Study offers insight into brain chemistry behind addiction
August 13, 2009
MONTREAL — Researchers at the Montreal Neurological Institute have gained fresh insight into the brain chemistry behind addiction by studying the least likely of addicts — Parkinson’s disease patients.
Typically, those suffering from the neurodegenerative disorder are the polar opposite of an addictive personality. Most patients with Parkinson’s are found to be introverted,
rigid and slow to anger — not the excitable, impulsive temperament that’s necessary for addiction, said Alain Dagher, lead author of the MNI study.
Yet paradoxically, some patients who are treated for the tremors associated with Parkinson’s disease do develop addictive behaviours. For example, the incidence of pathological gambling in treated Parkinson’s patients is eight per cent compared with one per cent in the general population.
What Dagher and his colleagues discovered is that some of these patients might have been given too much medication to stimulate dopamine, a neurotransmitter in the brain. People with the disease lack dopamine.
“In some instances, Parkinson’s disease patients become addicted to their own medication, or develop addictions such as pathological gambling, compulsive shopping or hypersexuality,” Dagher said.
So what does Parkinson’s have to do with addiction? Dagher, a neurologist, has found that people suffering from addiction have elevated levels of dopamine in their brains.
Thus, the link between some Parkinson’s patients under treatment and addicts is higher-than-normal levels of dopamine in their brains. Previously, some scientists had questioned whether too much dopamine in the brain could trigger addiction.
“People with addiction, we think, have an excess of dopamine,” Dagher explained. “And with Parkinson’s disease, you give a drug to increase dopamine in order to relieve symptoms, and some people get overdosed. One of the effects of this excessive dopamine stimulation from the drug appears to be the development of addictions — especially pathological gambling.”
The practical implications of the research means that doctors will have to be much more careful in prescribing medications to patients with Parkinson’s, Dagher said.
As for addiction, researchers will need to focus more on genes that predispose people to elevated dopamine.
Nearly 100,000 Canadians have Parkinson’s. Addiction prevalence is much higher. One out of every 10 Canadians, aged 15 and over, have symptoms consistent with alcohol or illicit drug dependence, according to the Centre for Addiction and Mental Health.
The MNI study was published Wednesday in the journal Neuron. Researchers from McGill and the University of Cambridge were also involved.
Montreal Gazette
© Copyright (c) The Montreal Gazette
Making Choices – Are We Really Free?
July 12, 2009
When God created us he gave us the freedom of choice. Fortunately or unfortunately, depending on how you look at it, we are in bondage to the consequences of that choice. Some people define freedom as the right to exercise their own choices, to be free moral agents. No restrictions! “I can do whatever I want to do,” say the libertarians, defending the right to make their own choices. “If I want to have a drink, I’m going to have a drink.” They don’t seem to have a clue as to how deep their bondage is… freedom doesn’t lie only in the exercise of choice; it is also always related to the consequences of that choice.
I suppose I am “free” to tell a lie, but wouldn’t I be in bondage to that choice? I would have to remember to whom I told the lie and what I told them. I suppose I am “free” to rob a bank, but wouldn’t I be in bondage to that act the rest of my life? I would always be looking over my shoulder, wondering if I would be caught. We can choose to drink shots all night, sleep with a prostitute, or inject heroin into our body… but we would have to live with the consequences of each choice.
So, I ask you, are we really free? The bible says in Deu 30:19
“I have set before you life and death, the blessing and the curse. So choose life in order that you may live.”
Spiritual Renewal (Part 5)
June 22, 2009
Addicts are spiritually immature by nature. They often search for black-and-white answers to their problems. If addicts have developmental issues it is easy to see that they will also have childish and adolescent beliefs about God (see May, 1988; Miller, 1987). They may have become angry with God for not “delivering” them of their cravings, longings, and lust.
There are several spiritual challenges for addicts when working with Christian counselors, pastors, and lay helpers:
1. Addicts must address their own need to control.
Many of them may have committed to Christ intellectually, but not emotionally. They may be angry with God for not healing or delivering them. They have a hard time letting go of the high and the mood alteration of their addictive activities. Addicts have become accustomed to their ways. Being enslaved to addiction is what they know.
In the 13th and 14th chapters of the book of Numbers we find the story of how God is trying to prepare the people of Israel to go to the Promised Land. God has already done a mighty work in delivering them out of the land of Egypt. They are being led by one of greatest religious leaders of all time, Moses. Ten of twelve spies who have been sent to survey the new land give a negative report of how difficult it will be to go there because of “giants” in the land. In the opening of the 14th chapter, the people cry out for a new leader and declare that it would be better to go back to Egypt and die as slaves than to go to a place they don’t know.
