care can help restore our brain's normal functions. For some, this process can take six months to two years.

Our brains are amazingly resilient. Most addicts find that in recovery their lives are better than they ever could have imagined.