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Biology of Addiction Part 2

Posted on February 6, 2015

Last week we introduced the drivers of addiction and discussed how trauma and a life of stress and pain can set someone up to become addicted to the substances that increase pleasure and decrease pain. This post will look deeper into the interplay of trauma and addiction. I hope this provides us with insight into why those with unresolved past trauma are five times more likely to experience addition, and why recovery can be so difficult.

Trauma impacts our biology in numerous ways. One powerful consequence of traumatic experiences is a decrease in dopamine receptors. Dopamine is a hormone and neurotransmitter that elicits a mental state of pleasure and plays a critical role in human motivation. Experiences, people, substances, and activities that bring us pleasure result in dopamine releases, which motivates us to want to repeat that experience again.

Dopamine is naturally released when certain brain cells (neurons) attempt to continue their energy and information to another receptive neuron. Neurons release dopamine and other neurotransmitters into the small space between neurons call the synaptic cleft. If a critical mass of neurotransmitters connects with the receiving neuron, the energy and information is passed from one neuron to the next, resulting in the firing of the receiving neuron. For any action or thought, this process happens millions if not trillions of times all throughout the brain. If you think of our brains as a chemical soup, dopamine is one of the key ingredients that bring us pleasure.

In the last post I introduced two fictional characters, Bill and Robert. On a life satisfaction scale, where 10 is someone who is extremely satisfied with their life and 1 is someone clinically and severely depressed and unsatisfied with life, Bill is an 8 and Robert a 2. Both try cocaine at a party. Bill enjoys the experience and would rate the experience as a 9.5 on our scale. Robert’s high was experienced as a much greater increase from his depressed baseline, and would rate the high a 7.

Let’s look at what is happening in the brain with these numbers. To do this, let’s say (in a very nonscientific way but for the sake of simplicity) that the life satisfaction scores are equivalent to a trillion dopamine receptors in the brain. In other words Bill has 8 trillion receptors and Robert has 2 trillion. Robert, due to unresolved past trauma, stress associated with poverty, and unhealthy relationships, lives a life without much pleasure in it. Therefore, there is not much dopamine is in his baseline chemical soup. His 2 trillion receptors are adequate to support his baseline of life satisfaction on any given day. Bill lives a happier life and his brain releases a great deal more dopamine throughout a typical day – therefore he has more active dopamine receptors.

Then they both use cocaine for the first time and enjoy the experience. Bill feels good and has a blast at the party. But this experience is one of many that brings pleasure into Bill’s life. Snowboarding, surfing, sex, running, hanging out with friends, going to concerts, and other experiences have also flooded his system with dopamine in the past, eliciting a great overall experience around these activities.

Robert, on the other hand, has rarely had these types of positive experiences, and the 7 he achieved from cocaine was one of the first floods of dopamine he has experienced in his life. His experience and resulting motivation to use again will likely be much greater than Bill’s. When next weekend rolls around, Bill might be out surfing with friends and Robert might be looking for another high to feel “7” again.

Let’s say Robert does find a group of people that use cocaine several times a week. The second time he uses he might get back up to the 7, but from there, the enjoyment starts to only get him to a 6, then a 5. Why is his pleasure decreasing?

Robert’s brain has established that 2 is normal, and has adjusted its biology to have 2 trillion dopamine receptors to maintain this baseline. If everything else in Robert’s life stays at a 2 level (job, social interactions, living conditions), his brain will try to adjust its dopamine intake to reflect 2 and not the artificial increase gained by consistent cocaine use. The brain is designed to maintain a balance between itself and the environment. If nothing else except has changed in Robert’s environment it will re-establishes its baseline of 2 by reducing the number of active dopamine receptors. Instead of 2 trillion, Robert’s receptors are reduced to 1.5 trillion. Cocaine use has now decreased Robert’s baseline number of receptors which leads to consequences for his experience of life, both while sober and while high.

