Neuroplasticity and Addiction Treatment: Part One

Neuroplasticity and addiction treatmentI firmly believe that the relationship discovered going forward between neuroplasticity and addiction treatment will greatly improve recovery outcomes. With addiction, although it might seem strange to someone who doesn’t understand addiction, the particular drug used is not so important as what happens to the brain when an addictive drug is taken by someone with a predisposition to addiction. The particular drug of choice will be important to the person in recovery because of environmental, social and emotional triggers that remind the recovering addict of a place, a smell, a friend or a feeling associated with their main drug of choice – understanding these triggers is vital to relapse prevention, but, otherwise, the brain reacts pretty much the same, in relation to addiction, to all addictive drugs. The neuro-chemical actions in the brain are different from one drug to another – however, the neural-pathways created by repetitive drug use are what make recovery so difficult. Because this is not a simple subject, I’ll write this in several parts.

Let’s start from when neural pathways are strengthened and make drugs seem necessary and good to the addict. The addict consumes a drug, dopamine flows, the midbrain remembers the quick sense of euphoria or well-being, and neural pathways are strengthened, repeat and repeat and so on. In most people who’re social drinkers, their brains never change to the point that craving a drug overwhelms reason and judgment. For the addict, brain chemicals make changes that create tolerance and the irrational craving for more and more of the drug. This vicious cycle continues until there’s treatment and a reversal of the process.

People on the outside who witness an addict go into treatment and come out with the drug completely out of his/her system are mystified when the person returns to the drug shortly after treatment. It’s usually because he/she stops doing anything further to promote recovery. After years of strengthening neural pathways that tell the brain a drug is good and necessary, these pathways are too strong to overcome with just a few weeks of treatment. In treatment an addict should learn that recovery is a long-term process. It takes a while to strengthen the neural pathways that tell the brain the drug is deadly, and that recovery is healthy and life enhancing.

If you’ve ever had to change your ideas about something that’s deeply ingrained in your brain, that you’ve reinforced for years, like eating fried food, or a long-term love relationship that you discover, after decades, has gone terribly awry,  you understand how hard it is to change the brain to see something you enjoyed immensely, loved or craved as harmful and something that you must resist. Now, take that understanding and multiply it and you’ll get an inkling of an understanding how hard it is to stay away from a drug that captured the body and mind for years. For years the addict could take the drug and, quickly, the strong feeling of euphoria or well-being was there on demand — the addict’s brain stored the powerful memory of immediate satisfaction deep in the midbrain and associated this memory with people, places and things that trigger the desire to use the drug — now the drug has turned on the person, but the brain still wants the relief, quickly, with power and consistency. It takes awhile to change this in the brain. The good news is that the brain can change and recovery is possible.

In the next few days, I’ll write more in detail about neuroplasticity and addiction treatment how the brain changes in recovery according to those doing research in this area.

 

Does Science Excuse Addiction?

Does Science Excuse Addiction

Understanding the brain

Myriad books have been written on free will, sin, moral responsibility and the science of addiction. A question asked often is – does science excuse addiction?  We hear about sex addiction, gambling addiction, drug addiction, food addiction — it seems like science makes excuses for what most people once called bad behavior or sinful behavior. Addiction, to be honest, has been spread thin, but science continues to discover more about how the brain works, and it never helps anyone when we ignore science. From my perspective, science is not excusing addiction — science creates the opportunity for humans to take more responsibility for their behavior.

Science discovers how brain chemicals influence our behavior. In the past when it was said that someone lacked self-control, well, now science is discovering why. Does this mean that people have no control over certain behaviors? No. Well, people with serious mental conditions like schizophrenia don’t respond well to treatment, but most who “lack of self-control” are amenable to change. Alcoholics are driven to drink by a chronic brain disease, but there’s treatment for alcoholism. A person who’s driven to overeat is influenced by certain brain chemicals that send a message to eat, eat, eat, but this person can find a way to handle the over-eating. The person who starts gambling and can’t stop, can stop if they understand what’s going on and do something different to recover from the condition. Why we think that mechanical devices need repair, and we even accept that are bodies need repair when we get sick, but find it shameful to admit that our brains need repair every once in awhile, I don’t know. Well, I do know, but it’s getting harder to understand this attitude in the Information Age.

So, science is helping humans understand their minds and bodies better, thus, we can change the parts of ourselves that cause us serious problems. Over-eating leads to serious health problems and emotional instability and, often, low self-esteem. When over-eaters were called slothful, it only added to the shame they felt. Now that the over-eater can gain knowledge provided by science that explains the urge to over-eat, there are no more excuses — it’s time to act to treat the condition and recover. The same goes for the alcoholic, the gambler, etc.

