Physiology of Addiction
Physiology of
Addiction
All Treatment had the pleasure of discussing the Physiology of
Addiction with Dr. Jason Powers, Chief Medical Officer at Spirit
Lodge in Texas.
AT: What causes addiction?
Dr. Jason Powers: What causes addiction? That's a great
question. We know that there is interplay between three main
factors which contribute to addiction: the host, the agent, and the
environment. There can be host factors that are either protective
or put the host at an increased risk, for example if there's family
history of alcoholism or
addiction, then there's an increased risk for that host. Or some
people may not metabolize alcohol very well and get sick, so that's
a protective factor. The agent, which is the substance used also
has a role to play. With alcohol, it usually takes a while for the
addiction to get activated, however with other drugs such as
cocaine, the addiction happens in a pretty short period of time.
The environment is the last factor, so those that are living in an
environment that could lead to increased use would obviously put
someone at more risk. However those that are living in environments
that offer healthy alternatives such as coping skills, pleasurable
activities, and good role models all serve as protective
factors.
We know what addiction looks like when
you've crossed that line and we know the risk factors ahead of time
but it's hard to define a formula for what causes addiction.
We know that the disease of addiction follows a progression and
occurs over time. There is a point at which, one's control is lost,
and that's addiction. Addiction is not just a question of how much
you're using and for how long - we're trying to define a way that
the brain changes as a result of the interplay of those factors.
The line at which you cross into addiction is fuzzy. We know what
addiction looks like when you've crossed that line and we know the
risk factors ahead of time but it's hard to define a formula for
what causes addiction.
AT: How is the brain affected by
addiction?
Dr. Jason Powers: The brain is greatly affected by the disease
of addiction. It's the kind of addiction that targets the brain. We
know today that addiction is a brain disease and there's a certain
part of the brain that is targeted by the disease, and that is the
limbic system, or the pleasure center, it's also a very primitive
part of the brain. What happens as a result of exposing a brain to
mind-altering substances is that the brain starts assigning a value
to drugs that is higher than the value it assigns other things that
create a sense of fulfillment and even survival. So people will
choose drugs over things they need to survive, and we call that
"hijacking the brain".
The brain is affected because our judgment is actually
supplanted by a very primitive part of the brain that wants to get
the drug at all cost. So it causes people with the disease of
addiction to fall victim to the disease itself. In the beginning of
an addiction, will power is involved because no one is repeatedly
forcing drugs or alcohol into the body. At some point however, will
power is lost and the brain of an addict is rendered very primitive
actually, almost like an amphibian or reptile. This is because the
frontal lobe, which makes human beings human, doesn't have much
input over the limbic system because the limbic system is going
full steam ahead, getting the drugs or alcohol at any cost. We know
that there are fundamental changes that occur in that pleasure
center that are irreversible; meaning once an addict, always an
addict. We can put someone with 20 years of sobriety into an MRI
machine and flash their drug of choice on the screen in front of
them for a millisecond - very quickly - so fast in fact the frontal
lobe doesn't even know it's being shown, yet parts of the brain
will light up that reflect craving and trigger. So at a very
primitive level, these changes are permanent.
At some point however, will power is lost
and the brain of an addict is rendered very primitive actually,
almost like an amphibian or reptile.
Now on the flip side, we know that healing happens. So if
someone can stay sober for long enough, about two to five years,
their brain will start to look like someone that has never abused
drugs or alcohol, of course with age appropriate changes. The great
news is that treatment is effective and that healing happens. In
fact, if you ask someone that has been sober for a long time, that
although they felt good at one time using drugs, they never have
felt better in their lives.
AT: What role does genetics play in
addiction?
Dr. Jason Powers: Genetics play a decent role in addiction,
similar to Type II Diabetes actually which has about 40-60% genetic
influence, which is the same for addiction, about 40-60%. And those
figures come from research and data we've done for years on
alcoholics. We know that if you have one parent that has
alcoholism, the chance of an offspring having it is 40%. If you
have a brother or sister with alcoholism, you have about a 25%
chance of having it. Now if that brother or sister is an identical
twin, then you have about a 55-60% chance of having it. The general
population however only has about a 10% shot of having
addiction.
Now if you look at identical twins, and if this were a 100%
genetic disease then you would think to yourself if one twin has an
addiction, then surely the other one will too because that would be
the same sperm, the same egg, the same genetic code. In reality
though, it's only 55-60% because this disease, while it has a
genetic component is not 100% genetic. For example, if you take a
raging alcoholic's child and they are raised in a home without
alcoholism, there's still a 40% chance that the child will develop
alcoholism. And if you take a non-alcoholic's child and raise them
in a home with alcoholics there's only about a 10% chance that
child will develop alcoholism.
the general population however only has
about a 10% shot of having addiction.
We did an interesting study with rats because we can easily
manipulate a rat population -- it's very difficult to manipulate
the human population, we don't tend to breed with each other on cue
[joking]. But if you put a whole bunch of rats in a cage and you
put one bowl of water on one side of the cage and a bowl of water
laced with vodka on the other side of the cage, you tend to find
about 10% of the rats will congregate around the vodka water. So if
you take those rats and you breed them and breed them and breed
them, and continue to take the rats congregating around the vodka
water and breed them and breed them, you can, in a laboratory,
produce a 100% alcoholic-only preferring strain of rat.
AT: Wow...