When he is sober, Robert’s brain can now take in ¼ less dopamine. This will result in a decrease in quality of life, increased irritability, higher levels of depression, a sense of social alienation, extreme fatigue, and other physical and emotional negative symptoms. We can roughly say that Robert’s brain can now only support a 1.5 life satisfaction due to these withdrawal symptoms. Robert’s life has already been a struggle due to past trauma and living in high stress environments. Now, not using cocaine brings his life satisfaction down even further, resulting in increased pain, which only getting high seems to elevate.

The other consequence of going from 2 trillion to 1.5 trillion dopamine receptors is that, from this lower baseline, Robert needs more cocaine to get back up to the 7 of his first high. We often call this tolerance and this is the reason many people can overdose. Here, Robert really enters the addiction cycle and can rapidly lose control of his life. Robert feels worse and worse when he is not high and he needs more and more cocaine to achieve any feeling of pleasure and elevate withdrawal symptoms. This increase in use results in even greater loss of dopamine receptors, increasing negative withdrawal symptoms (lowering life satisfaction even further), and requiring more cocaine to feel pleasure and eliminate the pain of withdrawal. And so on, and so on, and so on…

Eventually, Robert might get down to .5 trillion receptors and he needs an even larger amount of cocaine just to get back up to his original 2 baseline. Here is the other part of the addiction cycle. As Robert uses more and more, it isn’t just cocaine that is impacting his ever-decreasing quality of life. He might lose his job, friends and family, housing, social status, physical appearance, and self-worth. So not only is cocaine itself lowering Robert’s life satisfaction baseline, the social consequences of the addiction are also lowering life satisfaction.

It is also important to bring up another ingredient in the chemical soup of the brain. Endorphins are chemical messengers that:

  • Affect autonomic nervous system (heart, brain, and intestines)
  • Can reduce the experience of pain in the brain
  • Impact the health of the immune system
  • Impact bonding (especially mother-child, but also romantic and friend relationships)
  • When sad, endorphin receptors are less active
  • Are key to motivation and reward

Most drugs that flood the brain with dopamine also trigger endorphin release, adding to the experience of the high. Certain drugs, such as morphine, heroin, and other opiates, use the same receptors as naturally released endorphins. A very similar process happens with these receptors as does with dopamine receptors. A decrease in endorphins increases sensations of pain, isolation, illness, and depression. This would obviously push the life satisfaction score down even further, while increasing the motivation to minimize pain.

We need to mention one more impact of addiction that can affect normal development. Addiction impacts both grey and white matter in the brain. White matter is the fatty tissue surrounding axons which increases the efficiently of communication between neurons. Grey matter makes up the bodies of the neurons. White matter increases with age (I like to think of the increase in white matter as connected to the wisdom we have achieved as we’ve grown older). Addiction has been shown to limit or stop the formation of this age-related white matter.

This can start to explain why some people who have used for years might seem stuck in an earlier development stage. If Robert started to use cocaine at 15, parts of his brain might not develop much beyond this age. White matter is also critical in our ability to be flexible with our decision making, our ability to learn new knowledge, skills, and behaviors, and our ability to adapt to new life situations.

The impact on grey matter is just as critical. We’ve all heard that drugs destroy brain cells. Many of you may remember the “This is your brain, this is your brain on drugs” advertisement. While our brain can normally bounce back from one heavy night of drinking or substance use, addiction can do serious damage over time. Brain scans reveal that the number of years of addiction correlates to a decrease in grey matter in the cerebral cortex and pre-frontal cortex, both key to success in relationships, employment, and all other aspects of life. Addiction can damage the brain and, at the same time, prevent neurogenesis, or the creation of new neurons, which is how the brain naturally repairs damage.