This is how addicts often react. They don’t know a new place or a better way. They will want to hang on to the familiar. They are unable to trust God to see them through unknown and frightening future events. It is an issue of trust and total surrender. They will need to be guided to totally turn their lives over to God and face their own fears and need to control. In John 5, Jesus (our master psychologist) asks the paralyzed man at the pool of Bethesda, “Do you want to get well?” It seems like a silly question for a man who has been lying by this healing water for 38 years. The man, however, doesn’t answer affirmatively but instead gives excuses for why he hasn’t been able to get into the pool.
Christian counselors will also have to ask this hard question, “Do you want to get well and are you willing to take the risks, make the surrender, and do the hard work that will be necessary.” In Numbers 14, it is Joshua who says to the stubborn people, “We can do this with God’s help.”
Emotional and Cognitive Restructuring (Part 3)
June 18, 2009
Addicts come from families that might have wounded them emotionally, physically, sexually, and/or spiritually (Carnes, 1997). They have deep sadness, feelings of shame, and loneliness.
A. Protect against emotional triggers.
It is vitally important for these emotional issues to be addressed. Any stimulus that potentially triggers an addict into these feelings can provoke the old answers, addictive activities that were used to medicate and change these feelings. These rationalizations and lies are referred to as “stinkin’ thinkin’” in the AA vernacular. Cognitive restructuring involves identification, confrontation, and correction of this erroneous thinking and this requires a psycho-educational approach. One principle to remember is that unhealed wounds often yield a relapse.
The competent Christian counselor will either be skilled in this kind of work or will know whom to refer to who is. The process of healing requires several factors:
1. Understanding the nature of the harm that caused the woundedness.
2. Providing support for the importance of dealing with it.
3. Accepting any anger that will be a part of the experience.
4. Allowing the person to grieve the losses associated with the woundedness.
5. Helping the person find meaning in the suffering of the experience.
6. Guiding the person in the process of forgiveness of those who caused the harm.
This is a process and should not be avoided. It is irresponsible to suggest that a person should just “forgive and forget.” It is also irresponsible to suggest that a person who never let go of their anger so as not to get hurt again. Healing of life’s hurt can be a lifetime journey but there are ways to get stuck in sadness and anger.
B. Thought-stopping interventions.
Every addict starts his or her acting out behavior by obsessing or fantasizing about the substance or behavior. This very thought life is an attempt to alter mood, to relieve pain. Christian counselors will hear the fantasies of addicts and know that they are windows into the mind and heart of the addicted person. Substances and behaviors are often ways that addicts seek to heal wounds from the past. It is mostly useless to tell an addict to stop thinking about a substance or behavior. Seek understanding for what the thought life, the fantasies, mean. If healing can be achieved for the wound that the fantasy seeks to correct, the fantasy will eventually disappear.
Do You Want To Be Free?
June 17, 2009
It hasn’t always been this way
I remember brighter days
Before the dark ones came
Stole my mind
Wrapped my soul in chains
Now I live among the dead
Fighting voices in my head
Hoping someone hears me crying in the night
And carries me away
Set me free of the chains holding me
Is anybody out there hearing me?
Set me free
Morning breaks another day
Finds me crying in the rain
All alone with my demons I am
Who is this man that comes my way?
The dark ones shriek
They scream His name
Is this the One they say will set the captives free?
Jesus, rescue me
As the God man passes by
He looks straight through my eyes
And darkness cannot hide
Do you want to be free?
Lift your chains
I hold the key
All power on Heav’n and Earth belong to me
You are free
You are free
You are free
Behavioral Change (Part 2)
June 17, 2009
Addicts have developed strong, highly programmed, even automatic behavior patterns in order to maintain their addiction. They will go to extraordinary lengths to deny, minimize, or rationalize this addictive behavior.
1. Focus honesty and behavior change.
This requires the therapist to maintain a strong initial focus on honesty and behavior change. When the addict seeks to divert discussion to family, emotional, or relationship concerns prematurely, the therapist must redirect attention to behavior. While effective treatment may address these issues, the clinician must help the addict stop using them to escape dealing with his or her addictive behavior.
One way of doing this is to link the tangential topics the client raises with the central issue of their addiction. For example, a counselor might refocus a client’s response toward the behavior in this way: “So how is the way you approach your anger toward your wife similar to the way you acted out your anger in your sex addiction?” “How is your tendency to denigrate yourself reflected in your addiction ritual?” The assumption here is that addiction has a life of its own and operates apart from other concerns. Unlike many other clinical issues, addiction is both symptom and disease.