When we really consider the ramifications of scientific discoveries, the conclusion is not that excuses are made for bad behavior. Does science excuse addiction? No, science gives us an understanding of what makes us tick and, thus, how we can change for the better. Even if someone is religious, they’d have to believe that science is condoned if it helps us know ourselves better and enables us to become healthier and better able to help, understand and love one another.

Heroin in Savannah Ga

opiate withdrawal

Heroin addiction

For those who think heroin is a problem only for places like Harlem and South Central LA, heroin use is increasing across the nation, even in Savannah, Ga. You can Google “Savannah and heroin use” to see the stories about the growing number of heroin arrests and over-doses.

For years opiates were prescribed to treat pain with little regard for the problem of addiction. Now that opiate addiction is recognized as a major healthcare problem, and abuse of prescription drugs has become such a huge problem, regulations to tighten up on opiate prescriptions have driven opiate addicts to the streets in search of relief.

Heroin is cheap now compared to a couple of decades ago, and heroin can be snorted or smoked, so the needle aversion no longer prevents first time users from experimenting. Society has to change its mind about heroin addiction — it’s no longer confined to inner city ghettoes out of sight and mind from middle and upper class America.

Once the myths and stigma are removed, what we’re dealing with is a drug addiction, medically similar to alcoholism. Often the heroin addict has a dual problem with heroin and alcohol, going back and forth from one drug to the other. When a heroin addict “kicks” heroin, they often use alcohol as a substitute. Also, a fact that few people know, alcohol withdrawal is more dangerous and deadly than heroin withdrawal. Heroin withdrawal will make a person think they are dying – withdrawal from alcohol actually kills people.

If we can treat alcoholism, we can treat heroin addiction. In the past, treatment of opiate addiction hasn’t been very successful. When addicts have gotten off heroin on their own without any maintenance, they’ve not stayed clean for long. Opiate addiction rewires the brain, and it takes a long time to for the brain to adjust in recovery. Getting the opiate out of the body is just a first step, and timing is important.

Ongoing support is critical to recovery success. Narcotics Anonymous is a good support group, but it has yet to reach the full influence and reach of Alcoholics Anonymous. It’s time to stop treating heroin addicts as different, sending them to Methadone clinics to be chained away from decent society. Heroin addiction, alcohol addiction, benzo addiction — addiction is addiction and treatment professionals must deal with all addictions.

With new treatment tools like Suboxone, heroin/opiate addiction has become easier to treat, if the Suboxone is used as a proper, short-term tool and not perceived as a panacea.  At NewDay we’ve developed a treatment plan for opiate addicts that works better than the treatment efforts of the 80s and 90s I witnessed when opiate addicts would not complete treatment because the abstinence from opiates was too much to handle.

We can improve on treatment methods if society can help by dropping the stigma in their mind of the dirty, filthy heroin addict lying almost comatose in a doorway or alley. That’s all society could think of when healthcare providers first started trying to treat alcoholics — the skid row bum lying on the street. The heroin addict is just as likely to be a neighbor, a co-worker, a boss, family member or a “normal” looking person you’d never suspect compared to the vision of a junkie that so many people see when they think of heroin addicts.

Dual-Diagnosis in Addiction Treatment

dual diagnosisThere has been a great deal written and discussed regarding dual-diagnosis in addiction treatment. Dual-diagnosis is when a client is diagnosed with an alcohol/drug use disorder and mental health problems, such as depression or anxiety. In some cases schizophrenia or bi-polar depression can exist along with alcoholism. One disorder can mask the other, so the professional therapist has to sort all this out.

The professional has to determine if the mental health disorders require medication. The professional has to determine if the alcohol and drugs are the main cause of the mental health problems, or if the client abuses alcohol and drugs to deal with the mental health problems. If a client uses alcohol and drugs to deal with mental health disorders, then the professional has to wonder why a person would use alcohol/drugs to deal with mental health problems when the alcohol/drugs don’t alleviate mental health problems and often make them much worse. In fact, with people who experience mental health problems, alcohol and other drugs, like cocaine, can push the person over the edge.

In most instances of long term mental health problems, the person has seen mental health professionals and has been prescribed appropriate medications for the mental health problems, so why is the person using alcohol/drugs instead of the prescribed medication? The answer could be the person is using alcohol/drugs because they have an independent problem with alcohol/drugs. If this condition is misdiagnosed, and the client gets the impression that when they have dealt with the mental health problems they can successfully drink or do other drugs, then the client might experience more problems down the road when the addiction progresses.

A general rule of thumb for some professionals is when there are coexisting problems, first work on removing the alcohol/drug use until the professional knows what they are dealing with. If the person refuses to stop the alcohol/drug use, or can’t, then the therapist gains some very valuable information.