Here is the devastating reality of addiction:

  1. Unresolved trauma dramatically increases the likelihood of addiction by decreasing the number of dopamine/endorphin receptors and life satisfaction.
  2. Addiction damages the very parts of the brain that are needed for recovery (cerebral and pre-frontal cortexes).
  3. Social consequences of addition increase pain and decrease pleasure in life. Getting high provides a short respite not only from withdrawal but the painful reality of addiction.
  4. The person might not have developed the age-related brain maturity necessary critical to insight and violation needed to change destructive behavior.
  5. Recovery and other things that could improve life satisfaction are much less efficient (efficiency being the third key unconscious motivator) in reducing pain and experiencing pleasure. From a brain perspective, getting high is the most energy efficient way to deal with pain.
  6. Unless there is an opportunity to change environments, there will be constant reminders of use. These reminders trigger a dopamine release that the brain associates with the pleasures of the high, making relapse an ever-present struggle in recovery.

Recovery is so difficult due to the fact that the biology of addiction damages both the brain structures required for recovery and the social support needed to help the person through the recovery process. Recovery entails a gradual increase of life satisfaction, dopamine and endorphin receptors, repairing of underdeveloped or damaged brain areas, environmental changes, and social support. Stopping use of the drug is only one piece of the overall recovery process.

We need to think of recovery as an increase in life satisfaction as well as a reduction or elimination of drug use. From the Biopsychosocial perspective, recovery is a biological (brain and physical well-being), psychological (reclaiming of the mind and free will), and social (building strong social networks and healthy relationships) healing process, where abstinence or reduced use is only one goal. Like any trauma, addiction can bring great wisdom and strength through recovery and post-traumatic growth, but we have to be realistic about the intensity and length of time that this process often demands for long-term users.

This week, my question is about what you see as critical to the healing process. What variables have come together for your clients to recovery from addiction? Please put your thoughts and experiences in the comment section.

One last note. If you would like more information on addiction and trauma, I highly suggest Gabor Maté’s book, In the Realm of Hungry Ghosts. Maté is a physician at the Portland Hotel in Vancouver and brings the science to life in his experiences working in addiction and with those experiencing homelessness.

Biology of Addiction Part 2

Posted on February 6, 2015

Last week we introduced the drivers of addiction and discussed how trauma and a life of stress and pain can set someone up to become addicted to the substances that increase pleasure and decrease pain. This post will look deeper into the interplay of trauma and addiction. I hope this provides us with insight into why those with unresolved past trauma are five times more likely to experience addition, and why recovery can be so difficult.

Trauma impacts our biology in numerous ways. One powerful consequence of traumatic experiences is a decrease in dopamine receptors. Dopamine is a hormone and neurotransmitter that elicits a mental state of pleasure and plays a critical role in human motivation. Experiences, people, substances, and activities that bring us pleasure result in dopamine releases, which motivates us to want to repeat that experience again.

Dopamine is naturally released when certain brain cells (neurons) attempt to continue their energy and information to another receptive neuron. Neurons release dopamine and other neurotransmitters into the small space between neurons call the synaptic cleft. If a critical mass of neurotransmitters connects with the receiving neuron, the energy and information is passed from one neuron to the next, resulting in the firing of the receiving neuron. For any action or thought, this process happens millions if not trillions of times all throughout the brain. If you think of our brains as a chemical soup, dopamine is one of the key ingredients that bring us pleasure.

In the last post I introduced two fictional characters, Bill and Robert. On a life satisfaction scale, where 10 is someone who is extremely satisfied with their life and 1 is someone clinically and severely depressed and unsatisfied with life, Bill is an 8 and Robert a 2. Both try cocaine at a party. Bill enjoys the experience and would rate the experience as a 9.5 on our scale. Robert’s high was experienced as a much greater increase from his depressed baseline, and would rate the high a 7.