2. Changing ritual behavior patterns.
All addicts will need to change certain behavior patterns. Even those who engage in substance addictions need to evaluate behaviors that lead them into their use. These behaviors are usually referred to in the addiction community as “rituals.” The competent Christian counselor will help an addict assess the cycle of how he or she acts out. What behaviors always seem to lead to the addictive behaviors? Taking detailed histories of usage and behavioral patterns will be helpful.
When this information has been sorted out, addicts must establish boundaries against those behaviors. Alcoholics will need to avoid certain friends, areas of towns, or stressful situations that lead them to drink. Food addicts may even need to avoid going to the grocery store in the early days of recovery, or they may need to schedule meals at regular times and find help to eat at those times religiously. Sex addicts will need to avoid people and places that trigger them into their fantasies or “connecting” rituals. For example, those sex addicts who use the computer to connect will need to become accountable for every minute of access to it.
Physical Stabilization and Self-care (Part 1)
June 16, 2009
Addicts may have caused physical damage to their bodies. Alcoholics will have possible neurological, gastro-intestinal, or liver complications. Food addicts may starve themselves to death or suffer the effects of chronic obesity. Sex addicts run the risk of sexually transmitted diseases or a variety of sexual dysfunctions. Any addict also runs the risk of stress resulting from chronic fear and anxiety, often due to the consequences of the addiction.
It is always wise for addicts to undergo a complete medical evaluation. Alcoholics may need to even be hospitalized in order to stabilize the detoxification effect of stopping usage. Anorexics may also need to be stabilized in the hospital to prevent the effects of chronic malnutrition.
When stabilization has been achieved, it is always also wise for an addict to undergo a thorough neuro-psychiatric evaluation. Levels of depression must be determined. Assessment for the presence of a variety of forms of attention deficit disorder is also important. Some addicts will need pharmacological help for depression. Others will need different drugs that help manage the brains needs for constant stimulation. It is always wise to develop a relationship with a competent psychiatrist who can perform these kinds of evaluations.
Abstinence from the ‘drug’ of choice will, over time, deal with the level of neuro-chemical tolerance the addict has developed over the years. With help and sure accountability, alcoholics and drug users are able to achieve total abstinence from a substance. Food addicts may be able to abstain from certain kinds of food.
Those addicts who use a behavior or simply their thought life to achieve a neuro-chemical effect will have a harder time at abstaining, as secrecy is easier to maintain and accountability is so much more difficult. Some, like gamblers, can stop certain behaviors altogether. Sex addicts, however, can arouse themselves by fantasizing about sexual behavior can achieve the effect. Sex is perhaps the most notable example of this. The protocol with sex addicts is to have them abstain from all forms of sexual activity for a period of time, even if married, in order to achieve a detoxification effect from sinful sexual activity.
Finally, addicts will need to learn adequate self-care. As opposed to Paul’s teaching, they have been treating their body more like the city dump than the temple. Being tired or physically depleted makes any addict more vulnerable to acting out behavior.
The reasons for addiction are multi-faceted
June 15, 2009
The treatment of addiction requires a variety of approaches. Treatment must maintain a careful balance between confronting the addict’s denial and minimization and supporting them when they do the painful and difficult work of honest disclosure. At times, direct and intense confrontation is necessary because of the tendency for denial and minimization, but also remember that it is quite a threatening and shame-filled experience for a person to openly discuss the secrets and sins and despairs of their addictions.
The five following blog posts will present the five classic areas that must be addressed
Carrying Multiple Addictions?
June 9, 2009
Many addicts suffer from more than one addiction. It is not uncommon for them to use a variety of substances and behaviors to alter their mood. Carnes (1991), in a research project with sex addicts, found, for example that half of all sex addicts suffer from chemical dependency. Carnes also found that the more serious the wounds of childhood, the more likely there would be multiple addictions.
This dynamic has led to many speculating about “cross addictions,” or the “co-morbidity” of addictions. Carnes is currently proposing a new and broad diagnosis, “Multiple Addiction Disorder” (MAD—an appropriate acronym). Christian counselors need to evaluate a broad pattern of addiction and triage which of the addictions is the most immediately destructive.
Addictive behavior and the brain
June 8, 2009
What has long been debated is whether or not certain behaviors can affect the chemistry of the brain. As scientists have increased their ability to scan and produce images of the brain (through MRI and PET studies, for example), research projects have begun to demonstrate that behaviors can also do this.
When a person looks at another person who he or she loves or has feelings of sexual attraction for, certain opiates (catecholamines) are produced more rapidly in the brain. These neuro-chemicals have a heroin-like quality in the pleasure centers of the brain. That is why some have suggested that we can become Addicted to Love (Arterburn, 19–). At Vanderbilt University, researchers are showing the dramatic effects on the brain of looking at pornography (Carnes, 1991). Little doubt remains that all sexual thought and activity produce these same neurochemical effects.