Addiction and the Brain's Pleasure Pathway: Beyond Willpower

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1 Addiction and the Brain's Pleasure Pathway: Beyond Willpower The human brain is an extraordinarily complex and fine-tuned communications network containing billions of specialized cells (neurons) that give origin to our thoughts, emotions, perceptions and drives. Often, a drug is taken the first time by choice to feel pleasure or to relieve depression or stress. But this notion of choice is short-lived. Why? Because repeated alcohol or drug use disrupts well-balanced systems in the human brain in ways that persist, eventually replacing a person's normal needs and desires with a one-track mission to seek and use alcohol or drugs. At this point, normal desires and motives will have a hard time competing with the desire to take a drug. How Does the Brain Become Addicted? Typically it happens like this: A person takes a drug of abuse, be it marijuana or cocaine or even alcohol, activating the same brain circuits as do behaviors linked to survival, such as eating, bonding and sex. The drug causes a surge in levels of a brain chemical called dopamine, which results in feelings of pleasure. The brain remembers this pleasure and wants it repeated. Just as food is linked to survival in day-to-day living, drugs begin to take on the same significance for the addict. The need to obtain and take drugs becomes more important than any other need, including truly vital behaviors like eating. The addict no longer seeks the drug for pleasure, but for relieving distress. Eventually, the drive to seek and use the drug is all that matters, despite devastating consequences. Finally, control and choice and everything that once held value in a person's life, such as family, job and community, are lost to the disease of addiction. What brain changes are responsible for such a dramatic shift? Research on addiction is helping us find out just how alcohol and drugs change the way the brain works. These changes include the following: Addiction can develop despite a person s best intentions and in spite of their strength of character. Repeated drug use disrupts complex but well balanced systems in the human brain. Many people are addicted to more than one substance, complicating their efforts to recover. Reduced dopamine activity. We depend on our brain's ability to release dopamine in order to experience

2 pleasure and to motivate our responses to the natural rewards of everyday life, such as the sight or smell of food. Drugs produce very large and rapid dopamine surges and the brain responds by reducing normal dopamine activity. Eventually, the disrupted dopamine system renders the addict incapable of feeling any pleasure even from the drugs they seek to feed their addiction. Altered brain regions that control decision making and judgment. Drugs of abuse affect the regions of the brain that help us control our desires and emotions. The resulting lack of control leads addicted people to compulsively pursue drugs, even when the drugs have lost their power to reward. The disease of addiction can develop in people despite their best intentions or strength of character. Drug addiction is insidious because it affects the very brain areas that people need to "think straight," apply good judgment and make good decisions for their lives. No one wants to grow up to be a drug addict, after all. Relapse: Part of Addiction as a Chronic Disease Despite the availability of many forms of effective treatment for addiction, the problem of relapse remains the major challenge to achieving sustained recovery. People trying to recover from drug abuse and addiction are often doing so with altered brains, strong drug-related memories and diminished impulse control. Accompanied by intense drug cravings, these brain changes can leave people vulnerable to relapse even after years of being abstinent. Relapse happens at rates similar to the relapse rates for other wellknown chronic medical illnesses like diabetes, hypertension and asthma. How is relapse to drug abuse similar to what happens with other chronic diseases? Just as an asthma attack can be triggered by smoke, or a person with diabetes can have a reaction if they eat too much sugar, a drug addict can be triggered to return to drug abuse. With other chronic diseases, relapse serves as a signal for returning to treatment. The same response is just as necessary with drug addiction. As a chronic, recurring illness, addiction may require repeated treatments until abstinence is achieved. Like other diseases, drug addiction can be effectively treated and managed, leading to a healthy and productive life. To achieve long-term recovery, treatment must address specific, individual patient needs and must take the whole person into account. For it is not enough simply to get a person off drugs; rather, the many changes that have occurred - physical, social, psychological - must also be addressed to help people stay off drugs, for good. From: HBO, Inc.

3 2010 Home Box Office, Inc Home Box Office, Inc010 Home Box Office, Inc A question I often get asked, How much is too much? The answer is sometimes simple and sometimes a bit more complex. Here is a self administered questionnaire to point one in the right direction. Alcohol Screening Instrument for Self-Assessment Directions Number a sheet of paper from Read each question, one at a time, and simply choose one of the responses that fits your circumstance. Each response is weighted from 0-4 as indicated in parentheses. Place the score that appears in the parenthesis at the end of the response you have chosen next to the number of the question on your sheet of paper. 1. How often do you have a drink containing alcohol? ( ) monthly or less (1) ( ) two or four times/month (2) ( ) two or three times/week (3) ( ) four or more times/week (4) 2. How many drinks containing alcohol do you have on a typical day when you are drinking? ( ) 1 or 2 (0) ( ) 3 or 4 (1) ( ) 5 or 6 (2) ( ) 7-9 (3) ( ) 10 or more (4) 3. How often do you have six or more drinks on one occasion? 4. How often during the last year have you been unable to remember what happened the night before because of drinking? 5. How often during the last year have you found that you were not able to stop drinking once you started?

4 6. How often during the last year have you failed to do what is normally expected from you because of drinking (e.g., missed deadlines, poor classroom or work attendance, failed committee responsibilities, inconsistent work patterns)? 7. Have you or someone else been injured as a result of your drinking? 8. Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down? 9. How often the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? 10. How often during the past year have you had feelings of guilt or remorse after drinking? 11. Have people annoyed you by criticizing your drinking? 12. Have you ever felt that you should cut down on your drinking? Scoring After you have finished, total your individual item scores into one composite score for all 12 questions. Next, total your individual item scores for the last four questions only (9-12). You should now have two composite scores questions and one for the last four questions.

5 Interpretation A score of 8 or more for all 12 questions indicates that a harmful level of alcohol consumption is likely. The last four questions (9, 10, 11, 12) are considered a separate only the last four items, a total score of 1-2 indicates that you may have a drinking problem. A score of 3 or more indicates there is a significant possibility that you have a problem with alcohol. If your score exceeds the cut-off values on either instrument, you should seek help RESOURCES Member Assistance Program Ron Tapscott United Phoenix Firefighters Local 493 Officers and Trustees AETNA-EAP Our EAP Web Site: Our Company ID: 4PHXFIRE

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