Let’s look at what is happening in the brain with these numbers. To do this, let’s say (in a very nonscientific way but for the sake of simplicity) that the life satisfaction scores are equivalent to a trillion dopamine receptors in the brain. In other words Bill has 8 trillion receptors and Robert has 2 trillion. Robert, due to unresolved past trauma, stress associated with poverty, and unhealthy relationships, lives a life without much pleasure in it. Therefore, there is not much dopamine is in his baseline chemical soup. His 2 trillion receptors are adequate to support his baseline of life satisfaction on any given day. Bill lives a happier life and his brain releases a great deal more dopamine throughout a typical day – therefore he has more active dopamine receptors.

Then they both use cocaine for the first time and enjoy the experience. Bill feels good and has a blast at the party. But this experience is one of many that brings pleasure into Bill’s life. Snowboarding, surfing, sex, running, hanging out with friends, going to concerts, and other experiences have also flooded his system with dopamine in the past, eliciting a great overall experience around these activities.

Robert, on the other hand, has rarely had these types of positive experiences, and the 7 he achieved from cocaine was one of the first floods of dopamine he has experienced in his life. His experience and resulting motivation to use again will likely be much greater than Bill’s. When next weekend rolls around, Bill might be out surfing with friends and Robert might be looking for another high to feel “7” again.

Let’s say Robert does find a group of people that use cocaine several times a week. The second time he uses he might get back up to the 7, but from there, the enjoyment starts to only get him to a 6, then a 5. Why is his pleasure decreasing?

Robert’s brain has established that 2 is normal, and has adjusted its biology to have 2 trillion dopamine receptors to maintain this baseline. If everything else in Robert’s life stays at a 2 level (job, social interactions, living conditions), his brain will try to adjust its dopamine intake to reflect 2 and not the artificial increase gained by consistent cocaine use. The brain is designed to maintain a balance between itself and the environment. If nothing else except has changed in Robert’s environment it will re-establishes its baseline of 2 by reducing the number of active dopamine receptors. Instead of 2 trillion, Robert’s receptors are reduced to 1.5 trillion. Cocaine use has now decreased Robert’s baseline number of receptors which leads to consequences for his experience of life, both while sober and while high.

When he is sober, Robert’s brain can now take in ¼ less dopamine. This will result in a decrease in quality of life, increased irritability, higher levels of depression, a sense of social alienation, extreme fatigue, and other physical and emotional negative symptoms. We can roughly say that Robert’s brain can now only support a 1.5 life satisfaction due to these withdrawal symptoms. Robert’s life has already been a struggle due to past trauma and living in high stress environments. Now, not using cocaine brings his life satisfaction down even further, resulting in increased pain, which only getting high seems to elevate.

The other consequence of going from 2 trillion to 1.5 trillion dopamine receptors is that, from this lower baseline, Robert needs more cocaine to get back up to the 7 of his first high. We often call this tolerance and this is the reason many people can overdose. Here, Robert really enters the addiction cycle and can rapidly lose control of his life. Robert feels worse and worse when he is not high and he needs more and more cocaine to achieve any feeling of pleasure and elevate withdrawal symptoms. This increase in use results in even greater loss of dopamine receptors, increasing negative withdrawal symptoms (lowering life satisfaction even further), and requiring more cocaine to feel pleasure and eliminate the pain of withdrawal. And so on, and so on, and so on…

Eventually, Robert might get down to .5 trillion receptors and he needs an even larger amount of cocaine just to get back up to his original 2 baseline. Here is the other part of the addiction cycle. As Robert uses more and more, it isn’t just cocaine that is impacting his ever-decreasing quality of life. He might lose his job, friends and family, housing, social status, physical appearance, and self-worth. So not only is cocaine itself lowering Robert’s life satisfaction baseline, the social consequences of the addiction are also lowering life satisfaction.