Dr. Jason Powers: Exactly, wow! Because there is something that
is passed generation to generation that can produce the disease of
alcoholism. Now these weren't bad rats, they didn't have a lack of
will power, it's not like they weren't religious enough, and they
weren't traumatized. In a laboratory, you can eventually produce a
rat that only drinks alcohol. And even more interesting, they would
go on binges - they would behave alcoholically. They would drink,
drink, drink, and then they would pass out. They would fight with
each other, they would stop showing up for work [joking].
AT: What methods are most effective for treating
addiction?
Dr. Jason Powers: This is great; we've done outcome studies
in treating addiction and universally we know that a combination of
individual or group therapy combined with the 12 steps or something
similar offers the best outcome as long as there is a substantial
after-care program in place. We know that if you try and treat
addiction like you would acute appendicitis, you're not going to
get anywhere. Now if you have an inflamed appendix, you go to the
hospital, they take it out, and after that you'll never have to
worry about what it's like to be a reporter, a teacher, a wife, a
husband, or a brother without an appendix - you're going to be just
fine. However if you try treating an addiction like you do acute
appendicitis, you're going to have problems. We know that addiction
is a chronic disease, now remember, there are permanent brain
changes that occur, that last forever; once an addict, always an
addict. So if you want to stay in recovery, you pretty much have to
apply yourself for the rest of your life. It's like any other
chronic disease, for example if you've got high blood pressure
under control with medication and lifestyle changes, but then you
remove the medicine or the lifestyle changes, the symptoms are
going to come back. The same principle applies to addiction, you
can go to a substantial inpatient program, but if you don't
continue to engage in some accountable, after-care program, it's
very very likely that the symptoms of alcoholism or addiction will
come back.
we know that a combination of individual
or group therapy combined with the 12 steps or something similar
offers the best outcome as long as there is a substantial
after-care program in place.
There were studies done where we looked at specific models such
as the Matrix model and the Minnesota model. The Minnesota model is
essentially a combination of individual and group therapy infused
with 12 steps such as Alcoholics Anonymous or Narcotics Anonymous
and we found that those models offer people the best chance for
success because if they continue in a community of recovering
addicts they will get the support they need, they will make better
decisions, and they're getting called out by their peers about
their behavior and thinking. So there's a lot of informal
psychology that's applied. I don't mean to say that the 12 steps is
psycho-therapy, because it is not - and if someone should need
that, that's extremely important to note. But in terms of the best
chance for success, it's great to break the cycle of addiction with
the respected treatment standard that employs the Minnesota model
or the Matrix model or something similar where the addict is
encouraged to engage in a long-term recovery program.
AT: What recent discoveries have been made regarding
the brain and addiction?
Dr. Jason Powers: Some of the recent discoveries I've
previously mentioned such as we know that it's a brain disease and
we know the target of addiction is the area where the body controls
survival and feels pleasure, which is the limbic system. We have
made certain discoveries in terms of recognizing there are certain
pathways of relapse, so we'll utilize those to help people stay
sober. Interestingly enough, people in recovery have known this
saying forever "90 meetings in 90 days" because when the brain is
engaged in a habit for 90 days it becomes easier to do. So if
you're engaged in a program of recovery and you do it daily,
chances of relapse are less. Also, you want to avoid a lot of
stress. There's a pathway to relapse that's caused by emotions and
stress, which can include anger, sadness or happiness, so we really
work on giving patients a lot of nurturing during the early
recovery phase and encourage them not to go back to an environment
that could potentially be dangerous due to certain cues that could
trigger relapse. And we also want to avoid patients developing
another addiction, so we want to avoid using any mind-altering
medications that are most often prescriptions. We've also made some
really amazing discoveries involving new medication that targets
cravings. So there are certain medications that can help with
cravings and there are also medications that can also block certain
receptors. There's also new protocol that can help with patients
suffering from addiction. But these medications are only effective
if people are engaged in traditional behavioral modification during
recovery. So I would say we are continuing to make great
discoveries, but what we are finding is that you still need to use
the traditional nuts and bolts of recovery that have been working
for years and years.
What I see is nothing short of
miraculous. When individuals get better, families get better, and
communities get better.
AT: Is there anything else you would like to
add?
Dr. Jason Powers: Sure, just from my perspective, I've
never had a more fulfilling medical career than when I started to
practice in addiction medicine. What I see is nothing short of
miraculous. When individuals get better, families get better, and
communities get better. When individuals get better there's a light
that starts shining within them and they start to fulfill their
potential. When people come in to start their treatment, they
aren't living their lives to their full potential, not living their
lives according to their own integrity. Then when you see them a
few months later or a few years later, you:
- Don't even recognize them, they look amazing, and
- They're a lot more grateful than that person I first met when
they started treatment
It's really a win-win. I don't mean to say that everyone I treat
stays sober, but treatment of this chronic disease is as effective
as treating any chronic disease. So as an addiction medicine
specialist, my job really is to allow the patients to awaken the
healer within themselves. My patients are teaching me that we have
an incredible ability to heal. So if patients engage in prayer,
meditation, exercise, healthy diets, and other spiritual endeavors,
their brain actually starts to produce a lot of the
neurotransmitters that they were deficient in to begin with.
I would just like to say to anyone that is thinking about making
the journey or knows someone about to make the journey of recovery,
the results and promises that you're going to get are beyond
description. It's the most amazing outcome if you can do the
program one day at time.
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