It is also important to bring up another ingredient in the chemical soup of the brain. Endorphins are chemical messengers that:

  • Affect autonomic nervous system (heart, brain, and intestines)
  • Can reduce the experience of pain in the brain
  • Impact the health of the immune system
  • Impact bonding (especially mother-child, but also romantic and friend relationships)
  • When sad, endorphin receptors are less active
  • Are key to motivation and reward

Most drugs that flood the brain with dopamine also trigger endorphin release, adding to the experience of the high. Certain drugs, such as morphine, heroin, and other opiates, use the same receptors as naturally released endorphins. A very similar process happens with these receptors as does with dopamine receptors. A decrease in endorphins increases sensations of pain, isolation, illness, and depression. This would obviously push the life satisfaction score down even further, while increasing the motivation to minimize pain.

We need to mention one more impact of addiction that can affect normal development. Addiction impacts both grey and white matter in the brain. White matter is the fatty tissue surrounding axons which increases the efficiently of communication between neurons. Grey matter makes up the bodies of the neurons. White matter increases with age (I like to think of the increase in white matter as connected to the wisdom we have achieved as we’ve grown older). Addiction has been shown to limit or stop the formation of this age-related white matter.

This can start to explain why some people who have used for years might seem stuck in an earlier development stage. If Robert started to use cocaine at 15, parts of his brain might not develop much beyond this age. White matter is also critical in our ability to be flexible with our decision making, our ability to learn new knowledge, skills, and behaviors, and our ability to adapt to new life situations.

The impact on grey matter is just as critical. We’ve all heard that drugs destroy brain cells. Many of you may remember the “This is your brain, this is your brain on drugs” advertisement. While our brain can normally bounce back from one heavy night of drinking or substance use, addiction can do serious damage over time. Brain scans reveal that the number of years of addiction correlates to a decrease in grey matter in the cerebral cortex and pre-frontal cortex, both key to success in relationships, employment, and all other aspects of life. Addiction can damage the brain and, at the same time, prevent neurogenesis, or the creation of new neurons, which is how the brain naturally repairs damage.

Here is the devastating reality of addiction:

  1. Unresolved trauma dramatically increases the likelihood of addiction by decreasing the number of dopamine/endorphin receptors and life satisfaction.
  2. Addiction damages the very parts of the brain that are needed for recovery (cerebral and pre-frontal cortexes).
  3. Social consequences of addition increase pain and decrease pleasure in life. Getting high provides a short respite not only from withdrawal but the painful reality of addiction.
  4. The person might not have developed the age-related brain maturity necessary critical to insight and violation needed to change destructive behavior.
  5. Recovery and other things that could improve life satisfaction are much less efficient (efficiency being the third key unconscious motivator) in reducing pain and experiencing pleasure. From a brain perspective, getting high is the most energy efficient way to deal with pain.
  6. Unless there is an opportunity to change environments, there will be constant reminders of use. These reminders trigger a dopamine release that the brain associates with the pleasures of the high, making relapse an ever-present struggle in recovery.

Recovery is so difficult due to the fact that the biology of addiction damages both the brain structures required for recovery and the social support needed to help the person through the recovery process. Recovery entails a gradual increase of life satisfaction, dopamine and endorphin receptors, repairing of underdeveloped or damaged brain areas, environmental changes, and social support. Stopping use of the drug is only one piece of the overall recovery process.

We need to think of recovery as an increase in life satisfaction as well as a reduction or elimination of drug use. From the Biopsychosocial perspective, recovery is a biological (brain and physical well-being), psychological (reclaiming of the mind and free will), and social (building strong social networks and healthy relationships) healing process, where abstinence or reduced use is only one goal. Like any trauma, addiction can bring great wisdom and strength through recovery and post-traumatic growth, but we have to be realistic about the intensity and length of time that this process often demands for long-term users.

This week, my question is about what you see as critical to the healing process. What variables have come together for your clients to recovery from addiction? Please put your thoughts and experiences in the comment section.

One last note. If you would like more information on addiction and trauma, I highly suggest Gabor Maté’s book, In the Realm of Hungry Ghosts. Maté is a physician at the Portland Hotel in Vancouver and brings the science to life in his experiences working in addiction and with those experiencing homelessness.

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